Nursing Care of Lower Urinary Tract Infections

By Efris Kartika Sari

• The urinary tract is the most common site of nosocomial infections and urinary tract infections (UTIs) account for approximately 40% of all hospital-acquired infections (HAIs) in the US.

• More than 80% of HAIs are associated with an indwelling urinary catheter.

(Newman, 2010)

Definition

• Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract (the normal urinary tract is sterile above the urethra).

• UTIs are generally classified as infections in-volving the upper or lower urinary tract.

(Smeltzer., Bare., Cheeve, 2010)

Risk Factors

Female anatomy

Potential causes

• Escherichia coli (E. coli) is the most common organism in 80-90% of cases

• Staphylococcus saprophyticus • Pseudomonas • Other enterobacteria

Three main CaUTI entry points for bacteria:• Urethral meatus• The junction of catheter-bag connection• The drainage port of the collection bag

Urethro and Ureterovesical Reflux

• By increasing the normal slow shedding of bladder epithelial cells (resulting in bacteria removal), the bladder can clear itself of even large numbers of bacteria.

• Glycosaminoglycan (GAG), forming a water barrier that serves as a defensive layer be-tween the bladder and the urine.

The routes by which bacteria enter the urinary tract:

• Up the urethra (ascending infection)• Through the bloodstream (hematogenous

spread)• By means of a fistula from the intestine (direct

extension).

• For infection to occur, bacteria must gain access to the bladder, attach to and colonize the epithelium of the urinary tract to avoid being washed out with voiding, evade host defense mechanisms, and initiate inflammation.

Clinical ManifestationsCardinal Symptoms • Frequency • Dysuria • UrgencyOther • Nocturia• Incontinence• Suprapubic discomfort • Low back pain• Fever• Hematuria • Burning on urination• Painful urination

Diagnostic Tests

• Urinalysis• Urine Cultures• USG• CT Scan• Cystoscopy

Pharmacologic Therapy

Nursing Care

• Nursing care of the patient with lower UTI focuses on treating the underlying infection and preventing its recurrence.

• Major goals for the patient may include relief of pain and discomfort; increased knowledge of preventive measures and treat-ment modalities; and absence of complications.

• Based on the assessment data, the nursing diagnoses may include the following:

• Acute pain• Impaired urinary elimination• Hyperthermia• Deficient knowledge

If an indwelling catheter is necessary, however, specific nursing interventions are initiated to prevent infection:

• Using strict aseptic technique during insertion of the small-est catheter possible

• Securing the catheter with tape to prevent movement• Frequently inspecting urine color, odor, and consistency• Performing meticulous daily perineal care with soap and• water• Maintaining a closed system• Using the catheter’s port to obtain urine specimens

Expected patient outcomes may include:1. Experiences relief of pain2. Reports no symptoms of infection (fever,

dysuria, frequency) or renal failure (nausea, vomiting, fatigue, pruritus)

3. Explains UTIs and their treatment

• Cutaneous ureterostomy: procedure in which the distal ureter is detached from the bladder, brought through the abdominal wall, and attached to an opening in the skin.