all about UTI
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| What are the 4 types of UTI | Community Acquired, Catheter associated, Uncomplicated, Complicated
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| Uncomplicated UTI | Infection occurs in normal urinary tract and usually only involves the bladder
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| Complicated Infections occur with coexisting presence of: | Obstruction, stone, catheters, diabetes or neurologic disease, pregnancy- induced changes, and recurrent infection.
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| Those with complicated infection are at risk for what? | pyelonephritis, urosepsis, and renal damage
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| Neurogenic Bladder | Bladder is not functioning, not going to contract to allow urination. (stroke, paralysis, diabetes)
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| Problems with urine retained in bladder? | cause infection, cause hedonecrosis, and other renal problems.
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| What is the most common pathogen of UTI? | Ecoli
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| Indicate significant UTI | Counts >100,000 organisms/ml
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| Lower tract | Bladder/ urethra (cystitis/ Urethritis)
NO SYSTEMIC MANIFESTATIONS
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| Upper Tract | renal parenchyma/renal pelvis, ureters (Pyelonephritis)
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| Upper tract causes | fever, chills, flank pain
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| Risk factors for UTI include (8 items) | Female: short urethra
Sexual activity
BPH: obstruction increase risk in males
Aging
Invasive procedures
Obstruction/functional disorders
Exterrnal: bubble bath
Anything that causes bacteria to enter
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| Clinical Manifestations of UTI | Dysuria, Frequent urination (>q2hr) small amount, Urgency, suprapubic discomfort, Pyuria (cloudy), hematuria,
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| Progression to upper UTI (clinical manifestations) | Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)
Hematuria, foul smelling urine, tender, enlarged kidney
Systemic systems: N/V, chills, malaise
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| Older adult UTI | symptoms often absent, less likely to have a fever, superpubic discomfort, decreased appetite, cog. impairment, mental confusion, unexplained falls, sudden incontinence,
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| Only symptom older adult may have | mental confusion
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| Complications of UTI | Urosepsis- more common in elderly
Acute renal failure
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| cystitis symptoms | inflammation of bladder
frequency, urgency, suprapubic pain, dysuria, hematuria, fever, confusion in older adults
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| urethritis | inflammation of urethra
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| Urosepsis | UTI that has spread into systemic circulation
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| diagnostic studies for UTI | urinalysis
Urine culture and sensitivity
IVP or abdominal CT if obstruction suspected; renal ultra sound
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| Urinalysis | provides 1st clues
identifies nitrates, WBC, and leukocyte esterase
microscopic confirmation
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| Urine culture and sensitivity | clean catch preferred
sensitivity determines susceptibility to antibiotics and guides treatment
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| What do you do before giving antibiotic for UTI? | Get culture
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| Uncomplicated cystitis treatment | short term course of antibiotics (1-3 days)
Do well with less potent antibiotics (Nitro, Cipro)
increase fluid intake
prevention
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| Complicated UTI treatment | long term treatment (7-14 days +)
Cipro, Levaquin, Noroxin, Floxin, Tequin
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| Carbenicillin | strongest med and highest concentration in urine
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| For patients who experience frequent UTI | Prophylactic or suppressive antibiotics
TMP/SMX administered daily to prevent recurrence
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| Pyridium | Wont effect bacteria at all use with antibiotic
Helps BURNING sensation
stains urine reddish orange can be mistaken for blood & stain clothes
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| Unrised | not used as much, turn urine blue or green
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| Nursing Diagnosis for UTI | Impaired urinary elimination, Acute pain, knowledge deficit, Fluid volume deficit, Risk for sepsis/ renal damage/ impairment
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| Nursing interventions (Acute) | give adequate fluids avg- 2-3 liters/day
Drink cranberry juice, REST
Avoid: caffeine, alcohol, spicy foods, any bladder irritants
Apply warm compress to abdomen or lower back for pain
Sitz bath &urinate in bath- relieve burning w/ urination
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| Nursing Interventions cont. | Take full dose of meds until gone
Complicated may come in for follow up -onset of flank pain or fever call MD
Uncomplicated: no follow up, symptoms usually resolved
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| Complicated goals | relief of pain
normal temp
no complications
normal renal function
no recurrence of symptoms
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| Uncomplicated goals | relief from UTI
lower tract: prevention of upper tract involvement
Prevention of recurrence
normal urinary elimination patterns
Verbalize knowledge of treatment
Adequate fluids
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| Teaching | empty bladder regularly and completely
Promote regular bowel activity
WIPE FRONT TO BACK
cotton panties
DRINK FLUIDS
Daily intake of cranberry juice will help
Empty bladder before and after sex
take showers not baths
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| Individuals at risk | Debilitated persons, older adults, underlying diseases (HIV, DM), immunosuppressed
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| Infection control | WASH HANDS before and after con
Wear gloves for urinary care
ROUTINE AND THROUGH PERI CARE for all pts
NPSG prevention of CAUTIs
-Avoid unnecessary cath
-early removal of indwelling cath
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| CAUTI core preventions | insert for only appropriate indications
leave only as long as have to
hand hygiene
Aseptic technique and sterile equipment
maintain closed drainage
use ultrasound devices to see if urinary retention
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| use of indwelling catheters | Acute urinary retention or obstruction
peri operative use
Assist healing of wounds in incontinent pts
hospice, comfort care, palliative care
Required immobilization for trauma or surgery
Catheter in on admission
Acute obstruction- BP
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| What do you do when placing catheter | sticker on bag, chart date and placement of catheter, and purpose - **** DOCUMENT***
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| Pyelonephritis symptoms | flank pain, dysuria, mild fatigue, Malaise, chills, fever, vomiting, pain at costovertebral angle, SAME S&S as Cystitis
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| Pyelonephritis goals | May require hospitalization
severe cases: IV antibiotics initially
Monitor for Urosepsis to prevent septic shock
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