Urinary tract infection

1. URINARY TRACT
INFECTION (UTI)
SUBMITTED TO SUBMITTED BY
Mrs. SAVITA ANMOLPREET KAUR(05)
ASSO. PROF. ANSHIKA SHARMA(06)
CON ,DMC&H

2. What is UTI ?
Any infection anywhere along the urinary system is known as UTI.
A condition in which bacteria invade and grow in the urinary tract.
Urinary system consists of
• 2 kidneys
• 2 ureters
• Bladder
• urethra

4. Among women who are more prone to UTI and
why ?
PREGNANT WOMAN
This is due to some physiological changes in the urogenital
system that takes place during pregnancy

5. These changes are …..
1. Gravid uterus
Uterus sits directly on the floor the bladder
Uterus grows during pregnancy
Its increased weight can block the drainage of urine from the bladder
Stasis of urine in ureters and bladder
Multipication of bacteria
UTI

6. 2. Dilatation of ureters and renal pelvis mostly at six weeks of
gestation due to Progesterone related smooth muscle
relaxation
3. Immunocompromised state .
Pregnancy is the state of relative immunocomprise which may
lead to UTIs.

7. Types of UTI in pregnancy
UTI can occur as 3 types :
1.Asymptomatic bacteriuria
2.Acute cystitis
3.Acute pyelonephritis

8. Asymptomatic bacteriuria
 Most common form of UTI in pregnancy.
 Silent ( without symptoms) infection
 Caused by bacteria (E. coli) present in women system
before pregnancy.
 May lead to pyelonephritis if left untreated.

9. Acute cystitis or urethritis
 It is the infection of bladder or urethra
 In pregnancy almost always result from ascending infection
in long standing asymptomatic bacteriuria.
Pyelonephritis
 A bacterial infection of the kidney.
 Caused by E. coli
 Most common serious medical complication of
pregnancy
 It is the leading cause of septic shock during
pregnancy

10. Risk factors : women
• Female anatomy . A women has a shorter urethra than a man does ,
which shortens the distance that bacteria must travel reach the
bladder.
• Sexual activity . Having a new or multiple sexual partners also
increases risk.
• Certain types of birth control. Women who use diaphragms or
spermicidal agents for birth control may be at risk.
• Menopause. After menopause , a decline in circulating estrogen
causes changes in the urinary tract that make you more vulnerable to
infection.

11. Other Risk factors :
• Urinary tract abnormalities
• Blockages in urinary tract – kidney stones
• A suppressed immune system
• Catheter use – who are hospitalized , with
neurological problems , who are paralyzed.
• A recent urinary procedure or urinary surgery
• Pregnancy and postdelivery.

12. Causes
 Causative organisms:
o Escherichia coli.( most common )
o S. Aureus
o Group B streptococci

13. Other causes
oUrine stasis
oTrauma
oInadequate perineal hygiene
oInadequate asepsis technique

14. Signs and symptoms of UTI
• A strong, persistent urge to urinate
• A burning sensation during urinate
• Passing frequent small amount of urine
• Hematuria
• Fowl smelling urine
• Fever
• Flank pain

15. Diagnostic evaluation
• History collection
• Physical examination
• Urine routine and microscopy
( presence of pus cells 5> / high power film)
• Urine for culture and sensitivity test .
• Complete blood count with ESR.
• Blood culture ( if fever is associated with chill and rigor)
• Dipstick culture technique
( dipstick testing for nitrites and leucocyte esterase in the evaluation
of asymptomatic bacteriuria)
• Renal function test

16. Don’t forget
Proper Midstream clean catch
urine must be ensure to do urine
R/M/E and C/S test to get correct
investigation result.

17. MANAGEMENT
Pharmacological
 Oral antibiotics – continuation of treatment for at least 2 weeks
antibiotics
• Ampicillin 500 mg qid
• Nitrofurantoin 100 mg qid
• Amoxicillin – clavulanic acid 375 mg tid
• In case of recurrent infection , Nitrofurantoin 50mg or Amoxycillin 250mg
at night to continue till delivery
 Intravenous fluids
 Antipyretics

18. Nursing management
ASSESSMENT
 Assess the mother by taking history from woman related to retention of
urine , pain on micturition , malaise.
 Check the vital signs to assess the fever , whether having or not .
 Assess the perineal area to assess the hygienic conditions
 Assess the knowledge of woman related to UTI and its complications .
DIAGNOSIS :
 Altered urinary elimination related to urinary tract infection.
 Hyperthermia related to increased metabolic rate , due to illness or
trauma.
 Knowledge deficit .

19. Nursing intervention
• Review the lab test.
• Determine the patient previous pattern of elimination
• Palpate the bladder to assess retention.
• Encourage the fluid intake to maintain renal function and prevent
infection.
• Keep the perineal area clean and dry to reduce the risk of
infection.
• Monitor the temperature to evaluate the range of temperature.

20. Cont……
• Monitor the vital signs to evaluate the fluctuations in pulse rate ,
respiration, blood pressure in order to assess the associated
complications .
• Administer the prescribed medication to treat the infection.
• Administer the fluids if required or advice to take oral fluids .
• Encourage the woman to void frequently and to empty the bladder
completely
• Wash the perineal area after each voiding
• Teach the women about UTI prevention and about complications.

21. Complications
o Septicemia
o ARDS
o Renal abscess and scarring
o Preterm labor and delivery
o Increased perinatal morbidity and mortality
o DIC ( disseminated intravascular coagulation)

22. Prevention of UTI
• Keep the perineal area dry and clean
• Avoid bubble bath
• Encouraging fluid intake especially water
• Not to allow retention of urine , void frequently
• Wear cotton underpants
• Wash the perineal area after each void.

23. Recaptulization
1.Name the causative organisms of UTI .
2.What are the types of UTI in pregnancy?
3.Proper urine must be ensure
to do urine routine /culture examination to get
correct investigation result.