URINARY TRACT INFECTION

DEFINITION OF THE DISEASE

• UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract.
= Urinary tract is normally sterile. Due to the changes in hormones, which slows the flow of the urine, as a result, the bacteria have more time to
grow in the urine before being flushed out.
• It is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary
tract — the bladder and the urethra.

CLASSIFICATION
Urinary tract infections (UTIs) are classified by location:
• Lower urinary tract – which includes the bladder and urethra
 Infection of the bladder (Cystitis)
 Infection of the urethra (Urethritis)
• Upper urinary tract– which includes the kidneys and ureters
 Infection of the kidney (Pyelonephritis)

SIGNS AND SYMPTOMS

The symptoms are different depending on where the infection is.
• Symptoms of a UTI in the bladder (Cystitis)include:
 Pain or burning when urinate.
 An urge to urinate often, but usually passing only small amounts of urine.
 Pain in the lower belly.
 Urine that looks cloudy, is pink or red, or smells bad.
• Symptoms of a UTI in the urethra (Urethritis):
 Burning with urination
 Discharge
• Symptoms of a UTI in the kidney(Pyelonephritis):
 Pain in the flank - this is felt just below the rib cage and above the waist on one or both sides of the back.
 Fever and chills.
 Nausea and vomiting.
EPIDEMIOLOGY
• A UTI is the second most common infection in the body.
• Worldwide, UTIs' prevalence was estimated to be around 150 million persons per year.
• According to one study from the Centers for Disease Control and Prevention (CDC), 8% of pregnant women experience UTI.
= During pregnancy, the compression of the expanding ureters, and the challenge of keeping the perineal area clean due to the baby bump make it
even easier for the bacteria to enter in urinary tract that leads to urinary tract infection (UTI).
• Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI. Almost half of
all women will experience 1 UTI during their lifetime.
 Female anatomy
= a woman has a shorter urethra than a man does, which shorter and closer the distance that bacteria travel to reach the bladder.
 Sexual activity
= sexually active women tend to have more urinary tract infection (UTI) than women who aren’t sexually active. Why? Because of having a
new partner or having multiple partner which increase the risk of having a urinary tract infection (UTI)
 Certain types of birth control
= woman who use birth controls and spermicides during intercourse may increase women's risk of developing a urinary tract infection
because the 'good' bacteria that exist in the vagina are more susceptible to being killed off by these spermicides.

DIAGNOSTICS
• Urinalysis and urine culture
- The American College of Obstetrics and Gynecology recommends that a urine culture be obtained at the first prenatal visit
- Most doctors will ask for a “clean catch” sample, where you pee into a cup midstream after carefully wiping your outer vaginal
area.
= urinalysis and urine culture is the most frequent to use in evaluating if a client is having a UTI.
= also, urine is being collected at each prenatal visit to assess for glucose, protein, nitrates, and leukocytes which can indicate diabetes,
pregnancy induce hypertension (PIH), and infection such as the UTI.

• Ultrasound
= this is used in client who are having a frequent urinary tract infection. This is to check the kidneys and the bladder for irregularities that
may require treatment.
 • Cystoscopy & Ureteroscopy
= Cystoscopy is a diagnostic procedure that usually performed to look inside the urethra and the
bladder.
= Uteroscopy is a diagnostic procedure that performed to look inside the ureters and the kidneys.
= the cystoscope is shorter while the ureteroscope is longer and thinner. These two devices have an
eyepiece in one end, a flexible tube at the middle, and a tiny lens with light at the end. Through the
eyepiece, it is where the urologist sees the inside of the urinary tract – the kidneys, ureters, bladder, and the
urethra.

