I.

Introduction
I chose this case because I don’t have a case of UTI before. I am also interested on how it
begins and what are the complications related to it. What are the things we should avoid to
prevent having this kind of disease and what are the things I should do if I get this kind of
infection. Also, it is the only case available for me since the first case I’m about to handle is been
at the hospital for almost a month. It is hard to make a coarse in the ward with that long period of
time.

Urinary tract infection

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary
tract. The main etiologic agent is Escherichia coli. Although urine contains a variety of fluids,
salts, and waste products, it does not usually have bacteria in it. When bacteria gets into the
bladder or kidney and multiply in the urine, they may cause a UTI.

Urinary tract infection is common infections of the urinary tract, which consists of the
kidneys, ureters, bladder, urethra and the prostate gland. Urinary tract infections are the result of
an invasion of bacteria or other microorganisms into the urinary tract.

The most common type of UTI is acute cystitis often referred to as a bladder infection.
An infection of the upper urinary tract or kidney is known as pyelonephritis, and is potentially
more serious. Although they cause discomfort, urinary tract infections can usually be easily
treated with a short course of antibiotics.

Symptoms of Urinary Tract Infections

 strong, constant urge to urinate/frequent feeling or need to urinate

 sharp pain or burning in the urethra during urination
 inability to fully empty bladder
 possible blood in urine
 soreness in lower abdomen, back, or sides
 pain during urination
 cloudy urine

Urinary tract infections (UTI's) are among the most common infections encountered by
Physicians . In clinics of tertiary centers in Manila, Cavite and Zamboanga, they account for 5 to
17% of consultations. The Philippine Renal Disease Registry of the Philippine Society of
Nephrology reports chronic pyelonephritis as the cause of end stage renal disease in 11% of
patients undergoing maintenance dialysis and 8% of kidney transplant patients from six centers.
UTI’s also constitute over 40% of hospitalacquired infections. The clinical practice guidelines,
(CPGs) on UTI’s are formulated to assist practitioners in the diagnosis, treatment and prevention
of UTI in adults. The targeted users are general practitioners, family physicians and specialists.
To cover the various important issues on UTI management, recommendations are provided for
each of the following eight clinical syndromes, which differ from one another in terms of clinical
presentation, epidemiologic setting and requirements for antimicrobial therapy: acute
uncomplicated cystitis, acute uncomplicated pyelonephritis, asymptomatic bacteriuria, UTI in
pregnancy, recurrent UTI, complicated UTI, UTI in men and catheter-associated UTI. These
recommendations are based on evidence derived from critical review of existing data and utilize
modifications of the quality standards of the Infectious Diseases Society of America (IDSA).
They are given alphabetical ranking to reflect their strength. The standards are not intended to
supplant good clinical judgment. This caveat applies to all recommendations, particularly those
for which there is inadequate evidence for or against their use (Grade C). Despite lack of quality
evidence, some recommendations which are based on clinical experience, descriptive studies
and/or consensus reports of expert committees have been provided to specifically address
common problems which confront health care providers and their patients.

http://www.unilab.com.ph/hcp/CMS_Files/cpg1.pdf
II. Patient’s Profile

Name: Ms. JL Sex: Female

Age: 35 Religion: Roman Catholic
Civil Status: Single Birthday: 06/02/75
Address: F.Reyes St., Balibago Sta. Rosa City of Laguna
Health Insurance: none

Room No.: SPR 321

Attending Physician: Dr. Marbella

Admitting Physician: Dr. Ruben Lasala

Date of admission: 12/10/10 Time of admission: 10:09pm

Admission Dx:

UTI; Gastritis

History of Past Illness:

Last Monday night, pt. JL had a high grade fever and cough. She took Paracetamol and
Bioflu as medications for her fever but have no effect. Then on Thursday, the patient had
vomited 5x of her previously ingested food and complaints full back and leg pain on left side.

History of Present Illness:

After being admitted, pt. JL still has fever and complaints of abd pain and flank pain. She
had vomited 5x of her previously ingested food and medications. Her condition got better last
Saturday but still complaining of flank pain.

