Urinary Tract Infection, (uti) Is An Infection Of One Or

Urinary tract infection, (UTI) is an infection of one or more of the structures in the urinary tract. Most UTI’s happen from bowel organisms, (E-coli). Women are more prone to UTI’s because of the shortness of their urethra. CYSTITIS Infections of the lower urinary tract are called cystitis. This is an inflammation of the urinary bladder related to a superficial infection that doesn’t extend to the bladder mucosa, most often caused by ascending infection from the urethra; it can also be caused by sexual intercourse. •

Causes o o o o o o o o o

•

Other causes o o

o o

o •

Stagnation of urine in the bladder Obstruction of the urethra Sexual intercourse Incorrect aseptic technique during catheterization Incorrect perineal care Kidney infection Radiation Diabetes mellitus Pregnancy

Cystitis is usually due to a bacterial infection of the urine. Occasionally, in children it can be caused by a virus. The infection is more common in women because a woman's anatomy is designed in such a way that it makes it easier for bacteria to enter the bladder. Sexual intercourse, using spermicidal creams, and using diaphragms all increase the risk of developing Bladder Infection. People who have a catheter in their bladder or who have to periodically catheterize them have a higher risk of developing bladder infection. People with Bladder Cancers or abnormal connections between their bladder and intestines also have a higher risk of developing Bladder Infection.

Pathophysiology •

•

•

Bacterial infection from a second source spreads to the bladder, causing an inflammatory response. • Cell destruction from trauma to the bladder wall, particularly the trigone area, initiates an acute inflammatory response. Complications •

Chronic cystitis (recurrent or persistent inflammation of the bladder)

•

Urethritis (inflammation of the urethra)

•

Pyelenophritis (Infections of the upper urinary tract)

Clinical manifestations

Any changes in the clients voiding habits should be assessed as a possible UTI. The most common clinical manifestation of cystitis is burning pain of urination (dysuria), Frequency, urgency, voiding in small amount, inability to void, incomplete emptying of the bladder, cloudy urine and hematuria ( blood in urine). Asymptomatic bacteriuria (bacteria in urine). •

Nursing Diagnosis

Impaired Urinary Elimination. The primary diagnosis when a client is experiencing problems related to cystitis is Impaired Urinary Elimination related to irritation of the bladder mucosa.

Acute Pain. Another common nursing diagnosis for clients with cystitis is Acute Pain related to irritation and inflammation of bladder and urethral mucosa. •

How to diagnose

•

Often times, treatment may be based on the symptoms alone, without additional tests. Urinalysis (in which the urine is tested for the presence of an infection) is the most common method of diagnosis. o Blood and Urine cultures may also be required. o In women with frequent infections (more than three a year), a full examination of the urinary tract (usually by a specialist) needs to be done. Also, it is sometimes recommended that all men who develop any type of urinary infection, including Bladder Infections, need to be seen by a specialist. Diagnostic test findings o

o

•

•



Urine culture and sensitivity: positive identification of organisms (Escherichia coli, Proteus vulgaris, Streptococcus faecalis)



Urine chemistry: hematuria, pyuria,; increased protein, leukocytes, specific gravity



Cytoscopy: obstruction or deformity

Assessment findings 

Frequency of urination



Urgency of urination





Nocturia (need to get up during the night in order to urinate, thus interrupting sleep)

Burning or pain on urination



Low-grade fever



Lower abdominal discomfort



Urge to bear down during urination



Dark, odoriferous urine



Dysuria (refers to painful urination)



Flank tenderness or suprapubic pain



Dribbling

Medical management

 Diet: acid-ash diet with increased intake of fluids and vitamin C  Activity: as tolerated  Monitoring: vital signs and intake and output  Laboratory studies: specific urine culture and sensitivity •

gravity,

 Maintain the patients diet  Encourage fluids (cranberry orange juice) to 3qt (3L)/day

or

 Assess renal status  Monitor and record vital signs, I/O, and laboratory studies medications,

as

 Allay patient’s anxiety  Maintain treatments: perineal care

sitz

 Antibiotics: co- trimoxizole (Bactrim), cephalexin (Keflex)  Analgesic: oxycodone (Tylox)  Urinary antiseptic: (Pyridium)

Phenazopyridine

 Antipyretic: acetaminophen (Tylenol)

Nursing interventions

 Administer prescribed

 Treatment: Sitz baths

baths,

 Encourage voiding every 2 to 3 hours  Individualize home care instructions o

Avoid coffee, tea, alcohol and cola

o

Increase fluid intake to 3 qt (3L)/ day using orange juice and cranberry juice

o

Void every 2 to 3 hours and after intercourse

o

Perform perineal care correctly

o

Avoid bubble baths, vaginal deodorants ant tub baths

•

Evaluation

The client will have return of normal voiding habits within 3 days of starting antibiotic treatment as evidenced by an absence of fever, pain, burning, frequency, and urgency.

The client will be able to urinate with minimal or no discomfort within 24 hours after treatment begins and will return to normal voiding habits within 3 days, as evidenced by an absence of pain and burning on urination.