Urinary Tract Infections and Sepsis Overview

Study Notes

Urinary Tract Infections (UTIs) and Sepsis

Patient Profile: Often older adults (e.g., 94-year-old female) presenting with confusion and residing in long-term care facilities. Common comorbidities include atrial fibrillation, heart failure, hypertension, hypothyroidism, osteoporosis, and joint pain. May have a history of recurrent UTIs and prior surgical procedures (e.g., exploratory laparotomy in 2003).

UTI Classification

Upper Tract UTI: More serious, affecting the renal parenchyma, pelvis, and ureters. Symptoms include fever, chills, and flank pain. Pyelonephritis is an example, characterized by inflammation of the kidney's parenchyma and collecting ducts.
Lower Tract UTI: Localized to the bladder. Cystitis is an example, involving bladder wall inflammation.
Complicated vs. Uncomplicated UTI: Uncomplicated UTIs involve only the bladder in a normal urinary tract. Complicated UTIs involve factors like urinary obstruction, kidney stones, catheters, diabetes, or recurrent infections.

UTI Etiology and Pathophysiology

Causative Agents: Escherichia coli is a frequent culprit. UTIs account for a significant portion (33%) of gram-negative bacterial sepsis cases. Fungal and parasitic infections can also cause UTIs.
Defense Mechanisms: The body has mechanisms (e.g., acidic urine pH, high urea, glycoproteins) preventing UTI. Unsure about exact functioning here.
Risk Factors: Immunosuppression, diabetes mellitus, antibiotic use, urinary retention, and foreign bodies like catheters.

UTI Assessment and Diagnostics

Urinalysis: Screens for nitrites and white blood cells.
Culture & Sensitivity: Crucial for identification and appropriate antibiotic selection; avoid catheterization if possible.
Imaging: CT scans or intravenous pyelograms for complicated cases.
Symptoms: Urinary frequency, urgency, incontinence, nocturia, nocturnal enuresis, and pain during urination are important clues.
Older Adults: Older patients may lack clear symptoms (e.g., non-localized abdominal discomfort instead of dysuria). Cognitive impairment and absence of fever are potential signs in older individuals.

Collaborative Care

Antibiotics: Uncomplicated cystitis may require 1-3 days of antibiotics (e.g., TMP/SMX, Nitrofurantoin). Complicated UTIs necessitate 7-14 days of treatment (e.g., Ciprofloxacin).
Hospitalization: Necessary for severe cases, particularly those with dehydration or persistent symptoms.

Nursing Management

History: Seek details on previous UTIs, bladder control issues, medications, personal hygiene habits, and dietary intake.
Objective Data: Inspect fever, peculiar urine odor, hematuria (blood in the urine), kidney tenderness, and leukocytosis (elevated white blood cell count).
Nursing Interventions: Promote complete bladder emptying, encourage fluids (33mL/kg of body weight), and emphasize good hygiene (handwashing, using gloves). Avoid bladder irritants (caffeine, alcohol, acidic foods). Provide timely toileting and appropriate temperature management.

Complications: Urosepsis and Sepsis

Urosepsis: A serious systemic infection originating from the urinary tract. It can progress to septic shock.
Sepsis Indicators: Fever (temperature above 38°C or 100.4°F), rapid heart rate (over 90 bpm), increased respiratory rate (more than 20 breaths/min), low blood pressure and elevated white blood cell count (WBC) above the normal range.

Description

Explore the complexities of urinary tract infections (UTIs) and their connection to sepsis, particularly in older adults. This quiz covers classifications of UTIs, symptoms, and the impact of comorbidities. Enhance your understanding of how UTIs can lead to serious complications like sepsis in vulnerable populations.