Urinary Tract Infection

I – INTRODUCTION A. Overview of the Case The "urinary tract" consists of the various organs of the body that produce, store, and get rid of urine. These include the kidneys, the ureters, the bladder, and the urethra. The kidneys filter this blood, and the "filtrate" is processed to separate out waste products and excess amounts of minerals, sugar, and other chemicals. Since it sees so much of the body's blood flow, the kidneys also contain pressure-sensitive tissue which helps the body control blood pressure, and some of the minerals and water are saved or discarded partly to keep your blood pressure in the proper range. The waste products and "extras" make up the urine, which flows through "ureters" (one per kidney) into the bladder, where it is held until you are ready to get rid of it. When you urinate, muscles in the bladder wall help push urine out of the bladder, through the urethra, and out. (In men, the urethra passes through the penis; in women, the urethra opens just in front of the vagina.) When you aren't urinating (which is most of the time) a muscle called the "sphincter" squeezes the urethra shut to keep urine in; the sphincter relaxes when you urinate so that urine can flow out easily. Urine is normally sterile -- that is, it does not normally contain bacteria. This is a good thing, since the mineral and sugar content of urine make it a great medium for bacteria to grow in. Usually several things keep bacteria out of the urine. These include:

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The urethral sphincter: when the urethra is squeezed shut, bacteria cannot climb up the urethra from the "meatus" (the outside opening) into the bladder.

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The length of the urethra: it's a long way up to the bladder for a bacterium. (A woman's urethra is shorter than a man's, which is one reason why women are much more likely than men to get UTI's.)

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Frequent washing: any bacteria that make it into the urethra are flushed out the next time you urinate, and since most people empty their bladders almost completely when they urinate any bacteria that get to the bladder will be flushed out too. There are also valves where the ureters enter the bladder to prevent urine from "refluxing" from the bladder to the kidneys, so even if the bladder and its urine is infected the bacteria shouldn't travel up to the kidneys.

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary tract infections are usually quickly and easily treated by seeing a doctor promptly.

B. Objective of the Study

The objective of the study is to understand what Urinary Tract Infection is. The gathered Data Base and History, chief complaints of patient and History of present illness, Medications given to the patient, Nursing System Review Chart, Nursing Assessment and Health Teaching are the bases in this study.

C. Scope and Limitation of the Study

This study is to impart to the patient what to do for early recovery. The Nursing Process was used for scope and limitation of the study. Assessment, assessing the patient with interview while gathering the data. Diagnosis – Urinary Tract Infection (Acute Pyelonephritis). Planning – plan what would be best for the patient for fast recovery. Intervention – implement what would be the plans and finally Evaluation – if the objective was met.

II – HEALTH HISTORY A. Profile of Patient:

Name of Patient: Address: Civil Status: Sex: Age: Religion: Nationality: Date of Admission: Time: Hospital:

Vital Signs: Temperature:

38.1° C

Pulse Rate:

87 bpm

Respiratory Rate:

16 cpm

Blood Pressure:

110/80 mmHg

Height:

5’2 inches

Weight:

48 kg.

B. Family and Personal Health History:

Mr.X, the eldest in the family who was diagnosed of having a Urinary Tract Infection admitted at Polymedic General Hospital lasts January 9, 2007. According to my interview with him it was his first time to be admitted at the hospital. The previous illness that he experienced was only fever and cough last November 2006. He just have self medications and was able to treat himself.

C. History of Present Illness:

A case of 17 years old, male, Roman Catholic, single, from Poblacion, Lantapan Bukidnon. Admiited at the Polymedic General Hospital, Cagayan de Oro City on January 9, 2007 at 9:45 p.m.

D. Chief Complaints:

The patient Kenneth Mr. X was admitted at Polymedic General Hospital with the chief complaints of dysuria – difficult or painful urination. This is usually associated with urgency and frequency of urination due to cystitis or urethritis.

