Urinary Tract Infections (UTIs)

• Urinary tract infections (UTIs) are caused by bacteria, fungi, or parasites, with bacteria being the most common culprit.
• UTIs are more prevalent in women compared to men.
• Annually, over 100,000 individuals are hospitalized due to UTIs.
• The location of a UTI determines whether it is classified as upper or lower.
• Upper urinary tract infections usually cause fever, chills, and flank pain.
• Lower urinary tract infections usually don't have systemic symptoms.
• UTIs can also be classified as uncomplicated or complicated.

Types of UTIs

• Pyelonephritis involves inflammation of the renal parenchyma and collecting system.
• Cystitis involves inflammation of the bladder.
• Urethritis involves inflammation of the urethra.
• Urosepsis involves the systemic spread of a UTI, which is life-threatening and requires emergency treatment.
• The urinary tract above the urethra is normally sterile.
• Mechanical and physiological defense mechanisms maintain sterility
• Disruption of the defense mechanisms can increase the chances of developing a UTI.
• Most organisms causing UTIs originate in the perineum and enter through the urethra and are typically gram-negative bacilli.

UTI Risk Factors

• Urologic instrumentation
• Conditions that increase urinary stasis.
• Sexual intercourse (may predispose women).
• Poor personal hygiene.
• Fistula formation.
• Conditions that decrease a person's immune response.
• Menopause
• Short female urethra.
• Poor hygiene after sexual intercourse.
• Use of certain types of birth control, such as diaphragms.
• Catheter use.
• Inadequate water intake.
• Recurrent UTIs.
• Holding urine.

Clinical Manifestations

• Frequent urination
• Dysuria (painful urination)
• Urgency
• Suprapubic discomfort
• Hematuria or cloudy urine with sediment
• Systemic manifestations, including flank pain, fever, and chills.

UTI Diagnostic Tests

• History and physical examination
• Clean-catch urine sample
• Microscopic Urinalysis, checking nitrite, WBC (white blood cells) and leukocyte esterase levels
• Urine culture followed by sensitivity testing
• Computed tomography (CT) urogram or ultrasound is indicated if obstruction is expected, or patient has severe reoccurring UTIs

Collaborative Care

• UTI antibiotic therapy
• First-line uncomplicated UTI drugs: trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim, Septra, Macrodantin, and Monurol).
• Other antibiotics for uncomplicated UTIs: ampicillin, amoxicillin, and cephalosporins.
• UTI's caused by Complicated fluroquinolones (Cipro, Levaquin, Noroxin, Floxin, and Tequin)
• UTIs due to a fungus: fluconazole (Diflucan).
• Urinary analgesics (e.g., oral phenazopyridine like Azo standard or Pyridium) can reduce discomfort.

Nursing Management

• Health history, including allergies
• Physical examination, focusing on elimination patterns.
• Health management (urinary hygiene, sexuality, diet, etc).
• Review of medications
• Review of diagnostic findings
• Identifying those at risk for UTIs
• Health promotion activities like emptying the bladder completely, wiping the perineal area from front to back, drinking adequate liquids each day
• Promoting the intake of cranberry juice or cranberry tablets
• Use Aseptic technique when dealing with catheterization and remove indwelling catheters as soon as possible
• Perineal hygiene for hospitalized patients

Nursing Implementation

• Acute intervention involves adequate fluid intake and avoidance of bladder irritants like caffeine, citrus juices, chocolate, and spicy foods.
• Heat to the suprapubic area or lower back for acute pain.
• Instruct patients to finish the full course of medication.
• Ambulatory and home care involves patients adhering to prescribed drug regimens.
• Adequate fluid intake accompanied by regular voiding (do not hold urine).
• Urinating before and after intercourse
• Follow up care if symptoms do not subside

NCLEX Questions & Answers

• Question: A client asks, "How did I get this urinary tract infection?"
• Answer: In most instances, cystitis is caused by an ascending infection from the urethra.
• Question: When assessing a patient who has a lower urinary tract infection (UTI), the nurse should initially ask about what?
• Answer: Pain with urination.
• Question: A nurse is teaching a client in the emergency department about a new diagnosis of a urinary tract infection. Which intervention to be followed should the nurse include?
• Answer: Drink at least eight glasses of water a day.