NSG-320 Urinary Tract Infections

Urethritis:

- Inflammation of the urethra -Causes: Bacterial, viral, trichomonas, and monilial infection (especially in women), chlamydial infection, and gonorrhea (especially in men).

Care of the Patient with Urethritis:

- Once the infecting organism has been identified, the health care provider can order the appropriate antibiotic.

Two types of Urinary Tract Infections:

1. Upper UTI 2. Lower UTI

Urinary Tract Infections are caused by:

Bacteria introduced into the urethra

A patient presents with nausea and vomiting with fatigue, headache, and extreme thirst. The nurse notes tenderness over the left flank, pyuria, and a white blood cell count of 15. What collaborative care is a priority for this patient? A. Hospitalization B. Foley catheter C. Intravenous (IV) antibiotic therapy D. Intravenous (IV) fluid resuscitation E. Urinary stent placement

CORRECT: A, C, D - The patient's symptoms indicate pyelonephritis. Patients with pyelonephritis often require hospitalization for treatment. - Patients with pyelonephritis require IV antibiotic therapy and IV fluid resuscitation

Which urinary symptoms would indicate to the nurse that a urinary tract infection (UTI) has progressed to renal failure? A. Dysuria B. Oliguria C. Suprapubic pain D. Urinary frequency E. Flank pain

CORRECT: B, E - Oliguria is decreased production of urine and can indicate renal failure - Flank pain would indicate that damage to the kidneys has occurred and the UTI may have progressed to renal failure.

Drug Therapy for Pyelonephritis Mild symptoms:

- Empirically selected broad-spectrum antibiotics: ampicillin, vancomycin combined with an aminoglycoside (eg, tobramycin, gentamicin) - Switch to sensitivity-guided therapy: trimethoprim/sulfamethoxazole when results of urine and blood culture are available - Fluoroquinolones: ciprofloxacin, ofloxacin, norfloxacin, gatifloxacin

Chronic Pyelonephritis:

- In chronic pyelonephritis the kidneys become small, atrophic, and shrunken and lose function as a result of fibrosis (scarring). - Chronic pyelonephritis is usually the result of recurring infections involving the upper urinary tract. - However, it may also occur in the absence of an existing infection, recent infection, or history of UTIs.

Acute care for UTI:

- Increase fluids (this will dilute the urine and make it lest uncomfortable) - Application of local heat (Heating pad) - Emphasize in taking the full course of antibiotics!

Drug Therapy for Pyelonephritis Severe symptoms:

- Parenteral antibiotics - Empirically selected broad-spectrum antibiotics: ampicillin, vancomycin combined with an aminoglycoside (eg, tobramycin, gentamicin) Switch to sensitivity-guided antibiotic

Care of the Patient with Pyelonephritis:

- Parenteral antibiotics are often given initially in the hospital to rapidly establish high serum and urinary drug levels - Signs and symptoms typically improve or resolve within 48 to 72 hours after initiation of therapy. - Antibiotic prophylaxis may also be used for recurrent infections. - The effectiveness of therapy is evaluated based on the presence or absence of bacterial growth on urine culture.

Chronic Pyelonephritis symptoms:

- The level of renal function in chronic pyelonephritis depends on whether one or both kidneys are affected, the extent of scarring, and the presence of coexisting infection. - Chronic pyelonephritis often progresses to end-stage renal disease (ESRD), even if the underlying infection is successfully treated.

A patient presents with suprapubic pain, fever, and chills. The nurse notes heart rate of 112 beats/min, blood pressure of 146/88 mm Hg, and oxygen saturation of 100%. Which assessment findings would be most concerning? A. Dysuria B. Elevated white blood cell (WBC) count C. Urinary frequency D. Urinary retention

CORRETC: B - An elevated WBC count indicates infection and would be most concerning to the nurse.

