Week 13: Chp 63: Urinary Tract Infections Flashcards
Risk Factors for developing a UTI
sexual activity, diabetes, poor hygiene, estrogen deficiency, recent catheterizations, foreign objects such as kidney or bladder stones
-conditions causing incomplete bladder emptying, such as pelvic organ prolapse, because of retained urine acting as a reservoir for bacteria
Cystitis
if the infection is isolated to the lower urinary tract or bladder
Pyelonephritis
if the infection involves the upper urinary tract or kidneys
-fever, nausea, vomiting, and flank pain are associated if these symptoms are present
How does a UTI occur?
occurs when bacteria enters the sterile bladder, causing inflammation
-most common way is for bacteria to gain entrance to the bladder through the urethra
Why are females more at risk for developing a UTI?
because of their short urethra and its close proximity of the vagina and rectum
-this proximity allows vaginal and fecal flora to migrate to the urethra causing a UTI
Clinical Manifestations of a UTI
-bladder irritability or dysuria (painful urination)
-urinary frequency
-urinary urgency
-urinating in small volumes
-gross hematuria (blood in urine) or microhematuria (small amounts of blood in urine)
-suprapubic pain (lower abdomen pain)
>if fever, nausea, vomiting, and flank pain are present; infection has potentially migrated to the kidneys (pyelonephritis)
Diagnosis of a UTI is based on what?
clinical manifestations and aided by urinalysis
-urine culture may be done when necessary or in the case of a complicated UTI
A visual inspection of the urine specimen may reveal what?
bloody and/or cloudy urine
A urinalysis demonstrates what in the urine?
leukocytes, nitrates, hemoglobin, and bacteria
-
Why would leukocytes (WBCs) and red blood cells (RBCs) be present in the urine?
because of the inflammatory and infectious process associated with an infection
Why are nitrates present in the urine?
becomes some bacteria convert nitrate to nitrite
What would the urine culture reveal?
greater than 100,000 bacteria
- Escherichia coli, Enterobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae are common
- E. coli is 80% responsible for uncomplicated UTIs
Treatment of a UTI
-primarily medications
-first-line: antimicrobial therapy
>Complicated UTI: 7-10 day antibiotics
>Uncomplicated UTI: 3-day course
-Trimethoprim/ sulfamethoxazole (Bactrim DS)
-ciprofloxacin (Cipro)
-In addition, bladder analgesics: phenazopyridine (Pyridium)
The choice of antibiotics is dependent on what?
urine culture sensitivities
- an uncomplicated UTI can be treated on a 3-day course of antibiotics
- complicated UTI treated with 7 to 10 days of antibiotics
Uncomplicated UTI consists of?
women who are not pregnant, do not have diabetes, and are afebrile
-3 day course of antibiotics
Complicated UTI consists of?
diabetic, febrile, male gender
-7-10 day course of antibiotics
Common prescribed antibiotics for a UTI
-Trimethoprim/ sulfamethoxazole
-ciprofloxacin (Cipro)
>used because of their efficacy in treating urogenital pathogens
In addition to antibiotics, Bladder analgesics can be used for what?
decrease dysuria, frequency, and urgency
-phenazopyridine (Pyridium)
>can turn the urine an orange/red color
What needs to be obtained after completing antibiotics to verify the infection has been treated appropriately?
urinalysis and urine culture
Complications of a UTI
- drug resistance
- pyelonephritis
- renal abscess
How is drug resistance possible?
when a patient does not complete antibiotics as prescribed
What happens when the complication of drug resistance occurs?
the resistance makes it difficult to find an appropriate antibiotic when/if the infection returns
-untreated or incomplete treatment of a UTI allows for bacteria to migrate to the kidneys, causing pyelonephritis or renal abscess
Surgical Management of a UTI is reserved for when?
for patients with known risk factors for infection (bladder or kidney stones) or anatomical defects allowing for incomplete bladder emptying (pelvic organ prolapse in women or an enlarged prostate in men)
Example of a pelvic organ prolapse
cystocele
-occurs when the walls between the bladder and vagina are weakened, allowing the bladder to descend into the vagina
-this change in anatomy prevents the bladder from emptying completely, leading to UTIs
>surgical interventions: colporrhaphy; correct the defect in the vaginal wall, allowing the bladder to empty effectively, decreasing risk of UTI
Nursing Analysis and Assessment: When present, what clinical manifestations are you looking for with a patient with a UTI?
-fever
-dysuria (painful urination)
-urinary frequency
-urinary urgency
-gross hematuria
-cloudy urine
-malodorous urine
>these are due to the inflammatory process that occurs because of the infection
Physical examination fidings
- suprapubic tenderness, costovertebral tenderness, and fever may indicate pyelonephritis
- assess vital signs for temperature elevation, tachycardia, and low blood pressure, which can be indicative of an infection requiring hospitalization for fluid status monitoring and IV antibiotics
Nursing Diagnosis
- altered urinary elimination r/t irritation of bladder mucosa
- knowledge deficit r/t the infection
- acute pain r/t inflamed bladder mucosa
Nursing Assessments
- vital signs
- urinary symptoms
- abdominal examination
- urinalysis
- urine culture
Assessments: Vital signs
elevated temperature, elevated heart rate, and decreased blood pressure may indicate upper urinary tract involvement and dehydration or a patient developing a systemic infection
Assessment: Urinary symptoms
dysuria, urinary frequency, urgency, and gross hematuria are signs of a possible UTI
Assessment: Abdominal examination
suprapubic tenderness can indicate lower tract infections
-costovertebral tenderness can indicate upper respiratory tract infection
Assessment: Urinalysis
the presence of hematuria, leukocytes, nitrates, and cloudy urine indicates infection
(bacteria turns nitrates into nitrites, that’s why you can see them in urine, bacteria causes this so it shows bacteria is in urinary system)
Assessment: Urine cultures
urine culture with greater than 100,000 bacteria indicates an active infection
-antibiotic use is dictated by urine culture sensitivities
Nursing Actions
- administer antibiotics as ordered, dependent on urine culture sensitivities
- administer bladder analgesics such as phenazopyridine (Pyridium)
Actions: administer antibiotics as prescribed, dependent on urine culture sensitivities
treatment with antibiotics, if indicated to clear the infection and avoid ascending infection such as pyelonephritis
Actions: administer bladder analgesics such as phenazopyridine (Pyridium)
phenazopyridine (Pyridium) decreases irritative voiding symptoms associated with a UTI, such as dysuria, frequency, and urgency
- used only short term (3 days) to avoid masking continued symptoms of a UTI
- turns the urine an orange/red color
Nursing Patient Teachings
- report elevated temperature, flank pain, nausea, and vomiting
- increase fluid intake
- signs and symptoms of a UTI
- UTI prevention
- Medication education
Teachings: report elevated temperature, flank pain, nausea, and vomiting
fever, flank pain, nausea, and vomiting despite antimicrobial therapy may indicate spread of infection, antibiotic resistance, and the need for either hospitalization or a change in antibiotics
Teachings: Increase fluid intake
to prevent dehydration and to flush urine of bacteria
Teachings: Signs and symptoms of a UTI
early treatment of infection = decreased morbidity
Teachings: UTI prevention
wipe front to back and urinate before and after intercourse to prevent migration of bacteria to the bladder
Teachings: Medication education
complete all antibiotics as prescribed
- untreated or incomplete treatment of a UTI may cause pyelonephritis or renal abscess or drug resistance
- educate patients that phenazopyridine (pyridium) turns the urine an orange/ red color
A well-managed patient
resolution of irritative lower urinary tract symptoms after completing antimicrobial therapy
