CASE

PRESENTATION ON
URINARY TRACT
INFECTION
Praty Limbu
201909085
SMCON
 INTRODUCTION
As a part of 2nd year BSc nursing curriculum, I, Praty Limbu, bearing
reg. no 201909085 was posted in female medicine ward where I came
across a patient named Ganga Hangma Subba of 25 years, and is
diagnosed with Urinary Tract Infection.
This assignment gives a brief idea regarding my patient’s identification
data, past and present medical history, disease condition and nursing
care plan.
 • Name: • Monthly income:

IDENTIFICATION DATA
• Age: • Admission date:

• Sex: • Date of operation:

• Marital • Name of
status: operation

• Hospital • Diagnosis:
number:

• I.P number: • Under the

treatment of:

• Address:

• Religion:

• Education:

• Occupation:
CHIEF COMPLAINT
HISTORY OF PRESENT ILLNESS
HISTORY OF PAST ILLNESS
 FAMILY HISTORY
TYPE:
NO. OF MEMBERS:
SUPPORT PERSON:
FAMILY HISTORY OF ILLNESS
 HEALTH FACILITIES NEAR HOME
TYPE:
DISTANCE:
TRANSPORTATION FACILITIES:
 HOUSING
TYPE;
No. of rooms:
Toilet:
Electricity:
Drinking water:
 PERSONAL HISTORY
Personal hygiene:
Diet:
No. of meals per day:
Sleep & rest:
Substance abuse:
Allergies:
 ELIMINATION
Bowel per day:
Urine frequency: During day:
During night:
Mobility & exercise: Walking habits:
Exercise/Activity:
 Investigations

Sl.no Date Name of Normal Reported Remarks

Investigations value Value
 medications

Sl. Trade Pharm Classificatio Dose Frequency

no name a name n
Physical examination
 Vital signs
• Temperature:
• Pulse:
• Respiration:
• Blood pressure:
 Anthropometric measurement
•• Height:
 