COMPLICATIONS
When UTI is treated properly, lower urinary tract infections rarely lead to complications. But if it is
left untreated a urinary tract infection can lead to more serious complication.
 Renal failure – UTIs that are not treated properly could spread in the upper urinary tract and
become the cause of the renal failure.
 Urosepsis – is a term used to describe a type of sepsis that is caused by an infection in the urinary
tract. It is a complication often caused by urinary tract infections that are not treated quickly or
properly. It is when the bacteria may invade the urinary system and result in sepsis which is a
potential life-threatening complication of an infection, especially if the infection works upward
toward the upper urinary tract.
(Left) Cystoscope
 UTIs in pregnancy if not threated, this could increase the risk of delivering a low birthweight or
(Right) Ureteroscope
premature baby.
PATHOPHYSIOLOGY
Here is the kidney, the kidneys are bean-shaped
organs, each about the size of a tightly clenched-fist.
The ureter, are small tubes that carry urine from the renal
pelvis of the kidney to the posterior inferior portion of the
urinary bladder.
The bladder, is a hollow muscular container that lies in the
pelvic cavity just posterior to pubic symphysis. The urethra, it
is a tube that exist urinary bladder inferiorly and anteriorly.
Here we have the inferior vena cava, the color blue
that we see in the figure, and the renal vein comes from the
kidney and into the inferior vena cava. Behind the inferior
vena cava, we have the descending aorta, which is supply the
kidney and clenching the renal artery.

So what is initially happen:

So the bacteria contaminate the lower urinary tract, they
nefly colonize the urethra and the bladder, this triggers the
inflammatory response in the lower urinary tract. Neutrophil
infiltration, as you can see the bladder have bacteria and
have neutrophils, the bacteria multiply and they are able to
evade the immune system because of certain virulence
factors. The bacteria can form biofilms, biofilms is any group
of microorganisms in which they stick to each other and often
these microorganisms, and allows them to survive.
If this urinary tract infection is progressives and untreated or
if the patient accompromised has risk factors the bacteria can
ascend to the kidney, and they colonize the kidney causing it
upper urinary tract infection. If left kidney untreated, the
bacteria can spread into circulation via the renal vein causing
the worst case septic shock.
 A big risk factor for developing UTI, especially in female is urinary catheterization. The catheter can introduce infectious into the bladder. The
bacteria colonize the bladder initially in the immune response. Neutrophils enter for information. Fibrinogen accumulates on the catheter providing
an ideal environment. For the uropathogens that express fibrinogen biding proteins. After this bacteria initially to the fibrinogen for the catheters
the bacteria can multiply, and they can form biofilms.

MEDICATIONS USED TO TREAT UTI

• Cephalexin (Kerflex) - is an antibiotic. It belongs to group of antibiotics called cephalosporins. It is used to treat bacterial infections such as
pneumonia, Pneumonia is an infection of one or both of the lungs caused by bacteria, viruses or fungi, and skin infection, skin infection
occurs when parasite, fungi, or germs such as bacteria penetrate the skin spread. When this happens, it can cause pain, swelling, or other
types of discomfort, and also the urinary tract infection.

• Phenazopyridine (Pyridium) - is an medication which when excretes by the kidneys into the urine, has a local analgesic effect on urinary
tract.

• Nitrofurantoin- is an antibacterial medication used to treat bladder infection.

• Cotrimoxazole - is a combination of trimethroprim and sulfamethaxazole and in a class of medication called sulfonamides.

• Ampicillin- is an antibiotic used to prevent and treat a number of bacterial infections, such as respiratory tract infections and urinary tract
infections.

