NCM112
Lecture - Module 0
URINARY TRACT INFECTIONS
- Urinary tract infections are classified by location:
o the lower urinary tract (which includes the
bladder and structures below the bladder)
o the upper urinary tract (which includes the
kidneys and ureters).
- They can also be classified as uncomplicated or
complicated UTIs.
LOWER UTI’S UPPER UTI’S
Cystitis, prostatitis, Acute pyelonephritis,
urethritis chronic pyelonephritis, renal
abscess, interstitial
nephritis, perirenal abscess
UNCOMPLICATED LOWER OR UPPER UTIS
Community-acquired infection; common in young women and
not 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.
CONTRIBUTING CONDITIONS SUCH AS:
Female Altered states caused by incomplete
gender emptying of the bladder and urinary stasis
Diabetes Decreased natural host defenses or
immunosuppression
Pregnancy Inability or failure to empty the bladder
completely
Neurologic Inflammation or abrasion of the urethral
disorders mucosa
Gout Instrumentation of the urinary tract (e.g.,
catheterization, cystoscopic procedures)
OBSTRUCTED URINARY FLOW CAUSED BY:
1. Congenital abnormalities
2. Urethral strictures
3. Contracture of the bladder neck
4. Bladder tumors
5. Calculi (stones) in the ureters or kidneys
6. Compression of the ureter
ASSESSMENT & DIAGNOSTIC FINDINGS:
- Urinalysis
- Urine Cultures
- X-ray images, computed tomography (CT) scan,
ultrasonography, and kidney scans
MEDICAL MANAGEMENT:
 Management of UTIs typically involves pharmacologic
therapy and patient education. Various prescribed
medication regimens are used to treat UTI.
a) Acute Pharmacologic Therapy
b) Long-Term Pharmacologic Therapy
 Although brief pharmacologic treatment of UTIs for 3
days is usually adequate in women, infection recurs in
about 20% of women treated for uncomplicated UTIs.
Infections that recur within 2 weeks of therapy do so
because organisms of the original offending strain remain.
*Nursing care of the patient with a lower UTI focuses on
treating the underlying infection & preventing its recurrence.
Assessment:
 A history of pertinent signs and symptoms is obtained
from the patient with a suspected UTI. The presence of
pain, frequency, urgency, hesitancy, and changes in urine
are assessed, documented, and reported.
NURSING DIAGNOSES:
1. Acute pain related to infection within the urinary tract
2. Deficient knowledge about factors predisposing the
patient to infection and recurrence, detection and
prevention of recurrence, and pharmacologic therapy
Prelims - GMJ
Urinary Disorders
3. Acute kidney injury and/or chronic kidney disease may
occur as the long-term result of either an extensive
infective or inflammatory process
PLANNING & GOALS:
Major goals for the patient may include relief of pain and
discomfort, increased knowledge of preventive measures and
treatment modalities, and absence of complications.
NURSING INTERVENTIONS:
- Relieving pain
- monitoring and managing potential complications
EVALUATION:
1. Experiences relief of pain
a) Reports absence of pain, urgency, frequency,
nocturia, or hesitancy ▪ on voiding
b) Takes analgesic, antispasmodic, and antibiotic agents
as prescribed
2. Explains UTIs and their treatment
a) Demonstrates knowledge of preventive measures and
prescribed ▪ treatments
b) Drinks 8 to 10 glasses of fluids daily
c) Voids every 2 to 3 hours
d) Produces urine that is clear and odorless
3. Experiences no complications
a) Reports no symptoms of infection (fever, frequency)
b) Has normal kidney function, negative urine, and
blood cultures
c) Exhibits normal vital signs and temperature; no signs
or symptoms of sepsis (urosepsis)
d) Maintains adequate urine output more than 0.5
mL/kg/h
HEALTH EDUCATION:
The nurse instructs the patient on the following basic
information:
1) Hygiene
2) Fluid Intake
3) Voiding Habits
4) Take medication exactly as prescribed
5) For recurrent infection, consider acidification of the
urine through ascorbic acid (vitamin C), 1000 mg
daily, or daily consumption of cranberry juice.
6) Notify the primary provider if fever occurs or if signs
and symptoms persist.
