1. URINARY TRACT INFECTIONS FELIX K. NYANDE

2. UTIs O A general term, referring to invasion of the urinary tract by infectious organisms especially bacteria. O Most common nosocomial infections in hospitalised clients. O Described by their location in the urinary tract.  Lower urinary tract infections e.g. urethritis, prostatitis, and cystitis.  Upper urinary tract infections e.g. pyelonephritis and ureteritis.  May result in chronic renal failure, sepsis, or damage to the kidney.

3. Predisposing factors O Stasis of urine in the bladder (obstruction) due to O such as a clamped catheter O Failure to void frequently O Contamination in the perineal and urethral areas from O fecal soiling O sexual intercourse O Infection such as vaginitis, epididymitis, or prostatitis. O Instrumentation e.g. cystoscopy, catheterisation

4. Predisposing factors cont’d O Reflux of urine from the urethra to the bladder or the bladder to the ureter O Previous UTIs O Sex: Women are more susceptible than men due to the short length of the female urethra and close proximity to anus and vagina O Age

5. Diagnostic investigations O Urinalysis O Urine culture O Cystoscopy O Urethral swab for c/s O Pelvic USG O Blood c/s O IVP O Urography

6. Common signs and symptoms O dysuria O urgency O frequency O incontinence O nocturia O hematuria O back pain O cloudy foul-smelling urine O Fever O costo-vertebral tenderness

7. URETHRITIS O Inflammation of the urethra O may be due to O chemical irritants O bacterial infection O trauma O sexually transmitted disease Can be classified into gonococcal and non- gonococcal urethritis.

8. Clinical manifestions O Urgency O Frequency O Pain on urination O Urethral discharge Treatment is usually by identifying and treating the cause and providing symptomatic relief.

9. CYSTITIS O Inflammation and infection of the bladder wall. O can be caused by bacteria, viruses, fungi, or parasites. Fungal infections can occur during long-term antibiotic therapy. About 90% of UTIs are caused by Escherichia coli. Symptoms include: dysuria, frequency, urgency, and cloudy urine.

10. Cystitis cont’d O Cystitis is the most common UTI. The infection tends to remain superficial, involving the bladder mucosa. The mucosa becomes hyperemic; may hemorrhage and the inflammatory response causes pus to form

11. Clinical manifestations O Dysuria O Urgency O Nocturia O Pyuria O Hematuria O Suprapubic pain

12. PYELONEPHRITIS O An inflammation of the renal pelvis and parenchymal tissues due to infection. O Most infections are caused by normal inhabitants of the intestinal tract e.g. E. Coli. O Classified into: acute and chronic

13. Acute pyelonephritis O Typically a bacterial infection of the kidney; The ascending route from the urinary tract is the most common pathway for infection of the kidney.

14. Aetiology 1. It can develop following cystitis 2. Vesico-ureteral reflux in children 3. Infections e.g. E. coli 4. Bladder tumours 5. Prostatic hypertrophy 6. Strictures 7. Urinary stones

15. Clinical manifestations Fever Vomiting Malaise Flank pains Dysuria Haematuria Frequent urination Pyuria

16. Diagnostic investigations Urinalysis Urine C/S Pelvic USG FBC Blood culture Antibody-coated bacteria test IVP

17. Chronic pyelonephritis O It is usually the result of long standing UTIs with recurrences, relapses and re-infections. Grossly both kidneys are irregularly and asymmetrically scarred. The renal pelvis and calyses are deformed, blunted and dilated. O Associated with non-bacterial infections and non infectious processes that may be metabolic, chemical, or immunologic in origin.

18. predisposing factors O obstruction O neurogenic bladder O vesico-ureteral reflux. O Strictures of the ureter or urethra

19. Clinical manifestations Mostly assymptomatic fatigue, headache anorexia polyuria, excessive thirst, weight loss.

20. pyelonephritis O Diagnostic investigations IVU BUN & Cr Pelvic USG O Complications kidney failure hypertension renal calculi

21. Nursing Management O Acute pain O Impaired urinary elimination

22. Nursing Management Acute pain O Assess the level of the pain O Apply heat to suprapubic area O Administer prescribed medication e.g. analgesics, antimicrobials O Encourage frequent voiding O Teach client to avoid cola, coffee, tea, alcohol as they are urinary irritants.

23. Nursing Managment Impaired urinary elimination: frequency, nocturia, dysuria, and incontinence O Monitor urinary elimination including frequency, consistency, volume, and color to identify signs and symptoms. O Administer prescribed antimicrobial drugs O Teach patient signs and symptoms of UTI to monitor effectiveness of treatment and recognize symptoms of recurrence. O Encourage adequate fluids to prevent infection and dehydration.

24. Prevention of UTIs O Encourage fluids 2 to 3 L per day to flush bacteria from urinary tract and promote renal blood flow. O Give antimicrobial therapy O Teach patient to finish all prescribed medications to prevent recurrent infection. O Give antispasmodic agents as ordered to relieve bladder irritability and pain. O Encourage frequent voiding O Teach to avoid cola, coffee, tea, alcohol as they are urinary irritants.

25. Prevention cont’d O Encourage client to take a diet high in vitamin C to acidify the urine to reduce bacterial growth. O Empty bladder after sexual intercourse to flush bacteria out of the body. O Avoid substances such as bubble, douching, etc. O Teach client to practice good perineal hygiene, O Females should wipe from front to back. O Teach client to wear cotton underwear to reduce perineal moisture.