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Urinary tract infection (UTI)

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This is most common urological condition and multiple sites of urinary tract are involved in this type of infection. my this PPT slide is helpful to all the student and faculty to increasing their knowledge about UTI.

Published in: Health & Medicine
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Urinary tract infection (UTI)

  1. 1. B Y . M R . J A G D I S H S A M B A D M S C . N U R S I N G . N E P H R O - U R O L O G Y I K D R C C O L L E G E O F N U R S I N G
  2. 2. Introduction  Urinary tract infection (UTI) is a term that is applied to a variety of clinical conditions ranging from the asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis. UTI is one of the more common medical problems.
  3. 3. Definition of UTI  UTI is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria. - Smith
  4. 4. Causative pathogens  Most UTIs are caused by a single bacterial species. At least 80% of the uncomplicated cystitis and pyelonephritis are due to E. coli, with most of pathogenic strains belonging to the O serogroups (Orskov et al, 1982). Other less common uropathogens include Klebsiella, Proteus,and Enterobacter spp. and enterococci  In hospitalacquired UTIs, a wider variety of causative organisms is  found, including Pseudomonas and Staphylococcus spp. (Wagenlehner and Naber, 2000); UTIs caused by S.aureus often result from hematogenous dissemination.  Group B beta-hemolytic streptococci can cause UTIs inpregnant women (Wood and Dillon, 1981).
  5. 5. Common microorganism causing UTI  Escherichia coli  Enterococcus  Klebsiella  Enterobacter  Proteus  Pseudomonas  Staphylococcus  Serratia  Candida albicans
  6. 6. Predisposing factor to UTI 1. Factor increasing urinary stasis: Intrinsic obstruction due to stone on tumor in urinary tract. Extrinsic obstruction due to tumor and fibrosis. Urinary retention including neurogenic bladder. Renal impairment. 2. Foreign bodies: Urinary tract calculi Catheter Urinary tract instrumentation
  7. 7. Con.. 3. Anatomic factor: Congenital defect in genital tract leading to obstruction Fistula Shorter female urethra Obesity 4. Factor compromising immune response: Ageing HIV Diabetes mellitus
  8. 8. 5. Functional disorder: Constipation Voiding dysfunction due to detrusor sphincter dyssynergia 6. Other: Pregnancy Multiple sex partner Poor personal hygiene Hypo estrogenic state Use of spermicidal agent and contraceptive diaphragm (women)
  9. 9. Pathogenesis  Bacterial entry: Understanding of the mode of bacterial entry, host susceptibility factors, and bacterial pathogenic factors is essential to tailoring appropriate treatment for the diverse clinical manifestations of UTI. There are 4 possible modes of bacterial entry into the genitourinary tract. It is generally accepted that periurethral bacteria ascending into the urinary tract causes most UTI. Most cases of pyelonephritis are caused by the ascent of bacteria from the bladder, through the ureter and into the renal parenchyma
  10. 10. Clinical manifestation  LUTS are experienced in patient who have UTI of the upper urinary tracts as well as those confined to lower tract. These symptoms are related either bladder storage or emptying. These symptom are decide in to two parts: 1. EMPTYING SYMPTOMS 1. STORAGE SYMPTOMS
  11. 11. Emptying symptoms Weak urinary stream Hesitancy: difficulty starting the urine stream resulting in a delay between initiation of urination by relaxation of the urethral sphincter and when urine stream actually begins. Intermittency: interruption of the urinary stream while voiding. Post void dribbling: Urine loss after completion of voiding. Urinary retention or incomplete emptying: inability to empty urine from the bladder which can be caused atonic bladder or obstruction of the urethra. Can be cute or chronic. Dysuria: difficulty voiding Pain on urination
  12. 12. Storage symptoms  Urinary frequency: an abnormally frequent (usually >8 times in a 24 hr. period)  Urgency: a sudden strong or intense desire to void immediately, usually accompanied by frequency.  Incontinence: involuntary or unwanted loss or leakage of urine.  Nocturnal: waking up 2 or more times at night because of the need or urge to void.  Nocturnal enuresis: complaint of loss of urine during sleep. In children it is called bedwetting.
  13. 13. Investigation  History and physical examination  Urinalysis obtain a midstream voided “ clean- catch” urine specimen.  Urine for culture and severity (if indicated)  Imaging studies of urinary tract (e.g IVP, cystoscopy)
  14. 14. Treatment  Uncomplicated UTI:  Antibiotic: trimethoprim – sulfamethoxazole, nitrofurantion  Adequate fluid intake  Urinary analgesic: phenazopyridine or combination agent  Counseling about risk of recurrence and reduction risk factors.
  15. 15. Recurrent UTI  Repeat urinalysis and consider urine culture and sensitivity testing.  Antibiotic: 3-5 day treatment regimen of TMP-SMX, nitrofurantion  Sensitivity guided antibiotic  Urinary analgesic such as phenazopyridine or combination agent.  Cranberry or lingoberry juice (200-750 ml or equivalent tablets daily)  Adequate fluid intake.  Imaging study of urinary tract in selected cases.
  16. 16. Antimicrobial agents for genitourinary pathogens Diagnosis Pathogens Choice of antibiotic Duration of therapy Complicated UTI E.Coli Enterococai Pseudomonas Staphylococci 1st: Fluroquinole 2nd : Amniopenicilin 3rd : third generation cephalosporin Aminoglycosides 3-5 days after afebrile
  17. 17. PROPHYLACTIC ANTIBIOTIC REGIMEN Sr.no Tablet Dose 1. Nitrofurantoin 50-100 mg daily 2. Nitrofurantoin macrocrystals 100 mg daily 3. TMP-SMX 10/200 mg daily 4. Cephalexin 250mg daily 5. Ciprofloxacin 250mg daily 6. Trimethoprim 100mg daily
  18. 18. Nursing management Subjective data: - Asking past medical history, medication, surgery and other treatment. Objective data: - Taking history of the fever, chills , hematuria, foul smelling in urine, tenderness, enlarged kidney.
  19. 19. Nursing diagnosis 1. Impaired urinary elimination related to effect of urinary tract infection as evidenced by pain and burning on urination, flank, Suprapubic, or lower back pain; urgency, frequency, nocturia, or hematuria. 2. Acute pain related to infection on LUTS/ UUTS as evidenced infection on the lining of the interstial tissue of the urinary tract. 3. Ineffective therapeutic regimen management related to lack of knowledge regarding treatment regimen and prevention of recurrent infection as evidenced by verbalization of desire to manage treatment of illness and prevent recurrence.
  20. 20. Prevention of UTI

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