Chapter 45 Urinary Tract Infection

Urinary Tract Infections The second most common reason persons seek health care Lower UTI Cystitis Prostatitis Urethritis Upper UTI Pyelonephritis: acute and chronic Interstitial nephritis Renal abscess and perirenal abscess

Assessment Pain Increase frequency (voiding more than every 3 hours) burning upon urination Suprapubic, pelvic, or back pain Increase frequency (voiding more than every 3 hours) Nocturia; incontinence; hematuria; and change in urine or urinary pattern About half are asymptomatic Assess voiding patterns, association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene Elderly patients often lack the typical symptoms of UTI and sepsis.

Diagnostics Urine culture Cellular studies Ultrasound and CT scan Identify the underlying microorganism Cellular studies Microscopic hematuria is present in about half of patients with an acute UTI Pyuria (greater than 4 WBCs) occurs in all patients with UTI; however, it is not specific for bacterial infection. Ultrasound and CT scan Pyuria can also be seen with kidney stones, interstitial nephritis, and renal tuberculosis

Nursing Diagnosis Acute pain Deficient knowledge

Collaborative Problems/Potential Complications Sepsis Renal failure Many patients with catheter-associated UTIs are asymptomatic; however, any patient with a catheter who suddenly develops signs and symptoms of septic shock should be evaluated for urosepsis (sepsis resulting from infected urine).

Interventions Prevention Personal hygiene avoid indwelling catheters, care of catheters Personal hygiene Medications as prescribed: antibiotics, analgesics Application of heat to the perineum to relieve pain and spasm Increased fluid intake Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol Frequent voiding Patient education

Upper Urinary Tract Infections Pyelonephritis is a bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys

Causes upward spread of bacteria from the bladder spread from systemic sources reaching the kidney via the bloodstream. because static urine provides a good medium for bacterial growth. Bladder tumors, strictures, benign prostatic hyperplasia, and urinary stones are some potential causes of obstruction that can lead to infections. Systemic infections (such as tuberculosis) can spread to the kidneys and result in abscesses.

Acute Pyelonephritis Enlarged kidneys with interstitial infiltrations of inflammatory cells. Abscesses within the renal capsule and at the corticomedullary junction. Eventually, atrophy and destruction of tubules and the glomeruli may result.

Chronic Pyelonephritis When pyelonephritis becomes chronic, the kidneys become scarred, contracted, and nonfunctioning.

Nursing management: Acute and Chronic I & O Unless contraindicated, 3 to 4 L of fluids per day is encouraged to Dilute the urine Decrease burning on urination Prevent dehydration. Temperature every 4 hours Administers antipyretic and antibiotic agents as prescribed. Symptomatic patients are often more comfortable on bed rest.

Nursing management: Acute and Chronic Patient teaching prevention of further infection by consuming adequate fluids emptying the bladder regularly performing recommended perineal hygiene.

Urolithiasis and Nephrolithiasis Calculi (stones) in the urinary tract (Urolithiasis) or kidney (Nephrolithiasis) Pathophysiology Supersaturation of calcium or uric acid Causes; may be unknown Manifestations Depend upon location and presence of obstruction or infection Pain and hematuria Pyuria The patient has a desire to void, but little urine is passed Colicky pain radiating to the gentalia

Diagnosis X-ray (KUB) Ultrasound blood chemistries stone analysis; strain all urine and save stones Determine the composition of the stone KUB kidney ureter and bladder

Medical Management Opioid analgesic agents are administered to prevent shock and syncope NSAIDs inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone. Hot baths or moist heat to the flank areas may also be helpful. Unless contraindicated (E.G. heart failure) fluids are encouraged ten 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute A urine output exceeding 2 L/day is advisable.

Medical management Thiazide diuretics Reduce calcium loss in the urine Protein restriction to minimize uric acid

Potential Sites of Urinary Calculi

Methods of Treating Renal Stones

Methods of Treating Renal Stones

Methods of Treating Renal Stones

Nursing interventions Administering opoiods and NSAIDs Increased fluid intake is encouraged to prevent dehydration and promote passage of the stone. If the patient cannot take adequate fluids orally,  IV fluids are prescribed Ambulation is encouraged as a means of moving the stone through the urinary tract

Patient Teaching Signs and symptoms to report Urine pH monitoring Measures to prevent recurrent stones Importance of fluid intake Dietary teaching Medication teaching as needed

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