PATHOPHYSIOLOGY
- Stones are formed in the urinary tract when urinary
concentrations of substances such as calcium oxalate,
calcium phosphate, and uric acid increase.
- Referred to as supersaturation, this depends on the amount
of the substance, ionic strength, and pH of the urine.
- Stones may be found anywhere from the kidney to the
bladder and may vary in size from minute granular
deposits, called sand or gravel, to bladder stones as large
as an orange
CAUSES OF HYPERCALCEMIA &
HYPERCALCIURIA:
1. Hyperparathyroidism
2. Renal tubular acidosis
3. Cancers (e.g., leukemia, multiple myeloma)
4. Dehydration
5. Granulomatous diseases (e.g., sarcoidosis, tuberculosis),
which may cause increased vitamin D production by the
granulomatous tissue
6. Excessive intake of vitamin D
7. Excessive intake of milk and alkali
8. Myeloproliferative diseases such as polycythemia vera,
which produce an unusual proliferation of blood cells
from the bone marrow
CLINICAL MANIFESTATIONS:
Signs and symptoms of stones in the urinary system depend on
the presence of obstruction, infection, and edema
  Chills a) Consumes increased fluid intake (at least eight 8-
 Fever oz glasses of fluid per day)
 Frequency b) Participates in appropriate activity
 Pain c) Consumes diet prescribed to reduce dietary
 Discomfort factors predisposing to stone formation
 Hematuria d) Recognizes symptoms (fever, chills, flank pain,
 Pyuria hematuria) to be reported to primary provider
 Nausea and Vomiting occur
ASSESSMENT & DIAGNOSTIC FINDINGS:
- Noncontrast CT scan
- Blood chemistries
- 24-hour urine test for measurement of calcium, uric acid,
creatinine, sodium, pH, and total volume
- Stone analysis
MEDICAL MANAGEMENT:
a) Opioid analgesic agents
b) Nonsteroidal anti-inflammatory drugs (NSAIDs)
c) Thiazide diuretics Allopurinol (Zyloprim) -uric
NUTRITIONAL THERAPY:
 Fluid intake is the mainstay of most medical therapy for
kidney stones.
 Calcium-based kidney stones were recommended to
restrict calcium in their diet
PATIENT EDUCATION:
a) Avoid protein intake to decrease urinary excretion of
calcium and uric acid.
b) Limit sodium intake to 3–4 g/day. Table salt and high-
sodium foods should be reduced because sodium
competes with calcium for reabsorption in the kidneys.
c) Be aware that low-calcium diets are not generally
recommended, except for true absorptive hypercalciuria.
Evidence shows that limiting calcium, especially in
women, can lead to osteoporosis and does not prevent
stones.
d) Avoid intake of oxalate-containing foods (e.g., spinach,
strawberries, ▪ rhubarb, tea, peanuts, wheat bran).
e) Drink fluids (ideally water and one glass of cranberry
juice per day) every 1–2 hours during the day.
f) Drink two glasses of water at bedtime and an additional
glass at each nighttime awakening to prevent urine from
becoming too concentrated during the night.
g) Avoid activities leading to sudden increases in
environmental temperatures that may cause excessive
sweating and dehydration.
h) Contact the primary provider at the first sign of a urinary
tract infection
SURGICAL MANAGEMENT:
- Nephrolithotomy
- Pyelolithotomy
- Ureterolithotomy
- Cystotomy
- Cystolitholapaxy
NURSING DIAGNOSES
a) Acute pain related to inflammation, obstruction, and
abrasion of the urinary tract
b) Deficient knowledge regarding prevention of recurrence
of kidney stones
c) Infection and urosepsis (from UTI and pyelonephritis)
d) Obstruction of the urinary tract by a stone or edema with
subsequent acute kidney injury
PLANNING & GOALS
The major goals for the patient may include relief of pain and
discomfort, prevention of recurrence of kidney stones, and
absence of complications.
NURSING INTERVENTIONS
- Relieving pain
- Monitoring and managing potential complications
- Educating Patients About Self-Care.
- Need to be reported to the primary provider if
complication arises
EVALUATION
1. Reports relief of pain
2. States increased knowledge of health-seeking
behaviors to prevent recurrence