SULTAN KUDARAT EDUCATIONAL INSTITUTION

College of Nursing and Education, College of Midwifery

&Technical Vocational Courses
Tacurong, Sultan Kudarat

COMPLICATED UTI

PRESENTED BY:
Gadayan, Vince Joshua
Llarenas, Judilyn
Legaspi, Jesselyn
Gudal, Norhaime
Eusuya, Ronna mae
Dalaten, Shaina
Peralta, Amy
Tasil, Johaimer
Amil, Nera
Mangidla, Sofie

PRESENTED TO:

Ecija, Reynald RN, RM

(Clinical Instructor)

Insular, Shyrleen RN, LPT

(Clinical Instructor)

DATE:
APRIL, 25, 2020

TABLE OF CONTENTS
CHAPTER 1
Introduction
Objective of the study
Definition of terms
CHAPTER 2
Patient’s data
 Reason for seeking care
 Chief complain
Health assessment
Health history
Physical assessment
Gordon’s functional assessment
CHAPTER 3
Anatomy and physiology
Pathophysiology
 Medical management
Doctor’s order
Laboratories
Drug study
CHAPTER 4
 Nursing management
NCP
Discharge planning
Bibliography
 INTRODUCTION
A complicated UTI’s is an infection associated with a condition, such as structural or
functional abnormalities of the genitourinary tract or the presence of an underlying disease,
which increases the risks of acquiring an infection or of failing therapy. Complicated UTI can
arise in a heterogeneous group of patient. But neither patient age nor gender is part of the
complicated UTI.
Complicated urinary tract infection (UTI’s) may involve both lower and upper tracts. Their
primary significance is that they significantly increase the rate of therapy failures.
The prevalence of UTI’s increase with age, and in women aged over 65 is approximately
double the rate seen in the female population overall. In younger women, increased sexual
activity is a major risk factor for UTI’ and recurrence within 6 months is common. UTI’s are the
most common outpatient infections, with a lifetime incidence of 50-60% in adult women. In the
female population overall, more serious infections such as pyelonephritis are less frequent but
are associated with a significant burden of care due to the risk of hospitalization. UTI’s are the
most common infections in renal transplant patients. Up to 25% of these patients will develop a
UTI within the first year after a transplant. The prevalence on UTI’s in men is significantly lower
than in women, occurring primarily in men with urologic structural abnormalities and in older
adult men.
TREATMENT
Treatment strategy depends on the severity of the illness. Appropriate antimicrobial therapy
and the management of the urological abnormality are mandatory. If needed, supportive care is
given hospitalization is often necessary depending on the severity of the illness. With regards to
prognosis and clinical studies, it is advisable to stratify complicated UTI’s due to urological
disorder into at least two groups;
1.) Patients in whom the complicating factors could be eliminated b therapy, e.g. stone
extraction, removal of an indwelling catheter.
2.) Patients in whom the complicating factor could not be or is not removed satisfactorily during
therapy, e.g. permanent indwelling catheter, stone residuals after treatment or neurogenic
bladder.
SYMPTOMS

 Increase urinary frequency

 Urgency
OBJECTIVE OF THE STUDY
General Objective:
After reading and analyzing this case, the students will be able to present important
information in relation to the client’s condition. That will enhance their knowledge and skills in
dealing with the client’s having the same kind of condition, then application of this learning
appropriately in the clinical setting.

Specific objective:
At the end of the study, the student will be able to:
Present correctly the important information regarding of patient’s data by presenting the
following:
 Biographic Data
 Health history of the patient
 Observe the result of the physical assessment.
 Observe the involved anatomy and physiology of the system.
 Identify and prioritize the possible diagnosis to the client and formulate
applicable interventions.
 Present the drugs the drug administered by the physician for the wellness of the
client Discuss the mechanism and effects of drugs.
DIFINITION OF TERMS
 BLADDER OUTLET OBSTRUCTION
Bladder outlet obstruction (BOO) is a blockage at the base of the bladder. It
reduces or stops the flow of urine into the urethra. The urethra is the tube that carries
urine out of the body.

 INDWELLING CATHETER
An indwelling urinary catheter (IUC). Generally referred to as a “Foley” catheter is
a closed sterile system with a catheter and retention balloon that is inserted either through
the urethra or suprapubically to allow for bladder drainage. External collecting devices
(e.g. drainage tubing and bag) are connected to the catheter to urine collection.

 ANGIOEDEMA
Is the swelling of deep dermis, subcutaneous, or sub mucosal tissue due to
vascular leakage. Acute episodes often involve the lip, eyes, and face however;
angioedema may affect other part of the body, including respiratory and gastrointestinal
(GI) mucosa. Laryngeal swelling can be life threatening.

