Urinary Tract Infections: Causes, Symptoms, and Treatment - PDF

Module 3 health and healing **[Infectious & Inflammatory disorders of the urinary and renal systems:]** **Urinary tract infection (UTI)** - 2^nd^ most common bacterial disease - most common bacterial infection in women - recurrent UTI's are one of the most common bacterial infections in...

Module 3 health and healing **[Infectious & Inflammatory disorders of the urinary and renal systems:]** **Urinary tract infection (UTI)** - 2^nd^ most common bacterial disease - most common bacterial infection in women - recurrent UTI's are one of the most common bacterial infections in women - antibiotic resistance makes treatment and prevention of UTI's challenging - E. coli is the most common pathogen causing UTI - Fungal and Parasitic infections are less common Human Urinary System Diagram **Urinary tract infection (UTI)** Classification systems: - According to the location within the urinary system, upper or lower UTI - Upper involves: renal parenchyma, renal pelvis and ureters typically causes complicated UTI - Lower Inolves: bacteria confined, uncomplicated UTI, inflammation of bladder and urethra - For example; pyelonephritis, cystitis, urethritis - Infections can be complicated or uncomplicated - Complicated infections can cause flu like symptoms and symptoms that affect the whole body - Uncomplicated infections include symptoms such as: painful urination, frequent urination, sudden urge to urinate, cloudy urine, etc - **Initial infection:** uncomplicated uti in a person who has never had one or who experiences one with many years passing between infections - **Recurrent UTI:** reinfection in a person who experienced a previous infection that was successfully eradicated, often getting infections - **Unresolved bacteriuria:** when bacteria are initially resistant to the antibiotic used to treat an infection or when the antibiotic fails - **Bacterial persistence:** when bacteria develop resistance - Use of diaphragms and spermicides is thought to increase risk of periurethral colonization with gram-negative bacteria (E. Coli) by altering normal flora. This increased presence of non-resident bacteria can result in infection - Sexually active women are especially prone to urinary tract infections. Urethral massage, which occurs during intercourse, can introduce bacteria colonized in the urethra into the bladder. Because of the proximity of the urethral orifice to the anus, the urethra is prone to colonization with gram-negative bacilli (E. Coli), which are responsible for most urinary tract infections. With sexual activity, measures can be taken to help prevent urinary tract infection. - Recurrent urinary tract infections are common, especially in women. This information is important to determine so that previously effective treatments can be considered - When a urinary tract infection is present, it is important to check for indications of kidney involvement. Flank pain could indicate that infection has ascended into the kidney. Whether or not flank pain is present should be determined - Hematuria (blood in the urine) often occurs with urinary tract infection because of irritation of the bladder lining. Whether or not hematuria is present should be determined [Etiology and Pathophysiology] - the urinary tract above the urethra is normally sterile - several physiological and mechanical defence mechanisms assist in maintain sterility and preventing UTI's. these defences include 1) normal voiding with complete emptying of bladder 2) normal antibacterial capability of the bladder mucosa and urine 3) ureterovesical junction (UVJ) competence 4) peristaltic activity that propels urine toward the bladder. [Clinical manifestations] Lower: - dysuria (difficulty voiding) - hesitancy - intermittency - painful urination - postvoid dribbling - urinary retention - weak urinary stream - foul, cloudy urine - urge to urinate - lower abdominal pain Upper: - pain in the side, lower back or around genitals - a high temperature - shivering and chills - nausea/vomiting - flank pain - burning whilst urinating - confusion - urgency/frequency - mental changes - flushed skin - incontinence [Diagnostic studies] - dipstick and microscopic urinalysis - urine culture (midstream technique or catheterization or suprapubic needle aspiration - Intravenous pyelogram (IVP) or abdominal computed tomographic (CT) [Nursing management ] - Antimicrobial therapy - Patient education- adequate fluid intake, hygiene - Nursing assessment **Subjective:** previous utis, pregnancy, recent urological instrumentation, urinary frequency, urgency, nocturia, pain **Objective:** hematuria, foul smell, urinalysis positive for bacteria, pyuria, RBCS and WBCS, positive culture - Nursing diagnosis example: Inadequate urinary elimination resulting from multiple causality ( Effects of UTI ) - Goals: patient will have relief of LUTS, prevention of upper tract involvement, prevention of recurrence - Nursing Implementation: health promotion, identify at risk individuals, education, acute intervention, ambulatory and home care ***[Acute Pyelonephritis]*** [Etiology and pathophysiology] - Pyelonephritis- inflammation of the renal pelvis and kidney - Urosepsis- systemic infection arising from a urological source, can lead to septic shock and death if untreated - Most common cause is a bacterial infection - Recurring episodes of pyelonephritis can lead to chronic pyelonephritis - Commonly starts in the renal medulla and spreads to the adjacent cortex [Clinical Manifestations and Diagnostic studies] - vary from mild fatigue to the sudden onset of chills, fever, vomiting, malaise, flank pain, and the LUTS characteristic of cystitis - costovertebral tenderness on affected side - urinalysis, CBC, urine culture, blood cultures, ultrasound of urinary system [Interprofessional care and Medication therapy] - mild symptoms- outpatient basis with antibiotics - severe infections- require hospital admission [Nursing assessment and