Transcript UTI.2005
Urinary Tract Infection
(relates to Chapter 44,
“Nursing Management:
Renal and Urologic
Problems,” in the textbook)
Urinary Tract Infection
Second most common bacterial disease
Account for more than 8 million office
visits per year
Results in >100, 000 people hospitalized
annually
Urinary Tract Infection
>15% patients who develop gramnegative bacteria die
– 1/3 of these caused by infections
originating in urinary tract
Urinary Tract Infection
Bladder and its contents are free of
bacteria in majority of healthy patients
Minority of healthy individuals have
colonizing bacteria in bladder
– Called asymptomatic bacteriuria and
does not justify treatment
Urinary Tract Infection
E. coli most common pathogen
Counts of 105 CFU/ml indicate
significant UTI
Counts as low as 102 CFU/ml in a person
with signs and symptoms are indicative
Urinary Tract Infection
Classification
Upper tract involves renal parenchyma,
pelvis, and ureters
– Typically causes fever, chills, flank pain
Lower tract involves lower urinary tract
– No usual systemic manifestations
Urinary Tract Infection
Classification
Pyelonephritis is inflammation of renal
parenchyma and collecting system
Cystitis is inflammation of bladder wall
Urethritis is inflammation of the urethra
Urinary Tract Infection
Classification
Uncomplicated infection occurs in
otherwise normal urinary tract
Urinary Tract Infection
Classification
Complicated infections occur with
coexisting presence of
– Obstruction
– Stones
– Catheters
– Diabetes or neurologic disease
– Recurrent infection
Urinary Tract Infection
Classification
Initial infection
Recurrent UTI
Unresolved bacteriuria
Bacteria persistence
Urinary Tract Infection
Etiology and Pathophysiology
Physiologic and mechanical defense
mechanisms maintain sterility
Alterations in defense mechanisms
increase risk of infection
Organisms causing UTI usually
introduced via ascending route from
urethra
Urinary Tract Infection
Etiology and Pathophysiology
Contributing factor: urologic
instrumentation
Sexual intercourse promotes “milking”
of bacteria from perineum and vagina
UTIs rarely result from hematogenous
route
Urinary Tract Infection
Etiology and Pathophysiology
Common source of hospital-acquired
UTI is nosocomial infections
Urologic instrumentation common
predisposing factor
Urinary Tract Infection
Clinical Manifestations
Symptoms
– Dysuria
– Frequent urination (>q2h)
– Urgency
– Suprapubic discomfort or pressure
Urinary Tract Infection
Clinical Manifestations
Urine may contain visible blood or
sediment, giving cloudy appearance
Flank pain, chills, and fever indicate
infection of upper tract (pyelonephritis)
Urinary Tract Infection
Clinical Manifestations in Older Adult
Symptoms often absent
Experience non-localized abdominal
discomfort rather than dysuria
May have cognitive impairment
Less likely to have a fever
Urinary Tract Infection
Clinical Manifestations
Patients with significant bacteriuria may
have no symptoms or nonspecific
symptoms like fatigue or anorexia
Patients with bladder tumors or those
receiving intravesical chemotherapy or
pelvic radiation usually experience
frequency, urgency, and dysuria
Urinary Tract Infection
Diagnostic Studies
Initially obtain dipstick urinalysis to
identify presence of nitrates, WBCs, and
leukocyte esterase
Findings confirmed by microscopic
urinalysis
Following confirmation of bacteriuria
and pyuria, urine culture may be
obtained
Urinary Tract Infection
Diagnostic Studies
Urine culture indicated in complicated or
nosocomial, persistent bacteria, or
frequently recurring (>2 episodes
annually)
May be cultured if infection is
unresponsive to empiric therapy or
diagnosis is questionable
Urinary Tract Infection
Diagnostic Studies
Clean-catch is preferred
Specimen obtained by catheterization or
suprapubic needle aspiration has more
accurate results
Urinary Tract Infection
Diagnostic Studies
Sensitivity testing determines
susceptibility to antibiotics
Imaging studies are indicated in selected
cases
– IVP or abdominal CT when
obstruction suspected
Urinary Tract Infection
Collaborative Care
Drug Therapy
Antibiotic selected on empiric therapy or
results of sensitivity testing
Uncomplicated cystitis treated by shortterm course of antibiotics
Complicated UTIs require long-term
treatment
Urinary Tract Infection
Collaborative Care
Drug Therapy
Trimethoprim-sulfamethoxazole (TMPSMX) or nitrofurantoin used to treat
empiric uncomplicated or initial
– Inexpensive
– TMP-SMX taken bid
Urinary Tract Infection
Collaborative Care
Drug Therapy
Pyridium is OTC that provides soothing
effect on urinary tract mucosa
– Stains urine reddish orange that can be
mistaken for blood and may stain
underclothing
Effective in relieving discomfort
Urinary Tract Infection
Collaborative Care
Drug Therapy
Combination agents (e. g., Urised) used to
relieve pain
– Preparations with methylene blue tint
urine blue or green
Urinary Tract Infection
Collaborative Care
Drug Therapy
Prophylactic or suppressive antibiotics
sometimes administered to patients with
repeated UTIs
TMP-SMX administered qd to prevent
recurrence or single dose prior to events
likely to cause UTI
Urinary Tract Infection
Nursing Management
Nursing Assessment
Health History-what will you ask?
