Urinary Tract Infection: Nursing Care and Management

Joseph works in the department store of a big shopping mall. He only has two snack breaks and one lunch break every day. As a result, he contains his urge to urinate until it is time for his breaks. After a few months, he started feeling pain during urination. He also felt pain on the suprapubic area and sometimes could not urinate at all. He is diagnosed with cystitis.

Description


The urinary system is responsible for providing the route for drainage of urine formed by the kidneys, and these should be fully functional because they damage could easily affect other body systems.

  • Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract.
  • The normal urinary tract is sterile above the urethra.
  • UTIs are infections involving the upper or lower urinary tract and can be uncomplicated or complicated depending on other patient-related conditions.

Classification


UTIs are classified by location and are further classified according to other factors and conditions.

  • Lower UTIs. Lower UTIs include bacterial cystitis, prostatitis, and urethritis.
  • Upper UTIs. Upper UTIs are much less common and include acute and chronic pyelonephritis, interstitial nephritis, and renal nephritis.
  • Uncomplicated Lower or Upper UTIs. Most uncomplicated UTIs are community acquired and are common in young women but not usually recurrent.
  • Complicated Lower or Upper UTIs. Complicated UTIs usually occur in people with urologic abnormalities or recent catheterization and are often acquired during hospitalization.

Pathophysiology


For infection to occur, bacteria must gain access to the system.

  • Access. Infection occurs first as the bacteria gains access inside the urinary tract.
  • Attachment. The bacteria attach to the epithelium of the urinary tract and colonize it to avoid being washed out with voiding.
  • Evasion. The defense mechanisms are then evaded by the host.
  • Inflammation. As the defense mechanisms react to the bacteria, inflammation starts to set in as well as other signs of infection.

Urinary Tract Infection by Osmosis

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Statistics & Epidemiology


Urinary tract infection cases are widespread around the world and affect both the young and the old.

  • UTI is the second most common infection in the body.
  • Most cases of UTI occur among women; one out of five women in the United States will develop UTI during her lifetime.
  • The urinary tract is the most common site of infection, accounting for greater than 40% of the total number reported by hospitals.
  • UTI affects about 600, 000 patients each year.
  • More than 250, 000 cases of acute pyelonephritis occur in the United States each year, with 100, 000 requiring hospitalization.
  • Approximately 11.3 million women are diagnosed with UTIs in the United States annually.
  • The expenditure in direct healthcare costs amounts to $1.6 billion.

Causes


UTIs are primarily caused by bacteria that have invaded the urinary tract.

  • Inability or failure to empty the bladder completely. Stasis of urine inside the urinary bladder attracts bacteria into entering the tract.
  • Instrumentation of the urinary tract. Catheterization or cystoscopy procedures could introduce bacteria into the urinary tract.
  • Obstructed urinary flow. Abnormalities in the structure of the urinary tract could obstruct the flow of the urine and result in inability to empty the bladder completely.
  • Decreased natural host defenses. Immunosuppression or inability of the body to produce the body’s defenses predisposes the patient to UTI.

Clinical Manifestations


A variety of signs and symptoms are associated with UTI.

  • Burning on urination. The patient may feel pain during urinating and describe it as a burning sensation.
  • Frequency. The patient voids more than the usual every 3 hours.
  • Nocturia. Awakening at night to urinate is also a sign of UTI.
  • Suprapubic or pelvic pain. The patient may report pain at the suprapubic site or on the pelvic area.
  • Urgency. There is also a feeling that the patient would not be able to contain the urge anymore and would rush just to excrete it.

Prevention


Luckily. UTI is a preventable disease mainly focusing on the hygienic practices of the individual.

  • Avoid bath tubs. Shower rather than bathe in a tub because bacteria in the bath water may enter the urethra.
  • Perineal hygiene. After each bowel movement, clean the perineum and urethral meatus from front to back to reduce concentrations of pathogens at the urethral opening.
  • Increase fluid intake. Drink liberal amounts of fluids daily to flush out bacteria.
  • Avoid urinary tract irritants. Beverages such as coffee, tea, colas, alcohol, and others contribute to UTI.
  • Voiding habit. Void at least every 2 to 3 hours during the day and completely empty the bladder.
  • Medications. Take medications exactly as prescribed.

Complications


Early recognition of UTI and prompt treatment are essential to prevent recurrent infection and the possibility of complications.

  • Renal failure. UTIs that are not treated promptly could spread in the entire urinary system and become the cause of renal failure.
  • Urosepsis. The bacteria may invade the urinary system and result in sepsis.

Assessment and Diagnostic Findings


Results of various tests help confirm the diagnosis of UTI.

  • Urine cultures. Urine cultures are useful in identifying the organism present and are the definitive diagnostic test for UTI.
  • STD tests. Tests for STDs may be performed because there are UTIs transmitted sexually.
  • CT scan. A CT scan may detect pyelonephritis or abscesses.
  • Ultrasonography. Ultrasound is extremely sensitive for detecting obstruction, abscesses, tumors, and cysts.

Medical Management


Management of UTIs typically involves pharmacologic therapy and patient education.

