MS12.pdf

10/19/23, 3:41 AM Realizeit for Student Assessment and Diagnostic Findings Results of various tests, such as bacterial colony counts, cellular studies, and urine cultures, help confirm the diagnosis of UTI. In an uncomplicated UTI, the strain of bacteria determines the antibiotic of choice (Norris...

10/19/23, 3:41 AM Realizeit for Student Assessment and Diagnostic Findings Results of various tests, such as bacterial colony counts, cellular studies, and urine cultures, help confirm the diagnosis of UTI. In an uncomplicated UTI, the strain of bacteria determines the antibiotic of choice (Norris, 2019). Urine Cultures Urine cultures are useful for documenting a UTI and identifying the specific organism present. UTI is diagnosed by bacteria in the urine culture. A colony count greater than 100,000 CFU/mL of urine on a clean-catch midstream or catheterized specimen indicates infection (Fischbach & Fischbach, 2018). However, symptoms of UTI and subsequent sepsis have occurred with lower bacterial colony counts. The presence of any bacteria in specimens obtained by suprapubic needle aspiration of the urinary bladder, straight catheterization (insertion of a tube into the urinary bladder), or during surgery or cystoscopy is considered clinically significant (Fischbach & Fischbach, 2018). The following groups of patients should have urine cultures obtained when bacteriuria is present (Fischbach & Fischbach, 2018; Norris, 2019): All children All men (because of the likelihood of structural or functional abnormalities) Patients who have been recently hospitalized or who live in long-term care facilities Patients who have undergone recent instrumentation (including catheterization) of the urinary tract Patients with diabetes Patients with prolonged or persistent symptoms Patients with three or more UTIs in the previous year Women who are postmenopausal Women who are pregnant Women who are sexually active Women who have new sexual partners Women with a history of compromised immune function or renal problems Cellular Studies Microscopic hematuria is present in about half of patients with an acute UTI. Pyuria (white blood cells [WBCs] in the urine) occurs in all patients with UTI; however, it is not specific for bacterial infection. Pyuria can also be seen with renal calculi, interstitial nephritis, and renal tuberculosis. Other Studies A multiple-test dipstick often includes testing for WBCs, known as the leukocyte esterase test, and nitrite testing (Norris, 2019). Tests for sexually transmitted infections may be performed because acute urethritis caused by sexually transmitted organisms (i.e., Chlamydia trachomatis, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 1/5 10/19/23, 3:41 AM Realizeit for Student Neisseria gonorrhoeae, herpes simplex) or acute vaginitis infections (caused by Trichomonas or Candida species) may be responsible for symptoms similar to those of UTIs. X-ray images, computed tomography (CT) scan, ultrasonography, and kidney scans are useful diagnostic tools. A CT scan may detect pyelonephritis or abscesses. Ultrasonography and kidney scans are extremely sensitive for detecting obstruction, abscesses, tumors, and cysts (Norris, 2019). Medical Management Management of UTIs typically involves pharmacologic therapy and patient education. Various prescribed medication regimens are used to treat UTI. The American Urological Association (AUA) guidelines for treatment of UTIs, particularly for recurrent uncomplicated UTIs in women, guide medical management (AUA, 2019a, 2019b). Acute Pharmacologic Therapy The ideal medication for treatment of UTI in women is an antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora, thereby minimizing the incidence of vaginal yeast infections. The antibacterial agent should be affordable and should have few adverse effects and low resistance. Because the organism in initial, uncomplicated UTIs in women is most likely E. coli or other fecal flora, the agent should be effective against these organisms. Various treatment regimens have been successful in treating uncomplicated lower UTIs in women: single-dose administration, short-course (3-day) regimens, or 7-day regimens (Freeman et al., 2017). The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Medications commonly used to treat UTIs are listed in Table 49-1. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Longer medication courses are indicated for men, pregnant women, and women with pyelonephritis and other types of complicated UTIs. Men with UTIs should be evaluated for possible prostatitis (Eliopoulos, 2018). Hospitalization and intravenous (IV) antibiotics are occasionally necessary (Freeman et al., 2017). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 2/5 10/19/23, 3:41 AM Realizeit for Student Nursing Process The Patient With a Lower Urinary Tract Infection Nursing care of the patient with a lower UTI focuses on treating the underlying infection and preventing a recurrence. Assessment A 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 the bladder, the association of symptoms of UTI with penile-vaginal intercourse, contraceptive practices, and personal hygiene are assessed. The patient’s knowledge about prescribed antimicrobial medications and preventive health care measures is also assessed. In addition, the urine is assessed for volume, color, concentration, cloudiness, and odor—all of which are altered by bacteria in the urinary tract. Patients need to be asked specifically about the use of complementary and alternative medicine (CAM) therapies. Women with interstitial cystitis (inflammation of the bladder wall) use both complementary and conventional therapies. CAM therapies reported include behavioral therapy, physical therapy, stress reduction, and dietary manipulation (Oh-oka, 2017). Clinical efficacy was reported in a year-long clinical trial of intensive dietary manipulation (Oh-oka, 2017). Diagnosis NURSING DIAGNOSES Based on the assessment data, nursing diagnoses may include the following: Acute pain associated with infection within the urinary tract Lack of knowledge about factors predisposing the patient to infection and recurrence, detection and prevention of recurrence, and pharmacologic therapy COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS Potential complications may include the following: Sepsis (urosepsis) The long term result of either extensive infective or inflammatory processes have the potential to result in either acute kidney injury or chronic kidney disease. Planning and Goals Major goals for the patient may include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 3/5 10/19/23, 3:41 AM Realizeit for Student Nursing Interventions RELIEVING PAIN The pain associated with a UTI is quickly relieved once effective antimicrobial therapy is initiated. Antispasmodic agents may also be useful in relieving bladder irritability and pain. Analgesic agents and the application of heat to the perineum help relieve pain and spasm. The patient is encouraged to drink liberal amounts of fluids (water and cranberry juice are the best choices) to promote renal blood flow and to flush the bacteria from the urinary tract. Urinary tract irritants (e.g., coffee, tea, citrus, spices, colas, alcohol) should be avoided. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely, because doing so can lower urine bacterial counts, reduce urinary stasis, and prevent reinfection (Wu, Grealish, Moyle, et al., 2020). MONITORING AND MANAGING POTENTIAL COMPLICATIONS Early recognition of UTI and prompt treatment are essential to prevent recurrent infection and the possibility of complications, such as kidney disease, sepsis (urosepsis), strictures, and obstructions. The goal of treatment is to prevent infection from progressing and causing permanent kidney damage and injury. Thus, the patient must be educated to recognize early signs and symptoms, to test for bacteriuria, and to initiate treatment as prescribed. Appropriate antimicrobial therapy, liberal fluid intake, frequent voiding, and hygienic measures are commonly prescribed for managing UTIs. The patient is instructed to notify the primary provider if fatigue, nausea, vomiting, fever, or pruritus occurs. Periodic monitoring of renal function and evaluation for strictures, obstructions, or stones may be indicated for patients with recurrent UTIs. Patients with UTIs are at increased risk for gram-negative sepsis. For each day a urinary catheter is in place, the risk of developing CAUTI increases by 3% to 7% per day of catheterization (Gould, Umscheid, Agarwal, et al., 2019). The Centers for Medicare and Medicaid Services has classified a CAUTI as a “never event” which means no reimbursement to pay for the cost of treatment will be covered by CMS or other insurers if the CAUTI is incurred within an acute care or rehabilitation hospital (Gould et al., 2019). Urosepsis mortality rates following catheterization are reported to be 25% to 60% (Newman, 2017). Careful assessment of vital signs and level of consciousness may alert the nurse to kidney involvement or impending sepsis. Positive blood cultures and elevated WBC counts must be reported immediately. At the same time, appropriate antibiotic therapy and increased fluid intake are prescribed (IV antibiotic therapy and fluids may be required). Aggressive early treatment is the key to reducing the mortality rate associated with CAUTI especially in older patients, those with anemia, and those with elevated blood glucose levels (McCoy, Paredes, Allen, et al., 2017; Taylor, 2018). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 4/5 10/19/23, 3:41 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 5/5