Family History:

Pt. JL has a family history of hypertension. Her sister had a CVA. She is allergic to sea
foods and has been hospitalized due to allergy, appendicitis, typhoid fever and heart attack
(2008). She had undergone appendectomy when she was only 8y/o and cholescystectomy last 2
years.
III.Gordon’s Assessment Pattern
Before Hospitalization During Hospitalization Inference
I. Health Perception and “Kapag nagkakasakit “Ngayon, hindi ko na
The client is
Health Management ako, mga gamot na lang hahayaang tumagal conscious now
Pattern sa drug store yung yung nararamdaman with his health
iniinom ko.” ko para din a lumala
unlike before she
pa.” was only relying in
self medications.
II. Nutritional and “Normal naman ang “Wala akong ganang The client has loss
Metabolic Pattern pagkain ko. Medyo kumain.” her appetite when
malakas kumain din.” she was
hospitalized.
III. Elimination Pattern “Wala naming problema “Kahapon sumuka ako The client don’t
sa pag-ihi ko at ng 5beses. Pero wala have problem in
pagdume.” naman problema sa voiding and
pag-ihi at pagdume eliminating, but
ko.” had vomit several
times in the
hospital.
IV. Activity – Exercise “Sa bahay lang ako “Lalong wala na.” The client seem
Pattern palage ee.” don’t like to do
physical activities.
V. Cognitive – “Sumasakit lang yung “Ngayon parang buong The client is
Perceptual Pattern sa may bandang katawan na.” enduring the pain
balakang ko.” before and became
severe now.
VI. Sleep – Rest Pattern “Wala naman ako “Putol-putol ang The intermittent
problema sa pagtulog pagtulog ko ditto. pain experienced
nung di pa ko na Sumasakit kasi minsan by the client
oospital pati pahinga ko yung likod ko ee.” makes it difficult
ayos din naman.” for her to sleep.
VII. Self-Perception and “Masayahin naman “Ngayon medyo The client became
Self Concept Pattern akong tao.” iritable ako gawa ng irritable because of
masakit yung likod the pain she is
ko.” experiencing.
VIII. Role-Relationships “Marami naman akong “Di pa sila nabisita The client know
Pattern mga kaibigan. Medyo dito ee, kakaadmit ko how to socialized
palakaibigan kasi ako.” lang kasi.” with others and
gain lots of
friends.
IX. Sexuality- “Wala naman akong The client is not
Reproductive Pattern asawa kaya di masyado _________________ married but
active.” engaging in sexual
activity.

X. Coping-Stress “Hindi naman ako “Masakit talaga likod He does not

Pattern madalas mapagod kasi ko ee kaya medyo experience much
nga wala na kong iritable ako.” stress before being
trabaho. Kung mapagod hospitalized.
man ako, tinutulog ko
na lang.”
XI. Values-Belief “Sumisimba naman ako “Ayon nagdadasal ako She has a strong
Pattern tuwing Linggo.” n asana maging okay faith in God.
na ko.”
IV. Anatomy Of the Kidney
The urinary system

The urinary system consists of two kidneys, two ureters, one urinary bladder and one
urethra. After the kidneys filtered blood plasma, they return most of the water and solutes to the
bloodstream. The remaining water and solutes constitute urine, which passes through the ureters
and is stored in the urinary bladder until is excreted from the body through urethra.

More than three times of water is lost from the body in the form of urine and with feces
than is lost through respiratory surfaces while breathing, 8% of the water in the body content is
lost through the skin by sweating.

The kidneys

The kidneys are located high up at the back of the abdomen. There is one on each side of
the spinal column, partly encased by the lower ribs for protection. Each kidneys weigh about 5
ounces(140g) and is dark-red organ shaped like kidney bean or a large bar of soap. The kidneys
receiver their blood supply from the renal arteries, which are branches of the aorta. Filtered
blood leaves the kidneys along the renal veins to rejoin the vena cava going to the heart.
 Each of the paired kidneys in the human body is approximately 4 inches (10cm) long and
2 inches(5cm) wide. Within the kidney there are three major region, the outer layer is known as
the renal cortex. Inside this is the renal medulla. The medulla has many basically triangular
region with a striped appearance, the medullary pyramids. The broader the base of each pyramid
faces toward the cortex; its tip, the apex points toward the inner region of the kidney. The
pyramids are separated by extensions of cortex-like tissue, the renal columns.

Medial to the hilus is a flat, basin like cavity, the renal pelvis it is continuous with the
ureter leaving the hilus. Extension of the pelvis, calyces, form of cup shaped areas that enclose
the tips of pyramid onto the renal pelvis. Urine then flows from the pelvis into the ureter , which
transport it to the bladder for temporary storage.

External anatomy of the kidneys

Mass of 135-150g(4.5 – 5oz) the concave medial border of each kidney faces ,the
vertebral column. Near the center of the concave border is a deep vertical fissure called the renal
hilum through which the urether emerges from the kidney along with the blood vessels,
lymphatic vessels, and nerves.

