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  • Urinary Tract Infection (UTI)

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    A urinary tract infection occurs when bacteria enter the urethra and spreads upwards through the urinary tract. Symptoms include pain or burning during urination, frequent urination with little output, and cloudy or foul smelling urine. UTIs are more common in women due to anatomical differences. Diagnosis involves a urinalysis and urine culture. Treatment focuses on antibiotics and increasing fluid intake to flush out the infection.

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    A urinary tract infection occurs when bacteria enter the urethra and spreads upwards through the urinary tract. Symptoms include pain or burning during urination, frequent urination with little output, and cloudy or foul smelling urine. UTIs are more common in women due to anatomical differences. Diagnosis involves a urinalysis and urine culture. Treatment focuses on antibiotics and increasing fluid intake to flush out the infection.

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    41 views6 pages

    Urinary Tract Infection (UTI)

    Uploaded by

    Anonymous iG0DCOf
    A urinary tract infection occurs when bacteria enter the urethra and spreads upwards through the urinary tract. Symptoms include pain or burning during urination, frequent urination with little output, and cloudy or foul smelling urine. UTIs are more common in women due to anatomical differences. Diagnosis involves a urinalysis and urine culture. Treatment focuses on antibiotics and increasing fluid intake to flush out the infection.

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    of 6

    Urinary Tract Infection (UTI)

    What is a urinary tract infection (UTI)?It is an


    infection found within the urinary tract which can be caused by a bacteria (most
    common), virus, or fungus.

    Urinary tract infections can be found anywhere throughout the urinary system such as:

    Lower Urinary System:

     Urethra (Urethritis)
     Bladder (Cystitis)
    Upper Urinary System:

     Ureters (Ureteritis)…usually associated with bladder or kidney infection


     Kidneys (Pyelonephritis)
    *UTIs typically start in the urethra and spread upward to the bladder and can be found
    in both the lower or upper tract. If the infection is not treated promptly and correctly, it
    can spread to the ureters and kidneys. Pyelonephritis is extremely dangerous because
    the infection can enter the bloodstream and lead to sepsis….remember that we learned
    in the kidney and nephron anatomy video that the kidneys are very vascular and work
    closely with the heart.

    When an infection exists in the urinary tract it leads to inflammation of the structure
    involved which leads to pain, spasms, dark/cloudy urine, etc.

    Most at risk for urinary tract infections….women or men?Women!

    Why? The female anatomy! The female urethra is shorter than the males which allows
    for easier migration of an infectious agent to the bladder AND the close proximity of the
    urethra and the rectum increases the chances of the bacteria in the GI tract infecting the
    urinary system (wiping incorrectly…back to front or wearing tight underwear or pants
    etc.).

    Defense systems in place to help prevent Urinary Tract Infections


    *If one of these defense systems becomes compromised, there is an increased risk of a
    UTI developing.

     Physiology of how urine flows downward: This keeps urine flowing out of the
    system and prevents the retention or back flow of urine into the kidneys (hence
    bacteria can be easily flushed out). What structures help with this?
     Urine itself: it is normally sterile and possesses antiseptic qualities that can
    prevent bacteria from sticking to the lining of the bladder. In addition, the acidic
    conditions of the pH and amount of urea concentration can play a role in
    preventing a UTI….however, in some conditions, like uncontrolled diabetes
    mellitus where there are high amounts of glucose in the urine, the urine can act as
    a medium for bacteria growth.
     Lining of the urinary system has immune cells that work to fight off infection…a
    suppressed immune system decreases the cells effectiveness.
     Prostate gland (males): it secretes a fluid that has antimicrobial properties to
    keep bacteria out…in men with enlarged prostates the amount of fluid secreted is
    decreased.
     Normal flora in women: present in and around the vagina are bacteria
    (lactobacilli) that keeps the area around the urethra acidic which prevents bacteria
    from migrating, especially E.coli from the rectum….however, if a woman
    experiences a hormonal change (pregnancy, menopause, birth control usage) the
    flora can be destroyed.
    Causes of Urinary Tract Infection
    “Hard to Void”

    *The most common type of bacteria that causes a UTI is E. coli, which is usually from
    the GI system (rectum).

    Hormone changes: pregnancy, menopause, birth control (changes the normal flora in
    the vagina that normally fights bad bacteria that can migrate into the urethra).

    Antibiotics: changes the normal flora of the body

    Renal Stones: cause blockage..urine stays in kidney and can’t drain

    Diabetes: compromised circulation…immune system not able to work as strong as it


    should to fight the infection, high glucose in the urine: breeding ground for bacteria to
    flourish, bladder doesn’t empty as it should (urinary retention from nerve damage)

    Toiletries: excessive bubble baths, powders, perfumes, especially scented tampons and
    sanitary napkins

    Obstructive prostatic hypertrophy…seen in males with BPH: The urethra which is


    surrounded by the prostate gland becomes squeezed shut from the large prostate
    gland….urine stays in the bladder because the patient can NOT empty it completely,
    and the prostate gland isn’t able to properly secrete that fluid with antimicrobial
    properties.

