JEREMY G.

TELLAIN BSN4-1 ELECTIVE 2

URINARY TRACT INFECTION

Urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. Urinary tract infections have different names, depending on what part of the urinary tract is infected.

Bladder -- an infection in the bladder is also called cystitis or a bladder infection. Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection. Ureters -- the tubes that take urine from each kidney to the bladder are only rarely the site of infection. Urethra -- an infection of the tube that empties urine from the bladder to the outside is called urethritis.

PATHOPHYSIOLOGY

The pathophysiology of urinary tract infection begins with the entry of microorganisms through the outermost part of the urinary system called the urethra. Normal urine is acidic and resistant to bacterial growth, and urine flow is always toward the external environment. Other protective mechanisms against bacterial urinary infection include bladder emptying, the presence of contracting muscles called sphincters, and the availability of immune cells and antibodies in the urinary mucosa. Bacterial agents, such as Escherichia coli (E. coli), may be transferred from the anus to the urethral opening, leading to urethral infection. E. coli is an organism that lives in the colon and is passed out in the stools during defecation. The relationship between the anus and the urethra explains why UTI occurs more frequently in

women than in men. In women, the anal and urethral openings are closer to each other, and the urethral length is shorter. This leads to easier bacterial translocation and ascension to the upper parts of the urinary tract.
CAUSES E. coli and yeast infections E. coli and yeast infections are common causes of urinary tract infections. These organisms are spread to the bladder when they travel from the rectum and vaginal area to the urinary meatus in women. Once the bacteria or fungi have reached the opening of the meatus, they have a clear shot into the urethra and can enter the bladder. Always clean your private area from front to back after using the bathroom. The act of wiping from back to front is what spreads the organisms toward the urinary tract. When bathing, use the same technique as mentioned above. When washing, clean your private are from front to back, never wash from back to front. Always move the cloth from the cleanest to the dirtiest and never the other way around. Pathogenic organisms can easily be moved mechanically to the urinary tract by using the wrong cleansing technique. Dietary additives What we eat and drink can trigger urinary tract infections. The chemicals put in foods for preservatives and the chemicals in soft drinks can make it easier for the organisms to colonize on the wall of the urinary bladder. Additives in foods, such as high fructose, caffeine, alcohol can increase the likelihood to developing UTIs. Foods high in sugar content can promote the growth of bacteria and yeast. To prevent urinary tract infections, you can alter the internal environment of your body by drinking more acidic beverages such as cranberry juice and lemon juice. Avoid foods high in sugar content. Also avoid foods and beverages which contain alcohol and caffeine. Avoid dark sodas and diet sodas. The phosphoric acid in the dark sodas can increase the risk of developing a urinary tract infection. It is important to avoid foods and beverages which will irritate the urinary tract and embrace foods that contain antioxidants to prevent infections from occurring in the first place. Fruits, especially berries, are high in disease fighting antioxidants. Dehydration Dehydration can trigger a UTI; inadequate hydration can put stress on the kidneys, heart and immune system. When the immune system is compromised, bacteria can multiply much easier in the urinary tract.

It is important to keep the urinary tract flushed out. Drinking enough water will give the body's cells sufficient hydration to remain healthy. Staying hydrated will flush out the bacteria which enter into the urinary tract. Diabetes Diabetes puts stress on the entire body. A common characteristic of diabetes is that the blood contains elevated levels of glucose. People, especially women, who have elevated glucose levels, are prone to yeast infections. Yeast infections can trigger a urinary tract infection. A good way for diabetics to prevent UTIs is to try to keep their blood glucose levels under control. It is important to avoid foods and beverages which will increase the blood sugar level. It is also important to stay well hydrated to flush out bacteria. Overuse or misuse of antibiotics In the past, doctors would order us antibiotics every time we had a cold or sniffle or any type of infection. Unfortunately, antibiotics aren't always the best choice. The overuse of antibiotics has created super-germs over the recent decades. The bacteria become resistant to many of the antibiotics we take to kill an infection. Oftentimes, misuse of antibiotics can also trigger a urinary tract infection. When antibiotics are prescribed, it is important to take them until the prescription is gone. Oftentimes, the infection "appears" to be gone when we feel better and stop taking the antibiotic. When the medication gradually leaves the body, the stunned bacteria become active again and adapt to their environment and form a resistance to the medication. Sexual activity For younger women, most urinary tract infections occur within 24 hours of having sexual contact. Sexual position may be a factor in a woman developing a urinary tract infection, such as when the woman assumes the top position during intercourse. A fairly common diagnosis among younger women is "honeymoon cystitis." To prevent urinary tract infections during times of sexual activity, it is important to bathe your genital area before and after sexual contact. It is also important to avoid sexual positions which cause more friction. Friction during sexual activity can cause enough irritation to promote cystitis which can result in a urinary tract infection.

