fculty of nursing cairo university

1. THE CHILD WITH URINARY
TRACT INFECTION
Presented by
Mohamed Mostafa
Under supervisor
Dr. Ola Haikal
Dr .Mohamed said

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Outlines
 Introduction
 Definition
 Incidence
 Anatomy and physiology of urinary system
 Pathophysiology of UTI
 Causes
 Signs and symptoms
 Diagnostic procedures
 Complications
 Medical treatment
 Nursing care
 References

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Introduction to Urinary Tract Infection (UTI):
 The urinary system plays a vital role in removing
waste products and excess fluids from the body. It
consists of various components, each with its own
function. The kidneys filter waste substances and
produce urine, which is then transported through
the ureters to the bladder. The bladder acts as a
storage organ for urine until it is expelled through
the urethra during urination.

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Urinary tract infection is an infection
of one or more structures of the
urinary tract
Definition

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Incidence :
 1. Most common renal disease in children
 2. More common in females than in males, ratio
6:1 except in the neonatal period, when both
sexes are equally affected

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Incidence
 0.86 per 100 patient-years at age 0 to 1 year .
 1.58 per 100 patient-years at 2 to 5 years .
 1.24 per 100 patient-years at 6 to 11 years.
 1.37 per 100 patient-years at 12 to 17 years,

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Anatomy and physiology of urinary tract
system .
 The urinary tract consists of the bladder, urethra,
and ureters. The bladder is a balloon-shaped
pouch of a thin, flexible muscle, in which urine is
temporarily stored before being eliminated from
the body through the urethra. Urine is produced
by the kidneys and passed into the bladder
through two ureters, one from each kidney.

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Anatomy and physiology cont .
kidney
 The kidney are abean shaped organ located on other sides of the spine near the middle
of the back.
 The kidney filters the blood of solutes and then secretes, concentrates and excretes
urine into the lower urinary tract via the ureters
 remove waste products from the body.
 remove drugs from the body.
 balance the body's fluids.
 release hormones that regulate blood pressure.
 produce an active form of vitamin D that promotes strong, healthy bones.
 control the production of red blood cells

10. z Anatomy and physiology cont
Ureters:
 Long and narrow tube
 The ureters carry urine approximately 22-30cm from the kidneys to the
bladder for elimination. Gravity and peristaltic waves within the ureters
propel urine from one end to the other.
 Bladder:
 The bladder is a hollow muscular organ located in the belvic.
 The bladder is composed of smooth muscle fibers. Urine fills the
bladder at low pressures causing it to distend, up to a normal capacity of
about 500mL of urine in adult.

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Urethra:
 The urethra carries urine from the bladder to the external
environment
 External urethral sphincter (EUS): The EUS is composed of skeletal
muscle fibers that circle the membranous part of the urethra in
males and the upper two-thirds of the urethra in female .
 Internal urethral sphincter (IUS): The IUS is positioned between the
bladder neck and the proximal urethra. composed of smooth muscle
and connective tissue in a circular arrangement, and it is considered
a functional sphincter .
Anatomy and physiology cont

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Pathophysiology
 During infancy, the bacteria usually enter the urinary tract
through blood and cause infection. After infancy, UTI occurs
when bacteria enter the urinary tract by ascending through
the urethra. Females are at higher risk of Urinary tract
infection because of short urethra and its proximity to anal
opening. Males are at lower risk because of longer urethra
and prostate secretions that are antibacterial in nature.

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Pathophysiology cont .
 When bacteria enter the urinary tract, they
produce inflammatory changes in the urinary
tract. Due to inflammation, there is thickening
and fibrosis of uretero-vesical junction, leading to
incompetence of vesicoureteral valve. This causes
reflux of urine, allowing the organisms to enter
the upper urinary tract and causing infection of
renal parenchyma .

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Etiology
 Normal urine contains water, salts, and waste
products. It is free of germs such as bacteria,
viruses, and fungi. An infection happens when
germs enter the urethra, travel up to the bladder,
ureters, and kidneys, and begin to grow. Most
infections are caused by bacteria from the
digestive tract. The most common is Escherichia
coli (E. coli) bacteria. These normally live in the
colon.

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Etiology cont .
Etiologic agents:
1. GI flora Organisms responssible for 75% of all cases.
-E.Coli (most common causative agent)
-Aerobact- Entrobacte -blic Health Training
2. Streptococci and staphylococci causes most other cases.
3. Contributing causes
Obstruction Infection elsewhere in the body Poor perineal hygiene.
Short female urethra Catheteriztion

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Signs and symptoms
Symptoms of a UTI can vary depending on the degree of infection
and child’s age. Infants and very young children may not experience
any symptoms. When they do occur in younger children, symptoms
can be very general. They may include:
 fever
 poor appetite
 vomiting
 diarrhea
 irritability
 overall feeling of illness

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Infection in bladder
 blood in the urine
 cloudy urine
 pain, stinging, or burning with urination
 frequent urination
 waking from sleep to urinate
 feeling the need to urinate with minimal urine output
 urine accidents after the age of toilet training

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If the infection has traveled to the
kidneys .
The condition is more serious
 irritability
 chills with shaking
 high fever
 skin that’s flushed or warm
 nausea and vomiting
 side or back pain
 severe abdominal pain
 severe fatigue

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Complications :.
Untreated a UTI can result in a kidney infection that
may lead to more serious conditions, such as:
 kidney abscess
 reduced kidney function or kidney failure
 hydronephrosis, or swelling of the kidneys
 sepsis, which can lead to organ failure and death

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Diagnostic procedures
The sample we can use in :
 Urinalysis. Urine is tested with a special test
strip to look for signs of infection such as blood
and white blood cells. In addition, a microscope
may be used to examine the sample for bacteria
or pus.
 Urine culture. This laboratory test usually takes
24 to 48 hours. The sample is analyzed to
identify the type of bacteria causing the UTI, how
much of it exists, and appropriate antibiotic
treatment

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 Collecting a clean urine sample can be a challenge
for children who aren’t toilet trained.
 Urine collection bag. A plastic bag is taped over
the child’s genitals to collect the urine.
 Catheterized urine collection. A catheter is inserted
into the tip of a boy’s penis or into a girl’s urethra and
into the bladder to collect urine. This is the most
accurate method.

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Additional tests
 kidney and bladder ultrasound
 voiding cystourethrogram (VCUG)
 nuclear medicine renal scan (DMSA)
 CT scan or MRI of the kidneys and bladder

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Treatment
 child’s UTI will require prompt antibiotic treatment to prevent kidney damage.
The type of bacteria causing the child’s UTI and the severity of the child’s
infection will determine the type of antibiotic used and the length of treatment.
 The most common antibiotics used for treatment of UTIs in children are:
 amoxicillin
 amoxicillin and clavulanic acid
 cephalosporins
 doxycycline, but only in children over age 8
 nitrofurantoin
 sulfamethoxazole-trimethoprim

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Nursing care .
Nursing assessment
 Determine the patient’s general symptoms.
Cloudy urine- fever- blood in the urine
 Observe the urine characteristics.
Assess the urine’s volume, color, clarity, and odor
 Assess the patient’s hydration status
 Assess for risk factors that contribute to the development of urinary tract
infections.

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Nursing Care
1. Obtain mid-stream urine specimen whenever possible
and send to Lab. Immediately for examination
2. Administer antibiotics as prescribed by the pediatrician
3. Maintain bed rest, administer analgesics and antipyretic
drugs as prescribed, encourage fluid to reduce fever and
dilute the concentration of urine during the febrile period
4. Monitor and record vital signs to observe the progress of
disease
