URINARY TRACT INFECTION:-

INTRODUCTION:-
Urinary.Tract.Infection is a bacterial infection in part of the urinary tract. When it affects the
lower urinary tract, it is known as a simple cystitis (a bladder infection).When it affects the
upper urinary tract, it is known as pyelonephritis (a kidney infection).
UTI is 50 times more common in women, with about 5 per cent per year developing
symptoms. UTI is uncommon in men below 60 years of age, but the frequency is similar in
men and women in older age groups.

DEFINITION:-
A urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or
urethra.

MICHROORGANISM CAUSING UTI:-

Escherichia coli [causes 80% of cases]
1. Enterococcus
2. Klebsiella
3. Enterobactor
4. Proteus
5. Pseudomonas
6. Staphylococcus
7. Candida albicans

CLASSIFICATION:-
1. Asymptomatic bacteriuria- is a significant number of bacteria in the urine that
occurs without usual symptoms such as burning during urination or frequent
urination.

2. Acute cystitis- indicates inflammation of the bladder wall.

3. Acute pyelonephritis- implies inflammation (usually due to infection) of the renal

parenchyma and collecting system.

4. Acute urethritis- means inflammation of the urethra.

5. Acute prostatitis- is a serious bacterial infection of the prostate gland.

6. A urinary tract infection is said to be complicated if:-

a) It is in the upper tract
b) The person has diabetes mellitus
c) The person is pregnant
d) The person is male
e) The person has a weakened immune system (immunocompromised) because of another
illness.
RISK FACTORS:-
1. Factors increasing urinary stasis:-
➢ Intrinsic obstruction(stone, tumor of urinary tract, urethral strictures, BPH)
➢ Extrinsic obstruction(tumor, fibrosis compressing urinary tract)
➢ Urinary retention(including neurogenic bladder and low bladder wall
compliance)
➢ Renal impairment

2. Foreign bodies :-
➢ Urinary tract calculi
➢ Catheters ( indwelling external condom catherter, urethral stent, intermittent
catheterization)
➢ Urinary tract instrumentation( cystoscopy, urodynamics)

3. Anatomic factors :-
➢ Congenital defects leading to obstruction or urinary stasis
➢ Fistula exposing urinary system to skin, vagina, or fecal stream
➢ Shorter female urethra and colonization from normal vaginal flora
➢ Obesity

4. Factors comprising immune response:-

➢ Ageing

➢ Human immunodeficiency virus infection

➢ Diabetes mellitus
5. Functional disorders:-
➢ Constipation

➢ Voiding dysfunction

6.Other factors:-
➢ Pregnancy
➢ Hypoestrogenic state
➢ Multiple sex partners
➢ Poor personal hygiene

PATHOPHYSIOLOGY:
- The urinary tract above the urethra is normally sterile. Several mechanical and physiologic
defence mechanisms include normal voiding with complete emptying of the bladder,
ureterovesical junction competence and peristaltic activity that propels urine toward the
bladder. Antibacterial characteristics of urine are maintained by an acidic pH (<6.0) high urea
concentration, and abundant glycoproteins that interfere with the growth of bacteria. These
defence mechanisms assist in maintaining sterility and preventing UTIs.

CLINICAL MENIFESTATION:-
1. A strong, persistent urge to urinate
2. A burning sensation when urinating
3. Passing frequent, small amounts of urine
4. Urine that appears cloudy
5. Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
6. Strong-smelling urine
7. Pelvic pain, in women — especially in the center of the pelvis and around the area of the
pubic bone

ASSESSMENT AND DIAGNOSTIC FINDINGS:-

1. History taking with detailed clinical manifestations
2. Physical examination
3. Urine Tests
4. Urinalysis
5. Urine Culture-
6. Ultrasound- Ultrasound is a noninvasive imaging test that can be used to screen for
hydronephrosis (obstructions of the flow of urine)
7. X-Rays- Special x-rays can be used to screen for structural abnormalities, urethral
narrowing, or incomplete emptying of the bladder. Due to the possible risks to the fetus, x-
rays are not performed on pregnant women.
8. Voiding cystourethrogram- It is an x-ray of the bladder and urethra.To obtain a
cystourethrogram, a dye, called contrast material, is injected through a catheter inserted into
the urethra and passed through the bladder.
9 An intravenous pyelogram (IVP)- It is an x-ray of the kidney. For a pyelogram, the
contrast matter is injected into a vein and eliminated by the kidneys. In both cases, the dye
passes through the urinary tract and reveals any obstructions or abnormalities on x-ray
images.
10 Cystoscopy- Cystoscopy is used to detect structural abnormalities, interstitial cystitis, or
masses that might not show up on x-rays during an IVP.The patient is given a light
anesthetic, and the bladder is filled with water.The procedure uses a cystoscope, a flexible,
tube-like instrument that the urologist inserts through the urethra into the bladder
11. ComputedTomography (CT)- A computed tomography (CT) scans may be used to
check for kidney stones or other obstructions.
12. Blood Cultures- If symptoms are severe; the doctor will order blood cultures to
determine if the infection is in the bloodstream and threatening other parts of the body.

