UTI Concept Map

Disease Urinary Tract Infection (UTI) – Infections that affect urinary tract. Second most common bacterial disease and most common bacterial infection in women. Ecoli causes cases w/o structural abnormalities or stones, primarily in women. Candida albicans causes UTI associated with i d lli th t t ti Etiology & Pathophysiology · Body defenses – complete emptying of bladder, UVJ competence, ureteral peristaltic activity. · Antibacterial characteristics: Urine pH < 6, high urea conc, glycoproteins. · Ascending infection - organisms originate in perineum and ascend via urethra · Most infections cause by G- bacilli found in GI tract. · G+ (streptococci, enterococci, and Staphylococcus saprophyticus can cause UTI · Hematogenous infection – blood-borne pathogen invades kidney, ureter or bladder from elsewhere Risk Factors See table 45.2 Anatomic factors Factors compromising immune response Factors increasing urinary stasis Foreign Bodies Functional disorders · Other factors · · · · · Diagnostics & Labs · History and physical exam · Dipstick urinalysis (mid-stream/clean catch) – identify nitrates (bacteriuria), WBC, leukocyte esterase (pyuria - pus), hematuria - Can’t midstream? Catheterize. Results more accurate · Urine culture and sensitivity – determine bacteria susceptibility to antibiotic drugs · Ultrasound/CT scan – obstruction suspected or UTI recur · CBS WBC BMP Clinical Manifestation (S/S) · Range: Painful urination in uncomplicated urethritis or cystitis to severe systemic illness with abdominal or back pain, fever, and sepsis · LUTS – bladder storage or emptying s/s (See table 45.3) · UUTS – involves renal parenchyma, pelvis, and ureters. -Fever, chills, flank pain. · Older adults: localized abdominal pain Medical Management/Medication Uncomplicated: · Pt teaching · Adequate fluid intake (6-8oz/day) Drug therapy: · Antibiotics - Fluconazole (Diflucan) – fungal UTI - Fosfomycin (Monurol) - Nitrofurantoin (Macrodantin, Macrobid) - TMP/SMX (Bactrim, Bactrim DS) - Trimethoprim alone - pt with sulfa allergy - Phenazopyridine (Pyridium) – relieve dysuria Recurrent UTI: occur w/n 1 – 2 weeks after therapy · Repeat UA · Urine C/S · Adequate fluid intake · Repeat Pt teaching · Imaging studies of urinary tract Drug Therapy: · Antibiotic: Nitrofurantoin, TMP/SMX · Sensitivity-guided antibiotic therapy: ampicillin, amoxicillin, 1st gen cephalosporin (Cefa-, ceph-), fluoroquinolones (levofloxacin, ciprofloxacin) · 3 - 6month trial of suppressive or prophylactic antibiotic regimen Treatment · Uncomplicated UTI – short term course antibiotics for 3 days · Complicated UTI – tx for 7 – 14 days · 1st choice drugs trimethoprim/sulfamethoxazole (TMP/SMX) bid, cephalexin, nitrofurantoin and Fosfomycin · Suppressive therapy – limited d/t risk for Surgical Intervention Nursing Diagnosis · Impaired urinary system function or Impaired urinary elimination · Acute pain · Risk for deficient fluid volume · Risk for decreased cardiac output · Risk for impaired gas exchange · Lack of knowledge Nursing Intervention Goal: S/S relief, no upper UUT involvement or recurrence · Routine and thorough perineal hygiene · Answer call light and offer bedpan or urinal if bed ridden. · Avoid unnecessary catherization. Early removal to prevent CAUTIs. Aseptic technique · Application of local heat (heating pad warm Patient Education · Pyridium – change urine color to orange/red. Wear a pad to protect underwear · Empty bladder regularly and completely, q34h/day · Evacuating bowel regularly · Wiping perineal area from front to back after voiding and defecation · Drinking adequate fluids to dilute urine and make it less irritable. Flush out bacteria before they colonize - Estimate: Weight (lbs) / half number · Avoid bladder irritant foods: caffeine, alcohol, citrus juices, and spicy foods. · Talk about antibiotics prescribed. Symptoms may improve after 1 – 2 days but organisms may still be present. Take full course of antibiotics. · Hand hygiene · Empty bladder before and after sexual intercourse · Temporarily stop use of diaphragm · Avoid vaginal douches, harsh soaps, bubble baths, powders, and sprays in perineal area. · Report to HCP s/s of recurrent UTI. Ex: fever, cloudy urine, pain on urination, urgency, Additional Information · Bacterial count ≥ 105 CFU/mL– clinically significant UTI · 102 – 103 CFU/mL with s/s – UTI · Fungal and parasitic infections – rare. Occurs in pt traveling to developing countries, immunosuppressed, diabetes, kidney problems or multiple antibiotic therapy. · Classified as upper & lower UTI, complicated and uncomplicated UTI. - Pyelonephritis – inflammation or renal parenchyma and collecting system. - Cystitis – inflammation of bladder - Urethritis – inflammation of urethra - Urosepsis – UTI spread systemically. Life threatening, emergency condition. S/S: high fever, hypotension, tachycardia, tachypnea, weak pulse, diaphoresis, altered LOC, decreased or absent urine o Obstruction of flow of urine, decreased or no bladder emptying - Uncomplicated UTI – in normal urinary tract and involves bladder. o S/S uncomplicated UTI – frequency, urgency, cloudy urine, pelvic or lower abdominal discomfort, fever - Complicated UTI (at risk for pyelonephritis, urosepsis and renal damage)– structural/functional problems in urinary tract. Ex: obstruction, stones, AKI, CKD, abnormal GU tract, catheter, renal transplant, diabetes or neurologic disease, antibiotic resistance, immunocompromised, pregnancyinduced changes, recurrent infection. o Pyelonephritis S/S - back or abdominal pain, N/V, high fever, fatigue, night sweats, chills. · Urologic instruments – common factor for ascending infection. Ex: catheterization, cystoscopy examinations · Sexual intercourse – promote milking of bacteria from vagina and perineum. May cause minor urethral trauma and predispose women to UTI · For kidney infection to occur via hematogenous infection there must be prior injury to urinary tract. Ex: obstruction or ureter, stones, or renal scars. · Bacteriuria – no s/s or no specific s/s. Ex: fatigue and anorexia · Problems that produce LUTS similar to UTI symptoms include: - Intravesical chemotherapy and pelvic radiation – cause urinary frequency, urgency, and dysuria - Interstitial cystitis/painful bladder syndrome – symptoms confused with UTI · Asymptomatic bacteriuria – healthy person with bacteria colonizing bladder. Screening and treatment required for pregnant women and urologic procedures. · Ecoli is resistant to TMP/SMX, β-lactam, and ciprofloxacin · Drug Alert: Nitrofurantoin A id if C Cl < 30 L/ i