 PORPHYRIA(per-FEAR-e-uh)
Refers to a group of disorder that result from a buildup of natural chemicals that
produce porphyrin in your body. Porphyrins are essential for the function of hemoglobin-
a protein in your red blood cells that links to porphyrin, binds iron. and carries oxygen to
your organs and tissues.

 GLOMERULUS
Is a network of blood vessels (capillaries) known as a tuft, located at the beginning
of a nephron in the kidney.

 SPINA BIFIDA
Is a birth defect that occurs when the spine and spinal cord don’t form properly.

 CYSTITIS
Is an inflammation of the bladder. Inflammation is where part of your body
becomes irritated, red, or swollen.
PATIENT’S DATA
Patient’s x, a 2 years old female patient lives PUROK MAPOK, POBLACION
DATU PAGLAS MAGUINDANAO. She was born on November 22, 2018 and
she is a Islam. She was admitted at Sultan Kudarat Provincial Hospital last march
05, 2020 with the chief complain of scanty urine. Two days prior to admission,
the patient was noted to be holding urine with scanty urination, no fever and no
vomiting. Her admitting diagnosis is to consider complicated urinary tract
infection and her principal diagnosis was complicated UTI to consider bladder
outlet obstruction, congenital renal anomaly, spina bifida. Her family supports her
emotionally and financially to cope up with her condition, even if they belong to
indigent family but they’re trying their best to provide the needs of their daughter
and they believe that Allah will guide them and protected them especially their
loving young daughter.
HEALTH HISTORY
Past history:
According to the father of patient x she experienced common illness such as fever, common
colds and cough, no injuries happen. They tend to go in health center to have free medication and
they sometimes used herbal medicine to their child, and patient x 2months before she admitted to
SKPH she also suffer from difficulty urinating and admitted at the hospital.

Present illness:
Patient x 2days prior to admission, the patient was noted to be holding her urine with scanty
urination, no fever and didn’t vomit. She diagnosed that she had complicated UTI T/C bladder
outlet obstruction, congenital renal anomaly and spina bifida, and she transferred at Cotabato
Regional Medical Center to have further examination.
PHYSICAL ASSESSMENT
A 2 years old female patient examined her physical appearance, she has a pair
complexion , looks frail, and pale, slouching posture, she was well groomed,
appear neat and clean when inspectioning her skin, it was pale, dry and wrinkled
due to her illness, her hair was black and equally distributed with fine texture.
Finger nails and toe nails were pale in color, her scalp was smooth and little bit
oily, her scalp appeared clean and no lumps or lesion noted. Her eyes were
positioned and aligned symmetrically, eyebrows were symmetrically and evenly
distributed, ears are equal in size no lesion, swelling or tenderness. Her nose was
slightly pointed, no signs of flaring lesions and swelling. The sinuses were
palpated and no evidence of swelling or lumps. For her mouth, her lips were dry
and slightly pale, her teeth seen several cavities. Her tongue was pale in color and
had whitish coating. Her neck is equal in size, head was centered and had
coordinated, smooth movements and no discomfort felt. Her lower back it has
reddish to purple color humps to consider spina bifida.
GORDON’S FUNCTIONAL HEALTH PATTERN

HEALTH PERCEPTION & HEALTH MANAGEMENT:

The patient perceived of her parents/family that she is a living unhealthy lifestyle when
she was baby. Right now her normal activities are affected due to his present illness. 2days PFA
or caused by traumatic events and to foster short-and long-term adaptive functioning and coping.

NUTRITION & METABOLISM PATTERN:

Before Hospitalization:
24-hour dietary intake review (her usual daily menu)
• Breakfast: rice, fish and banana
• Snacks: soda or crackers
• Lunch: rice, egg and soda
• Dinner: rice, vegetables and bread

The patient normally ate his meal before hospitalization at 7:30am-1pm-6pm. She didn’t take
any vitamin supplements. The patient took 2 to 5 glasses of water daily.

During Hospitalization:
24-hour dietary intake review (her usual daily menu)
• Breakfast: rice, vegetables and papaya
• Lunch: Banana, rice and soap’s
• Dinner: rice, fish and vegetables
The patient was advised by the doctor to have a soft diet meal. The patient ate his meal at 6:30
am-11am-6pm. She was given multivitamins to supplement his dietary intake. The patient took
6to 8 glasses of water daily.
BLADDER ELIMINATION PATTERN:
Before Hospitalization:
The patient had abnormal bladder elimination she scanty urination she can’t void
normally. The amount of her daily voiding was approximately one glasses of urine with
yellowish color. According to patient, she experienced pain every time she urinated.
During Hospitalization:
There was no change with regards to his bladder elimination pattern.
After Hospitalization:
Bladder elimination pattern still appeared not normal.

