UTI

What are examples of potential bladder irritants that should be avoided?

-Caffeine -Alcohol -Citrus juices -Chocolate -Highly spiced foods

What are risk factors for a UTI?

-Diminished host defenses -Women at more risk (shorter urethra than men, vagina close to rectum), BC (diaphragm and spermicidal agents), sexual intercourse, hormone,etc.) (sexual intercourse promotes "milking" of the bacteria) -Urinary tract abnormalities (Babies born with urinary tract abnormalities that don't allow urine to leave the body normally or cause urine to back up in the urethra); Fistulas and obesity can also contribute to UTIs. -Blockages in urinary tract (Kidney stones or a large prostate) -Urinary retention (BPH (prostate secretes an antimicrobial but when enlarged it does not secrete right and closes off the urethra, tumor, neurogenic bladder are some of the conditions that promote stasis of urine) -Suppressed immune system (DM, HIV, etc.) (Immunosuppressive drugs or cortocosteroids) -Catheterization and other procedures (Urinary catheters, instrumentation, cystoscopic examinations) -Toiletries- excessive bubble bath -Constipation- extra pressure on bladder *Diabetes mellitus, calculi (STONE), hormonal changes, aging, sexual intercourse, Pregnancy, BPH (Benign prostatic hyperplasia - enlarged prostate), catheterized patients, urinary retention, women and elderly, synthetic underwear, wet bathing suits are all risk factors for UTI.

Education for a patient taking the antibiotic, Trimethoprim/Sulfamethoxazole (Bactrim), for a UTI:

1st- if urine is concentrated this med can cause crystalluria. Hydration= dilution of urine

When a person is on antibiotics for a UTI when should symptoms start to be relieved and when should they call the physician?

24-48 hours By the 3rd day if symptoms are not better contact the physician

What diagnostic test is initially performed for a UTI and what should accompany it?

A urine culture and sensitivity

For a urine sample from a foley never get the sample from the collection bag, get it from the...

Access port

What are acute intervention for nursing management with a UTI?

Acute intervention: Avoid potential bladder irritants. Instruct patient about drug therapy Emphasize taking full course of antibiotics. Second or reduced dosage of a drug may be ordered after initial course in susceptible patients.

Why is menopause a risk for UTI?

After menopause, a decline in circulating estrogen causes changes in the urinary tract lining that make you more vulnerable to infection.

What do you always check first before giving an antibiotic (or any medication)?

Allergies!

What are ambulatory and home care nursing management includes what?

Ambulatory and home care Emphasize importance of compliance Maintain adequate fluids Regular voiding (every 3 to 4 hours) Void after intercourse Temporarily discontinue use of contraceptive diaphragm Instruct on follow-up care Recurrence of symptoms: typically 1 to 2 weeks after therapy

What is included in drug therapy for a UTI?

Antibiotics Antispasmodics Analgesics

Patient education for a person taking the antibiotic, Nitrofurantoin (Macrodantin, for a UTI:

Avoid sunlight Use sunscreen wear protective clothing health care provider immediately if fever, chills, cough, chest pain, dyspnea, rash, or numbness or tingling of fingers or toes develops.

What is the most common cause of inflammation of the urinary tract?

Bacterial infection is by far the most common (can be caused by a variety of other disorders).

What is CAUTI and how does it cause a UTI?

Catheter Associated UTIs Bacteria biofilms develop on inner surface of catheter

What is the most common HAI?

Catheter-associated urinary tract infections (CAUTIs) E. Coli is the most common cause of CAUTIs and less frequently, Pseudomonas organisms.

A specimen collected via what is more accurate than a clean-catch specimen?

Catheterization

What is your differentiating factor of a UTI in an older person due to the absence of symptoms and a fever?

Cognitive impairment and confusion possible *less likely to experience a fever with a UTI, the value of body temperature as an indicator of a UTI is unreliable. *Confusion/cognitive impairment will worsen in a person that has dementia with a UTI.

If there is an order to start antibiotic therapy on a pt. that has a UTI but also has ordered a urine culture, what do you do first?

Collect urine culture first! The antibiotics will start treating and alter the results. *A urine cultures takes 48-72 hours to result

Patient education for dicyclomine, an antispasmodic medication:

Contraindicated for GI/GU obstruction Provide gum and hard candy for dry mouth (anticholinergic effects) Confusion in elderly patients *Also known as Bentyl

How is cranberry juice known to help treat or prevent UTIs?