Contraceptives Women who use a diaphragm as a contraceptive device are more likely to get a urinary tract infection than women who don't. Certain types of condoms and spermicidal foams can also increase the likelihood of inducing UTIs in women. Ask your doctor what you can do to prevent UTIs when using spermicidal preparations and diaphragms for contraceptive purposes. It could just be a matter of changing the type or size of the diaphragm or changing from one spermicidal agent to another. Always wash your hands before handling the diaphragm while inserting it and taking it out. Allergies Sometimes urinary tract infections are initially caused by allergic reactions to the products that women use in their private area. Soaps, deodorants, powders and other products can cause allergies and inflammation to the tissues around the urinary meatus. Some of these products may promote the growth of microorganisms in the woman's private area. If you are prone to UTIs, you might need to avoid using powders, deodorants and perfumed soaps on the peri-area. If you have questions about possible allergic reactions to products used on your private area, talk to your doctor.

ASSESSMENT

A strong, persistent urge to urinate A burning sensation when urinating Passing frequent, small amounts of urine Urine that appears cloudy Urine that appears red, bright pink or cola-colored a sign of blood in the urine Strong-smelling urine Pelvic pain, in women Rectal pain, in men UTIs may be overlooked or mistaken for other conditions in older adults.

Types of urinary tract infection Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Kidneys (acute pyelonephritis)

Signs and symptoms Upper (flank) pain High fever Shaking and chills Nausea Vomiting back and side

Bladder (cystitis)

Pelvic pressure Lower discomfort Frequent, painful urination Blood in urine abdomen

Urethra (urethritis)

Burning with urination

DIAGNOSTIC TEST

Urinalysis: is done to look for white blood cells, red blood cells, bacteria, and to test for certain chemicals, such as nitrites in the urine. Most of the time, your doctor or nurse can diagnose an infection using a urinalysis. Urine culture - clean catch: may be done to identify the bacteria in the urine to make sure the correct antibiotic is being used for treatment.

Ultrasound or a computerized tomography (CT) scan: to create images of your urinary tract. Intravenous pyelogram (IVP) :uses X-rays with contrast dye to create images. Cystoscopy: using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder.

COMPLICATIONS Kidney infection, medically known as pyelonephritis, can happen when bacteria travel from the bladder to the kidneys. Symptoms:

Feverish Shivery sick pain in your back or side. Kidney failure is when the kidneys stop working properly Blood poisoning (sepsis) is a rare, but potentially fatal, complication of kidney infection. It happens when bacteria spreads from the kidneys into the bloodstream. Once bacteria are in your blood, the infection can spread to any part of your body, including all of the major organs. NURSING INTERVENTION BATHING AND HYGIENE

Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change the pad each time you use the bathroom. Do not douche or use feminine hygiene sprays or powders. As a general rule, do not use any product containing perfumes in the genital area. Take showers instead of baths. Avoid bath oils. Keep your genital area clean. Clean your genital and anal areas before and after sexual activity. Urinate before and after sexual activity. Wipe from front to back after using the bathroom.

CLOTHING

DIET

Avoid tight-fitting pants. Wear cotton-cloth underwear and pantyhose, and change both at least once a day.

Drink plenty of fluids (2 to 4 quarts each day). Drink cranberry juice or use cranberry tablets, but NOT if you have a personal or family history of kidney stones. Do NOT drink fluids that irritate the bladder, such as alcohol and caffeine.

MEDICATION Antibiotics trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline, and fluoroquinolones. hydrochloride (Pyridium)

to relieve the burning pain and urgent need to urinate