Nursing diagnosis] - include but are not limited to those for a client with a UTI - goals include: relief of pain, no complications, normal body temperature, normal renal function, no recurrence of symptoms - health promotion (similar to those for cystitis) - acute intervention and home care includes: antibiotic therapy, adequate water intake, patient education, follow up urine culture ***[Chronic Pyelonephritis]*** - A term used to describe a kidney that has become\ shrunken and has lost function owing to scarring or\ fibrosis - It usually occurs as the outcome of recurring infections\ involving the upper urinary tract - Diagnosed by radiological imaging and histological\ testing as opposed to an assessment of clinical features - Often progresses to end-stage renal disease when both\ kidneys are involved ***[Urethritis]*** inflammation of the urethra **Causes:** - Bacterial or viral infection - Trichomonas and monilial infection (especially in women) - Chlamydia - Gonorrhea (especially in men) **Symptoms:** - LUTS, similar to cystitis **Diagnosis & Treatment:** - Split urine cultures or any urethral discharge - Difficult to diagnose in women - Treatment includes identifying and treating the cause - Providing symptomatic relief - Sulphamethoxazole or nitrofurantoin are commonly prescribed to treat condition ***[Immunological disorders of the kidney]*** **[Glomerulonephritis]** - An immune-related inflammation of the glomeruli - Characterized by proteinuria, hematuria, decreased urine production and edema - Affects both kidneys equally - Clinical manifestations include hematuria, proteinuria and elevated BUN and creatinine **[Acute post-streptococcal glomerulonephritis]** - Most common in children and young adults - Develops 5-21 days after an infection of the pharynx or the skin - Clinical manifestations include generalized body edema, hypertension, oliguria, hematuria with a smoky or rusty appearance and proteinuria - Diagnostic studies include a complete history and physical exam, lab studies to determine presence or history of group A β-hemolytic streptococcus in a throat or skin lesion - More than 95% of patients recover completely - Dipstick and urine sediment microscopy will reveal presence of erythrocytes in a significant number - Management focuses on symptomatic relief **[Goodpasture's syndrome]** - An autoimmune disease characterized by circulating antibodies against glomerular and alveolar basement membranes - Damage to the kidneys and lungs results when binding of the antibody causes an inflammatory reaction mediated by complement activation - Rare disease- mostly seen in young male smokers - Clinical manifestations include hemoptysis, pulmonary insufficiency, crackles, wheezes, renal involvement with hematuria, renal failure, weakness, pallor and anemia, pulmonary hemorrhage usually occurs - Diagnosis- circulating serum anti-glomerular basement membrane antibodies - Immunosuppressive therapy and transplantation techniques - Management consists of corticosteroids, immunosuppressive medications, plasmapheresis, and dialysis - Abnormal diagnostic findings include low hematocrit and hemoglobin levels, elevated BUN and creatinine levels, hematuria and proteinuria [\ ] - Protein and phosphate restrictions may slow the rate of kidney disease - Congenital or acquired - Obstructions may be a result of intrinsic or extrinsic or functional causes - Damage from urinary tract obstruction affects the system above the level of obstruction [Nephrotic Syndrome] - A clinical course that can be associated with a number of disease conditions - Common causes include primary glomerular disease, diabetes, lupus, strep, syphilis, hepatitis, Hodgkins, leukemia, heroin, allergens - Manifestations include peripheral edema, massive proteinuria, dyslipidemia and hypoalbuminemia - Characteristic blood chemistries Include decreased serum albumin, decreased serum protein, and elevated serum cholesterol - Patients with nephrotic syndrome have the potential to become malnourished or anorexic, serving small frequent meals may encourage better dietary intake A close-up of a medical information Description automatically generated - Calculus-abnormal stone formed in body tissues by an accumulation of mineral salts - 5 major categories of stones 1) calcium phosphate 2) calcium oxalate 3) uric acid 4) cystine 5) struvite (magnesium-ammonium phosphate) - Clinical manifestations include abdominal or flank pain, hematuria and renal colic - Urinalysis, urine culture, IVP, retrograde pyelogram, ultrasound, cystoscopy - Stones \>4mm are unlikely to pass on their own - Cystoscopy- removes small stones located in bladder - Cystolitholapaxy- removes larger stones - Lithotripsy- uses sound waves to breakdown renal stones that can be eliminated from the urinary tract - Pyelolithotomy- incision into the renal pelvis to remove a stone - Ureterlithotomy- stone is located in ureter - Cystomy- bladder calculi - Nutritional therapy includes drinking adequate water and limiting oxalate-rich foods A close-up of a medical report Description automatically generated **[Genetic disorders of the urinary and renal systems:]** [Polycystic Kidney Disease (PKD)] - One of the most common genetic diseases in Canada - involves both kidneys - Occurs in males and females - the cortex and medulla are filled with cysts that enlarge and destroy surrounding tissue by compression - Usually progresses to end-stage renal failure - Symptoms appear when cysts enlarge - Early symptoms include abdominal or flank pain, palpable biltateral enlarged kidneys - Hematuria, UTI and HTN - Nursing management is the same as for end-stage renal disease A close-up of a medical report Description automatically generatedA diagram of the internal organs of the human body Description automatically generatedA diagram of urinary bladder Description automatically generatedA white card with black text Description automatically generatedA close-up of a medical report Description automatically generated