  • Acute pharmacologic therapy. The ideal medication for treatment of UTI is an antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora.
  • Long-term pharmacologic therapy. Reinfection with new bacteria is the reason for recurrence, and these patients with recurrence are instructed to begin treatment on their own whenever symptoms occur, to contact their physician only when symptoms persist.

Nursing Management


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

Nursing Assessment

A history of signs and symptoms related to UTI is obtained from the patient with a suspected UTI.

  • Assess changes in urinary pattern such as frequency, urgency, or hesitancy.
  • Assess the patient’s knowledge about antimicrobials and preventive health care measures.
  • Assess the characteristics of the patient’s urine such as the color, concentration, odor, volume, and cloudiness.

Nursing Diagnosis

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

  • Acute pain related to infection within the urinary tract.
  • Deficient knowledge related to lack of information regarding predisposing factors and prevention of the disease.

Nursing Care Planning & Goals

Main article: 6 Urinary Tract Infection Nursing Care Plans

Major goals for the patient may include:

  • Relief of pain and discomfort.
  • Increased knowledge of preventive measures and treatment modalities.
  • Absence of complications.

Nursing Interventions

Nurses care for patients with urinary tract infection in all settings.

  • Relieve pain. Antispasmodic agents may relieve bladder irritability and analgesics and application of heat help relieve pain and spasm.
  • Fluids. The nurse should encourage the patient to drink liberal amounts of fluids to promote renal blood flow and to flush bacteria from the urinary tract.
  • Voiding. Encourage frequent voiding every 2 to 3 hours to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection.
  • Irritants. Avoid urinary irritants such as coffee, tea, colas, and alcohol.

Evaluation

Expected outcomes may include:

  • Experiences relief of pain.
  • Explains UTI and their treatment.
  • Experiences no complications.

Discharge and Home Care Guidelines

Care of the patient with UTI must continue until at home because it has a high recurrence rate.

  • Personal hygiene. The nurse should instruct the female patient to wash the perineal area from front to back and wear only cotton underwear.
  • Fluid intake. Increase and fluid intake is the number one intervention that could stop UTI from recurring.
  • Therapy. Strictly adhere to the antibiotic regimen prescribed by the physician.

Documentation Guidelines

The focus of documentation should include:

  • Individual assessment findings, including client’s description and response to pain, expectations of pain management, and acceptable level of pain.
  • Prior medication use.
  • Plan of care and those involved in planning.
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.

Practice Quiz: Urinary Tract Infection


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1. An example of an upper urinary tract infection is:

A. Acute pyelonephritis.
B. Cystitis.
C. Prostatitis.
D. Urethritis.

2. A sign of possible UTI is:

A. A negative urine culture.
B. An output of 200 to 900 mL with each voiding.
C. Cloudy urine.
D. Urine with specific gravity of 1.005 to 1.022.

3. The most common site of a lower UTI is the:

A. Bladder
B. Kidney
C. Prostate
D. Urethra

4. There is an increased risk of UTIs in the presence of:

A. Altered metabolic states
B. Immunosuppression.
C. Urethral mucosa abrasion
D. All of the above

5. Health information for a female patient diagnosed as having cystitis includes all of the following except:

A. Cleanse around the perineum and urethral meatus from front to back.
B. Drink liberal amounts of fluid.
C. Shower rather than bathe in a tub.
D. Void no more frequently than every 6 hours.

1. Answer: A. Acute pyelonephritis

  • A: Acute pyelonephritis is an inflammation of the renal pelvis.
  • B: Cystitis is an infection of the lower urinary tract.
  • C: Prostatitis is an infection of the lower urinary tract.
  • D: Urethritis is an infection of the lower urinary tract.

2. Answer: C. Cloudy urine.

  • C: Cloudy urine shows infection because of the bacteria that has invaded the urinary tract.
  • A: A negative urine culture is a sign that there is no infection.
  • B: A large output is not indicative of UTI.
  • D: The specific gravity mentioned is within the normal limits of 1.001 to 1.025.

3. Answer: D. Urethra

  • D: The urethra is part of the lower urinary system.
  • A: The bladder is part of the upper urinary system.
  • B: The kidneys are part of the upper urinary system.
  • C: The prostate is part of the upper urinary system.

4. Answer: D. All of the above

  • D: all of the mentioned risk factors contribute to the development of UTI.
  • A: Altered metabolic state is a risk factor of UTI.
  • B: Immunosuppression is a risk factor of UTI.
  • C: Urethral mucosa abrasion is a risk factor of UTI.

5. Answer: D. Void no more frequently than every 6 hours.

  • D: Void frequently every 2 to 3 hours to flush out the bacteria in the bladder.
  • A: Perineal hygiene should involve wiping the perineum from front to back.
  • B: Increase amounts of fluid intake helps flush out the bacteria.
  • C: Bathing in a tub could allow entrance of bacteria in the urethra.

See Also


Posts related to Urinary Tract Infection:

Further Reading and Recommended Resources


Recommended books and reading materials:
  1. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
  2. Medical-Surgical Nursing: Assessment and Management of Clinical Problems
  3. Medical-Surgical Nursing: Patient-Centered Collaborative Care
  4. Saunders Comprehensive Review for the NCLEX-RN Examination
  5. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing
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