1. Chapter 45 Urinary Tract Infection

2. 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

3. 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.

4. 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

5. Nursing Diagnosis
Acute pain
Deficient knowledge

6. 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).

7. 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

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

9. 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.

10. 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.

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

12. 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.

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

14. 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

15. 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

16. 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.

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

18. Potential Sites of Urinary Calculi

19. Methods of Treating Renal Stones

20. Methods of Treating Renal Stones

21. Methods of Treating Renal Stones

22. 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

23. 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

24. Questions?