Classification, management, and treatment of UTI's

Nursing interventions for UTI

1. administration of antibiotics, antispasmodic agents, analgesic agents and the application of heat to the perineum help relieve pain and spasm.

risk factors of UTI in older adults

1. high incidence of multiple chronic medical conditions 2. frequent use of antimicrobial agents 3. presence of infected pressure ulcers

acute uncomplicated pyelonephritis

2-week course of antibiotic agents is recommended for this, because renal parenchymal disease is more difficult to eradicate than mucosal bladder infections

Nursing interventions for UTI

2. Encourage liberal amounts of fluids promote renal blood flow and to flush the bacteria from the urinary tract.

1. hand hygiene 2. careful perineal care 3. frequent toileting

3 factors that may decrease the chance of getting a UTI

Nursing interventions for UTI

3. Avoid irritants (e.g., coffee, tea, citrus, spices, colas, alcohol)

Nursing interventions for UTI

4. Frequent voiding (every 2 to 3 hours) is encouraged because doing so can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection

risk factors of UTI in older adults

4. immunocompromise 5. cognitive impairment & immobility 6. incomplete emptying of bladder

Elderly

In these patients, decreased bladder tone, neurogenic bladder, urinary stasis, and incomplete emptying of the bladder increase the risk of UTI

chronic pyelonephritis

Long-term use of prophylactic antimicrobial therapy may help limit recurrence of infections and renal scarring for this condition

uncomplicated

Most community acquired UTIs are classified as what?

1. Using strict aseptic technique during insertion of the smallest catheter possible 2. Securing the catheter to prevent movement

Nursing interventions for preventing a CAUTI

3. Frequently inspecting urine color, odor, and consistency 4. Performing meticulous daily perineal care with soap and water

Nursing interventions for preventing a CAUTI

5. Maintaining a closed system 6. Following the manufacturer's instructions when using the catheter port to obtain urine specimens

Nursing interventions for preventing a CAUTI

altered sensorium lethargy anorexia new incontinence hyperventilation low-grade fever

Older patients often lack the typical symptoms of UTI and sepsis, these symptoms may be only clue to UTI in the elderly

chronic bacterial prostatitis

The most common cause of recurrent UTIs in older males

transurethral

The most common route of urinary infection

Community-acquired infection (uncomplicated)

These type of UTI's are common in young women and not usually recurrent

whether the UTI is recurrent and the duration of the infection

UTIs are further classified as uncomplicated or complicated, depending on what factors?

urethrovesical reflux

a condition where there is an obstruction to free-flowing urine. and urine flows backward from the urethra into the bladder

Glycosaminoglycan (GAG)

a hydrophilic protein, that normally exerts a nonadherent protective effect against various bacteria

CT scan

a test that detects pyelonephritis or abscesses

renal abscesses

an upper UTI

acute pyelonephritis

atrophy and destruction of tubules and the glomeruli may result with this condition

ureterovesical or vesicoureteral reflux

backward flow of urine from the bladder into one or both ureter

Bacteriuria

bacteria in the urine

Pyelonephritis

bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys (can be acute or chronic)

Symptoms associated with Cystitis (uncomplicated lower UTI)

burning on urination urinary frequency urgency nocturia incontinence suprapubic or pelvic pain. back pain Hematuria (rare)

Urethrovesical reflux

can be caused by dysfunction of the bladder neck or urethra, or by menopause, but is most often noted in young children

CAUTI

catheter-associated urinary tract infection

chronic pyelonephritis

cause of chronic kidney disease that can result in the need for renal replacement therapies such as transplantation or dialysis.

Symptoms of acute pyelonephritis

chills, fever, leukocytosis, bacteriuria, and pyuria, low back pain, flank pain, nausea and vomiting, headache, malaise, and painful urination are

end-stage kidney disease, hypertension, and formation of kidney stones

complications of chronic pyelonephritis include:

incidence of bacteriuria

confusion, dementia, or bowel or bladder incontinence increases the chance of this

The GAG molecule

forms a water barrier that serves as a defensive layer between the bladder and the urine

Urine culture

identifies the specific organism present in the UTI

prostatic hyperplasia

increases the chance of UTI in men as they age

interstitial nephritis

inflammation of the kidney (this is an upper UTI

bacterial prostatitis

inflammation of the prostate gland (this is a lower UTI)

pyelonephritis

inflammation of the renal pelvis (this is an upper UTI) ( can be acute or chronic)

bacterial urethritis

inflammation of the urethra (this is a lower UTI

Bacterial cystitis

inflammation of the urinary bladder (this is a lower UTI)