BOWEL ELIMINATION PATTERN:

Before Hospitalization:
The patient didn’t have regular bowel elimination. The color of her stool was tarrying
black with a normal consistency as a manifestation of Complicated Urinary tract infection.
During Hospitalization:
The patient had only one bowel elimination during her stay in the hospital. The color of
her stool was still carry black with normal consistency.

SLEEP-REST PATTERN:
Before Hospitalization:
The patient usually sleeps only three to five hours every night before hospitalization and
didn’t take nap during the day. This was due to urinary pain.
During Hospitalization:
Her sleeping pattern increased from three hours to eight hours but admitted she is bit
uncomfortable due to heat and discomforts in their environment.
ACTIVITY & EXERCISE PATTERN:
Activity of Daily Living:
Before Hospitalization:
Patient was restricted of doing her normal daily activities due to increasing pain.
During Hospitalization:
Patient was confined in the hospital for recovery thus her daily activities were altered.
Exercise Routine:
The patient didn’t have any exercise routine, except when she does eating and shower.
Occupational Activities:
The patient’s activities focus on herself and her family.

COGNITION & PERCEPTION PATTERN:

Ability to Understand:
The patient is a 2-year-old baby, at her young age she couldn’t read and write because
she’s still young. Thought could understand and express her feelings well. She could read and
write. Though she can learn little by little by simply the guidance of her mother and sometimes
through watching TV.

SELF-PERCEPTION & SELF CONCEPT PATTERN:

The parents of the patient describe her child as simple person living a simple life. Her
family gives her strength. Although her family feels worried with her illness but they learned to
accept things as they are.

ROLES & RELATIONSHIP PATTERN:

As a parent, I have responsibility to take good care of my child; I cook for them, clean the
house and do the most important in her life. She is well rounded with peaceful neighborhood and
good community. They lived there a long time already. He didn’t participate in any social groups
or neighborhood activities.
COPING & STRESS TOLERANCE PATTERN:
The parents said the major change in their life is being incapable of earning money to
sustain their family needs, making her present condition, the most stressful situation in his life
right now. It doesn’t only affect them emotionally but also financially. Fortunately, her family
supports him to come up with her present condition. They always pray to God for guidance and
blessings, and her family serves as her motivation in life.

VALUES & BELIEF PATTERN:

Her major source of strength and hope in life is God/Allah, her parents prays for her fast
recovery and prays for her life.
GENERAL APPEARANCE
The patient is 2 years old, female with fair complexion. She looked frail and pale, slouching
posture. She was well groomed, appear neat and clean.
H e r p a r e n t s welcomed our intrusion very well and answered our questions without any
apprehensions. Despite the patient’s level age, she could converse and listen well,
had good comprehensions and level of consciousness.

MENTAL STATUS
The parents of the patient were conscious and alert to all questions being asked.
They could answer promptly, but notable to expand their answers. They were
oriented to time, place, person and present situation. They were able to recall both
long term and short term memories.

SKIN, HAIR AND NAILS

Skin was pale, dry, wrinkled, due to her complicated urinary tract infection.
Hair was long black due to aging and equally distributed with fine texture.
Fingernails and toenails were pale in color and cool to touch. No lesions or
abnormalities noted.
HEAD AND SKULL
Hair was all equally distributed with fine texture. Scalp was smooth and little
bit oily. Her scalp appeared clean and no lumps or lesions noted.
Skull size and contour was normal with no lumps or lesions. Face was wrinkled,
and symmetrical in shape. She was asked to elevate and lower his eyebrows, close
his eyes tightly, puff his cheeks, smile and show his teeth. Impressively she made
these procedures with easy despite his advancing age, symmetric facial expression
were noted.

EYES
The patient’s eyes were positioned and aligned symmetrically.
Eyebrows were black in color and thin, symmetrically and evenly distributed.
Eyelashes were short and straight, no lesions, swelling and no secretions noted
on both eyelids, inner and outer cantus. Noted also was good condition. Both eyes
could move in coordination, with the outer cantus parallel with the pinna of the
ears.
The peripheral and visual field test were assessed to the patient and diminished
eye movement and reflexes were noted.

EARS
Ears were equal in size. Color was the same with the skin. No lesions,
abnormalities, swelling or tenderness were found in the auricles and earlobe.
Whispered words heard bilaterally.