NAME (GENRIC MECHANISM OF DOSAGE ROUTE INDICATIONS CONTRAINDICATIONS SIDE EFFECT NURSING
NAME) ACTION AND FREQUENCY RESPOSIBILITY
Generic Name: Cephalexin is a Adult dosage (ages Cephalexin is an Cephalexin and other • Painful • Arrange for
Cephalexin first-generation 18 to 64 years) antibiotic that is cephelosporins are urination culture and
cephalosporin. effective against contraindicated in • Diarrhea sensitivity
Brand Name: Cephalexin is a 1–4 grams per day most gram-positive patients with a • Upset test of
Apo-Cephalex (CAN), beta-lactam taken in divided cocci. Additionally, penicillin allergy, as stomach infection
Biocef, Kerflex, antibiotic, meaning doses. The usual cephalexin is this poses an • Nausea and before and
Novo-Lexin (CAN), its structure dose is 250 mg effective against increased risk of an vomiting during
Nu-Cephalex (CAN) contains a beta- taken every 6 gram-negative allergic reaction to • Dizziness therapy if
lactam ring. In a hours, or a dose of bacteria, cephalexin and other • Tiredness infection
bacterial cell, 500 mg every 12 particularly E. coli, cephalosporins. • Headache does not
peptidoglycan hours may be Proteus mirabilis, resolve.
gives the cell wall given. Your doctor and Klebsiella • Give drug
mechanical may give you a pneumonia. with meals;
stability. larger dose if you Cephalexin arrange for
Cephalexin use a have a severe indications include small,
beta-lactam ring to infection. treating acute and frequent
inhibit the chronic urinary meals if GI
synthesis of Child dosage (ages tract infections, complications
peptidoglycan, 15 to 17 years) gonorrhea, upper occur.
which is a critical and lower • Refrigerate
step in the 1–4 grams per day respiratory tract suspension,
formation of the taken in divided infections, scarlet discard after
bacterial cell wall. doses. The usual fever, beta- 14 days.
Specifically, the dose is 250 mg lactamase- • Complete the
beta-lactam binds taken every 6 producing full course of
to penicillin- hours, or a dose of staphylococcal this drug
binding proteins, 500 mg every 12 infections, and even if you
resulting in hours may be streptococcal feel better
inhibition of the given. Your doctor septicemia. • This drug is
last phase of may give you a prescribed
peptidoglycan larger dose if you for this
synthesis, which is have a severe particular
a transpeptidation infection. infection; do
reaction required not self-treat
for bacterial Child dosage (ages any other
peptidoglycan 1 to 14 years) infection.
cross-linking. This
activity results in 25–50 mg/kg of
the loss of cell body weight per
viability and day taken in
eventually leads to divided doses.
bacterial cell Your doctor may
autolysis. double your dose
for severe
infections.
 NAME (GENRIC MECHANISM OF DOSAGE ROUTE INDICATIONS CONTRAINDICATIONS SIDE EFFECT NURSING
NAME) ACTION AND FREQUENCY RESPOSIBILITY
Generic Name: Phenazopyridine For oral dosage Phenazopyridine is Phenazopyridine HCI • Little or no • Assess patient
Phenazopyridine HCI is excreted in form (tablets): indicated for the is contraindicated in urinating for urgency,
the urine where it For relieving symptomatic relief patients with renal • Confusion, frequency, and
Brand Name: exerts a topical pain, burning, and of pain, burning, insufficiency. loss of pain on
Pyridium analgesic effect on discomfort in the urgency Phenazopyridine HCI appetite, urination prior
the mucosa of the urinary tract: frequency, and should not be used in pain in to and
urinary tract. This • Adults and other discomforts patients who have your side throughout
action helps to teenagers— arising from previously exhibited or lower therapy.
relieve pain, 200 irritation of the hypersensitivity to it. back • Lab test
burning, urgency milligrams mucosa of the • Swelling, Considerations:
and frequency. (mg) three lower urinary tract rapid renal function
times a day. caused by weight gain should be
• Children— infection, trauma, • Fever, pale monitored
The dose is surgery, or periodically
based on endoscopic yellowed during course
body procedure, or the skin, of therapy.
weight and passage of sounds nausea, Interferes with
must be or catheters. vomiting urine tests
determined and based on the
by your stomach color reactions
doctor. The pain (ketones,
usual dose • Shortness bilirubin,
is 4 mg per of breath protein,
kilogram • Mood steroids,
(kg) (about changes glucose)
1.8 mg per • Increased • Inform patient
pound) of thirst that drug
body causes reddish-
weight orange
three times discoloration
a day. of urine that
may stain
clothing or
bedding.
 • Instruct patient
to take
medication
exactly as
directed.
• Administer
medication
with or
following
meals to
decrease GI
irritation.