• Weight:
• BMI: 
 General appearance
• Nourishment: well nourished/moderately nourished/under nourished
• Body built: Ectomorphic/mesomorphic/endomorphic
• Health: healthy/unhealthy
• Activity: Active/dull/fatigue/lethargic
• PICCLE: Pallor/Icterus/ Cyanosis/Clubbing/Lymphadenopathy/Oedema
 Mental status
• Consciousness: Conscious/unconscious/delirious/talking incoherently
• Look: anxious/worried/depressed/happy
 posture
• Body curve: normal/Lordosis/Kyphosis/Scoliosis
• Range of motion:
 Skin conditions
• Color: normal skin complexion/pallor/jaundice/cyanosis/flusing
• Texture: smooth/dryness/flaking/wrinkling/excessive moisture
• Temperature: normal/warm/cold/clammy
• Lesions: absent/macules/papules/vesicles/wounds
• Injury: cuts/abrasions/scar
 Head & face
• Hair: texture/color
• Scalp: cleanliness/condition of the hair/dandruff/pediculosis/ringworm
infestation/injury
• Face: pale/flushed/puffiness/fatigue/pain/fear/anxiety
• Sinus: frontal/maxillary sinusitis
 neck
• Thyroid gland: normal/enlarged
• Lymph node: normal/enlarged
• External jugular veins: normal/dilated
• Carotid pulse:
 eyes
• Eyebrows: symmetry
• Eye lashes:
• Eye lids: oedema/lesions/ectropion(eversion)/entropion(inversion)
• Eyeballs: sunken/protruded
• Conjunctiva: conjunctivitis/anemia/normal pinkish
• Sclera: normal whitish/jaundice/bleeding
• Cornea & Iris: irregularities/abrasion
• Pupils: dilated/PERRLA(Pupils equally round and reactive to light accommodation)
• Lens: opaque/transparent
• Vision: normal/myopia(short sighted)/hypermetropia(long sighted)
 ears
• External ear: discharge/cerumen/obstruction
• Weber’s test: Lateralization of the sound
• Rinnies test:
Air conduction Bone conduction
Right ear
Left ear
 nose
• External nares: crust/discharge
• Nasal septum: deviated/normal
• Nostril: inflammation/polyps/discharge
 Mouth & pharynx
• Lips: redness/swelling/cyanosis/any abnormalities like cleft lip etc.
• Mouth: halitosis
• Uvula: color/position/any infection
• Teeth: color/dental caries
• Gums: swelling/bleeding/pus formation/gingivitis
• Tongue: glossitis/cyanosis/lesions
• Tonsils: tonsilitis/inflammation
• Throat & Pharynx: sore throat/hoarseness of voice
 chest
• Thorax: shape/symmetry
• Breath sounds:
• Respiratory:
• Heart:
• Heart sound:
• Heart rate:
 abdomen
• Inspection:
• Auscultation: bowel sound
• Percussion: presence of gas/fluid
• Palpation: tenderness/ hepatomegaly/splenomegaly
 extremities
• Range of motion:
• Legs: amputation/fracture/varicose vein/oedema/refles
• Hands: reflexes/amputation/fracture
Back:
Kyphosis/Scoliosis/Lordosis
DISEASE CONDITION
(URINARY TRACT
INFECTION)
 introduction
A urinary tract infection (UTI) is a bacterial infection in 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 year developing
symptoms. UTI is uncommon in men below 60 years of age, but the frequency is
similar in men and women of older age groups
Definition
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.
 classification
Urinary tract infections are classified according to the location, complication and
their natural history.
• According to location:
 Upper UTI: These are much less common and include
 Acute or chronic pyelonephritis: inflammation of renal pelvis.
 Interstitial nephritis: inflammation of the kidney .
 Renal abscesses
 Lower UTI: These are more common and include
 Bacterial cystitis: inflammation of urinary bladder.
 Bacterial prostatitis: inflammation of prostate gland.
 Bacterial urethritis: inflammation of the urethra.
• According to complication
Complicated: UTI with underlying structural, medical or neurologic disease
Uncomplicated: UTI without underlying renal or neurologic disease.
• According to their nature
Initial Infection/1st/Isolated Infection
Recurrent UTI
Unresolved Bacteriuria
Bacterial Persistence
 A N ATO M Y
AND
PHYSIOLOGY
O F U R I N A RY
SYSTEM
 Anatomy of urinary system
The urinary system consists of two kidneys, two ureters, a urinary
bladder, and a urethra. The kidneys alone perform the functions
described and manufacture urine in the process, while the other
organs of the urinary system provide temporary storage reservoirs for
urine or serve as transplantation channels to carry it from one body
region to another.
 The kidneys
• The kidneys, which maintain the purity and constancy of our internal fluids, are
perfect examples of homeostatic organs.
• Location. These small, dark red organs with a kidney-bean shape lie against the
dorsal body wall in a retroperitoneal position (beneath the parietal peritoneum) in
the superior lumbar region; they extend from the T12 to the L3 vertebra, thus
they receive protection from the lower part of the rib cage.
• Positioning. Because it is crowded by the liver, the right kidney is positioned
