Urinary Tract Infections (UTI)

*Most Common Route of Infection*

*The most common route of infection is transurethral, in which bacteria (often from fecal contamination) colonize the periurethral area and subsequently enter the bladder by means of the urethra*

Most UTIs are treated with:

-Antibiotics -Urinary tract analgesics

Pharmacological Therapy for UTI

-Antibiotics -Analgesics -Bladder anti-spasmodics -Antipyretic

Nonpharmacologic Nursing Interventions

-Application of heat—warm packs, heating pad, Sitz baths -Encourage Fluids

Critical Nursing Skills to Treat/Prevent UTI

-Assessment -Patient teaching -Medication administration -Hand hygiene and use of PPE -Collection of urinary specimens -Aseptic technique and urinary catheterization

UTI is diagnosed by presence of:

-Clinical indicators -Bacteria and leukocytes in urine (leukocyte ester)

Risk Factors for UTI

-Gender—female -Age—older adult -Other illnesses/conditions: Diabetes, SCI or nerve damage to bladder, Pregnancy, Suppressed immunity Urinary tract structural abnormalities or obstruction -Lifestyle behaviors: Use of spermicides, condoms, or a diaphragm

Increased Risk of UTIs in Women

-In women, the short urethra offers little resistance to the movement of uropathogenic bacteria. -Sexual intercourse forces the bacteria from the urethra into the bladder & accounts for the increased incidence of UTIs in sexually active women

Classification of UTIs

-Lower vs. Upper -Uncomplicated vs. Complicated

Primary Prevention UTI

-Patient education including clinical indicators and risk factors for UTI -Patient education including general measures to prevent UTI and promote urinary system health

Tertiary Prevention UTI

-Patient follow-up after antibiotic therapy -Patient education about measures to promote return to normal urinary function including complementary therapy

Secondary Prevention UTI

-Screen for presence of immune disorders and other conditions that increase risk for UTI

Three Routes of Infection UTIs

-Transurethral route: Ascending Infection -Hematogenous spread: Bloodstream -Direct extension: Fistula from the Intestine

*Clinical indicators for UTI include*

-Urgency, frequency or dysuria, -Fever -Suprapubic (Pelvic) Pain -Costovertebral Tenderness sd Other—fatigue, weakness, muscle aches, back pain, hematuria

Diagnostic Test

-Urinalysis and urine C&S -Kidney and bladder ultrasound -Voiding cystourethrogram -CT scan or MRI -Radionuclide scan -Cystoscopy and urodynamic studies

Urinalysis UTI

-Urine pH: Alkaline -Urine Specific Gravity: Increased (normal 1.010-1.025) -Urine Protein: Present (Normal is 0-Trace) -Urine WBCs: Positive (Leukocyte ester could be +2) -Urine RBCs: Possibly Positive

Bladder Anti-Spasmodics

Anticholinergics (act on muscarinic receptors) -Oxybutynin (Ditropan) -Tolterodine (Detrol)

Most Common Organism Causing UTI

Bacteria are the most common cause of UTI with Escherichia coli being the most causative organism

Oral Analgesics

Can be Systemic(Tylenol/morphine/lortab/norco) or Urinary Tract Urinary Tract = Phenazopyridine - Removes Pain & symptoms related to UTI (turns urine orange)

Uncomplicated UTIs

Community-acquired infection; common in young women and not usually recurrent

Comprehensive History for UTI

Comprehensive history -Current urinary symptoms -Risk factors -Previous UTIs -Current medications

Surgical Interventions

Correction of structural and functional anomalies of the Urinary tract

Antibiotics

First line treatment for uncomplicated UTI is: -Trimethoprim/sulfamethoxazole (Bactrim) -Ciprofloxacin (Cipro) -levofloxacin (Levaquin)

Lower UTIs

Most infections involve the lower urinary tract in the BLADDER or URETHRA -Cystitis: Inflammation of the urinary bladder -Prostatitis: Inflammation of the prostate gland -Urethritis: Inflammation of the urethra

Upper UTIs

Not nearly as common as Lower UTIs -Acute pyelonephritis -Chronic pyelonephritis -Renal abscess -Interstitial nephritis -Perirenal abscess

Complicated UTIs

Often acquired in the hospital and related to catheterization; occur in patients with urologic abnormalities, pregnancy, immunosuppression, diabetes, and obstructions and are often recurrent

Urinary Tract Infections (UTI)

Refers to infection involving any part of the urinary system