Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.

1. SWATILEKHA DAS
M.SC NURSE

2.  A urinary tract infection (UTI) is a bacterial infection in
part of the urinary tract. When it affects the lower
urinary tract, it is known as a simple cystitis (a bladder
infection).When it affects the upper urinary tract, it is
known as pyelonephritis (a kidney infection).
 UTI is 50 times more common in women, with about 5
per cent per year developing symptoms. UTI is
uncommon in men below 60 years of age, but the
frequency is similar in men and women in older age
groups.

3. A urinary tract infection (UTI) is an infection involving
the kidneys, ureters, bladder, or urethra.These are the
structures that urine passes through before being
eliminated from the body.

4.  Escherichia coli [ causes 80% of cases ]
 Enterococcus
 Klebsiella
 Enterobactor
 Proteus
 Pseudomonas
 Staphylococcus
 Candida albicans

5. Several classification systems can be used for UTIs.Therefore depending on
the site involved, the clinical presentation of UTI is as follows:
 Asymptomatic bacteriuria- is a significant number of bacteria in the
urine that occurs without usual symptoms such as burning during
urination or frequent urination.
 Acute cystitis- indicates inflammation of the bladder wall.
 Acute pyelonephritis- implies inflammation (usually due to infection) of
the renal parenchyma and collecting system.
 Acute urethritis- means inflammation of the urethra.
 Acute prostatitis- is a serious bacterial infection of the prostate gland.

6. A urinary tract infection is said to be complicated if:
 it is in the upper tract
 the person has diabetes mellitus
 the person is pregnant
 the person is male
 the person has a weakened immune system
(immunocompromised) because of another illness.

7. 1. Factors increasing urinary stasis
 Intrinsic obstruction(stone, tumor of urinary tract, urethral strictures, BPH)
 Extrinsic obstruction(tumor, fibrosis compressing urinary tract)
 Urinary retention(including neurogenic bladder and low bladder wall
compliance)
 Renal impairment
2. Foreign bodies
 Urinary tract calculi
 Catheters ( indwelling external condom catherter, urethral stent,
intermittent catheterization)
 Urinary tract instrumentation( cystoscopy, urodynamics)
3. Anatomic factors
 Congenital defects leading to obstruction or urinary stasis
 Fistula exposing urinary system to skin, vagina, or fecal stream
 Shorter female urethra and colonization from normal vaginal flora
 obesity

8. 4. Factors comprising immune response
 Ageing
 Human immunodeficiency virus infection
 Diabetes mellitus
5. Functional disorders
 Constipation
 Voiding dysfunction
6. Other factors
 Pregnancy
 Hypoestrogenic state
 Multiple sex partners
 Poor personal hygiene

9. The urinary tract above the urethra is normally sterile.
Several mechanical and physiologic defence
mechanisms include normal voiding with complete
emptying of the bladder, ureterovesical junction
competence and peristaltic activity that propels urine
toward the bladder. Antibacterial characteristics of
urine are maintained by an acidic pH (<6.0) high urea
concentration, and abundant glycoproteins that
interfere with the growth of bacteria. These defence
mechanisms assist in maintaining sterility and
preventing UTIs.

10.  A strong, persistent urge to urinate
 A burning sensation when urinating
 Passing frequent, small amounts of urine
 Urine that appears cloudy
 Urine that appears red, bright pink or cola-colored
— a sign of blood in the urine
 Strong-smelling urine
 Pelvic pain, in women — especially in the center of
the pelvis and around the area of the pubic bone

11.  History taking with detailed clinical
manifestations
 Physical examination
 UrineTests
 Urinalysis-
 Urine Culture-
 Clean-Catch Sample-

12.  Ultrasound- Ultrasound is a noninvasive imaging test that can be used to
screen for hydronephrosis (obstructions of the flow of urine).
 X-Rays- Special x-rays can be used to screen for structural abnormalities,
urethral narrowing, or incomplete emptying of the bladder. Due to the
possible risks to the fetus, x-rays are not performed on pregnant women.
 Voiding cystourethrogram- It is an x-ray of the bladder and urethra.To
obtain a cystourethrogram, a dye, called contrast material, is injected
through a catheter inserted into the urethra and passed through the
bladder.
 An intravenous pyelogram (IVP)- It is an x-ray of the kidney. For a
pyelogram, the contrast matter is injected into a vein and eliminated by
the kidneys. In both cases, the dye passes through the urinary tract and
reveals any obstructions or abnormalities on x-ray images.

13.  Cystoscopy- Cystoscopy is used to detect structural abnormalities,
interstitial cystitis, or masses that might not show up on x-rays
during an IVP.The patient is given a light anesthetic, and the
bladder is filled with water.The procedure uses a cystoscope, a
flexible, tube-like instrument that the urologist inserts through the
urethra into the bladder
 ComputedTomography (CT)- A computed tomography (CT) scans
may be used to check for kidney stones or other obstructions.
 Blood Cultures- If symptoms are severe; the doctor will order
blood cultures to determine if the infection is in the bloodstream
and threatening other parts of the body.

14. Management of UTIs typically involves pharmacologic
therapy and patient education. The nurse teaches the
patient about medication regimens and infection
prevention measures.
1. Acute PharmacologicTherapy-
a) Uncomplicated cases- single dose of
administration, short course (3 to 4 days) regimens, or
7 to 10 days regimens. The antibacterial agent should
be affordable and should have few adverse effects.
Most cases are cured after 3 days of treatment.

