WELCOME

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 D231: Medical & Surgical Nursing
Lecture On
URINARY TRACT INFECTION (UTI)

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 Learning Objective
• Definition
• Common Microorganisms
• Classification of UTIs
• Predisposing Factors to UTIs
• Pathophysiology of UTI
• Signs & Symptoms
• Diagnostic tests
• Medical & Nursing Management
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INTRODUCTION
 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.
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Definition of UTI
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.

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 COMMON MICROORGANISMS CAUSING UTI

 Escherichia coli [ causes 80% of cases ]

 Enterococcus
 Klebsiella
 Enterobactor
 Proteus
 Pseudomonas
 Staphylococcus
 Candida albicans

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 CLASSIFICATION OF UTI

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
sensation 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. 7
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 other illness.

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 Predisposing Factors to Urinary Tract Infection
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 9
 Predisposing Factors to UTI Cont…

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
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 PATHOPHYSIOLOGY OF UTIs

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.
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 CLINICAL MANIFESTATIONS OF UTIs
 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
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 ASSESSMENT & DIAGNOSTIC TESTS

 History taking with detailed clinical features

 Physical examination
 Urine Tests
 Urinalysis-

 Urine Culture-
 Clean-Catch Sample-

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 Other Investigations
 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. 14
 Investigations... Cont..

 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
 Computed Tomography (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.
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 MEDICAL MANAGEMENT

Management of UTIs typically involves pharmacologic

therapy and patient education. The nurse teaches the
patient about medication regimens and infection
prevention measures.
1. Acute Pharmacologic Therapy-

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.
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 b) Complicated cases
Name of Drugs Details
Cephalosporin or ampicillin/
aminoglycoside For 7 to 10 days for the treatment to be effective.
combination
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.

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 MEDICAL MANAGEMENT Cont..
2. Long Term Pharmacologic Therapy-
 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. 18
 MEDICAL MANAGEMENT Cont..
3. Patient education-
 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 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.
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 NURSING MANAGEMENT

ASSESSMENT
 Historyof 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.
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 NURSING MANAGEMENT Cont..
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.
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 NURSING MANAGEMENT Cont..
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.

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 NURSING MANAGEMENT Cont..
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. 23
 NURSING MANAGEMENT Cont..
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. 24

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