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Urinary Tract Infection
JenniferLee DiBernardo
Pathophysiology Project
OBJECTIVES
By the end of this presentation the learner should be
able to identify:
• The basic structures and functions of the Urinary
System.
• The most common microorganisms that cause
Urinary Tract Infections.
• Risk factors for Urinary Tract Infections.
• The most common laboratory tests in diagnosing
Urinary Tract Infections.
• Treatments and prevention measures for Urinary
Tract Infections.
Basic Structures of the Urinary System
• The urinary system
consists of:
– two kidneys
– two ureters
– one urinary bladder
– one urethra
Functions of the Basic Structures
of the Urinary System
• Kidney – small, dark red kidney bean shaped structures. The kidneys are
responsible for continuously cleansing the blood and adjusting its composition,
urine formation, excretion of Nitrogen containing wastes, maintaining water
and electrolyte balance of the blood, maintaining the acid – base balance of the
blood and the formation of urine.
• Ureters – slender tubes each 10 to 12 inches in long and ¼ inch in diameter.
Each ureter runs from the kidney down to the urinary bladder and attaches
itself to the posterior aspect of the bladder on a slight angle. The ureters are
passageways to carry urine from the kidneys to the bladder.
• Urinary Bladder – is a smooth, collapsible, muscular sac with 3
openings, the 2 ureter openings and the urethra opening. When the bladder is
empty, it is collapsed and it is 2 to 3 inches long at most, when the bladder is
moderately full about 500ml it is about 5 inches long. The bladder is able to
hold twice that amount though. The main function of the urinary bladder is to
provide a temporary storage tank for urine.
• Urethra – is a thin walled tube that carries urine by peristalsis from the
bladder to the outside of the body. The length and relative function of the
urethra differs in both sexes.
Functions of the Urinary System
• The principal function of the urinary system is to maintain the volume
and composition of body fluids within normal limits. One aspect of
this function is to rid the body of waste products that accumulate as a
result of cellular metabolism.
• The urinary system maintains an appropriate fluid volume by
regulating the amount of water that is excreted in the urine. Other
aspects of its function include regulating the concentrations of various
electrolytes in the body fluids and maintaining normal pH of the blood
• In addition to maintaining fluid homeostasis in the body, the urinary
system controls red blood cell production by secreting the hormone
erythropoietin. The urinary system also plays a role in maintaining
normal blood pressure by secreting the enzyme renin.
Differences Between the Male and
Female Urinary System
Male
Urethra
Female
Urethra
Approx 8
inches long
Approx 1.5
inches long
Located
further from
anus
Located more
proximate to
anus
Has two
functions,
urination &
passageway
for sperm
Has one
function,
urination
Definition of Urinary Tract
Infection (UTI)
• Is a common infection that usually
occurs when bacteria enter the opening
of the urethra and multiply in the
urinary tract.
Most Common Organisms Which
Cause UTIs
•
•
•
•
•
Escherichia coli
Enterobacter
Pseudomas
Serratia
Staphylococcus
saprophyticus
• Candida
Signs and Symptoms of UTIs
•
•
•
•
•
•
•
Dysuria (burning pain upon urination)
Frequency
Urgency
Voiding in small amounts
Inability to void
Incomplete emptying of bladder
Low back / Suprapubic pain
Assessment Findings in UTIs
•
•
•
•
•
•
•
•
Hematuria (bloody urine)
Cloudy urine
Flank pain
Abdominal pain
Fever
Nausea
Vomiting
Most Common Laboratory Tests
Used in Diagnosing UTIs
• Urinalysis ( U/A )
– Dip Stix
• Culture and
Sensitivity ( C & S )
Urinalysis Laboratory Findings
Normal Findings
• pH - 4.6 – 8.0
• Appearance – clear
• Color – pale yellow to amber
yellow
• Odor – aromatic
• Specific Gravity – 1.005 –
1.030
• Protein - none
• Glucose – none
• Ketones – none
• Blood – none
• Leukocyte esterase (WBCs) –
none
• pH – Alkaline ( increases)
• Appearance – cloudy
• Color - deep amber
• Odor – foul smelling
• Specific Gravity – may change
• Protein – maybe present
• Glucose – maybe present
• Ketones - maybe present
• Blood – maybe present
•Leukocyte esterase (WBCs)- present
Urinalysis Laboratory Findings
Microscopic Examination
Normal Findings
• Red Blood Cells
(RBCs) – none
• White Blood Cells
(WBCs) – none
• Casts – none
• Crystals – none
• Bacteria - none
• Red Blood Cells
(RBCs) – present
• White Blood Cells
(WBCs) – present
• Casts – none
• Crystals – present
• Bacteria - present
Culture & Sensitivity Laboratory
Findings
Normal Findings
• No bacteria present in
urine.
• Bacteria present in
urine.
Treatment of UTIs
• Antibiotics
• Analgesics
• Increase fluids (ex.
Cranberry Juice)
• Repeat urine culture
and sensitivity after
antibiotics are finished
Risk Factors in UTIs
Males
Females
•
•
•
•
Age
Loss of bactericidal properties of
prostatic secretions
– sperm
Obstructive Uropathy
– BPH
– Presence of indwelling catheter
– Foley
•
•
•
Sexual intercourse
– poor fitting diaphragms
– use of spericide
– Pregnancy/Menopause
Clothing
– tight jeans
– wet bathing suits
– pantyhose
– synthetic underwear
Allergens/Irritants
– feminine hygiene sprays
– bubble baths
– perfumed toilet paper / soap
– sanitary napkins
Presence of indwelling catheter
– Foley
Prevention of UTIs
• Encourage menopausal women to use estrogen vaginal creams to
restore vaginal pH
•
Teach women to use water soluble lubricants for intercourse,
especially after menopause
•
Maintain closed drainage system for hospitalized patients with an
indwelling catheter and provide meticulous catheter care
•
Ensure that patients understand the importance of taking all antibiotics
and having repeat culture and sensitivities done
•
Monitor older male patients, especially those with BPH, for the
presence of infection
Prevention of UTIs Continued
•
• Teach female patients good perineal hygiene
• Teach women proper way to wipe after urination ( front to
back )
• Teach women to shower instead of bathing in tub.
• Teach women to avoid using feminine hygiene sprays and
other irritants
• Teach women to wear cotton underwear
• Avoid tight jeans, sitting around in wet bathing suits
• Teach pregnant women to void every 2 hours
• Teach patients the signs and symptoms of UTIs
References
• Black, Joyce M.& Matassarin – Jacobs, Esther. (2001) MedicalSurgical Nursing: Clinical Management for Continuity of Care (5th
ed.) W.B. Saunders Company
• Christensen, Barbara & Kockrow, Elaine. (2000) Foundations of
Nursing (2nd ed.) St. Louis: Mosby
• Harkness, Gail A. & Dincher, Judith R. (2000) Medical –Surgical
Nursing: Total Patient Care (9th ed.) St. Louis: Mosby
• Marieb, Elaine N. (2001) Essentials of Human Anatomy & Physiology
(4th ed.) Redwood City, California: The Benjamin/Cummings
Publishing Company, Inc.
• Pagana, Kathleen Deska & Pagana, Timothy James (2002) Diagnostic
and Laboratory Test Reference (2nd ed.) St.Louis: Mosby
• Timby, Barbara K. (2000) Fundamental Skills and Concepts in Patient
Care (6th ed.) Philadelphia: Lippincott
• All Images, www.google.com