slightly lower than the left.
• Size. An adult kidney is about 12 cm (5 inches) long, 6 cm (2.5 inches) wide,
and 3 cm  (1 inch) thick, about the size of a large bar of soap.
• Adrenal gland. Atop each kidney is an adrenal gland, which is part of the
endocrine system is a distinctly separate organ functionally.
• Fibrous capsule. A transparent fibrous capsule encloses each
kidney and gives a fresh kidney a glistening appearance.
• Perirenal fat capsule. A fatty mass, the perirenal fat capsule,
surrounds each kidney and acts to cushion it against blows.
• Renal fascia. The renal fascia,
the outermost capsule, anchors the kidney and helps hold it in
place against the muscles of the trunk wall.
• Renal cortex. The outer region, which is light in color, is the renal cortex.
• Renal medulla. Deep to the cortex is a darker, reddish-brown area, the renal
medulla.
• Renal pyramids. The medulla has many basically triangular regions with a
striped appearance, the renal, or medullary pyramids; the broader base of
each pyramid faces toward the cortex while its tip, the apex, points toward the
inner region of the kidney.
• Renal columns. The pyramids are separated by extensions of cortex-like
tissue, the renal columns.
• Renal pelvis. Medial to the hilum is a flat, basinlike cavity, the renal pelvis,
which is continuous with the ureter leaving the hilum.
• Calyces. Extensions of the pelvis, calyces, form cup-shaped areas that
enclose the tips of the pyramid and collect urine, which continuously
drains from the tips of the pyramids into the renal pelvis.
• Renal artery. The arterial supply of each kidney is the renal artery, which
divides into segmental arteries as it approaches the hilum, and each
segmental artery gives off several branches called interlobar arteries.
• Arcuate arteries. At the cortex-medulla junction, interlobar arteries give
off arcuate arteries, which curve over the medullary pyramids.
• Cortical radiate arteries. Small cortical radiate arteries then branch off
the arcuate arteries and run outward to supply the cortical tissue.
 nephrons
• Nephrons. Each kidney contains over a million tiny structures called
nephrons, and they are responsible for forming urine.
• Glomerulus. One of the main structures of a nephron, a glomerulus is a knot
of capillaries.
• Renal tubule. Another one of the main structures in a nephron is the renal
tubule.
• Bowman’s capsule. The closed end of the renal tubule is enlarged and cup-
shaped and completely surrounds the glomerulus, and it is called
the glomerular or Bowman’s capsule.
• Podocytes. The inner layer of the capsule is made up of highly
modified octopus-like cells called podocytes.
• Foot processes. Podocytes have long branching processes called foot processes that
intertwine with one another and cling to the glomerulus.
• Collecting duct. As the tubule extends from the glomerular capsule, it coils and twists
before forming a hairpin loop and then again becomes coiled and twisted before
entering a collecting tubule called the collecting duct, which receives urine from many
nephrons.
• Proximal convoluted tubule. This is the part of the tubule that is near to the
glomerular capsule.
• Loop of Henle. The loop of Henle is the hairpin loop following the proximal
convoluted tubule.
• Distal convoluted tubule. After the loop of Henle, the tubule continues to coil and
twist before the collecting duct, and this part is called the distal convoluted tubule.
• Cortical nephrons. Most nephrons are called cortical nephrons because they
are located almost entirely within the cortex.
• Juxtamedullary nephrons. In a few cases, the nephrons are called
juxtamedullary nephrons because they are situated next to the cortex-
medullary junction, and their loops of Henle dip deep into the medulla.
• Afferent arteriole. The afferent arteriole, which arises from a cortical radiate
artery, is the “feeder vessel”.
• Efferent arteriole. The efferent arteriole receives blood that has passed
through the glomerulus.
• Peritubular capillaries. They arise from the efferent arteriole that drains the
glomerulus.
 ureters
The ureters do play an active role in urine transport.
• Size. The ureters are two slender tubes each 25 to 30 cm (10 to 12
inches) long and 6 mm (1/4 inch) in diameter.
• Location. Each ureter runs behind the peritoneum from the renal hilum
to the posterior aspect of the bladder, which it enters at a slight angle.
• Function. Essentially, the ureters are passageways that carry urine
from the kidneys to the bladder through contraction of the smooth
muscle layers in their walls that propel urine into the bladder by
peristalsis and is prevented from flowing back by small valve-like folds