NOSE AND SINUSES

Nose was slightly pointed and symmetrical no signs of flaring, lesions and
swelling. She was able to smell well. The sinuses were palpated and no evidence of
swelling or lumps noted and no felt by patient either.
MOUTH AND OROPHARYNX
Lips were dry and slightly pale. Both upper and lower teeth were slightly
yellowish and several cavities noted. The gums are red color, moist and firm.
The tongue was pale in color, moist, slightly rough, thick and had a whitish
coating, and had a lateral margins and no lesions noted. It was located at the center
of the mouth and was freely movable.

NECK
The muscles in neck were equal in size, head was centered and had coordinated,
smooth movements with no discomforts felt. The thyroid gland was not visible on
inspection.

LOWER BACK
She has reddish to purple humps in her back to consider spina bifida.
MEDICAL MANAGEMENT
ANATOMY AND PHYSIOLOGY
The renal system, which is also called the urinary system, is a group of organs in the body
that filters out excess fluid and other substances from the bloodstream. The purpose of the renal
system is to eliminate wastes from the body, regulate blood volume and pressure, control levels
of electrolytes and metabolites, and regulate blood Ph.
The renal system organs include the kidneys, ureters, bladder, and urethra. Metabolic wastes
and excess ions are filtered out of the body, along with water, and leave the body in the form of
urine.
ORGANS OF THE RENAL SYSTEM
Kidneys and Nephrons
Kidneys are the most complex and critical part of the urinary system. The primary function
of the kidneys is to maintain a stable internal environment (homeostasis) for optimal cell and
tissue metabolism. The kidneys have an extensive blood supply from the renal arteries that leave
the kidneys via the renal vein.
Nephrons are the main functional components inside the parenchyma of the kidneys, which
filter blood to remove urea, a waste product formed by the oxidation of proteins, as well as ions
like potassium and sodium. The nephrons are made up of capsule capillaries (the glomerulus)
and a small renal tube.
The renal tube of the nephrons consists of a network of tubules and loops that are selectively
permeable to water and ions. Many hormones involved in homeostasis will alter the permeability
of these tubules to change the amount of water that is retained by the body.

URETERS
Urine passes from the renal tube through tubes called ureters and into the bladder.
BLADDER
The bladder is flexible and is used as storage until the urine is allowed to pass through
urethra and out of the body.
URETHRA
The female and male renal system are very similar, differing only in the length of the
urethra.
URETER
These are two long, narrow ducts that carry urine from the kidneys to the urinary bladder.
OSMOREGULATION
The most important function of the renal system, in which blood volume, blood pressure,
and blood osmolality (ion concentration) is maintained in homeostasis.

b
 PATHOPHYSIOLOGY OF UTI TO CONSIDER COMLICATED UTI

PRECIPITATING FACTORS PRE-DISPOSING FACTORS

 Increasing age  Bladder outlet obstruction
 Obesity  Congenital abnormalities
 Gender  Indwelling urinary catheter

Attachment of bacteria to the urethra

Proliferation of bacteria in the urethra

Inflammation of the skin between the

rectum and urethra

Introduction of bacteria into the bladder

Sign/ Symptoms
Proliferation of bacteria in the bladder  Feeling very
quickly
 Small amount
Cystitis/ Inflammation of the bladder of urine
 Dysuria
 Fever
Infection of the urinary tract  Chills
 Nausea
 Vomiting

If left untreated If left treated

 It can damage kidneys  No kidney failures

from acute and chronic
kidney infections.
 No painful urination
Develop complications  No damage kidneys
 No feeling of
discomfort
It can lead to death
 DOCTORS ORDER

Date;
03-05-20 -Admit patient
-Secure consent
-Vital sign every 4 hours
-DAT/Diet as Tolerated
Problem;
Oliguria x 2days
Labs; CBC, Platelet count, Blood tying,
Urinalysis, Serum creatinine, UTZ and KUB
(-)BM Problem -IVF PNSS IL@400CC/hr.
(+)Distended bladder FD 100cc
T/C Complicated UTI
With Hx of anuria meds;
Admitted@ 1.)Furosemide 50mg IVTT now
Cotabato Regional hospital 2.)Ceftriaxone 500mg IVTT every 12hrs. ANST
3.) Ranitidine 10mg IVTT every 8hrs
Secure problem;
-for straight catheterization-please notes U/O
-I/O every hours
-refer accordingly

Date;
03-05-20 -fast drip 200cc
-furosemide 50mg IVTT now
-Regulate IVF @ 60cc/hr.
-cont. meds
-follow up result

03-06-20 -Insert catheter

-Transfer to hospital of choice

03-07-20 -Transfer to CRMC for further evaluation and

management.
Diagnostic Studies

A complicated urinary tract infection associated with a condition, such as structural or functional
abnormalities of the genitourinary tract or the presence of an underlying disease, which increase
the risks of acquiring an infection or of failing therapy. Complicated urinary tract infection can
arise in a heterogeneous group of patients.

