Download LOWER URINARY TRACT INFECTIONS (UTI)

LOWER URINARY TRACT
INFECTIONS
(UTI)
Fadi Jehad Zaben RN MSN
IMET 2000
Overview
 Definition
 Mechanism of Disease – common pathogens
 Classification – Lower v.s Upper infection
 Signs and Symptoms
 Physical Exam
 Urine analysis and culture
 Treatment
 Nursing care
Definition:
A UTI is caused by the presence of
pathogenic microorganisms in the urinary
tract with or without signs and symptoms.
Lower UTIs may predominate at the
bladder (cystitis) or urethra (urethritis).
Bacteriuria refers to the presence of
bacteria in the urine (105 bacteria/mL of
urine or greater generally indicates
infection).
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 In asymptomatic bacteriuria, organisms are
found in urine, but the patient has no symptoms.
 Recurrent UTIs may indicate the following:
 Relapse recurrent infection with an
organism that has been isolated during a prior
infection
 Reinfection recurrent infection with an
organism distinct from previous infecting
organism
Pathophysiology and Etiology:
 Ascending infection after entry by way of the urinary
meatus:
 Women are more susceptible to developing acute
cystitis because of shorter length of urethra,
anatomical proximity to vagina, periurethral
glands, and rectum (fecal contamination), and the
mechanical effect of coitus.
 Women with recurrent UTIs typically have gramnegative organisms at the vaginal introitus; there
may be some defect of the mucosa of the urethra,
vagina, or external genitalia of these patients that
allows enteric organisms to invade the bladder.
 Poor voiding habits may result in incomplete
bladder emptying, increasing the risk of recurrent
infection.
 Acute infection in women most commonly arises
from organisms of the patient's own intestinal flora
(Escherichia coli).
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 E. coli causes 86% of UTIs, other pathogens,
such as Klebsiella species, Proteus species, and
Staphylococcus saprophyticus, may also cause
infections.
 In men, obstructive abnormalities (strictures,
prostatic hyperplasia) are the most frequent
cause.
 UTI is a considerable source of nosocomial
infection and sepsis in older adults.
 Upper urinary tract disease may occasionally
cause recurrent bladder infection.
Classifications of infections:
 Lower urinary tract infections: urethritis,
prostatitis, cystitis.
 Upper urinary tract infection: pyelonephritis
(inflammation of kidney and renal pelvis).
Risk Factors:
 Aging:
A.
Increased incidence of diabetes mellitus
B.
Increased risk of urinary stasis
C.
Impaired immune response
 Females: short urethra, having sexual intercourse, use of
contraceptives that alter normal bacteria flora of vagina and
perineal tissues; with age increased incidence of cystocele,
rectocele (incomplete emptying).
 Males: prostatic hypertrophy, bacterial prostatitis, anal
intercourse.
 Urinary tract obstruction: tumor or calculi, strictures.
 Impaired bladder innervation.
 Pregnant women are at increased risk for UTI's starting in week 6
through week 24.
Clinical Manifestations:
 Dysuria, frequency, urgency, nocturia
 Suprapubic pain and discomfort
 Blood or mucus in the urine
 Cramps or pain in the lower abdomen
 Pain during sexual intercourse
 Microscopic or gross hematuria
Manifestations in older adults:
Change in behavior
Acute confusion
Incontinence
Diagnostic Evaluation:
 Urine dipstick may react positively for blood,
white blood cells (WBCs), and nitrates indicating
infection.
 Urine microscopy shows RBCs and many WBCs
per field without epithelial cells.
 Urine culture is used to detect presence of
bacteria and for antimicrobial sensitivity testing.
 Patients with indwelling catheters may have
asymptomatic bacterial colonization of the urine
without UTI. In these patients, UTI is diagnosed
and treated only when symptoms are present.
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 Urinalysis showing many epithelial cells is likely
contaminated by vaginal secretions in women
and is therefore inaccurate in indicating infection.
 Urine culture may be reported as contaminated
as well. Obtaining a clean-catch, midstream
specimen is essential for accurate results, and
catheterization may be necessary in some
patients.
Management:
 Antibiotic therapy according to sensitivity results:
 A wide variety of antimicrobial drugs are
available.
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 For uncomplicated infection:
 Women with uncomplicated cystitis may be
treated with a 3-day course of a
fluoroquinolone such as ciprofloxacin (Cipro), a
7-day course of nitrofurantoin (Macrodantin), or
a 3-day course of co-trimoxazole (Bactrim,
Septra). Seven to 10 days of therapy are
recommended for women over age 65.
 Men are treated with 7 to 10 days of antibiotic
therapy.
 Follow-up culture to prove treatment
effectiveness may be indicated.
 Adverse effects include nausea, diarrhea, drugrelated rash, and vaginal candidiasis.
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 Pregnant women are usually treated for 7 to 10
days.
 Women with recurrent infections may be treated
longer, undergo diagnostic testing to rule out a
structural abnormality, or be maintained on a
daily dose of antibiotic as prophylaxis.
Complications:
Pyelonephritis
Hematogenous spread resulting in sepsis
Nursing Diagnoses:
 Acute Pain related to inflammation of the
bladder mucosa
 Deficient Knowledge related to prevention of
recurrent UTI
Relieving Pain:
 Administer or teach self-administration of antibiotic
eradication of infection is usually accompanied by
rapid resolution of symptoms.
 Encourage patient to take prescribed analgesics and
antispasmodics if ordered.
 Encourage rest during the acute phase if symptoms
are severe.
 Encourage plenty of fluids to promote urinary
output and to flush out bacteria from urinary tract.
Increasing Understanding and Practice of
Preventive Measures:
 For women with recurrent UTIs, give the following instructions:
 Reduce vaginal introital concentration of pathogens by
hygienic measures.
 Wash genitalia in shower or while standing in bathtub
bacteria in bath water may gain entrance into urethra.
 Cleanse around the perineum and urethral meatus after
each bowel movement, with front-to-back cleansing to
minimize fecal contamination of periurethral area.
 Drink liberal amounts of water to lower bacterial concentrations
in the urine.
 Avoid bladder irritants coffee, tea, alcohol, cola drinks, and
aspartame.
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 Decrease the entry of microorganisms into the bladder during
intercourse.
 Void immediately after sexual intercourse.
 A single dose of an oral antimicrobial agent may be prescribed after
sexual intercourse.
 Avoid external irritants such as bubble baths, talcum powders,
perfumed vaginal cleansers or deodorants.
 Patients with persistent bacteria may require long-term
antimicrobial therapy to prevent colonization of periurethral area
and recurrence of UTI.
 Take antibiotic at bedtime after emptying bladder to ensure adequate
concentration of drug overnight because low rates of urine flow and
infrequent bladder emptying predispose to multiplication of bacteria.
 Use self-monitoring tests (dipsticks) at home to monitor for UTI.
THE END