III – DEVELOPMENTAL DATA

Erikson believed that childhood is very important in personality development. All of the stages in Erikson's theory are implicitly present at birth (at least in latent form), but unfold according to both an innate scheme and one's upbringing in a family that expresses the values of a culture. Each stage is characterized by a psychosocial crisis, which is based on physiological development, but also on demands put on the individual by parents and/or society. Ideally, the crisis in each stage should be resolved by the ego in that stage, in order for development to proceed correctly. The outcome of one stage is not permanent, but can be altered by later experiences. Everyone has a mixture of the traits attained at each stage, but personality development is considered successful if the individual has more of the "good" traits than the "bad" traits. Kenneth Jay Isip belongs to the Identity vs. Role Confusion (or Diffusion). •

The adolescent is newly concerned with how they appear to others.

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Ego identity is the accrued confidence that the inner sameness and continuity prepared in the past are matched by the sameness and continuity of one's meaning for others, as evidenced in the promise of a career.

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The inability to settle on a school or occupational identity is disturbing.

IV – MEDICAL MANAGEMENT

The first step in treating a UTI is to make sure there really is one. The only certain way to know if there is a UTI is to take a sample of urine and test for urinalysis. If there are bacteria, we can then test several antibiotics to see which ones kill the bacteria most efficiently. The problem here is in getting a good sample of urine for culture. Simply urinating into a sterile cup may not stop contamination by bacteria on the skin, especially with girls. If you can control your urine, it is possible to use a "cleancatch" sample. You get this by cleaning the meatus and the surrounding area thoroughly with antiseptics (such as iodine solution), then urinating a little into the toilet before filling the sample cup, and finishing your urination in the toilet. This flushes out bacteria that may be in the urethra or meatus. Once we have diagnosed a UTI we treat the patient with antibiotics. Typical antibiotics used for UTIs include trimethoprim-sulfamethoxamole, nitrofurantoin, and certain penicillins such as amoxicillin. In some cases, when we are pretty sure from the symptoms that you actually have a UTI, we will start antibiotics right after we get the urine culture; if the culture result shows that we need a different antibiotic, we can always change. We repeat the culture 3-5 days after starting antibiotics to make sure that we are actually killing all the bacteria, and again soon after the antibiotics are finished to make sure we killed everything that needed killing. B. Actual Nursing Management

ACTUAL NURSING INTERVENTIONS S

O

SUBJECTIVE: “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the patient. - Facial grimace - Guarding - Restlessness

A

Alteration in comfort pain related to urinary infection evidenced by reports of pain and dysuria.

P

At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize relief/ control of pain.

I

Assess pain noting location, characteristics and intensity. (0-10 scale). - Helps evaluate degree of discomfort. Note urine flow and characteristics. - Decrease flow may reflect urinary retention. Cloudy urine may be normal (presence of mucous). Apply hot or cold compress when indicated. - Reduces pain Provide comfort measures e.g. back rub, repositioning the patient. - Promotes relaxation and may enhance coping abilities. DEPENDENT: Administer medications as indicated e.g. narcotics, analgesics. - Relieves pain enhances comfort and promotes rest.

E

At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized relief/ control of pain.

ACTUAL NURSING INTERVENTIONS S

SUBJECTIVE:

“Basta mangihi ko kay haplos lahi dayon sakit” as verbalized by the patient. O

OBJECTIVE: - facial grimace - guarding

A

Urinary Elimination impaired related to bladder atony evidenced by urinary tract infection.

P

At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize behaviors and techniques to prevent urinary infection.

I

Assess voiding pattern: frequency, amount. And compare urine output with fluid intake. - Identifies characteristics of bladder function. Palpate for bladder distention. - Bladder distention can precipitate autonomic dysreflexia. Have patient obtain urine sample for Urinalysis. - To know any abnormalities in the urine, e.g. presence of bacteria, protein and glucose. Encourage patient to increase fluid intake 2-4 L/ day. - Prevents infection and urinary stone. DEPENDENT Administer medications as indicated. e.g. Vit. C and urinary antiseptics. - Maintains acidic environment and discouraged bacterial growth.

E

At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized behaviors and techniques to prevent urinary infection.

ACTUAL NURSING INTERVENTIONS S

SUBJECTIVE:

“gi- hilanat ko, labad lagi akong ulo” as verbalized by the patient. O

OBJECTIVE: - weak - skin hot to touched - restlessness

A

Hyperthermia related to increased metabolic rate evidenced by increased in body temperature.

