Urinary Tract Infection: UTI- Medications, Causes and Complications

 URINARY TRACT INFECTION

Overview

• A urinary tract infection (UTI) refers to any portion of the lower urinary tract ( ureters, bladder, urethra, prostate). This includes the following.
• Cystitis
• Urethritis
• Prostatitis
• An upper UTI refers to conditions such as pyelonephritis ( inflammation of the kidney pelvis)
• UTI are caused by Enterobacteriaceae micro-organism (klebsiella, proteus), pseudomonas, staphylococcus saprophyticus, and most commonly, Escherichia coli.
• Untreated UTI may lead to pyelonephritis and urosepsis, which can cause septic shock and death.

ASSESSMENT

• FEMALE GENDER 
• Short urethra predisposes women to UTIs.
• Close proximity of the urethra to the rectum.
• Decreased estrogen in ageing women promotes atrophy of the urethral opening towards the rectum( increase the risk of urosepsis in women).
• Sexual intercourse.
• Frequent use of feminine hygiene spray, tampons, sanitary napkins, and spermicidal jellies.
• pregnancy.
• Poorly fitted diaphragm.
• Hormonal influence within the vaginal flora.
• Wet bathing suits
• Frequent submersion of baths or hot tubs
• indwelling urinary catheters (significant sources of infection in clients who are hospitalized)
• stool incontinence
• Bladder distension
• Urinary conditions (anomalies, stasis, calculi, residual urine)
• Possible genetic links
• Disease ( diabetic Mellitus)
• Older adult clients have an increased risk of bacteremia, sepsis, and shock.
• Incomplete bladder emptying caused by an enlarged prostate or prostatitis in male
• Bladder prolapse in females
• Inability to empty bladder as a result of a stroke or parkinson"s disease.
• Faecal incontinence with poor perineal hygiene
• Hypoestrogen female affecting the mucosa of the vagina and urethra, causing bacteria to adhere to the mucosal surface.
• Renal complications increase due to decreased number of functioning nephrons and fluid intake.

Subjective data

• Lower back and lower abdomen discomfort and tenderness over the bladder area.
• Nausea
• Urinary frequency and urgency
• Dysuria, bladder cramping, spasms.
• Feeling of incomplete bladder emptying or retention of urine
• Perineal itching
• Hematuria
• pyuria ( greater than 4 WBC in urine sample 

Objective data

• Fever 
• Vomiting
• Voiding in small amounts
• Nocturia
• Urethral discharge
• Cloudy or foul-smelling urine

Older adult clinical manifestation of UTI

• Mental confusion
• Incontinence
• Loss of appetite
• Nocturia and dysuria
• Hypotension, tachycardia, tachypnea, and fever (signs of urosepsis)

Laboratory test

Urinalysis and urine culture sensitivity 

• Nursing action
• Instruct the client regarding proper technique for the collection of a clean-catch urine specimen
• Collect catheterized urine specimen using sterile technique.
• Expected findings including the following.
• Bacteria, sediment, white blood cells, and red blood cells
• Positive leukocyte esterase and nitrates ( 68% to 88% positive result indicates UTI)

WBC count and differential if urosepsis is suspected.

• White blood cell count at or above 10,000/uL with a shift to the left, indicating an increased number of immature cells (neutrophils) in response to infection.

Rule out sexually transmitted infections, which can symptoms of a UTI.

• Chlamydia trachomatis, neisseria gonorrhoea, and herpes simplex can cause acute urethritis.
• Trichomonas or candida can acute vaginal infection.

Diagnostic procedures

• Cystoscopy is used for -complicated UTIs.
• Cystourethroscopy to detect strictures, calculi, tumours, cystitis.
• Computed tomography (CT) scan to detect pyelonephritis.
• Ultrasonography to detect cysts, tumours, calculi, abscesses.
• Transrectal ultrasonography to detect prostate and bladder conditions in males.

Patient-centred care

• Promote fluid intake 3L per day
• Consult with the provider regarding prescribed fluid restriction if needed.
• Administer antibiotic medications as prescribed.
• Encourage clients to urinate every 3 to 4 hr instead of waiting until the bladder is complete full.
• Recommend warm sitz bath two or three times a day to provide comfort.
• Avoid the use of indwelling catheters if possible. This reduces the risk for infection. 

Medications

• Fluoroquinolones ( ciprofloxacin, norfloxacin, levofloxacin), nitrofurantoin, trimethoprim, or sulfonamides are antibiotics used to treat urinary infections by directly killing bacteria and inhibiting bacterial reproduction. 
• Penicillins and cephalosporins are administered less frequently because the medication is less effective and tolerated. 
• Nitrofurantoin is an antibacterial medication where therapeutic levels are achieved in the urine only. 
• Phenazopyridine is bladder analgesic used to treat UTIs. 
• The medicine will not treat the infection, but it will help relieve bladder discomfort. 
• Urology service may be consulted for managing UTI

Complications 

• Urethral obstruction 
• Pyelonephritis
• CKD
• Urosepsis
• Septic shock