Urinary Tract

Infection
 Overview
UTIs are common infections that happen when
bacteria, often from the skin or rectum, enter the
urethra, and infect the urinary tract. The infections
can affect several parts of the urinary tract, but the
most common type is a bladder infection (cystitis).
Prevalence
During the first year of life, the incidence of UTI is approximately 0.7%
in girls and 2.7% in uncircumcised boys . In febrile infants in the first
two months of life, the incidence of UTI is approximately 5% in girls
and 20% in uncircumcised boys . During the first 6 months,
uncircumcised boys have a 10 to 12-fold increased risk of developing
UTI. In the neonatal period, UTI is more common in premature infants
than term infants . It has been estimated that approximately 7.8% of
girls and 1.7% of boys by the age of 7 years will have had a UTI. By the
age of 16 years, 11.3% of girls and 3.6% of boys will have had a UTI.
Clinical Manifestations
In the neonatal period, the signs and symptomsare nonspecific. A neonate might present with
signs of sepsis, such as temperature instability, peripheral circulatory failure, lethargy,
irritability, apnea, seizure, or metabolic acidosis. Alternatively, a neonate might present with
anorexia, poor sucking, vomiting, suboptimal weight gain, or prolonged jaundice. Foul-smelling
urine is an uncommon, but more specific symptom of UTI.

The symptoms of UTI usually remain nonspecific throughout infancy. Unexplained fever is the
most common during the first two years of life. In fact, it may be the only presenting symptom
of UTI in this age group. In general, the prevalence of UTI is greater in infants with
temperatures >39°C than those with temperatures < 39°C. Other nonspecific manifestations
include irritability, poor feeding, anorexia, vomiting, recurrent abdominal pain, and failure to
thrive. Specific symptoms and signs include increased or decreased number of wet diapers,
malodorous urine, and discomfort with urination. A weak or dripping urinary stream suggests a
neurogenic bladder or obstruction in the low urinary tract such as posterior urethral valves in
boys.

After the second year of life, the symptoms and signs of UTI are more specific. Signs and
symptoms of pyelonephritis include fever, chills, rigor, vomiting, flank pain, back pain, and
costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain,
abdominal pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, daytime
wetting, nocturnal enuresis of recent onset, and suprapubic tenderness. Urethritis without
cystitis may present as dysuria without urinary frequency or urgency
 DIAGNOSTIC TESTS
A healthcare provider may order the following tests to diagnose a UTI:
Urinalysis. During this test, you’ll pee into a special cup. The provider will send the sample to
a laboratory, where technicians will examine it for signs of a UTI using multiple variables such
as nitrites, leukocyte, esterase, and white blood cells.
Urine culture. You’ll pee into a special cup, and lab technicians will test your sample to grow
and identify any bacteria that are present. Urine cultures are important because they help
your provider determine the most appropriate treatment.

If your infection doesn’t respond to treatment, a provider may order the following tests to
examine your urinary tract for a disease or injury:
Ultrasound. An ultrasound is an imaging test that helps your provider look at your internal
organs. An ultrasound is painless and doesn’t require any preparation.
Computed tomography (CT) scan. A CT scan is another imaging test. It’s a type of X-ray that
takes cross-section images of your body — like slices — that create 3D images of the inside of
your body. A CT scan is more precise than a standard X-ray.
Cystoscopy. A cystoscopy uses a cystoscope to look inside your bladder through your
urethra. A cystoscope is a thin instrument with a lens and a light at the end.
 Risk Factors
Some people are at higher risk of getting a UTI. UTIs are more common in
females because their urethras are shorter and closer to the rectum. This
makes it easier for bacteria to enter the urinary tract.

Other factors that can increase the risk of UTIs:

A previous UTI
Sexual activity
Changes in the bacteria that live inside the vagina, or vaginal flora. For example,
menopause or the use of spermicides can cause these bacterial changes.
Age (older adults and young children are more likely to get UTIs)
Structural problems in the urinary tract, such as enlarged prostate
Poor hygiene, for example, in children who are potty-training
MEDICATION
 Signs and Symptoms

A UTI causes inflammation in the lining of your urinary tract. The inflammation may cause the following problems:
Pain in your flank, abdomen, pelvic area or lower back.
Pressure in the lower part of your pelvis.
Cloudy, foul-smelling pee.
Urinary incontinence.
Frequent urination.
Urge incontinence.
Pain when you pee (dysuria).
Blood in your pee (hematuria).

Other UTI-associated symptoms may include:

Pain in your genitals.
Feeling extremely tired (fatigue).
Fever.
Chills.
Nausea and vomiting.
Mental changes or confusion.
 PREVENTION
Prevention

Luckily. UTI is a preventable disease mainly focusing on the hygienic practices of the
individual.
Avoid bath tubs. Shower rather than bathe in a tub because bacteria in the bath
water may enter the urethra.
Perineal hygiene. After each bowel movement, clean the perineum and urethral
meatus from front to back to reduce concentrations of pathogens at the urethral
opening.
Increase fluid intake. Drink liberal amounts of fluids daily to flush out bacteria.
Avoid urinary tract irritants. Beverages such as coffee, tea, colas, alcohol, and
others contribute to UTI.
Voiding habit. Void at least every 2 to 3 hours during the day and completely empty
the bladder.
Medications. Take medications exactly as prescribed.
 Assessment
Symptoms of uncomplicated UTI are a pain on urination (dysuria), frequent
urination, inability to start the urine stream, sudden onset of the need to urinate,
and blood in the urine (hematuria).

Usually, patients with uncomplicated UTI do not have fever, chills, nausea, vomiting,
or back pain, which are signs of kidney involvement or upper tract
disease/pyelonephritis. Clinical symptoms can overlap, and in some cases, it is hard
to distinguish uncomplicated UTI from a kidney infection. When in doubt, treat
aggressively for possible upper renal tract disease. Diagnosis is a combination of
signs, symptoms, and urinalysis. Be careful of literature that is based on the results
of urinalysis of asymptomatic patients.
 NURSING DIAGNOSIS

Acute Pain related to Inflammation and infection of the urinary

tract
Impaired Urinary Elimination related to Frequent urination,
urgency, and hesitancy
Hyperthermia related to infectious process
Knowledge deficit related to Unfamiliarity with the nature and
treatment of UTI
 Nursing Management
Nursing Management
Recognize signs of infection and prevent the development of further
complications.

1. Determine if symptoms are present and if the patient had difficulty

urinating on a daily basis.
2. Obtain specimens, report findings, and administer antibiotics and
medications as prescribed.
3. Describe self-care related to regular emptying of bladder, proper perineal
cleansing, and the need for increased fluids.
4. Observe and record the response to treatment.
 Nursing Interventions
Assess the symptoms of UTI.
Monitor Vital Signs
Monitor I & O
Encourage patient to drink fluids.
Administer antibiotic as ordered.
Encourage patient to void frequently.
Educate patient on proper wiping (from front to the back)
Educate patient on drinking acidic juices which help deter
growth of bacteria.
Take antibiotics as prescribed.
GOALS AND OUTCOME
Major goals for the patient may include:
Relief of pain and discomfort.
Increased knowledge of preventive measures and treatment modalities.
Absence of complications.

Evaluation
Expected outcomes may include:
Experiences relief of pain.
Explains UTI and their treatment.
Experiences no complications.

22/08/22 · Week 6 Term 3

Thank You!