1. JenniferLee DiBernardo Pathophysiology Project Urinary Tract Infection

2. OBJECTIVES By the end of this presentation the learner should be able to identify: The basic structures and functions of the Urinary System. The most common microorganisms that cause Urinary Tract Infections. Risk factors for Urinary Tract Infections. The most common laboratory tests in diagnosing Urinary Tract Infections. Treatments and prevention measures for Urinary Tract Infections.

3. Basic Structures of the Urinary System The urinary system consists of: –two kidneys –two ureters –one urinary bladder –one urethra

4. Functions of the Basic Structures of the Urinary System Kidney – small, dark red kidney bean shaped structures. The kidneys are responsible for continuously cleansing the blood and adjusting its composition, urine formation, excretion of Nitrogen containing wastes, maintaining water and electrolyte balance of the blood, maintaining the acid – base balance of the blood and the formation of urine. Ureters – slender tubes each 10 to 12 inches in long and ¼ inch in diameter. Each ureter runs from the kidney down to the urinary bladder and attaches itself to the posterior aspect of the bladder on a slight angle. The ureters are passageways to carry urine from the kidneys to the bladder. Urinary Bladder – is a smooth, collapsible, muscular sac with 3 openings, the 2 ureter openings and the urethra opening. When the bladder is empty, it is collapsed and it is 2 to 3 inches long at most, when the bladder is moderately full about 500ml it is about 5 inches long. The bladder is able to hold twice that amount though. The main function of the urinary bladder is to provide a temporary storage tank for urine. Urethra – is a thin walled tube that carries urine by peristalsis from the bladder to the outside of the body. The length and relative function of the urethra differs in both sexes.

5. Functions of the Urinary System The principal function of the urinary system is to maintain the volume and composition of body fluids within normal limits. One aspect of this function is to rid the body of waste products that accumulate as a result of cellular metabolism. The urinary system maintains an appropriate fluid volume by regulating the amount of water that is excreted in the urine. Other aspects of its function include regulating the concentrations of various electrolytes in the body fluids and maintaining normal pH of the blood In addition to maintaining fluid homeostasis in the body, the urinary system controls red blood cell production by secreting the hormone erythropoietin. The urinary system also plays a role in maintaining normal blood pressure by secreting the enzyme renin.

6. Differences Between the Male and Female Urinary System Male Urethra Female Urethra Approx 8 inches long Approx 1.5 inches long Located further from anus Located more proximate to anus Has two functions, urination & passageway for sperm Has one function, urination

7. Definition of Urinary Tract Infection (UTI) Is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract.

8. Most Common Organisms Which Cause UTIs Escherichia coli Enterobacter Pseudomas Serratia Staphylococcus saprophyticus Candida

9. Signs and Symptoms of UTIs Dysuria (burning pain upon urination) Frequency Urgency Voiding in small amounts Inability to void Incomplete emptying of bladder Low back / Suprapubic pain

10. Assessment Findings in UTIs Hematuria (bloody urine) Cloudy urine Flank pain Abdominal pain Fever Nausea Vomiting

11. Most Common Laboratory Tests Used in Diagnosing UTIs Urinalysis ( U/A ) –Dip Stix Culture and Sensitivity ( C & S )

12. Urinalysis Laboratory Findings pH – Alkaline ( increases) Appearance – cloudy Color - deep amber Odor – foul smelling Specific Gravity – may change Protein – maybe present Glucose – maybe present Ketones - maybe present Blood – maybe present Leukocyte esterase (WBCs)- present

13. Urinalysis Laboratory Findings Microscopic Examination

14. Culture & Sensitivity Laboratory Findings Normal Findings No bacteria present in urine. Bacteria present in urine.

15. Treatment of UTIs Antibiotics Analgesics Increase fluids (ex. Cranberry Juice) Repeat urine culture and sensitivity after antibiotics are finished

16. Risk Factors in UTIs Females Sexual intercourse –poor fitting diaphragms –use of spericide –Pregnancy/Menopause Clothing –tight jeans –wet bathing suits –pantyhose –synthetic underwear Allergens/Irritants –feminine hygiene sprays –bubble baths –perfumed toilet paper / soap –sanitary napkins Presence of indwelling catheter –Foley Males Age Loss of bactericidal properties of prostatic secretions –sperm Obstructive Uropathy –BPH –Presence of indwelling catheter –Foley

17. Prevention of UTIs Encourage menopausal women to use estrogen vaginal creams to restore vaginal pH Teach women to use water soluble lubricants for intercourse, especially after menopause Maintain closed drainage system for hospitalized patients with an indwelling catheter and provide meticulous catheter care Ensure that patients understand the importance of taking all antibiotics and having repeat culture and sensitivities done Monitor older male patients, especially those with BPH, for the presence of infection

18. Prevention of UTIs Continued Teach female patients good perineal hygiene Teach women proper way to wipe after urination ( front to back ) Teach women to shower instead of bathing in tub. Teach women to avoid using feminine hygiene sprays and other irritants Teach women to wear cotton underwear Avoid tight jeans, sitting around in wet bathing suits Teach pregnant women to void every 2 hours Teach patients the signs and symptoms of UTIs

19. References Black, Joyce M.& Matassarin – Jacobs, Esther. (2001) Medical- Surgical Nursing: Clinical Management for Continuity of Care (5 th ed.) W.B. Saunders Company Christensen, Barbara & Kockrow, Elaine. (2000) Foundations of Nursing (2 nd ed.) St. Louis: Mosby Harkness, Gail A. & Dincher, Judith R. (2000) Medical –Surgical Nursing: Total Patient Care (9 th ed.) St. Louis: Mosby Marieb, Elaine N. (2001) Essentials of Human Anatomy & Physiology (4 th ed.) Redwood City, California: The Benjamin/Cummings Publishing Company, Inc. Pagana, Kathleen Deska & Pagana, Timothy James (2002) Diagnostic and Laboratory Test Reference (2 nd ed.) St.Louis: Mosby Timby, Barbara K. (2000) Fundamental Skills and Concepts in Patient Care (6 th ed.) Philadelphia: Lippincott All Images, www.google.com