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