Internal anatomy of the kidneys

A frontal section through the kidney reveals two distinct regions. A superficial; smooth-
textured reddish area called the renal medulla. The renal medulla consist of 8 to 18 cone-shaped
renal pyramids.

Ureters

The ureters are slender tubes each 25 to 30 cm (10 to 12 inches) long and 6 mm(1/4
inch)in diameter. Each ureter runs behind the peritoneum from the hilus of a kidney to the
posterior aspect of the bladder, which it enters at a slight angke. The superior end of each ureter
is continuous with that lining the renal pelvis and the bladder berlow

Each of the two ureters transport urine from renal pelvis of the kidney to the urinary
bladder. Peristaltic contractions of muscular walls of the ureters push urine toward the urinary
bladder, but hydrostatic pressure and gravity also contribute. Once urine has entered the bladder,
it is prevented from flowing back into thew ureter by a small valve like folds of bladder mucosa
that flap over the ureter opening.

Urinary bladder

The urinary bladder is a smooth, collapsible, muscular sac that stores urine temporarily.
It is located at retroperitoneal in the pelvis just posterior to the pubic symphysis. If the interior of
the bladder is scanned, three opening are seen - the two ureter opening and the single opening of
the urethra, which drains the bladder base outlined by these three openings is called trigone. The
trigone is important clinically because of infections to tend to persist in this region. In males, the
prostate gland surrounds the neck of the bladder where it empties into the uretra.

The bladder wall contains three layers of smooth muscles, collectively called the detrusor
muscle, and its mucosa is a special type of ithelium, transitional epithelium. Both of these
structural features make the bladder uniquely suited for its function of urine storage. When the
bladder is empty it, collapsed, 5 to 7.5 cm (2 to 3 inches) long at most, and its walls are thick and
thrown into folds. As urine accumulates, the bladder expands and rises in the abdominal cavity.
Its muscular wall stretched ,and transitional epithelial layer thins, allowing the bladder to store
more urine without substantially increasing its internal pressure. A moderately full bladder is
about 12.5cm(5 inches) long and holds about 500ml of urine, but it is capable of holding more
than twice that amount.

Urethra

Is a thin-walled tube that carries urine by peristalsis from the bladder to the outside of the
body. At the bladder-urethra junction, a thickening of smooth muscle forms the internal urethral
sphincter, an involuntary sphincter that keeps the urethra closed when urine is not being passed.
A second sphincter, the external urethral sphincter, is fashioned by skeletal muscle as the urethra
passes through the pelvic floor. This sphincter is voluntary controlled.

The length and relative function of the urethra differ in two sexes. In females, it is about
3 to 4cm long, and external orifice, or opening, lies anteriorly to the vaginal opening. Its function
is to conduct urine to the body exterior . Since the female urinary orifice is so close to the anal
opening, and feces contain a good deal of bacteria, improper toileting can easily carry bacteria in
the urethra.

In males, the urethra is approximately 20cm long and has three named regions the
prostatic, membranous, and spongy or penile, urethrae. It opens at the tip of the penis after
travelling down its length. The urethra of the male has two functions. It carries urine out of the
body, and passageway for the sperm when ejected from the body.

http://en.wikipedia.org/wiki/Urinary_tract_infection
 Pathophysiology

Non- Modifiable Factors: Modifiable Factors:

♠SEX- It has a higher incidence ♣Avoidance of the urge to void.
rate with the female gender. ♣Inadequate fluid intake.

Bacteria invasion
(i.e.E-coli)

Multiplication of bacteria-causing uti in the urinary tract

Interruption in the normal hemeostatic environment of the

urinary tract

Immune response by the body (defence Increase WBC Change in Urine

mechanism of the body to foreign bodies) subsequent to pus color
formation

Cytokine and prostaglandin

release

The body response by

producing physiologic changes
aimed at elevating body Inflammation of the
lining of the urinary Elimination of the lining
temperature
tract.
of the urinary tract
FEVER

Narrow urine passage Urethritis and Spasm of the

dysuria bladder
Poor emptying of the bladder

Frequent urination and Urinary incontenence

urgency, and nocturia

Diagnosis:
♦Urinalysis and
Sometimes urine culture
♦Imaging
 Cystitis;UTI
(Urinary tract Infection)

If treated: If not treated:

Treatment: Complications:
♦Antibiotics Recovery ♦ Kidney infections
♦Occasionally surgery (pyelonephritis)
(eg, to drain abscesses, ♦Sepsis
correct underlying ♦Scarring in the kidneys
structural abnormalities, ♦Renal hypertension
or relieve obstruction) ♦Kidney failure

Death
http://www.scribd.com/doc/39229892/uti-patho