NAME (GENRIC MECHANISM OF DOSAGE ROUTE INDICATIONS CONTRAINDICATIONS SIDE EFFECT NURSING
NAME) ACTION AND FREQUENCY RESPOSIBILITY
Generic Name: The mechanism of Adult dosage Nitrofurantoin or Anuria, oliguria, or • Diarrhea • Monitor I&O.
Nitrofurantoin antimicrobial (ages 18–64 Macrobid is significant impairment • Rash report oliguria
action of years) indicated only for of renal function • Itching and any change
Brand Name: nitrofurantoin is the treatment of (creatinine clearance • Nausea in I&O ratio.
Macrobid unusual among Macrodantin and acute under 60 ml per • Vomiting Drug should be
antibacterials. its generic form: uncomplicated minute or clinically • Change in discontinued if
Nitrofurantoin is 50–100 mg four urinary tract significant elevated urine color oliguria or
reduced by times per day. infections (acute serum creatinine) are • Loss of anuria develops
bacterial Length of cystitis) caused by contraindications. appetite or creatinine
flavoproteins to treatment varies. susceptible strains Because of the • Headache clearance falls
reactive Macrobid and its of Escherichia coli possibility of • Abdominal below
intermediates generic forms: or Staphylococcus hemolytic anemia due pain 40ml/min.
which inactivate or 100 mg every 12 saprophyticus. to immature • Lab tests:
alter bacterial hours for 7 days. erythrocyte enzyme Perform C&S
ribosomal proteins systems, the drug is prior to therapy;
and other Child dosage contraindicated in recommended
macromolecules. (ages 12–17 pregnant patients at in patients with
years) term (38-42 weeks recurrent
gestation), during infections.
Macrodantin and labor and delivery, or • Be alert to signs
its generic form: when the onset of of urinary tract
5–7 mg/kg of labor is imminent. superinfections
body weight per Macrobid is (perineal
day in four contraindicated in irritation, foul-
divided doses. patients with a smelling of
Length of previous history of urine, milky
treatment may cholestic urine, and
vary. jaundice/hepatic dysuria)
Macrobid and its dysfunction • Assess for
generic form: 100 associated with nausea. May be
mg every 12 nitrofurantoin. relieved by
hours for 7 days. using
macrocrystalline
Child dosage preparation or b
(ages 1 month–11 reducing
years) dosage.
Macrodantin and
its generic form:
5–7 mg/kg of
body weight per
day in four
divided doses.
Length of
treatment may
vary.
Macrobid and its
generic form:
These drugs have
not been studied
in children
younger than 12
years. They
should not be
used in this age
group.
 NAME (GENRIC MECHANISM OF DOSAGE ROUTE AND INDICATIONS CONTRAINDICATIONS SIDE EFFECT NURSING
NAME) ACTION FREQUENCY RESPOSIBILITY
Generic Name: Sulfamethoxazole For oral dosage forms Bactrim is Bactrim is • Nausea • Assess
Trimethoprim and competitively (liquid or tablets): indicated in the contraindicating in • Painful or symptoms.
Sulfamethoxazole inhibits  Adults—1 tablet treatment of patients with a swollen • Evaluate
dihydropteroate (DS tablet) of 800 severe or hypersensitivity to tongue therapeutic
Brand Name: synthase, the milligrams (mg) complicated trimethoprim or • Vomiting response.
Bactrim enzyme of urinary tract sulfonamides, in a • Loss of • In women of
responsible for sulfamethoxazole infections in history of a patient appetite childbearing
bacterial and 160 mg of adults and with drug induced • Sleep age require
conversion of trimethoprim, 2 pediatric immune problems about last
PABA to tablets of 400 mg patients two thrombocytopenia, (Insomia) menstrual
dihydrofolic acid. of months of age and patient with • Dizziness period.
Inhibition of this sulfamethoxazole and older due to documented • Tiredness • Patient who
pathway prevents and 80 mg of susceptible megaloblastic anemia • Spinning are having
the synthesis of trimethoprim, or strains of due to folate sensation long-term
tetrahydrofolate 4 teaspoonfuls or Escherichia coli, deficiency. • Ringing in therapy need
and ultimately the 20 milliliters (mL) Klebsiella your ears regular blood
synthesis of of oral liquid species, count
bacterial purines every 12 hours Ectobacter assessment.
and DNS, resulting for 10 to 14 days. species, • Take
in a bacteriostatic Your doctor may Morganella trimethoprim
effect. adjust this dose if morganii, on an empty
needed. Proteus mirabilis stomach,
 Children 2 and proteus one hour
months of age vulgaris when before two
and older—Dose oral hours after
is based on body administration of meals.
weight and must Bactrim is not • Be sure to
be determined feasible and complete the
by your doctor. when the entire course
The usual dose is organism is not of
40 milligrams susceptible to medication.
(mg) per single-agent
kilogram of body antibacterial
weight of effective in
 sulfamethoxazole urinary tract.
and 8 milligrams
(mg) per
kilogram of body
weight of
trimethoprim,
given in two
divided doses
every 12 hours
for 10 days.
- Weighing 40 kilograms
(kg)—4 teaspoonfuls (20
mL) of oral liquid or 2
tablets (or 1 DS tablet) 2
times a day for 10 days.
- Weighing 30 kg—3
teaspoonfuls (15 mL) of
oral liquid or 1 ½ tablet 2
times a day for 10 days.
- Weighing 20 kg—2
teaspoonfuls (10 mL) of
oral liquid or 1 tablet 2
times a day for 10 days.
- Weighing 10 kg—1
teaspoonful (5 mL) of
oral liquid 2 times a day
for 10 days.
• Children younger
than 2 months of
age—Use is not
recommended.