    Photo credits: ducu59us/shutterstock.com


    Vesicoureteral reflux (VUR): most common in pediatric patients and is when urine from
    the bladder backflows into the kidneys. It is usually a congenital defect to the
    ureterovesical valves that are found between the bladder and ureters. They don’t close
    properly and there is a backflow of urine into the ureters.
    Overextended bladder: bladder is full for long periods of time and the bladder muscles
    become weak which leads to urinary retention. Patients who are immobile are at risk for
    this.

    Indwelling catheters, invasive procedures, intercourse (especially with the usage of


    spermicides), incontinence of the bowel

    Decreased immune system…can’t fight germs (immunosuppressed) and majorly at risk


    for UTIs that are fungal and viral in origin.

    How is a UTI Diagnosed?


    Urinalysis (U/A): assesses for bacteria or WBCs in urine

     Nurse’s role: properly collecting urine sample and educating the patient how to
    do this….WHY? to prevent contamination to the specimen
     It is best to collect the urine when the bladder has been full for about 2-3
    hours. It will be more concentrated….don’t want diluted urine.
     First wipe with an antiseptic wipe
     Void small amount into the toilet
     Then collect the urine (midstream) and fill cup halfway
     Keep the cup a few inches away from the urethra

     How to collect out of a Foley catheter? Use access port (found at the top of the
    tubing…never collect from the Foley collection bag)…..clean access port with
    antiseptic and use needless sterile syringe to withdraw urine.
    Urine culture: to assess what bacteria is causing the UTI…so antibiotics can be
    ordered correctly

    Cystoscopy: assesses the inside of the urethra and bladder (ordered for recurrent
    infections)

    Signs and Symptoms of Urinary Tract Infection


     Pain when voiding (burning)
     Persistent need to void but not a lot is voided or can’t void
     Strong odor to urine that is dark and cloudy (can have blood)
     Cramping in abdomen or pain at the costovertebral angle
     Costovertebral angle is found under the 12th rib and between the spine
    (please watch video above for a demonstration). Lay non-dominate hand flat
    over the angle and make a fist with the dominate hand and firmly thump the
    fist onto the flat hand….if pain is experienced a kidney infection may be
    present (pyelonephritis).

     Spasms of the bladder or urethra


     Fever
     Increased WBC on U/A
    NOTE: In the geriatric population, confusion, sudden increase in falling, and agitation
    are typically seen rather than the typical signs and symptoms above…they are less
    likely to have a fever or pain.

    Nursing Interventions for Urinary Tract Infection


    Assess for signs and symptoms of UTI (catch it before it becomes complicated….many
    patients in the hospital setting are at risk for a UTI)

    Maintain fluid status (intake and output) and monitor that urinary output is at least 30
    cc/hr

    Control pain with nonpharmacological and pharmacology methods:

     Warm sitz bath or heating pad


     Tylenol, NSAIDs, or Pyridium per MD order
     Pyridium “Phenazopyridine”: analgesic that will coat bladder wall and
    urethra to decrease spasms and help with urinary frequency/burning.
    However, that patient will void ORANGE-COLORED urine…this is a normal
    side effect…educate patient about this.
    Monitor for complications (sepsis, renal failure)

    Administer antibiotic medications per MD order… Sulfonamide “Bactrim” (educate


    patient about consuming 2.5 to 3 L of fluid/day to keep urine diluted due to
    crystalluria )…give antibiotic at same time every day to keep blood level constant
    because a decrease in blood levels can decrease the effectiveness of the medication.

     If antibiotics are ordered for treatment along with urine culture…COLLECT URINE
    CULTURE BEFORE starting the first dose of antibiotics
    Encourage the patient to take in 2.5 to 3L of fluid per day. WHY? This keeps the urine
    diluted and helps the system flush out the infection. In addition, if the urine becomes
    concentrated this increases the risk of crystalluria in patients taking sulfonamides like
    Bactrim.

    Encourage frequent voiding at least every 2-3 hours.

    Remove indwelling catheter if present per MD order (remember a major cause of UTI)

    Patient Education for UTI:

     Take all the antibiotics


     Wipe front to back
     Urinate immediately after intercourse
     Avoid tight pants or underwear (wear cotton underwear that is loose fitting)
     Avoid bubble bath, powders, and perfumes in the genital area
     Change sanitary pads often and avoid tampons
     Avoid caffeine and alcohol…irritate bladder
     Every 2-3 hours void

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