Urinary tract infections (UTI) are caused by pathogenic microorganisms in the urinary tract (kidney, bladder, urethra). Most UTIs are caused by the bacterium Escherichia coli (E. coli), normally found in the digestive system. Usually, bacteria that enter the urinary tract system are removed by the body before they can cause symptoms. But, in some cases, bacteria overcome the natural defenses of the body, therefore causes infection. UTIs are usually classified as infections involving the upper or lower urinary tract. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may ascend to the ureters to multiply and cause the infection of the kidneys (pyelonephritis). Signs and symptoms of urinary tract infections include; fever, chills, a strong, persistent urge to urinate, burning sensation when urinating, cloudy, foul-smelling urine, and pelvic pain in women.
Nursing Care Plans
The focus of this nursing care plan for urinary tract infections includes nursing interventions to relieve pain and discomfort, increase the client’s knowledge about the preventive measures and treatment regimen, and manage potential complications.
- Acute Pain UPDATED
- Impaired Urinary Elimination UPDATED
- Hyperthermia UPDATED
- Deficient Knowledge UPDATED
May be related to
- Inflammation and infection of the urinary tract (e.g., urethra, bladder, and other urinary tract structures).
May be evidenced by
- Burning on urination.
- Facial grimace.
- Guarding behavior.
- Protective decreased physical activity.
- Spasm in the lower back and bladder area.
Desired goals and outcomes
- Client will use pharmacological and nonpharmacological pain relief strategies.
- Client will report satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.
- Client will report absence of pain.
Nursing Assessment and Rationale
1. Assess the client’s description of pain, such as quality, nature, and severity of pain.
Pain associated with UTI is described as burning on urination, flank pain, lower abdominal or suprapubic pain (Gupta et al., 2017; Lee et al., 2007). In comparison, some clients with recurrent infections are asymptomatic. This information will help in determining the choice of intervention. You can also check our Acute Pain nursing diagnosis for a more comprehensive nursing assessment for pain.
2. Assess for signs and symptoms of urinary tract infection.
Common signs and symptoms of UTI include dysuria (painful, burning sensation, or difficult urination), urinary frequency & urgency, and nocturia (voiding two or more times at bedtime). Additionally, pyuria (foul-smelling or cloudy urine) or hematuria (bloody urine) may also occur due to excess white cells in the urine and bleeding of the inflamed bladder wall (Flores-Mireles et al., 2019).
3. Assess for risk factors for UTI.
A history of sexually transmitted infections, catheter use, and previous surgeries of the genitourinary tract are at risk of developing UTI. Blockages of the urinary tract, such as those caused by a kidney stone or an enlarged prostate, can block urine flow and increase the risk of UTI. (Storme, Saucedo, Garcia-Mora, 2019).
4. Monitor laboratory and diagnostic studies, as indicated:
- 4.1. WBC count.
Increased WBC count is a systemic response to infection.
- 4.2. Urinalysis.
To assess for pyuria, bacteria, and blood cells in the urine that is associated with the inflammation process during an infection.
- 4.3. Bacteria in the urine.
Colony count of greater than 100,000 CFU/mL of urine during a clean-catch midstream or catheterized specimen indicates infection, although lower counts may also indicate UTI.
- 4.4. Urine culture and sensitivity.
Used to identify the infecting organism and to determine the most effective and suitable antibiotic. Additionally, test for sexually transmitted infections is performed if acute urethritis is suspected.
- 4.5. Computed tomography (CT scan).
Used for detecting renal calculi, pyelonephritis, and abscess.
- 4.6. Ultrasound and kidney scans.
Used for detecting obstruction, abscesses, tumors, and cysts.
Nursing Interventions and Rationales
1. Apply a heating pad to the suprapubic area or lower back.
The application of heat to the perineum help relieve pain and spasm.
2. Administer analgesics (e.g., acetaminophen) or antispasmodics (e.g., phenazopyridine), as indicated.
Antispasmodic and analgesic agents are useful in relieving bladder irritability, spasm, and pain.
3. Encourage the patient to increased oral fluid intake unless contraindicated.
Increasing fluid intake to 2 to 3 liters per day helps facilitate urine production, dilutes urine, reduces irritation of the inflamed bladder, promotes renal blood flow, and flushes bacteria from the urinary tract.
4. Instruct to avoid coffee, tea, spices, alcohol, and sodas.
These foods are considered urinary tract irritants and may irritate the urinary system.
5. Encouraged the client to void frequently.
Frequent voiding every 2 to 3 hours to completely empty the bladder is encouraged to prevent bladder distention, lower bacterial urine counts, reduce stasis of the urine, and prevent reinfection.
6. Use of non-pharmacological techniques for pain management as appropriate.
Alternative therapies such as relaxation, massage, guided imagery, or distraction may decrease pain and provide comfort.
7. Administer antibacterial agents as indicated.
Trimethoprim (TMP) or cephalexin are usually the first choices of antibiotics. Short-course therapy using a single antibiotic or a 3-day course reduces treatment cost, increases compliance to therapy, and a lower rate of side effects.
8. Stress the importance of completing the antibiotic therapy
Even if the symptoms disappear, the client should finish the prescribed duration of the antibiotic therapy. Unable to do so may result in reinfection.
Other Nursing Care Plans
Additional nursing diagnoses you can use to create your own nursing care plans for urinary tract infections.
- Disturbed Sleep Pattern related to pain, nocturia.
- Risk for Urge Urinary Incontinence.
- Risk for Ineffective Renal Tissue Perfusion.
- Urinary Retention.
References and Sources
- Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection. Topics in spinal cord injury rehabilitation, 25(3), 228-240.
- Gupta, K., Grigoryan, L., & Trautner, B. (2017). Urinary tract infection. Annals of internal medicine, 167(7), ITC49-ITC64.
- Lee, J. B., & Neild, G. H. (2007). Urinary tract infection. Medicine, 35(8), 423-428.
- Storme, O., Tiran Saucedo, J., Garcia-Mora, A., Dehesa-Dávila, M., & Naber, K. G. (2019). Risk factors and predisposing conditions for urinary tract infection. Therapeutic advances in urology, 11, 1756287218814382.
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