NAME (GENRIC MECHANISM OF DOSAGE ROUTE INDICATIONS CONTRAINDICATIONS SIDE EFFECT NURSING
NAME) ACTION AND FREQUENCY RESPOSIBILITY
Generic Name: Ampicillin are Adult dosage (ages Ampicillin used to Contraindicated with • Dark urine • Take the
Ampicillin interference with 18–64 years) treat certain allergies to penicillin's, • Vaginal itching oral drug on
cell wall synthesis Typical dosage is infections that are cephalosporin, or or discharge an empty
Brand Name: by attachment to 500 mg four times caused by bacteria other allergies. • Headache stomach, 1
Omnipen penicillin-binding per day. such as meningitis, Use cautionary with • Allergic hour before
proteins, inhibition Severe or chronic urinary tract, renal disorders. reaction 2 hours
of cell wall infections may gastrointestinal • Noisy after meals;
peptidogly can require larger tract, infection of breathing do not take
synthesis and doses. the throat, lungs, • Inflammation with fruit
inactivation of sinuses, in the kidney juice or soft
inhibitors to Child dosage reproductive • Anemia drinks.
autolytic enzymes. (children who organs. • Vomiting • Take this
weigh more than • Swelling or drug
20 kg) inflammation around the
Typical dosage is of the large clock.
500 mg four times intestine/colon • Take the
per day. • Nausea full course
• Seizure of therapy.
Child dosage • Hives • Report pain
(children who • Fever or
weigh 20 kg or • rash discomfort
less) at sites.
Typical dosage • Check IV
is 100 mg/kg per site
day in four equally carefully for
divided and signs of
spaced doses. thrombosis
or drug
Child dosage reactions.
(children who • Culture
weigh less than 20 infected
kg) area before
Typical dosage treatment.
is 100 mg/kg per
day in four equally
divided and
spaced doses.
 3 PRIORITY NURSING DIAGNOSIS

ASSESSMENT DIAGNOSIS PLANNING NURSING RATIONALE EVALUTION

INTERVENTION
Impaired urinary The client will be able Assess the patient’s Serves as a basis for Client will achieve normal
elimination related to to achieve normal pattern of elimination. determining urinary elimination
 Feelings of disease process (UTI) urinary elimination appropriate pattern, as evidence by
urgency on pattern, as evidence by interventions. absence sign of urinary
urination absence sign of urinary disorders (urgency,
 Some burning disorders (urgency, Encourage increased To help improve renal oliguria, dysuria)
sensations when oliguria, dysuria fluid intake (2-3 liters a blood flow
voiding may day if tolerated)
claimed
 Incomplete Instruct the female Proper perineal care
emptying of the client to wipe the area helps in minimizing the
bladder from front to back and risk of contamination
avoidance of bath tubs. and re-infection.

Encourage the client to To prevent the

void every 2-3 hours. accumulation of urine
thus limiting the
number of bacteria.

