Please enable JavaScript.
Coggle requires JavaScript to display documents.
URINARY TRACT INFECTION, references: Lewis, S. L., Bucher, L., Heitkemper…
URINARY TRACT INFECTION
PRIORITY NURSING ASSESSMENT
SUBJECTIVE DATA
Past health history
previous UTI, urinary calculi, reflux, strictures or retention
neurologic bladder, pregnancy, benign prostatic hyperplasia, bladder cancer, sexually transmitted infection
Medications
antibiotic, anticholinergics, antispasmodics
Surgery or treatments
recent urologic instrumentation (catheterization, cystoscopy
elimination
urinary frequency, urgency, hesitancy. Dysuria, nocturia
cognitive-perceptual: suprapubic or low back pain, costovertebral tenderness, bladder spasms, dysuria, burning on urination
OBJECTIVE DATA
fever, chills, dysuria
hematuria, cloudy, foul-smelling urine. tender, enlarged kidney
Atypical presentation in older adults: afebrile, absence of dysuria, loss of appetite, altered mental status
UA positive for bacteria, positive urine culture
PATHOPHYSIOLOGY
Most common bacterial infection (E.Coli) in women. Inflammation of the urinary tract may be caused by a variety of disorders
Common factor contributing to ascending infection is urologic instrumentation (catherterization, cystoscopic examinations) - instruments allows bacteria that are normally present at the opening of the urethra to enter into the urethra or bladder
Sexual intercourse promotes "milking" of bacteria from the vagina and perineum and may cause minor urethral trauma that predisposes women to UTIs
TYPE
Pyelonephritis
Cystitis
Urethritis
Urosepsis - spread systemically and life threatening condition
SIGNS AND SYMPTOMS
painful urination in uncomplicated urethritis or cystitis to severe systemic illness associated with abdominal or back pain, fever, sepsis, and decreased kidney function in some cases of pyelonephritis
LUTI
hesitancy
intermittency
postvoid dribbling
urinary retention or incomplete emptying
dysuria
urinary frequency
urgency
incontinence
nocturia
nocturnal enuresis
in older adult: nonlocalized abdominal discomfort rather than dysuria and suprapubic pain
Cognitive impairment or generalized clinical deterioration
DELEGATED TASKS
UAP
collect urine samples
apply local heat to the suprapubic area or lower back may relieve the discomfort associated with a UTI
assist warm shower or sitting in a tub of warm water
LVN/LPN
administer medications
RELATED DISORDERS
Pyelonephritis
urosepsis
renal damage
MEDICATIONS
antibotics
nitrofurantoin
Ampicillin, amoxicillin, cephalosporins
Trimethoprim/Sulamethoxazole
Fluoroquinolones
Ciprofloxacin
levofloxacin
ofloxacin
INDEPENDENT NURSING INTERVENTION
Teach patient take all antibiotics as prescribed.
Practice appropriate hygiene
wipe front to back after urinating
cleanse with warm soapy water after each bowel movement
carefully clean the perineal region by separating the labia when cleansing
Empty bladder before and after sexual intercourse
Urinate regularly, approximately every 3-4hr during the day
maintain adequate fluid intake
avoid vaginal douches and harsh soaps, bubble baths, powders and sprays in the perineal area
report to HCP symptoms or signs of recurrent UTI
Consider drinking unsweetened cranberry juice or taking cranberry extract tablets 300-400 mg/day for UTI prevention
COLLABORATIVE NURSING INTERVENTIONS
Pharmacists
Physician
Radiologist - imagine studies
references:
Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding , M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis, MO: Elsevier, Inc.