Cranberry juice or cranberry tablets may reduce the number of UTIs. It is thought that enzymes found in cranberries inhibit attachment of urinary pathogens (especially E. coli) to the bladder epithelium.

What is considered a LOWER UTI and what symptoms are involved?

Cystitis- BLADDER INFECTION Urethritis- URETHRA INFECTION does not usually present with systemic manifestations *A lower UTI is confined to the lower urinary tract and does not usually present with systemic manifestations.

The nurse identifies that the patient with the greatest risk for a urinary tract infection is A. A 37-year-old man with renal colic associated with kidney stones. B. A 26-year-old pregnant woman who has a history of urinary tract infections. C. A 69-year-old man who has urinary retention caused by benign prostatic hyperplasia. D. A 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.

D. A 72-year-old woman hospitalized with a stroke who has a urinary catheter because of urinary incontinence.

What antispasmodic is given for a UTI?

Dicyclomine

What is E. Coli and how does it cause a UTI?

E. coli is an aerobic, gram negative bacterium and is resident flora in the GI tract. When it enters the sterile urinary tract E. coli causes inflammatory reaction and signs and symptoms of infection are manifested. *Others UTI causing microorganisms are Klebsiella, Proteus, Staphylococcus and pseudomonas species.

What is the most common cause of a UTI?

E.coli

What diagnostic studies could be performed for a UTI?

History and physical examination CBC - Elevated WBC, neutrophils Urinalysis Microscopic UA Urine for culture and sensitivity Imaging studies: CT Urography Intravenous Pyelogram- CONSENT Cystoscopy Ultrasonography *Imaging studies including CT urography or ultrasonography may be done when obstruction suspected.

What is HAI and how does it cause a UTI?

Hospital Acquired Infection Cause is usually due to use of antibiotics (become resistant, do not take full dose), instrumentation and catheterization. *. Most often, hospital-acquired UTIs are under recognized and undertreated, leading to complications such as renal abscesses, arthritis, epididymitis, peri-urethral gland infections, and bacteremia.

What is indicated when a person has Flank pain (UPPER ABD OR BACK AND SIDES), chills, and fever?

Infection of upper tract - Pyelonephritis

Education for a male on a urine sample for a UA (A voided midstream technique; clean catch):

Instruct them to wipe the glans penis around the urethra. The specimen is collected 1 to 2 seconds after voiding begins. *Refrigerate urine immediately on collection. *The urine should be cultured within 24 hours of refrigeration.

Patient education for a person taking the analgesic, Phenazopyridine (Pyridium), for a UTI:

It can stain the urine reddish orange and can be mistaken for blood and may stain underclothing nurse should advise patients to avoid long-term use of Phenazopyridine because it can produce hemolytic anemia.

Patient education for a person taking the analgesic, Methenamine/phenyl salicylate (Urised), for a UTI:

Methenamine/phenyl salicylate (Urised) can also be used in combination with antibiotics and is used to relieve UTI symptoms. Preparations with methylene blue color urine blue or green.

What are examples of the cause host defenses for a UTI?

Normal voiding with complete emptying of the bladder, ureterovesical junction competence, and ureteral peristaltic activity which propels urine forward into the bladder, antibacterial characteristics of urine maintained by an acidic pH (less than 6.0), normal flora in the periurethral area in women and prostatic fluid in men and immune response contribute to the host defenses. An alteration in any of these defense mechanisms increases the risk of contracting a UTI.

An ultrasound or CT scan (CT urogram) may be obtained when?

Obstruction of the urinary system is suspected or UTIs recur (more than 2 or 3 episodes per year).

Pathogens causing a UTI can enter how?

Pathogens enter urinary tract from perineal area or from blood stream (UNCOMMON).

What are nursing management goals for a patient with a UTI?

Patient will have: -Relief from lower urinary tract symptoms -Prevention of upper urinary tract involvement -Prevention of recurrence

What analgesics are given for a UTI?

Phenazopyridine (Pyridium) Methenamine/phenyl salicylate (Urised)

What is a UTI?

Presence of microorganisms in the urinary tract leading to infection and inflammation in the urinary tract.

What is considered an UPPER UTI and what symptoms are involved?