 Analyzing a urine sample. Your doctor may ask for a urine sample for lab analysis to
look for white blood cells, red blood cells or bacteria. To avoid potential contamination of
the sample, you may be instructed to first wipe your genital area with an antiseptic pad
and to collect the urine midstream

Treatment:
Treatment depends on your age, the type and size of your complicated urinary tract infection
and symptoms. Your doctor might suggest:

Medication:

Furosemide 50mg IVTT NOW

Ceftriaxone 500mg IVTT q 12hours ANST

Ranitidine10mg IVTT q 8hour

 LABORATORIES

BLOOD TYPING;
03-05-20 BLOOD TYPE B POSITIVE

DATE; 03-05-20
HEMATOLOGY

PARAMETERS RESULTS REFERENCE INTERPRETATION

RANGE
WBC 11.85 10^9/L 5.00-10.00
NEUTROPHIL 63 20.0-40.0 INCREASE
-May indicate acute
bacterial infection, tumor
inflammation, stress and
drugs reaction.
DECREASE;
-May indicate acute viral infec
anorexia nervosa, bone ma
suppression.
LYMPHOCYTES 24 3.0-12.0 INCREASE
-May indicate chronic
bacterial infection, viral
infection.
DECREASE
-May indicate aplastic anemia, leuke
immunodeficiency.
MONOCYTES 8 0.5-5.0 INCREASE
-May indicate viral
infection. Parasitic
disease.
DECREASE
-Use of corticosteroids.
EOSINOPHIL 5 0.0-1.0 INCREASE
-Ma indicate allergic
disorder,eosinophillicleuk
emia
DECREASE
-Ma indicate endocrine disorder
stress
BASOPHI - - INCREASE
L -May indicate
myeloproliferative
disease
DECREASE
-May indicate
infection and
stress
 `PARAMETERS RESULTS UNIT REFERANGE INTERPRETATION
RANGE
RBC 4.02 10^12/ 3.50-5.50 INCREASE
L -May indicate anoxia
dehydration,
polycythemia Vera.
DECREASE
-May indicate
anemia, hemorrhage
leukemia.
HGB 93 g/L 130-180 IINCREASE
-May indicate
dehydration and
polycythemia
DECREASE
-Ma indicate anemia,
hemorrhage
leukemia.
HCT 29.0 % 37.0-48.0 INCREASE
-May indicate
dehydration and
polycythemia.
DECREASE
-Ma indicate anemia,
hemorrhage
leukemia.
NGV 72.1 FL 80.0-100.0
MCH 22.1 pg 27.0-34.0
MCHC 306 g/L 320-360
RDW-CV 17.1 % 11.0-16.0
RDN-SD 40.6 fL 35.0-36.0

URINALYSIS URINALYSIS
DATE 03-06-2020
COLOR; light yellow
Transparency; clear
 Specific gravity; 1.015
Reaction;6.0
Protein and sugar-negative
Pus cell; 10.25 /hpf
RBC; 5/10 /hpf
Squamous; Epithelial cell rate

PLATELET 294 ^10^9/L INCREASE

-May indicate dehydration and
polycythemia.
DECREASE
-Ma indicate anemia,
hemorrhage leukemia.

NURSING MANAGEMENT
NCP:
DISCHARGE PLANNING:
M-Patient X was given IVTT meds such as furosemide 50mg, ceftriaxone 500mg q 12 hours
(ANST) and ranitidine 10mg q 8hours. This meds will help the patient to improve her condition.
E- (Environment) - please you should do the home making skills for clean environment,
surrounding and fresh air for your child.
T-(treatment) - encourage but don’t force your child to take her medication as what was given to
you by the doctor. Those medications help your child to recover.
H-(health) –follow all medications and have your child drink plenty of fluids. Tell your child to
empty her bladder when urinating and teach your child to wipe from the front and back after
going to the bathroom.
O-(outpatient referral) –please always remember your child checkup as what told by the doctor.
D-(diet) –you should eat healthy foods like vegetables, fruits and drink plenty of water because
that is essential when fighting off a UTI.

BIBLIOGRAPHY/REFERENCES
https://www.webmd.comedecine.medscape.com courses.lumenlearning.com
Nursing 2008 drug handbook nurse's pocket guide edition 13