Urinary tract infection, lower

Nursing Considerations-Nursing Diagnoses

Acute pain Disturbed sleep pattern Impaired urinary elimination Risk for infection Risk for injury Sexual dysfunction

Treatment-Medications

Antibiotic therapy based on culture and sensitivity of the organism Co-trimoxazole for uncomplicated UTIs Nitrofurantoin macrocrystals for patients with allergies to co-trimoxazole or resistance to E. coli Nitrofurantoin macrocrystals, amoxicillin, or cephalexin for UTIs during pregnancy Other antibiotics, such as ampicillin, gentamicin sulfate, cefixime, cefpodoxime proxetil, or ciprofloxacin Fluoroquinolones, such as ciprofloxacin, levofloxacin, or ofloxacin; sulfamethoxazole-trimethoprim; or cephalosporin for complicated UTIs Co-trimoxazole, often in combination with nitrofurantoin macrocrystals, for continuous antimicrobial prophylaxis for chronic UTIs Phenazopyridine for 1 to 2 days for relief of dysuria

Overview-Causes

Ascending infection by a single gram-negative, enteric bacterium, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia Simultaneous infection with multiple pathogens Neisseria gonorrhoeae, Chlamydia trachomatis (urethritis)

Overview

Bacterial infection of the lower urinary tract system Two forms: Cystitis (infection of the bladder) Urethritis (infection of the urethra most often related to sexually transmitted infection) Cystitis (infection of the bladder) Urethritis (infection of the urethra most often related to sexually transmitted infection)

Nursing Considerations-Associated Nursing Procedures

Blood pressure assessment Clean-catch (midstream) urine collection, female Clean-catch (midstream) urine collection, male Health history interview and physical assessment Intake and output assessment Nutritional screening Oral drug administration Pain management Postoperative care Preoperative care Preparing a patient for urologic surgery, OR Pulse assessment Respiration assessment Sitz bath Temperature assessment

Nursing Considerations-Nursing Interventions

Collect all urine specimens appropriately. Obtain clean-catch urine specimens as indicated; assist the patient in collecting a clean-catch specimen if necessary. Administer drug therapy: Give co-trimoxazole with 8 oz of water on an empty stomach. Give the prescribed antimicrobial agent for the specified duration (for example, 3 days or 7 to 10 days for the first infection and 14 to 21 days for complicated or recurrent infections). Give co-trimoxazole with 8 oz of water on an empty stomach. Give the prescribed antimicrobial agent for the specified duration (for example, 3 days or 7 to 10 days for the first infection and 14 to 21 days for complicated or recurrent infections). Encourage oral fluid intake unless contraindicated; urge the patient to avoid bladder irritants, such as coffee, tea, alcohol, and cola drinks; encourage frequent voiding and emptying of the bladder. Assist with perineal care and hygiene. Use sitz baths or warm compresses, as needed.

Overview-Pathophysiology

Colonization of the vaginal introitus (in females) or urethra (in males) occurs; the organism ascends by way of the urethra into the bladder. Local defense mechanisms in the bladder break down. Bacteria invade the bladder mucosa and multiply. Bacteria can't be readily eliminated by normal urination. The pathogen's resistance to prescribed antimicrobial therapy usually causes bacterial flare-up during treatment. Recurrent lower UTIs result from reinfection by the same organism or a new pathogen.

Overview-Complications

Damage to the urinary tract lining Pyelonephritis Sepsis Renal abscess Acute urinary outlet obstruction Recurrent UTI Acute bacterial prostatitis (male)

Treatment-Surgery

Extracorporeal shockwave lithotripsy or endoscopic, percutaneous, or open surgery in cases of recurrent infections from infected renal calculi, chronic prostatitis, or structural abnormalities

Treatment-Diet

Increased fruit juice intake Increased fluid intake

Nursing Considerations-Monitoring

Intake and output Urine characteristics Voiding patterns Vital signs Adverse effects of antimicrobial therapy

Overview-Incidence

Lower UTIs are much more common in females than in males (except elderly males), probably because natural anatomic features facilitate infection. More than 50% of women have had at least one lower UTI in their lifetime. Approximately 25% to 50% of women between ages 20 and 40 have had a UTI. Lower UTIs are uncommon in males younger than age 50; however, the incidence increases with age.

Diagnostic Test Results-Laboratory

Microscopic urinalysis may show a red blood cell count greater than 5 per high-power field and a white blood cell count greater than 10 per high-power field, suggesting a lower UTI. Clean-catch urinalysis may show a bacterial count of more than 100,000/mL, confirming a lower UTI; protein levels may be slightly elevated. Urine dipstick testing may be positive for blood, white blood cells, and nitrates. Sensitivity testing determines the appropriate antimicrobial drug. If the patient history and physical examination warrant, a blood test or a stained smear of urethral discharge may rule out sexually transmitted infections.

Overview-Risk Factors

Natural anatomic variations Inadequate fluid consumption Trauma or invasive procedures Urinary catheter Urinary tract obstructions Vesicourethral reflux Urinary stasis Diabetes Bowel incontinence Immobility Benign prostatic hyperplasia Use of spermicides or diaphragm

Assessment-Physical Findings

Pain or tenderness over the bladder Hematuria Cloudy, foul-smelling urine Urethral discharge (urethritis in males) Prostatic tenderness (males)

Treatment-General

Sitz baths or warm compresses

Assessment-History

Urinary urgency and frequency Bladder cramps or spasms Pruritus Feeling of warmth during urination Nocturia or dysuria Urethral discharge (in men, urethritis) Lower back or flank pain Malaise and chills Nausea and vomiting Low-grade fever

Diagnostic Test Results-Imaging

Voiding cystourethrography or excretory urography may demonstrate congenital anomalies, predisposing the patient to recurrent UTIs.

Patient Teaching-General

disorder, diagnosis, and treatment, including the need for antimicrobial agents to eradicate the infection and the fact that symptoms typically resolve within 2 to 3 days after starting drug therapy fact that 25% of women with a first UTI experience a second UTI within 6 months and that 50% develop a UTI again sometime during their lifetime prescribed drug therapy regimen, including drug names, dosages, frequency and schedule of administration, and duration of therapy, usually 7 to 10 days adverse effects associated with antimicrobial therapy, such as photosensitivity with co-trimoxazole need to take co-trimoxazole with a large glass of water on an empty stomach fact that nitrofurantoin may turn urine dark yellow or brown need to complete the full course of prescribed drug therapy, even if symptoms subside comfort measures, such as warm sitz baths and compresses proper perineal hygiene care measures, including wiping from front to back, avoiding feminine hygiene sprays and douches, and emptying the bladder immediately before and after sexual intercourse need to refrain from sexual intercourse until symptoms resolve measures to prevent recurrence, such as not postponing voiding, voiding after sexual intercourse, and increasing fluid intake signs and symptoms of recurrence and the need to notify a health care provider if any occur importance of increasing fluids, especially those that acidify the urine; suggest the use of cranberry juice, which is associated with inhibiting bacterial adherence to the bladder epithelium.

Nursing Considerations-Expected Outcomes

report increased comfort verbalize feeling well rested after undisturbed periods of sleep demonstrate skill in managing the urinary elimination problem remain free from further signs or symptoms of infection avoid or minimize complications reestablish sexual activity at the pre-illness level.