Pyelonephritis- KIDNEY INFECTION fever, chills, flank pain *upper UTI involves the renal parenchyma, pelvis, and the ureters and causes fever, chills, and flank pain.

What are nursing management/health promotion for a person with a UTI:

Recognize individuals at risk (women, elderly. pregnant women, immunosuppressed) Emptying bladder regularly and completely (Q 3-4 hours) Evacuating bowel regularly (constipation can cause UTI) Wiping perineal area front to back (E. Coli!) Drinking adequate fluids and cranberry juice (no apple juice) (person's weight in pounds/2) Avoid unnecessary catheterization and early removal of indwelling catheters (goal is remove in 24 hours) Aseptic technique - handwashing, gloving Perineal care for all hospitalized patients Heat therapy to supra pubic or lower back (low setting) *Patient may think drinking more fluids will necessitate needing help to go to the restroom. Fluids dilute urine, making bladder less irritable and also flushes out bacteria before they can colonize. Avoid incontinent episodes.

A urine culture should accompany what and what is it used for?

Sensitivity testing to dtermine the bacteria's susceptibility to a variety of antibiotic drugs. The results allow the HCP to select an antibiotic.

What are clinical manifestations of a UTI?

Signs of infection - fever, chills, malaise, cloudy and foul smelling urine, increased WBC, nausea and vomiting Urinary frequency (> Q 2 hours) and voiding small amounts, intermittency, weak stream, hesitancy, urgency, dysuria, inability to void, incomplete emptying of the bladder, post void dribbling, incontinence, nocturia, nocturnal enuresis, hematuria, pyuria Pain at the lower abdominal or back, burning micturition (CONTRACTION OF BLADDER), bladder spasms.

What are the clinical manifestations of a UTI in an older adult?

Symptoms often absent Nonlocalized abdominal discomfort rather than dysuria Cognitive impairment possible Fever less likely

Education on antibiotic therapy:

Take the entire course even if symptoms subside Take them at the same time every day to keep blood levels constant Can be harsh on stomach

Education for a female on a urine sample for a UA (A voided midstream technique; clean catch):

Teach them to spread the labia and wipe the periurethral area from front to back, using a moistened, clean gauze sponge (no antiseptic is used because it could contaminate the specimen and cause false-positive results). Then tell them to keep the labia spread and collect the specimen 1 to 2 seconds after voiding starts. *Refrigerate urine immediately on collection. *The urine should be cultured within 24 hours of refrigeration.

Nursing management evaluation of a UTI include:

The patient with a UTI will: Experience normal urinary elimination patterns Report relief of bothersome urinary tract symptoms Verbalize knowledge of treatment regimen

What antibiotics can be used long-term, prophylactic to prevent recurring UTIs?

Trimethoprim/sulfamethoxazole (Bactrim) Nitrofurantoin (Macrodantin) *A low dose of TMP/SMX, nitrofurantoin, or another antibiotic may be administered on a daily basis in an attempt to prevent recurring UTIs, or a single dose may be taken before an event likely to provoke a UTI, such as sexual intercourse. Although suppressive therapy is often effective on a short-term basis, this strategy is limited because of the risk of antibiotic resistance.

First-choice antibiotics used to treat uncomplicated UTIs include?

Trimethoprim/sulfamethoxazole (Bactrim) Nitrofurantoin (Macrodantin) Ampicillin, amoxicillin, cephalosporins

True or Fale: UTI are the most common bacterial infection in women.

True

What are the classifications of a UTI?

Upper UTI Lower UTI Urosepsis

What is involved in urosepsis/what is it?

Urosepsis- SYSTEMIC, SEVERE Urosepsis is a systemic infection and is life threatening. Can enter the bloodstream

Although ______ and ______ infections may also cause UTIs, this is uncommon. UTIs from these causes are sometimes found in patients who are immunosuppressed, have diabetes mellitus, have kidney problems, or have undergone multiple courses of antibiotic therapy.

fungal parasitic *Could be found in persons who live in or have traveled to certain developing countries.

The urinary tract above the urethra is normally ______.

sterile

Many residents of long-term care facilities, especially women, have chronic asymptomatic bacteriuria. However, usually only __________ UTIs are treated.

symptomatic

It is best to collect a urine sample for a UA when...

the bladder has been 2-3 hours full; concentrated not diluted.