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Urinary Tract Infection

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.

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Urinary Tract Infection

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  1. Urinary Tract Infection (relates to Chapter 44, “Nursing Management: Renal and Urologic Problems,” in the textbook)

  2. 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

  3. Urinary Tract Infection • >15% patients who develop gram- negative bacteria die • 1/3 of these caused by infections originating in urinary tract

  4. 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

  5. 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

  6. Urinary Tract InfectionClassification • Upper tract involves renal parenchyma, pelvis, and ureters • Typically causes fever, chills, flank pain • Lower tract involves lower urinary tract • No usual systemic manifestations

  7. Urinary Tract InfectionClassification • Pyelonephritis is inflammation of renal parenchyma and collecting system • Cystitis is inflammation of bladder wall • Urethritis is inflammation of the urethra

  8. Urinary Tract InfectionClassification • Uncomplicated infection occurs in otherwise normal urinary tract

  9. Urinary Tract InfectionClassification • Complicated infections occur with coexisting presence of • Obstruction • Stones • Catheters • Diabetes or neurologic disease • Recurrent infection

  10. Urinary Tract InfectionClassification • Initial infection • Recurrent UTI • Unresolved bacteriuria • Bacteria persistence

  11. Urinary Tract InfectionEtiology 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

  12. Urinary Tract InfectionEtiology and Pathophysiology • Contributing factor: urologic instrumentation • Sexual intercourse promotes “milking” of bacteria from perineum and vagina • UTIs rarely result from hematogenous route

  13. Urinary Tract InfectionEtiology and Pathophysiology • Common source of hospital-acquired UTI is nosocomial infections • Urologic instrumentation common predisposing factor

  14. Urinary Tract InfectionClinical Manifestations • Symptoms • Dysuria • Frequent urination (>q2h) • Urgency • Suprapubic discomfort or pressure

  15. Urinary Tract InfectionClinical Manifestations • Urine may contain visible blood or sediment, giving cloudy appearance • Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)

  16. Urinary Tract InfectionClinical 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

  17. Urinary Tract InfectionClinical 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

  18. Urinary Tract InfectionDiagnostic 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

  19. Urinary Tract InfectionDiagnostic 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

  20. Urinary Tract InfectionDiagnostic Studies • Clean-catch is preferred • Specimen obtained by catheterization or suprapubic needle aspiration has more accurate results

  21. Urinary Tract InfectionDiagnostic Studies • Sensitivity testing determines susceptibility to antibiotics • Imaging studies are indicated in selected cases • IVP or abdominal CT when obstruction suspected

  22. Urinary Tract Infection Collaborative Care Drug Therapy • Antibiotic selected on empiric therapy or results of sensitivity testing • Uncomplicated cystitis treated by short-term course of antibiotics • Complicated UTIs require long-term treatment

  23. Urinary Tract Infection Collaborative Care Drug Therapy • Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric uncomplicated or initial • Inexpensive • TMP-SMX taken bid

  24. 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

  25. 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

  26. 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

  27. Urinary Tract InfectionNursing ManagementNursing Assessment • Health History-what will you ask? • Subjective Data- what symptoms might the client describe? • Objective Data- what signs might you find?

  28. Urinary Tract InfectionNursing ManagementNursing Diagnoses • Acute pain • Impaired urinary elimination

  29. Urinary Tract InfectionNursing ManagementPlanning Patient will have • Relief from lower urinary tract symptoms • Prevention of upper urinary tract involvement • Prevention of recurrence

  30. Urinary Tract InfectionNursing ManagementNursing Implementation • Health Promotion • Recognize individuals at risk

  31. Urinary Tract InfectionNursing ManagementNursing Implementation • Health Promotion • Emptying bladder regularly and completely • Evacuating bowel regularly • Wiping perineal area front to back • Drinking adequate fluids (15 ml per lb)

  32. Urinary Tract InfectionNursing ManagementNursing 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

  33. Urinary Tract InfectionNursing ManagementNursing Implementation • Health Promotion • Aseptic technique must be followed during instrumentation procedures • Wash hands before and after contact • Wear gloves for care of urinary system

  34. Urinary Tract InfectionNursing ManagementNursing 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

  35. Urinary Tract InfectionNursing ManagementNursing 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

  36. Urinary Tract InfectionNursing ManagementNursing 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

  37. Urinary Tract InfectionNursing ManagementNursing 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

  38. Urinary Tract InfectionNursing ManagementNursing 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

  39. Urinary Tract InfectionNursing ManagementNursing Implementation • Ambulatory and Home Care • Emphasize compliance with drug regimen • Take as ordered • Maintain adequate fluids • Regular voiding • Void after intercourse

  40. Urinary Tract InfectionNursing ManagementNursing Implementation • Temporarily discontinue use of diaphragm • Instruct on follow-up care with urine culture • Recurrent symptoms typically occur in 1-2 weeks after therapy

  41. Urinary Tract InfectionNursing ManagementEvaluation • Use of nonanalgesic relief measures • Appropriate use of analgesics • Pass urine without urgency • Urine free of blood • Adequate intake of fluids

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