of bladder mucosa that flap over the ureter openings.
 Urinary bladder
• The urinary bladder is a smooth, collapsible, muscular sac that stores urine
temporarily.
• Location. It is located retroperitoneally in the pelvis just posterior to the
symphysis pubis.
• Function. The detrusor muscles and the transitional epithelium both make the
bladder uniquely suited for its function of urine storage.
• Trigone. The smooth triangular region of the bladder base outlined by these
three openings is called the trigone, where infections tend to persist.
• Detrusor muscles. The bladder wall contains three layers of smooth muscle,
collectively called the detrusor muscle, and its mucosa is a special type of
epithelium, transitional epithelium.
 urethra
• The urethra is a thin-walled tube that carries urine by peristalsis from the bladder to the
outside of the body.
• Internal urethral sphincter. At the bladder-urethral junction, a thickening of the smooth
muscle forms the internal urethral sphincter, an involuntary sphincter that keeps the
urethra closed when the urine is not being passed.
• External urethral sphincter. A second sphincter, the external urethral sphincter, is
fashioned by skeletal muscle as the urethra passes through the pelvic floor and
is voluntarily controlled.
• Female urethra. The female urethra is about 3 to 4 cm (1 1/2 inches) long, and its external
orifice, or opening, lies anteriorly to the vaginal opening.
• Male urethra. In me, the urethra is approximately 20 cm (8 inches) long and has three
named regions: the prostatic, membranous, and spongy (penile) urethrae; it opens at
the tip of the penis after traveling down its length.
 Blood supply
• The kidneys are supplied blood via renal arteries.
• Ureter: Upper end receives blood from the renal arteries. The middle part may
receive branches from the abdominal aorta, the testicular or ovarian arteries, and
the common iliac arteries. In the pelvic cavity, the ureters are supplied by one or
more arteries from the branches of the internal iliac arteries and inferior vesical
arteries.
• The bladder receives blood by the vesical arteries.
• Prostatic urethra-supplied by the inferior vesical artery. Membranous urethra-
supplied by the bulbourethral artery.
 Pathophysiology
• Urinary tract above urethra is sterile. ( normal voiding with complete
emptying of bladder, peristaltic activity)
• Antibacterial characteristics of urine maintained by acidic pH
maintained at <6.0, high urea concentration and abundant
glycoproteins interfere with bacterial growth.
• Alteration in these increases risk factor for UTI.
 Etiological factors
• Common microorganisms:
• Escherichia coli- 80%
• Enterococcus
• Klebsiella
• Enterobacter
• Proteus
• Pseudomonas
• Staphylococcus
• Serratia
• Candida albicans- received broad spectrum antibiotics and have an indwelling
catheter
• Pre-disposing Factors:
• Factors increasing urinary stasis- Intrinsic obstruction, extrinsic obstruction,
urinary retention, renal impairment.
• Foreign bodies- urinary tract calculi, catheters, urinary tract instrumentation.
• Anatomic factors- congenital defects, fistula, shorter female urethra, obesity
• Factors compromising Immune response- aging, HIV, DM
• Functional disorders- constipation, voiding dysfunction
• Other factors- pregnancy, hypoestrogenic state, multiple sex
partners( women), use of spermicidal agents, poor personal hygiene,
menopause.
• Hospital acquired or nosocomial infections
• Catheter aquired UTI
• UTI during menopause:
• Before menopause, glycogen rich epithelial cells and the normal
bacterial flora Lactobacillus keep the vaginal ph acidic ( 3.5-4.5).
• This acidic environment prevent growth of organisms
• In postmenopausal women, lower estrogen levels cause vaginal
atrophy, decrease in vaginal lactobacilli and an increase in vaginal
pH.
 Risk factors
Urinary tract infections are common in
women, and many women experience
more than one infection during their
lifetimes. Risk factors specific to women
for UTIs include:
• Female anatomy
• Sexual activity
• Certain types of birth control
• Menopause
Other risk factors for UTIs include:
• Urinary tract abnormalities
• Blockages in the urinary tract
• A suppressed urinary system
• Catheter use
• A recent urinary procedure
 Clinical manifestations
Book picture Patient picture
• Burning on urination
• Urinary frequency
• Urgency
• Nocturia
• Incontinence
• Suprapubic or pelvic pain
• Hematuria
• Back pain
 Diagnostic evaluation
Book picture Patient picture
History taking
Physical examination
Urinalysis
Urine culture
Cystoscopy (if indicated)
IVP (Intravenous pyelogram) (if indicated)
Clean catch sample
Ultrasound
X-rays
Voiding cystourethrogram
Computed topography (CT)