MANAGEMENT:-
Management of UTIs typically involves pharmacologic therapy and patient education. The
nurse teaches the patient about medication regimens and infection prevention measures.
1. Acute PharmacologicTherapy-
a) Uncomplicated cases- single dose of administration, short course (3 to 4 days) regimens,
or 7 to 10 days regimens. The antibacterial agent should be affordable and should have few
adverse effects. Most cases are cured after 3 days of treatment.
Name of Drugs Details:-
A) Cephalosporin or ampicillin/ aminoglycoside combination For 7 to 10 days for the
treatment to be effective.
B)Trimethoprim- sulfamethoxazole These are commonly used medicine.
C)Ciprofloxacin(fluoroquinolone) It is often used as a first line drug because E. coli has
developed resistance to ampicillin or amxicillin.
D) Levofloxacin(fluoroquinolone) It is another fluoroquinolone, is a good choice for short
term therapy for uncomplicated, mild to moderate UTIs.
E)Nitrofurantion It should not be used in patients with renal insufficiency because it is
ineffective at glomerular filtration rates of less than 50ml/min and may cause peripheral
neuropath.
F) Phenazopyridine It is a urinary analgesic may be prescribed to relieve the discomfort
associated with the infection. b) Complicated cases-

Patient education:-
➢ The following are measures that studies suggest may reduce the incidence of urinary
tract infections.
➢ These may be appropriate for people, especially women, with recurrent infections:
Do not delay urination when it is necessary.
➢ A high fluid intake is essential.
➢ Cleaning the urethral meatus (the opening of the urethra) after intercourse has been
shown to be of some benefit; however, whether this is done with an antiseptic or a
placebo ointment (an ointment containing no active ingredient) does not appear to
matter.
➢ Drinking 250 to 500ml of cranberry juice daily and avoidance of bubble baths may
also help.
➢ Often long courses of low-dose antibiotics are taken at night to help prevent
otherwise unexplained cases of recurring cystitis.

1. NURSING DIAGNOSIS :-
Acute pain related to infection within the urinary tract as manifested by pain on
urination, suprapubic pain and bladder spasms.

GOAL Pain and discomfort will be relieved.

INTERVENTION :-
Assess the onset, duration and level of pain.
➢ Provide analgesic drugs.
➢ Provide comfortable position.
➢ Reassure and provide divertional therapy.
➢ Give psychological support.
➢ Alert patient that phenazopyridine will color urine orange.
➢ Apply heating pad to painful area. EVALUATION Reports relief of pain.
2.NURSING DIAGNOSIS :-
Impaired urinary elimination related to UTIs as manifested by urgency, frequency,
incontinence or hematuria and verbalization of concern over altered elimination pattern.

GOAL Normal urination pattern will be returned.

INTERVENTION :-
Assess for changes in usual voiding pattern.
Instruct patient regarding reason for symptoms.
Encourage high fluid intake or administer IV fluid as ordered.
Obtain urine for culture and sensitivity.
Administer antimicrobial medications as ordered.
Instruct patient about good perineal care and cleansing after each bowel movement.
Tell patient to observe urine for color, odor,amount and frequency.
EVALUATION Exhibits normal urination pattern.

3 NURSING DIAGNOSIS:-
Hyperthermia related to infection as manifested by elevation in temperature,
tachycardia, chills and malaise

GOAL Normal body temperature will be returned.

INTERVENTION
Assess vital signs 2-4 hourly.
Administer antipyretics and antibiotics as ordered.
Ensure hydration via oral or IV route.
Monitor intake and output.
Cover patient and keep him dry.
Provide cooling sponge baths or compresses.

EVALUATION Reports return of normal temperature.