Subjective Data- what symptoms might the
client describe?
Objective Data- what signs might you find?
Urinary Tract Infection
Nursing Management
Nursing Diagnoses
Acute pain
Impaired urinary elimination
Urinary Tract Infection
Nursing Management
Planning
Patient will have
Relief from lower urinary tract symptoms
Prevention of upper urinary tract
involvement
Prevention of recurrence
Urinary Tract Infection
Nursing Management
Nursing Implementation
Health Promotion
– Recognize individuals at risk
Urinary Tract Infection
Nursing Management
Nursing Implementation
Health Promotion
– Emptying bladder regularly and
completely
– Evacuating bowel regularly
– Wiping perineal area front to back
– Drinking adequate fluids (15 ml per lb)
Urinary Tract Infection
Nursing Management
Nursing Implementation
Health Promotion
– Daily intake of cranberry juice or
cranberry essence may help reduce risk
– Avoid unnecessary catheterization and
early removal of indwelling catheters
Prevents
nosocomial infections
Urinary Tract Infection
Nursing Management
Nursing Implementation
Health Promotion
– Aseptic technique must be followed
during instrumentation procedures
– Wash hands before and after contact
– Wear gloves for care of urinary system
Urinary Tract Infection
Nursing Management
Nursing Implementation
Health Promotion
– Routine and thorough perineal care for
all hospitalized patients
– Avoid incontinent episodes by answering
call light and offering bedpan at frequent
intervals
Urinary Tract Infection
Nursing Management
Nursing Implementation
Acute Intervention
– Adequate fluid intake
Patient
may think will worsen condition due
to discomfort
Dilutes urine, making bladder less irritable
Flushes out bacteria before they can colonize
Urinary Tract Infection
Nursing Management
Nursing Implementation
Acute Intervention
– Avoid caffeine, alcohol, citrus juices,
chocolate, and highly-spiced foods
Potential
–
bladder irritants
Application of local heat to suprapubic or
lower back may relieve discomfort
Urinary Tract Infection
Nursing Management
Nursing Implementation
Acute Intervention
– Instruct patient about drug therapy and
side effects
– Emphasize taking full course despite
disappearance of symptoms
– Second or reduced drug may be ordered
after initial course in susceptible patients
Urinary Tract Infection
Nursing Management
Nursing Implementation
Acute Intervention
– Instruct patient to watch urine for
changes in color and consistency and
decrease in cessation of symptoms
– Counsel on persistence of lower tract
symptoms beyond treatment or onset of
flank pain or fever should be reported
immediately
Urinary Tract Infection
Nursing Management
Nursing Implementation
Ambulatory and Home Care
– Emphasize compliance with drug regimen
Take
–
–
–
as ordered
Maintain adequate fluids
Regular voiding
Void after intercourse
Urinary Tract Infection
Nursing Management
Nursing Implementation
–
–
–
Temporarily discontinue use of
diaphragm
Instruct on follow-up care with urine
culture
Recurrent symptoms typically occur in 12 weeks after therapy
Urinary Tract Infection
Nursing Management
Evaluation
Use of nonanalgesic relief measures
Appropriate use of analgesics
Pass urine without urgency
Urine free of blood
Adequate intake of fluids