Blood Culture

STD tests
Urinalysis: The most important initial study in the evaluation of a
patient suspected of having UTI is urinalysis.
Urine culture: It is useful for documenting a UTI and identifying the
specific organism present.
Ultrasound: It is a non-invasive imaging test that can be used to
screen for hydronephrosis(obstruction of the flow of urine).
X-ray: special x-ray can be used to screen for structural
abnormalities, urethral narrowing, or incomplete emptying of
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.
Intravenous pyelogram: 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.
Cystoscopy: It 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): CT scans may be used to check for kidney stone 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.
STDs Test: Tests for STDs may be performed because most of the UTIs may be
transmitted sexually.
Management of
UTI
 Medical management
Management of UTIs typically involves pharmacologic therapy and patient
education.
Acute pharmacologic therapy:  The ideal medication for the treatment of
UTI is an antibacterial agent that eradicates bacteria from the urinary
tract with minimal effects on fecal and vaginal flora.
Long-term pharmacologic therapy: Reinfection with new bacteria is
the reason for recurrence, and these patients with recurrence are
instructed to begin treatment on their own whenever symptoms occur, to
contact their physician only when symptoms persist.
 Medications

Book picture Patient picture

• Nitrofurantoin (Macrodantin, Furandantin)
• Cephalexin(Keflex)
• Cefadroxil (Duricef, Ultracef)
• Ciprofloxacin(Cipro)
• Ofloxacin(Floxin)
• Norfloxacin (Noroxin)
• Co-trimoxazole (Bactrim, Septra)
• Phenazopyridine(Pyridium)
 Surgical management
a) Surgical removal of renal calculi, bladder calculi.
b) Urethroplasty
c) Reimplantation of ureters if VUR is present.
 Nursing management
Nursing assessment:
 History of pertinent signs and symptoms is obtained from the patient with a
suspected UTI.
 The presence of pain, frequency, urgency, hesitancy, and changes in urine are
assessed, documented, and reported.
 The patient’s usual pattern of voiding is assessed to detect factors that may
predispose them to UTI.
 Infrequent emptying of bladder, the association of symptoms of UTI with
sexual intercourse, contraceptive practices, and personal hygiene are assessed.
 The patient’s knowledge about prescribed antimicrobial medications
and preventive health care measures is also assessed.
 Also, the urine is assessed for volume, color, concentration,
cloudiness, and odor---- all of which are altered by presence of
bacteria in urine.
 Need of the patient
• To improve pain status of the patient.
• To improve elimination pattern.
• To improve hyperthermia(increased temperature).
• To improve the risk for infection.
• To improve sleep pattern of the patient.
• To improve knowledge of the patient about the disease condition.
Nursing diagnosis
• Acute pain related to infection within the urinary tract as evidenced
by pain on urination, suprapubic pain and bladder spasms.
• Impaired urinary elimination related to UTI as evidenced by urgency,
frequency, incontinence or hematuria and verbalization of concerned
over altered elimination pattern.
• Hyperthermia related to infection as evidenced by elevation in
temperature, tachycardia, chills and malaise.
• Risk of infection related to lack of knowledge regarding measwures
to prevent recurrence.
• Deficient knowledge related to treatment of UTI as evidenced by
multiple questions and verbalizing wrong information.
• Disturbed sleep pattern related to pain and nocturia as evidenced by
restlessness and irritability.
 NURSING
CARE PLAN
Assessment Nursing diagnosis Goal Planning Rationale Implementation Evaluation
Subjective  Acute pain To relieve • Assess the onset, duration • This will help us to • The onset, duration After 7 days of
assessment: related to pain and and level of pain. determine the choice and level of pain was nursing
infection within provide of intervention. assessed. intervention
the urinary tract comfort. patient reported
as evidenced by no pain in
pain on urination, • Encourage increased fluid • Increased hydration • The patient was urination, no
suprapubic pain intake. flushes bacteria and encouraged to pain in
and bladder toxins. increase the fluid suprapubic
spasms. intake. region.

• Provide comfort measures • Promotes relaxation, • The patient was

like back rub, helping refocuses attention taught deep
patient assume position of and may enhance breathing exercises,
comfort. Suggest use of coping abilities. and relaxation
relaxation techniques, and techniques.
deep breathing exercises.

• Administer analgesic drugs. • To control the pain.

• Analgesics were
administered.
Assessment Nursing diagnosis Goal Planning Rationale Implementation Evaluation

Subjective data  Impaired urinary • To return • Assess the patient’s • To determine • The patient’s After 7 days of
elimination related the normal pattern of interventions. pattern of nursing
to UTI as evidenced urinary elimination. elimination was intervention
by urgency, pattern. • Encourage the patient • To support the renal assessed. the patient
frequency, to drink as much as blood flow and to flush • The patient was reported in
incontinence or possible and reduce bacteria from urinary encouraged to reduction in
hematuria and drinking in the tract. drink water. frequency and
verbalization of afternoon. • Cause it significantly urgency.
concerned over • Encourage the patient lowers the number of • The patient was
altered urinary to urinate every 2-3 bacteria in urine, asked to urinate .
elimination. hours and when it reduced urine status
suddenly felt. and prevent recurrence
of infection.

