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Monday, October 26, 2020

Urinary Tract Infection: UTI- Medications, Causes and Complications



  • 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.

    • 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. 

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

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