Compilation Bachelor of Science in Nursing Laguna State Polytechnic University

1. INFECTIONSOF THE URINARY TRACT
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OVERVIEW OF THE DISEASE
Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary
tract (the normal urinary tract is sterile above the urethra). UTIs are generally classified as
infections involving the upper and lower urinary tract and further classified as uncomplicated or
complicated, depending on other patient-related conditions.
PREVALANCE
 A UTI is the second most common infection in the body. Most cases occur in women;
one out of every five (5) women in the United States will develop a UTI during her
lifetime.
 The urinary tract is the most common site of nosocomial infection, accounting for 40% of
the total number reported by hospitals and affecting about 600,000 patients each year. In
most of these hospital-acquired UTIs, instrumentation of the urinary tract or
catheterization is the precipitating cause.
 More than 250,000 cases of acute pyelonephritis occur in the United States each year,
with 100,000 patients requiring hospitalization. Approximately 11.3 million women are
diagnosed with UTIs in the United States.
CLASSIFYING URINARY TRACT INFECTIONS
Urinary tract infections are classified by location:
 Lower urinary tract: Includes the bladder and structures below the bladder.
 Cystitis
 Prostatitis

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 Urethritis
 Upper urinary tract: includes the kidneys and ureters.
 Acute pyelonephritis, chronic pyelonephritis, renal abscess, interstitial nephritis,
perirenal abscess
 Uncomplicated lower or upper UTIs
 Community-acquired infection; common in young women and usually recurrent
 Complicated lower or upper UTIs
 Often acquired in the hospital and related to catheterization; occur in patients with
urologic abnormalities, pregnancy, immunosuppression, diabetes and obstructions
and are often recurrent.
RISK FACTORS
 Inability or failure to empty the bladder completely
 Obstructed urinary flow caused by:
 Congenital abnormalities
 Urethral strictures
 Contracture of the bladder neck
 Bladder tumors
 Calculi (stones) in the ureters or kidneys
 Compression of the ureters
 Decreased natural host defenses or immunosuppression
 Instrumentation of the urinary tract (catheterization, cystoscopic procedures)
 Inflammation or abrasion of the urethral mucosa
 Contributing conditions such as:

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 Female gender/anatomy
 Diabetes
 Pregnancy
 Neurologic disorders
 Gout
 Altered states caused by incomplete emptying of the bladder and urinary stasis
LOWER URINARY TRACT INFECTION
Bacterial invasion of the urinary tract
By increasing the normal slow shedding of bladder epithelial cells (resulting in bacteria
removal), the bladder can clear the large numbers of bacteria. Glycosaminoglycan (GAG) a
hydrophilic protein, normally exerts a non-adherent protective effect against various bacteria.
The GAG molecule attracts water molecules, forming a water barrier that serves as a defensive
layer between the bladder and the urine, GAG may be impaired by certain agents. The normal
bacterial flora of the vagina ang urethral immunoglobolins A (IgA) in the urethra may also
provide a barrier to bacteria.
Reflux
An obstruction to free-flowing urine is a condition known as Urethrovesial reflux, which is
the reflux (backward flow) of urine from the urethra into bladder with coughing, sneezing, or
straining, the bladder into the urethra. When the pressure returns to normal , the urine flows back
into the bladder, bringing into bladder bacteria from the anterior portion of the urethra.

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Uropathogenic Bacteria
Bacteriuria is a bacteria in the urine. Because urine samples (especially women) are
commonly contaminated by the bacteria normally present in the urethral area, a bacterial count
exceeding 10 colonies/ml of clean catch midstream urine is the measure that distinguishes true
bacteriuria from contamination. In men, contamination of the collected urine sample occur less
frequently; hence, bacteriuria is defined as 10 colonies/ml urine.
Clinical Manifestations
A variety of symptoms are associated with UTI. Sign and symptoms of an uncomplicatd lower
UTI (cystitis) include:
 Burning on urination
 urinary frequency (voiding more than every 3 hours)
 urgency
 Nocturia (awakening at night to urinate)
 Incontinence
 Suprapubic or pelvic pain
UPPER URINARY TRACT INFECTION
Pyelonephritis is a bacterial infection of tge renal pelvis, tubules and interstitial tissue of
one or both kidneys. Causes involve either the upward spread of bacteria from the bladder or
spread from the systemic sources reaching the kidney via the bloodstream. Pathogenic bacteria
from the bladder ascend into the kidnet resulting in pyelonephritis.

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Acute Pyelonephritis
Clinical Manifestations
 Chills
 Fever
 Leukocyctosis
 Bacteriuria
 Pyuria
 Low back pain, flank pain
 Vomiting and Nausea
 Headache and malaise
 Painful urination
Chronic Pyelonephritis
Clinical Manifestations
 Fatigue
 Headache
 Poor appetite
 polyuria
 Excessive thirst
 Weight loss

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Assessment and Diagnostic Findings
 Bacterial colony counts
 Cellular studies
 Urine cultures
 BUN
 Creatinine levels
The following groups of patients should have urine cultures obtained when bacteriuria is present:
 All men ( because of likelihood of structural or functional abnormalites)
 All children
 Women with history of compromised immune function or renal problems
 Patients with diabetes
 Patients who undergone recent instrumentation (including catheterization) of the urinary
tract
 Patients with prolonged or persistent symptoms
 Pregnant women
 Postmenopausal women
 Women who are sexually active
 Women who have new sexual partners

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Medical Management
Medications used to treat urinary tract infection and pyelonephritis
Drug classes Generic (brand) names Major indications
Anti-infective, urinary tract
bactericidal
Cephalosporins
Fluoroquinolone
Penicillin
Trimethoprim-
sulfamethoxazole combination
Nitrofurantoin (Macrodantin,
furadantin)
Cephalexin (keflex)
Cefadroxil (Duricef, ultracef)
Ciprofloxacin (Cipro)
Ofloxacin (Floxin)
Norfloxacin (Noroxin)
Gatifloxacin (Zymar)
Levofloxacin (Levaquin)
ampicillin (Principen,
Omnipen)
amoxicillin (Amoxil)
Co-trimoxazole (Bactrim,
Septa)
UTI
Genitourinary infection
UTI
UTI
Pyelonephritis
Uncomolicated UTI
UTI-Not commonly used
alone due to E.coli resistance
pyelonephritis

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Urinary analgesic agent Phenazopyridine (pyridium) UTI
Pyelonepritis
For relief of burning pain
NURSING DIAGNOSIS
 Acute pain related to infection within Urinary tract
 Deficient knowledge about factors predisposing the patient to infection and recurrence,
detection and prevention of recurrence and pharmacologic therapy
Reference : Brunnerand Suddarth'sMedical Surgical nursing Chapter 55 Management of patients with Urinary
Disorders pages1574-1581