 UTI- typically in the urethra and bladder

o Cystitis- bladder infection

- If it climbs up the bladder, it may reach the kidneys then results to pyelonephritis (or
kidney infection)
 Signs and symptoms
o Fever
o Dysuria- burning sensation during urination
o Urinary frequency- constant feeling of having to void
o Diagnostics:
 Urinalysis
 Cloudy and smelly- indicate bacteria in urine
 WBC- indicate general infection
 Nitrates- indicate kidney infection
 Urine culture and sensitivity
 Over 10,000 organisms/ml
 Same s/s with UTI but WORSE
o Difference is pain location
 CVA pain- dull flank pain (extending towards the umbilicus)
 Not sharp, excruciating pain (this indicates kidney stones rather)
 Causes:
o Urinary retention- flourishes bacteria and infection is easier to take hold
 So in men, BPH patients are more prone to this because of larger prostate
causing urine to not be expelled out easily
o Kidney stones or renal calculi- causes obstruction that holds back urine
o Ineffective bladder contraction ????
o Catheterization- (foley catheter) bacteria can easily climb up the bladder
 So for patients that uses catheter, it must be remembered that the longer the
catheter stays, the higher the risk for infection
o E. coli- when it enters the urethra (or urinary system in general), more typical among
female due to their anatomy where the urethra is shorter than men (closer to the anus)
 Complications
o Neural sepsis (among elderly)
 Manifested by:
 Confusion
 Disorientation
 Delirium (gone once the cause is treated)
 Nursing intervention
o Increase fluid intake to 2000 mL water daily
o Void after sex
o Take cranberry supplement or acid-ash diet (to acidify urine LMAO??)
o Avoid caffeine and alcohol- coz it causes more acidic urine
o No douching
o NO bubble bath and use cotton underwear
 o Wipe front to back

ACUTE PAIN

Heat applied to the perineum might help reduce pain and

spasms.
Apply a heating pad
to the patient’s
lower back or
suprapubic area.

Encourage the
Increasing fluid consumption to 2 to 3 liters per day aids
patient to increase
urine production, dilutes urine, relieves bladder irritation,
the oral fluid intake,
improves renal blood flow, and flushes microorganisms
unless
from the urinary system.
contraindicated.

Encourage the
To avoid bladder distention, lower bacterial urine counts,
patient to void on a
reduce urine stasis, and prevent reinfection, frequent
regular basis and
voiding every 2 to 3 hours to completely empty the
when the urge is
bladder is recommended.
felt.

Encourage the patient to avoid urinary tract irritants.

Sodas, spices, tea, alcoholic beverages, and coffee are considered
urinary tract irritants and should be avoided.
Encourage rest.
Fatigue can contribute to pain. A quiet, darkened room with minimal
noise and interruptions can promote rest and reduce pain.
PHARMA INTERVENTION

HYPERTHERMIA
Assess and monitor vital signs.
Changes in vital signs including tachycardia and hypertension indicate
progression of hyperthermia.
Assess intake, output, and signs of dehydration.
Hyperthermia can result in dehydration. Signs and symptoms of
dehydration include thirst, poor skin turgor, dry oral membranes, weak
and fast pulse, decreased urine output, and increased urine
concentration.
Provide a tepid sponge bath as needed
A sponge bath with tepid water will reduce fever by dilating the
superficial blood vessels, ultimately releasing heat and lowering body
temperature. Do not induce shivering as this is the body’s attempt to
increase temperature.

Encourage adequate fluid intake.

Adequate fluid intake will help prevent dehydration, which is
precipitated by the increase in body temperature.

Maintain bed rest.

Adequate rest allows the reduction of metabolic demands and oxygen
consumption, resulting in a decrease in body temperature.

Administer antipyretic medications as indicated.

Antipyretic medications reduce prostaglandin synthesis to lower body
temperature.
Urinary Urgency
1. Measure intake and output accurately.
A record of the patient’s intake and output can help determine changes
in urine characteristics (amount and concentration), which can indicate
the progression of pyelonephritis.

2. Instruct the patient to void every 2-3 hours.

This will help to empty the bladder and prevent the buildup of urine.
Bladder training helps in reducing urine leakage and a sense of urgency
by increasing the amount of fluid the bladder holds and the time
between emptying of the bladder.

3. Check for distention with a bladder scanner.

This can help determine bladder distention or incomplete emptying after
urination.

4. Encourage increased fluid intake.

Adequate fluid intake promotes hydration, increases urine production,
and flushes out bacteria from the urinary tract system. Patients with
incontinence issues can be hesitant to drink enough which creates an
environment for dehydration and urinary infection.

5. Facilitate a comfortable voiding position, making use of urinals or

bedpans as needed.
Discomfort can affect the patient’s elimination patterns. Offer urinary
devices frequently for the patient who cannot communicate to support
urination.
Modifiable Risk Factors:
Instrumentation
Instrumentation/Catheteriaztion
Renal Calculi
Urinary Retention
Urinary Obstruction