Urinary Tract Infection

Urinary Tract InfectionUrinary Tract InfectionUrinary Tract InfectionUrinary Tract Infection

(relates to Chapter 44, “Nursing Management: Renal and Urologic Problems,” in the textbook)


Second most common bacterial diseaseAccount for more than 8 million office

visits per yearResults in >100, 000 people hospitalized

annually


>15% patients who develop gram- negative bacteria die– 1/3 of these caused by infections

originating in urinary tract


Bladder and its contents are free of bacteria in majority of healthy patients

Minority of healthy individuals have colonizing bacteria in bladder– Called asymptomatic bacteriuria and

does not justify treatment


E. coli most common pathogenCounts of 105 CFU/ml indicate

significant UTICounts as low as 102 CFU/ml in a person

with signs and symptoms are indicative

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Upper tract involves renal parenchyma, pelvis, and ureters– Typically causes fever, chills, flank pain

Lower tract involves lower urinary tract– No usual systemic manifestations


Pyelonephritis is inflammation of renal parenchyma and collecting system

Cystitis is inflammation of bladder wallUrethritis is inflammation of the urethra


Uncomplicated infection occurs in otherwise normal urinary tract


Complicated infections occur with coexisting presence of – Obstruction– Stones– Catheters– Diabetes or neurologic disease– Recurrent infection

Initial infectionRecurrent UTIUnresolved bacteriuriaBacteria persistence

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Urinary Tract InfectionUrinary Tract Infection Etiology and PathophysiologyEtiology and PathophysiologyUrinary Tract InfectionUrinary Tract Infection Etiology and PathophysiologyEtiology and Pathophysiology

Physiologic and mechanical defense mechanisms maintain sterility

Alterations in defense mechanisms increase risk of infection

Organisms causing UTI usually introduced via ascending route from urethra


Contributing factor: urologic instrumentation

Sexual intercourse promotes “milking” of bacteria from perineum and vagina

UTIs rarely result from hematogenous route


Common source of hospital-acquired UTI is nosocomial infections

Urologic instrumentation common predisposing factor

Urinary Tract InfectionUrinary Tract Infection Clinical ManifestationsClinical ManifestationsUrinary Tract InfectionUrinary Tract Infection Clinical ManifestationsClinical Manifestations

Symptoms – Dysuria– Frequent urination (>q2h)– Urgency– Suprapubic discomfort or pressure


Urine may contain visible blood or sediment, giving cloudy appearance

Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)

Urinary Tract InfectionUrinary Tract Infection Clinical Manifestations in Older AdultClinical Manifestations in Older AdultUrinary Tract InfectionUrinary Tract Infection Clinical Manifestations in Older AdultClinical Manifestations in Older Adult

Symptoms often absent Experience non-localized abdominal

discomfort rather than dysuriaMay have cognitive impairmentLess likely to have a fever


Patients with significant bacteriuria may have no symptoms or nonspecific symptoms like fatigue or anorexia

Patients with bladder tumors or those receiving intravesical chemotherapy or pelvic radiation usually experience frequency, urgency, and dysuria

Urinary Tract InfectionUrinary Tract Infection Diagnostic StudiesDiagnostic StudiesUrinary Tract InfectionUrinary Tract Infection Diagnostic StudiesDiagnostic Studies

Initially obtain dipstick urinalysis to identify presence of nitrates, WBCs, and leukocyte esterase

Findings confirmed by microscopic urinalysis

Following confirmation of bacteriuria and pyuria, urine culture may be obtained


Urine culture indicated in complicated or nosocomial, persistent bacteria, or frequently recurring (>2 episodes annually)

May be cultured if infection is unresponsive to empiric therapy or diagnosis is questionable


Clean-catch is preferredSpecimen obtained by catheterization or

suprapubic needle aspiration has more accurate results


Sensitivity testing determines susceptibility to antibiotics

Imaging studies are indicated in selected cases– IVP or abdominal CT when

obstruction suspected

Urinary Tract Infection Urinary Tract Infection Collaborative Care Collaborative Care Drug TherapyDrug Therapy


Antibiotic selected on empiric therapy or results of sensitivity testing

Uncomplicated cystitis treated by short-term course of antibiotics

Complicated UTIs require long-term treatment



Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric uncomplicated or initial– Inexpensive– TMP-SMX taken bid



Pyridium is OTC that provides soothing effect on urinary tract mucosa– Stains urine reddish orange that can be

mistaken for blood and may stain underclothing

Effective in relieving discomfort



Combination agents (e. g., Urised) used to relieve pain– Preparations with methylene blue tint

urine blue or green



Prophylactic or suppressive antibiotics sometimes administered to patients with repeated UTIs

TMP-SMX administered qd to prevent recurrence or single dose prior to events likely to cause UTI

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment

Health History-what will you ask?

Subjective Data- what symptoms might the client describe?

Objective Data- what signs might you find?

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing Management Nursing DiagnosesNursing Diagnoses

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing Management Nursing DiagnosesNursing Diagnoses

Acute painImpaired urinary elimination

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing ManagementPlanningPlanning

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing ManagementPlanningPlanning

Patient will haveRelief from lower urinary tract symptomsPrevention of upper urinary tract

involvementPrevention of recurrence

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing Management Nursing ImplementationNursing Implementation


Health Promotion – Recognize individuals at risk



Health Promotion – Emptying bladder regularly and

completely– Evacuating bowel regularly– Wiping perineal area front to back– Drinking adequate fluids (15 ml per lb)



Health Promotion– Daily intake of cranberry juice or

cranberry essence may help reduce risk– Avoid unnecessary catheterization and

early removal of indwelling cathetersPrevents nosocomial infections

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Health Promotion– Aseptic technique must be followed

during instrumentation procedures– Wash hands before and after contact– Wear gloves for care of urinary system



Health Promotion– Routine and thorough perineal care for

all hospitalized patients– Avoid incontinent episodes by answering

call light and offering bedpan at frequent intervals



Acute Intervention– Adequate fluid intake

Patient may think will worsen condition due to discomfort

Dilutes urine, making bladder less irritableFlushes out bacteria before they can colonize



Acute Intervention – Avoid caffeine, alcohol, citrus juices,

chocolate, and highly-spiced foods Potential bladder irritants

– Application of local heat to suprapubic or lower back may relieve discomfort



Acute Intervention – Instruct patient about drug therapy and

side effects– Emphasize taking full course despite

disappearance of symptoms– Second or reduced drug may be ordered

after initial course in susceptible patients



Acute Intervention – Instruct patient to watch urine for

changes in color and consistency and decrease in cessation of symptoms

– Counsel on persistence of lower tract symptoms beyond treatment or onset of flank pain or fever should be reported immediately



Ambulatory and Home Care– Emphasize compliance with drug regimen

Take as ordered

– Maintain adequate fluids– Regular voiding– Void after intercourse



– Temporarily discontinue use of diaphragm

– Instruct on follow-up care with urine culture

– Recurrent symptoms typically occur in 1-2 weeks after therapy

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing Management EvaluationEvaluation

Urinary Tract InfectionUrinary Tract Infection Nursing ManagementNursing Management EvaluationEvaluation

Use of nonanalgesic relief measuresAppropriate use of analgesicsPass urine without urgencyUrine free of bloodAdequate intake of fluids

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Urinary Tract Infection