Transrectal ultrasonography

is the procedure of choice for men with recurrent or complicated UTIs

Periodic monitoring of renal function and evaluation for strictures, obstructions, or stones

management for patients with recurrent UTIs

IV pyelogram

may be indicated if functional and structural renal abnormalities are suspected with pyelonephritis

cystourethroscopy

may be indicated to visualize the ureters or to detect strictures, calculi, or tumors

indwelling catheters & frequent use of antibiotic agents

may increase the chances of UTIs in the institutionalized older adult

Urinary tract infection (UTI)

most common cause of acute bacterial sepsis in patients older than 65 years, in whom gram-negative sepsis carries a mortality rate exceeding 50%

change in cognitive functioning

most common objective finding of UTI in older adults, especially in those with dementia

generalized fatigue

most common subjective presenting symptom of UTI in older adults

Pyuria

occurs in all patients with UTI; however, it is not specific for bacterial infection

Yeast vaginitis

occurs in as many as 25% of patients treated with antimicrobial agents for UTI

E. coli

organism most frequently responsible for UTIs are those normally found in the lower gastrointestinal (GI) tract

Urinary tract infection (UTI)

pathogenic microorganisms in the urinary tract (the normal urinary tract is sterile above the urethra), cause what urinary condition?

the ureterovesical junction

prevents urine from traveling back into the ureter

transurethral

route of urinary infection in which bacteria (often from fecal contamination) colonize the periurethral area and subsequently enter the bladder by means of the urethra

chronic pyelonephritis

symptoms for this may include fatigue, headache, poor appetite, polyuria, excessive thirst, and weight loss

chronic pyelonephritis

the extent of this disease is assessed by an IV urogram and measurements of creatinine clearance, blood urea nitrogen, and creatinine levels.

Aggressive early treatment

the key to reducing the mortality rate associated with gram-negative sepsis, especially in older patients

maintain the sterility of the bladder

the physical barrier of the urethra & urine flow are 2 mechanisms that do what?

urosepsis

the spread of infection from the urinary tract to the bloodstream that results in a systemic infection).

maintain the sterility of the bladder

the ureterovesical junction competence & various antibacterial enzymes and antibodies antiadherent effects mediated by the mucosal cells of the bladder are 2 mechanisms that do what?

Complicated UTIs

these often are caused by a broader spectrum of organisms, have a lower response rate to treatment, and tend to recur

patients with indwelling catheters

these patients are more likely to be infected with organisms Proteus, Klebsiella, Pseudomonas, or Staphylococcus rather than E. coli (the common organism associated with UTI)

males and in patients with indwelling bladder catheters

these patients have higher rates of Pseudomonas and Enterococcus organisms

1. bacterial colony counts 2. cellular studies 3. urine cultures

these test help confirm diagnosis of UTI

coughing, sneezing, or straining

things that can cause urethrovesical reflux

use of indwelling catheters

this causes increased risks of getting a UTI

Complicated UTIs

this classification of UTI usually occurs in people with urologic abnormalities or recent catheterization and are often acquired during hospitalization

microscopic hematuria

this is present in about half of patients with an acute UTI

Careful assessment of vital signs and level of consciousness

this may alert the nurse to kidney involvement or impending sepsis

ultrasonography

this test is extremely sensitive for detecting obstruction, abscesses, tumors, and cysts

1. transurethral route 2. through the bloodstream 3. by means of a fistula from the intestine

three ways bacteria enter the urinary tract

causes of Pyelonephritis

upward spread of bacteria from the bladder or spread from systemic sources reaching the kidney via the bloodstream

acute pyelonephritis

usually leads to enlargement of the kidneys with interstitial infiltrations of inflammatory cells

Complicated

with these kind of UTIs, manifestations can range from asymptomatic bacteriuria to gram-negative sepsis with shock

uncomplicated

with this classification of UTI, the strain of bacteria determines the antibiotic of choice

Ureterovesical or vesicoureteral reflux

with this condition, bacteria may reach the kidneys and eventually destroy them.

chronic pyelonephritis

with this condition, the kidneys become scarred, contracted, and nonfunctioning