ASSESSMENT DIAGNOSIS PLANNING NURSING RATIONALE EVALUTION

INTERVENTION
“I want to know more Deficient knowledge Client will be able to Explain to the client Frequent recurrences Client will verbalize
about my illness and I related to unfamiliarity verbalize knowledge of about the urinary tract of urinary tract knowledge of causes and
do not know the with nature and causes and treatment infection risk factors, infection may indicate treatment of urinary tract
treatment of my treatment of urinary of urinary tract prevention, and that client has no infection, controls risk
disease.” tract infection. infection, controls risk treatment with less understanding of the factors, and completes
factors, and completes medical terminologies. disease and its medical treatment of
medical treatment of management. urinary tract infection.
urinary tract infection.
To empower the
 Educate the patient patient to manage its
about how to own urinary health and
determine and report to allow early detection
any recurrence of UTI of UTI recurrence. UTI
signs and symptoms. signs and symptoms
usually occur within 1
to 2 weeks after
completion of
antibiotics therapy.

In the first few days of

Encourage the client to antibiotics therapy,
finish all prescribed urinary symptoms of
antibiotics, even if burning, frequency, and
symptoms resolve. urgency usually resolve.
However, not finishing
the antibiotic on the
prescribed time will
make the bacteria grow
and multiply again.

Teach the client about The goal of client

the importance of teaching is to resolve
preventing urinary tract the current infection
infection. and prevent
recurrence.

ASSESSMENT DIAGNOSIS PLANNING NURSING RATIONALE EVALUTION

INTERVENTION
Subjective Data: Urinary retention Patient will be able to Allow patient to keep Retention of urine Patient will empty the
related to bladder empty the bladder record of the amount increase pressure in the bladder completely.
Patient complains fullness and hesitancy completely. and time each voiding. kidney and ureters
of bladder fullness, as evidenced by urinary Take down decreased which may lead to renal Patient will rate the pain
incomplete bladder tract infection and Patient will be able to urinary output. insufficiency. less than 3 on 1-10 pain
emptying, and severe urethral blockage. rate the pain less than 3 Determine specific Insufficiency of blood scale within 5 hours of
pain on right flank. on 1-10 pain scale gravity as ordered. circulation to the hospitalization.
She rates the pain 8 within 5 hours of kidney alters its
on 1-10 pain scale. hospitalization. capability to filter and
She also states when concentrate substance.
she is able to void it
burns and has a foul Monitor time intervals Keeping an hourly
odor. between voiding and record for 48 hours can
document the quantity help in establishing a
Objective Data: voided. toileting program and
gives a clear picture of
Vital signs taken as the patient’s voiding
follows: pattern.
HR: 85
If incomplete emptying
BP: 120/80 Retention of urine in
is presumed,
TEMP: 38.50C the bladder predispose
catheterize and
URINE OUTPUT: < 30 the patient to urinary
measure residual urine.
mL/hr tract infection and may
indicate the need for an
intermittent
catheterization
program.
Secure the catheter of
the female patient to This technique prevents
her thigh. urethral fistula and
avoids accidental
dislodgement.

DISCHARGE INSTRUCTION AND HEALTH TEACHINGS

 Encourage the patient to drink liberal amounts of fluids (water is the best choice) to promote renal blood flow and to flush the bacteria
from urinary tract.
 Drink cranberry juice because it is the most well-established natural treatments for UTI’s, and also it contains antioxidants, including
polyphenols, which have antibacterial and anti-inflammatory properties.
  Avoid coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants.
 Use probiotics such as yogurts, because it can help keep urinary tract healthy. This probiotic may do preventing of harmful bacteria from
attaching to urinary tract cells.
 Wipe from front to back, after urinating wipe in a way that prevents bacteria from coming into contact with genitals. Use separate pieces of
toilet paper to wipe the genitals and anus.
 Practice good sexual hygiene, in practicing good sexual hygiene can help to reduce the number of bacteria that people can transfer during
intercourse and other sexual acts. Good sexual hygiene includes urinating before and immediately after sex, washing the genitals especially
the foreskin, before and after engaging in sexual acts or intercourse, and using barrier contraception such as condom.
 The patients take shower rather than bathe in tub because bacteria in the bath water may enter the urethra.
 Change sanitary pads or tampons, because it will help to prevent germs from getting into your urinary tract.
 Talk to your healthcare provider about your birth control method, if you need to change this method if it is increasing your risk for UTI’s.

Reported by: Maramag, Eunice Marie E.

Laman, Jenny Pearl A.