15. Name of Drugs Details
Cephalosporin or ampicillin/ aminoglycoside
combination
For 7 to 10 days for the treatment to be effective.
Trimethoprim- sulfamethoxazole These are commonly used medicine.
Ciprofloxacin(fluoroquinolone) It is often used as a first line drug because E. coli has developed resistance to
ampicillin or amxicillin.
Levofloxacin(fluoroquinolone) It is another fluoroquinolone, is a good choice for short term therapy for
uncomplicated, mild to moderate UTIs.
Nitrofurantion It should not be used in patients with renal insufficiency because it is ineffective at
glomerular filtration rates of less than 50ml/min and may cause peripheral
neuropathy.
Phenazopyridine It is a urinary analgesic may be prescribed to relieve the discomfort associated
with the infection.
b) Complicated cases-

16. 2. LongTerm PharmacologicTherapy-
 Relapse of UTIs suggest that the source of bacteriuria may be the upper
urinary tract or the initial treatment was inadequate or administered for
a too short time.
 The women with recurrent UTIs may be instructed to begin treatment to
her own whenever symptoms occur and to contact her health care
provider only when symptoms persist, fever occurs, or the number of
treatment episodes exeeds four in a 6 month period.
 If infection recurs after complete antimicrobial therapy another short
course (3 to 4 days) of full dose antimicrobial therapy may be prescribed.
 After treatment and sterilization of urine low dose preventive therapy
(trimethoprim with or without sulfamethoxazole) each night at bed time
is often prescribed.

17. 3. Patient education-
 The following are measures that studies suggest may reduce the
incidence of urinary tract infections. These may be appropriate for
people, especially women, with recurrent infections:
 Do not delay urination when it is necessary.
 A high fluid intake is essential.
 Cleaning the urethral meatus (the opening of the urethra) after
intercourse has been shown to be of some benefit; however,
whether this is done with an antiseptic or a placebo ointment (an
ointment containing no active ingredient) does not appear to
matter.
 Drinking 250 to 500ml of cranberry juice daily and avoidance of
bubble baths may also help.
 Often long courses of low-dose antibiotics are taken at night to
help prevent otherwise unexplained cases of recurring cystitis.

18. ASSESSMENT
 History of signs and symptoms related to UTIs is
obtained from the patient with suspected UTI.
 The presence of pain, frequency, urgency and
hesitancy and changes in urine are assessed,
documented and reported.
 Patient’s knowledge about prescribed
antibacterial medications and preventive health
care measures is also assessed.

19. 1. NURSING DIAGNOSIS
Acute pain related to infection within the urinary tract as manifested by pain
on urination, suprapubic pain and bladder spasms.
GOAL
Pain and discomfort will be relieved.
INTERVENTION
 Assess the onset, duration and level of pain.
 Provide analgesic drugs.
 Provide comfortable position.
 Reassure and provide divertional therapy.
 Give psychological support.
 Alert patient that phenazopyridine will color urine orange.
 Apply heating pad to painful area.
EVALUATION
Reports relief of pain.

20. 2. NURSING DIAGNOSIS
Impaired urinary elimination related to UTIs as manifested by urgency, frequency,
incontinence or hematuria and verbalization of concern over altered elimination
pattern.
GOAL
Normal urination pattern will be returned.
INTERVENTION
 Assess for changes in usual voiding pattern.
 Instruct patient regarding reason for symptoms.
 Encourage high fluid intake or administer IV fluid as ordered.
 Obtain urine for culture and sensitivity.
 Administer antimicrobial medications as ordered.
 Instruct patient about good perineal care and cleansing after each bowel
movement.
 Tell patient to observe urine for color, odor,amount and frequency.
EVALUATION
Exhibits normal urination pattern.

21. 3. NURSING DIAGNOSIS
Hyperthermia related to infection as manifested by elevation in
temperature, tachycardia, chills and malaise
GOAL
Normal body temperature will be returned.
INTERVENTION
 Assess vital signs 2-4 hourly.
 Administer antipyretics and antibiotics as ordered.
 Ensure hydration via oral or IV route.
 Monitor intake and output.
 Cover patient and keep him dry.
 Provide cooling sponge baths or compresses.
EVALUATION
Reports return of normal temperature.

22. 4. NURSING DIAGNOSIS
Risk for reinfection related to lack of knowledge regarding measure to prevent recurrence.
GOAL
Signs of infection will not be present.
INTERVENTION
 Assess the signs and symptoms of infection.
 Explain importance of taking all the antibiotics as prescribed. Symptoms will improve
after 1-2 days of therapy, but organisms may still be present.
 Instruct the patient on appropriate hygiene, including-
 Careful cleansing of perineal region.
 Wiping from front to back after urinating.
 Cleansing with soap and water after each bowel movement.
 Explain the emptying of bladder before and after intercourse.
 Instruct the patient to urinate when the urge occurs or at least 2-4 hour during the day.
 Instruct the patient about the need to maintain adequate fluid intake.
 Advise patient to report symptoms or signs of recurrent UTI.
EVALUATION
Improves knowledge level of patient.