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Urinary Tract Infections
- pathogenic microorganisms
- 2nd most common infection
- occurs most in women
- most common site of nosocomial infections (hospital and cath)
- ecoli #1
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Lower Urinary Tract Infections (UTI)
Risk Factors
- inability/failure empty bladder = urinary stasis
- obstructed flow = kidney stones- enlarged prostate
- decrease defense
- inflammation
- instruments in urinary tract
- contributing conditions
- increased risk of kidney stones with diabetes and pregnancy
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Lower UTI- Patho
- bacteria enter bladder, attach to epithelium, initiate inflammation
- water barrier between bladder/urine- defense layer
- normal flora vagina/urethra area- defense against E Coli.
- uropathogenic (disorder involving the urinary tract) bacteria- bacterial count more than 100,000 colonies/ml- women
sugar substances- sacrine and aspertane eat away the defense layer
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Routes of Infection
- ascending infection- from urethra (most common)- improper hygiene
- bloodstream- distant infection
- direct extension- fistula from intestine- opening between intestine and urinary tract
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Clinical Manifestations of Lower UTI (S&S)
- half have bacteriuria with no symptoms, many patients with cath associated UTI
- burning on urination, freq, urgency, nocturia, incontinence, pain, hematuria
- symptoms less common with elderly- pts in nursing homes with chronic bacteriuria; urinary stasis, post menopausal women (estrogen protects against bacteria)
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Lower UTI- Nursing Process Assess/Diagnose
- assess voiding pattern/urine note any s&s's
- assess knowledge
- urine cultures- clean catch (midstream) or cath specimen
- pyuria- pus in urine
- WBC's in urine- all with UTI
- hematuria- present with 1/2 pts with UTI
diagnosis- acute pain r/t .... manifested by .... deficient knowledge
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Medical Management for Lower UTI's
- involves meds and pt education:
- 1. acute pharmacologic therapy- antibacterial agent that kills urinary tract bacteria with minimal effects- most cured with 3 day treatment
- 2. long term pharmacologic therapy- keflax and ?
- 25% get yeast infection
- 90% reinfected with new bacteria
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Lower UTI Nursing Interventions
- administer antimicrobial (relieves pain), may need antispasmodic agents, may need Analgesic
- heat to perineum
- hygiene- basic, front to back, shower over bath
- fluids and what to avoid- cranberry and blueberry juice are good! avoid- alcohol, coffee, soda and tea
- frequent urination- q 2-3hrs
vitamin C for recurrent UTI's because it acidifies urine
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Outcomes for Lower UTI's
- relief of pain
- knowledge of UTI's/treatment
- no complications
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Upper UTI- Acute Pyelonephritis
Patho and Clinical Manifestations (S&S)
- bacterial infection of renal pelvis, tubules, and interstitial tissue of 1 or both kidneys
- *Acutely ill- chills, fever, pyuria, bacteriuria, pain, n/v, headache, malaise, dysuria, tenderness costovertebral angle
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Upper UTI Assess/Diagnose
- assess s&s
- assess diagnostic findings- urine c/s, ultrasound/ct scan, IVP, urine c&s
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Upper UTI Medical Management
- treated as outpt without symptoms dehydrations, n/v, sepsis symptoms
- 2 week course antibiotics (cipro)
- may need up to 6 wks if recurrent symptomless infection- followed by urine c&s 2 wks after med done to make sure it worked
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Chronic Pyelonephritis- Clinical manifestations (S&S)
- repeat acute pyelonephritis may lead to chronic
- usually no symptoms
- symptoms with acute exacerbation- may include fatigue, headache, poor appetite, polyuria, thirst, weight loss
- may produce scarring of kidney- renal failure result
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Upper UTI Assess/Diagnose/Manage
- assess extent of disease- IVP, creatinine clearance, BUN, creatinine levels
- complications- renal disease, hypertension, kidney stones
- medical management- long term prophylactic antimicrobial, assess renal function r/t meds
- nursing management- monitor i&o, increase fluids if able, assess temp q4hrs, teaching r/t prevention infections
- possible antipyretics for temp
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Adult voiding dysfunction- urinary incontinence
- involuntary loss of urine
- underdiagnosed and underreported
- risk factors- # vaginal deliveries, menopause, high impact exercise, etc
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types of incontinence
- stress- pt with intact urethra, results of sneezing, coughing, changing position - after prostate cancer surgery for men
- urge- strong urge to void cannot be suppressed- just can't get to bathroom fast enough
- functional- urinary tract ok but cognitive or physical issue
- iatrogenic- related to meds
- mixed- several types together
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