• Provide/encourage • Reduce the risk of • Perineal care was

the patient to do contamination or provided, and the
perineal care. infection increased. patient was
encouraged to
follow the steps as
taught.
Assessment Nursing diagnosis Goal Planning Rationale Implementation Evaluation

Subjective  Hyperthermia • To bring the • Assess any • Increased body • The signs for increased After 7 days of
data related to body complaints or signs temperature will body temperature was nursing
infection as temperature of increased body show a variety of assessed. intervention the
evidenced by back to normal. temperature symptoms such as reported no
elevation in changes. red eyes and the fever, no
temperature, body will feel warm. palpable heat
tachycardia, • Observation of vital • To determine and the vitals
chills and signs, especially interventions. • Vital signs was taken. were within the
malaise. temperature as normal limits.
indicated.

• Warm water
compression on the • To stimulate the • Warm water
forehead and both hypothalamus to the compression was
axilla. temperature control given.
center.
• Collaboration of
antipyretic drugs. • To control the fever.

• Antipyretic
drug(Paracetamol) was
administered.
 complications
When treated promptly and properly, lower urinary tract infections rarely lead to any
complications. But left untreated, a urinary tract infection can have serious
consequences. Complications of UTI may include:
• Recurrent infections, especially in women who experience two or more UTIs in a
six-month period or four or more within a year.
• Permanent kidney damage from an acute or chronic kidney infection
(pyelonephritis) due to an untreated UTI.
• Increased risk in pregnant women of delivering low birth weight or premature
infants.
• Urethral narrowing (stricture) in men from recurrent urethritis, previously seen
with gonococcal urethritis.
• Sepsis, a potentially life-threatening complication of infection, especially if the
infection works its way up the urinary tract to kidneys.
prognosis
Urinary tract infections (UTIs) typically respond very well
to treatment. A UTI can be uncomfortable before the
start of treatment, but once the healthcare provider
identifies the type of bacteria and prescribes the right
antibiotic medication, the symptoms should improve
quickly. It’s important to keep taking the medication for
the entire amount of time the healthcare provider
prescribed. If you have frequent UTIs or if the symptoms
aren’t improving, the provider may test to see if it’s an
antibiotic-resistant infection. These are more complicated
infections to treat and may require intravenous
antibiotics (through an IV) or alternative treatments.
 Progress note
DAY 1 DAY 2 DAY 3
Temperature
Pulse
Respiration
Blood pressure

DAY 1
DAY 2
DAY 3
 Health education
Hygiene
• Shower rather than bathe in the tub because bacteria in the bathwater may enter
the urethra.
• After each bowel movement , clean the perineum and urethral meatus from front
to back. This will help reduce concentrations of pathogen at the urethral opening
and, in women, the vaginal opening.
Fluid intake
• Drink liberal amounts of fluids to flush out bacteria.
• Avoid coffee, tea. Colas, alcohol, and other fluids that are urinary tract irritants.
Voiding habits
• Void every 2-3 hours during the day, and completely empty the bladder. This
prevents overdistension of the bladder and compromised blood supply to the
bladder wall. Both predispose the patient to urinary tract infection.
• Precautions expressly for women include voiding immediately after sexual
intercourse.
Interventions
• Take medications exactly as prescribe4d. Special timing of administration may be
required.
• If bacteria continue to appear in the urine, long-term antimicrobial therapy may be
required to prevent colonization of the periurethral area and recurrence of
infection.
• For recurrent infection, consider acidification of the urine through ascorbic acid
(vitamin c), 1000 mg daily, or cranberry juice.
• If prescribed, test urine for presence of bacteria following instructions.
• Notify the physician if fever occurs or if signs and symptoms persist.
• Consult the physician regularly for follow up.
summary