Ambulatory care for UTI:

- Adhere to drug regimen!!! - Teach to void regularly every 3-4 hours - Urinate before and after intercourse - Wipe front to back! - Drink cranberry juice

Acute Pyelonephritis

- Begins with colonization and infection of the lower urinary tract. -Physical abnormalities may also be present: Vesicoureteral reflux (retrograde [backward] movement of urine from lower to upper urinary tract) Dysfunction of the lower urinary tract

Urethritis symptoms:

- Bothersome lower urinary tract symptoms similar to those seen with cystitis, including: - Dysuria - Urgency - Frequent urination

Complicated UTIs are classified as infections occurring in patients with:

- Coexisting obstruction, stones, or catheters - Abnormal gastrointestinal tract - Diabetes or neurologic diseases - Resistance to antibiotics - Weakened immune system - Pregnancy-induced changes - Recurrent infections

A patient presents with a fever of 102° F, fatigue, nausea, and urinary urgency. On percussion during physical examination, the nurse notes costovertebral tenderness on the left side. Urinalysis indicates bacteriuria. Which provider order would the nurse implement first? A. Administer intravenous (IV) ampicillin. B. Give oral acetaminophen. C. Give an oral dose of long-acting nitrofurantoin. D. Administer promethazine intramuscularly.

CORRECT: A - The patient's symptoms indicate pyelonephritis. The nurse would administer a broad-spectrum IV antibiotic.

A female patient presents with urinary frequency and dysuria. The nurse notes white blood cells in the urine and bacteriuria. What patient education is necessary to prevent future infections? A. Continue taking the medication. B. Obtain necessary follow-up care. C. Corticosteroid therapy is needed. D. Void immediately after sex. E. Repeat blood cultures will be done. F. Wear loose-fitting pants and underwear.

CORRECT: A, B, D, F - Patients with urinary tract infections should be taught to continue taking antibiotics until the full course is complete. - Patients with urinary tract infections should be taught about the appropriate follow-up care - Female patients should be taught to void immediately after sex to prevent urinary stasis and urinary tract infections. - Loose-fitting pants and underwear should be worn to maintain a clean, dry perineal area.

Which infections of the urinary tract may manifest systemically as symptoms of fever, chills, and flank pain? A. Upper urinary tract infection (UTI) B. Lower urinary tract infection (UTI) C. Urethritis D. Acute pyelonephritis E. Chronic pyelonephritis

CORRECT: A, D - Upper UTIs involve the kidneys and often present with fevers, chills and flank pain. - Acute pyelonephritis is often caused by infection and is accompanied by fever, chills, and flank pain.

A patient diagnosed with acute pyelonephritis is treated with a full course of ampicillin. The patient asks whether he needs to be doing anything else to treat the infection, even though the symptoms have resolved. What is the appropriate response from the nurse? A. "Increase urination to at least every 1 to 2 hours." B. "Continue to increase oral fluid intake even if symptoms have resolved." C. "A second round of antibiotics will be required to fully cure the infection." D. "Once the full course of oral antibiotics is complete, steroid therapy is necessary."

CORRECT: B - Patients should be taught to continue to increase fluid intake to flush the kidneys and bladder and prevent recurrence of infection.

A patient who is 5'5" and 180 lb is diagnosed with a urinary tract infection (UTI). The patient reports drinking 50 ounces of water a day and regular bowel movements and urination throughout the day. Which additional information should the nurse provide to the patient to help prevent future infections? A. Tell patient to lose 20 pounds. B. Tell patient that enema use is important. C. Tell patient to increase water intake to 90 ounces per day. D. Tell patient to ask the provider about prophylactic antibiotics.

CORRECT: C Take your weight and divide by 2= the amount of water you should drink

A patient presents with urinary pain and urgency but no systemic symptoms. Urinalysis indicates a bacteria count of 103 CFU/mL. The patient's chart indicates no coexisting obstruction or health concern. However, the patient has been seen for urinary tract infections (UTIs) five times in the last year. Which antibiotic should the nurse expect the provider to prescribe for this patient? A. Trimethoprim-sulfamethoxazole (TMP/SMX) B. Ampicillin C. Ciprofloxacin D. Nitrofurantoin

CORRECT: C - Ciprofloxacin is used to treat complicated UTIs and for patients with frequently recurring UTIs.

The nurse is caring for a patient being treated with ciprofloxacin for a catheter-associated urinary tract infection (UTI). Which assessment finding would be most concerning to the nurse? A. White blood count (WBC) of 11 B. Temperature of 100.2° F C. 3+ bacteria in the urine D. Costovertebral angle (CVA) tenderness

CORRECT: D - CVA tenderness indicates kidney involvement and worsening infection. This finding would be concerning to the nurse.

Acute Pyelonephritis symptoms:

The clinical manifestations of acute pyelonephritis vary and may include: - Mild fatigue - Sudden onset of chills or fever - Vomiting - Malaise - Flank pain - Dysuria - Urgency - Frequency - Costovertebral tenderness to percussion (costovertebral angle [CVA] pain), typically present on the affected side