P

At the end of 30 minutes of rendering nursing intervention the patient will be able lower down body temperature back to normal range.

I

Monitor patient’s temperature; noting shaking chills. - To obtain baseline and to see changes in patient’s temperature. Check environmental temperature; limit or add bed linen as indicated. - Room temperature and number of blankets should be altered to maintain near normal body temperature. Perform Tepid Sponge Bath and avoid the use of alcohol. - May help reduced fever, alcohol may cause chills. Provide cooling blankets. - Used to reduced fever. DEPENDENT Administer antipyretics e.g. biogesic 500 mg every four hours. - help to reduced fever.

E

At the end of 30 minutes of rendering nursing intervention the patient was able to lower down body temperature back to normal range.

V – PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

Bacteria enters the Bladder

Adhere to the mucosal – surface (colonize epithelium of the urinary tract to avoid being washed out during voiding).

Inflammation of the bladder and urethra

Signs and Symptoms: dysuria, difficult, painful urination

Urinary Tract Infection The "urinary tract" consists of the various organs of the body that produce, store, and get rid of urine. These include the kidneys, the ureters, the bladder, and the urethra. The kidneys filter this blood, and the "filtrate" is processed to separate out waste products and excess amounts of minerals, sugar, and other chemicals. Urinary Bladder is hollow, smooth collapsible, muscular sac that stores urine temporarily. It is located in the hypogastric region.

The urethra is a tube that connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the

outside, and also a reproductive function in the male, as a passage for sperm. In human male, the urethra is about 8 inches (20cm) long and opens at the end of the penis. The ureters are the ducts that carry urine from the kidney to the urinary bladder, passing anterior to the Psoas major. The ureters are muscular tubes that can propel urine along by the motions of peristalsis. In the adult, the ureters are usually 50 to 70cm long.

VII – REFERRALS AND FOLLOW-UP

Instruct the patient to follow the home medications prescribed by the attending physician. Advised the patient to perform exercises such as jogging or walking exercises in order to promote muscle tone and to regain patient’s strength and condition. Encourage him to increase fluid intake, urinate when there is an urge to urinate in order to prevent infection, proper positioning during sleep and urinating frequently to avoid Urinary Tract Infection.

Instruct the patient for follow-up check-up on his condition after he was discharge, one week after the discharge will do. Encouraged the patient to drink plenty of fluids. Eat nutritious foods like fruits and vegetables. Avoid eating salty foods, junk foods and acidic softdrinks.

IX – EVALUATION AND IMPLICATION

Common organisms that can cause UTI’s include: Escherichia coli and Staphylococcus saprophyticus. Less common organisms include Proteus mirabilis, Klebsiella pneumoniae and Enterobacter. The urinary tract can be infected from above (by bacteria entering the kidneys from the bloodstream and travelling downward) or from below (by bacteria entering the urethra and travelling upward). Infection from above is most often seen in newborns with generalized infection or "sepsis". If there are many bacteria in the bloodstream, some are likely to get through the filters of the kidney to the urine. This is especially likely if the filters are immature, or if there are a lot of bacteria. In older children and adults infection most often starts from below. In small children still using diapers, stool (which is largely bacteria) can sit for some time right at the meatus; the longer it sits there, the more likely it is that bacteria may enter the urethra. Baby boys are less likely to have this happen than baby girls, because girls' urethrae are much shorter and the head of the penis isn't as likely to sit in stool. (Note, though, that bacteria can hang out in any moist, warm area, and that UTI's in boys under 1 year old seem to happens more often in uncircumcised boys than in circumcised boys since bacteria can accumulate beneath the foreskin.) Older girls may become prone to UTI's through wiping back-to-front when they are first toilet-trained, which pulls stool into the vaginal/meatal area. Sexually active teenage and adult women are more prone to UTI's because of friction at the meatus, which tends to push bacteria into the urethra (urinating after intercourse helps avoid UTI's); the same mechanism may

cause UTI's in teenage boys and adult men, although they are again less prone to UTI's than women of the same age.

B. Bibliography

Anatomy and Physiology Compilation Book http://www.haverford.edu/psych/ddavis/p109g/erikson.stages.html http://www.drreddy.com/uti.html