COLLEGE OF NURSING, IMS, BHU VARANASI

LESSON PLAN ON
UTI in Pregnancy

SUBMITTED TO SUBMITTED BY

Mrs. Kavita Devi  Ms. Shikha Kumari

 Mr. Vikash Gautam

 IDENTIFICATION PERFORMA

Subject : Obstetric and Gynecology nursing

Topic : UTI in Pregnancy

Group of students : B.Sc. Nursing 1st year

Number of students : 34

Name of student teacher : Ms. Shikha Kumari and Mr. Vikash Gautam

Method of teaching : Lecture cum Discussion

Date of teaching :

Time of teaching :

Duration : 60 min

Teaching aids : LCD and pamphlets

Venue : LT-1

Supervisor : Mrs. Kavita Devi (Nursing tutor/CI, college of Nursing, IMS, BHU)
Previous knowledge of the students : Students have some basic knowledge from previous class.

Specific objectives:
At the end of the class students will be able to
1. Introduce the topic.
2. Describe anatomy and physiology of urinary system.
3. Define Urinary Tract Infection
4. Explain epidemiology.
5. Classify UTI in pregnancy
6. Identify etiologic of UTI.
7. Discuss pathophysiology of UTI..
8. Enumerate clinical manifestations.
9. Enlist the diagnostic measures.
10. Identify possible complications.
11. Elaborate the management of UTI in pregnancy.
12. Describe nursing management.
13. Enlist the prevention of UTI.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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I. Develop rapport 1/2 Self introduction
with the students min Myself, Shikha and myself Vikas, B.Sc.
Nursing 4th year students.

Assess the previous Assess previous knowledge of the students

II. knowledge of the 1 min By asking question Discussion Have you any
students What do you understand by UTI in pregnancy? idea about UTI?

Announcement of the topic Lecture

III. Appraise the topic 1/2 Today, we are going to take class on UTI in
min pregnancy

INTRODUCTION:- Lecture cum

IV. At the end of the 3 min Urinary tract infections are the second most discussion LCD
class students will common bacterial disease and the most
be able to
common bacterial infection in woman.
1. Introduce UTI in
pregnancy With at least one third of woman developing a
UTI before the age of 24 during their life time,
more than half of woman will have a UTI and
up to 50 of those will have another infection
within UTIS.

-Infections are caused ascending when

pathogen moves from urethra to be bladder .
and descending when pathogen travels from
the kidney to the bladder.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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2. Students will be 8 min Most of UTIS are bacterial but they are be Lecture cum LCD
able to describe caused by viruses goals and ping it is discussion
anatomy and important to tract UTI to prevent renal scaring
physiology of that can lead to Failure.
urinary system.
ANATOMY
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be  A urinary tract infection is an
able to describe infection that begins in the urinary Lecture cum LCD
anatomy and system. discussion
physiology of  UTIs limited to the bladder can be
urinary system. pumps and annoying.
PARTS OF THE URINARY TRACT :-
TWO KIDNEY- A pair of purplish brown
organ located below the ribs towards the
middle of the back.
TWO URETERS- Narrow tubes that carry
urine from the kidney to the bladder.
BLADDER- A triangle shaped hollow organ
located in the lower abdomen.
TWO SPHINCTER MUSCLES- Circular
muscles that help keep urine from leaking by
closing tightly link a rubber band around the
opening of the bladder.
URETHRA- The tube that allows urine to
pass outside the body.
CHANGE IN THE URINARY SYSTEM
DURING PREGNANCY –

 Kidney enlargement.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be  Compression of the urethras and Lecture cum LCD
able to describe bladder. discussion
anatomy and  In complete emptying of the bladder.
physiology of  The urine in not as acidic.
urinary system.  It contains more sugar, protein and
hormones.
Function of kidney: What are the
functions of the
 Removal of waste products urinary system?
 Removal of excess fluid
 Balance minerals and chemicals
 Control of blood pressure
 RBC production
 To maintain healthy bone

3. Define UTI in 2 min Definition- a/c to ICD- 10 Lecture LCD

pregnancy
 Urinary tract infection are infection
affecting structures participate in be
secretions and elimination of urine the
kidneys, urinary bladder and urethra.
 The term urinary tract infection usually
refers to the presence of organism in
the urinary tract together a symptom
and sometime signs of information.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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4. Students will be 2 min EPIDEMIOLOGY – Lecture cum LCD
able to Explain discussion
epidemiology. 1. UTI are most common bacterial
infection during pregnancy, studies
have shown that the frequently of
asymptomatic bacteria in pregnancy
range between 2%-18.5% (2011).
2. Cystic on the other hand complication
about1.3% pregnancy (scnnarr2008).
3. Certain to morbidities have been
associated with test risk for UTI during
pregnancy the prevalence of UTI in
pregnancy is related closely with socio-
economic status such as drainage in
case of renal observations. UTIS occur
in up to 20% of provenances is
disadvantaged group (Vazquez-2003).
4. Other risk factor include, recurrent UTI
and anatomical abnormalities of the
urinary tract higher parity, sickle cell
dis case and ageless then is year at first
UTI have also been thought to be risk
factors- (2010)
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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5. Students will be 5 min CLASSIFICATION Lecture cum Pamphlet According to
able to classify UTI discussion severity what are
-Classification of urinary tract infection is the classification
in pregnancy important for the purpose of research quality, of UTI?
measurement and teaching it is based on-

 The clinical presentation and

anatomical level of infection.
 The grade or severity of infection.
 Risk factors and microbiological
findings.
 Causative Pathogens and their
susceptibility to treatment.
UTIS are ascendance in nature with infection
organisers moving from the perinea region and
vagina. Anatomically therefore the level of the
urinary system reached by the infection can be
the urethra bladder kidney or in the blood
stream.
A/C to severity
Grade 1- cystitis low severity
Grade 2- pyelonephritis with moderate
symptoms.
Grade 3- established pyelonephritis with
severity symptoms.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be Grade 4- Urosepsis with systematic Lecture cum Pamphlet
able to classify UTI inflammatory response symptoms. discussion
in pregnancy Grade 5- Urosepsis with organ dysfunction.
Grade 6- Urosepsis with organ failure.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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6. Students will be 2 min ETIOLOGY: Common caused-E.coli (80- Lecture cum LCD
able to Identify 90%) discussion
etiology of UTI.
Other pathogens-
 Klebsiellapneumonia (5%)
 Proteus mirabilis (5%)
 Enterobacterspecies (3%)
 Streptococcus saprophytic (2%)
 Group B beta haemolytic streptococcus
(GBS 1%)
 Proteus species (2%)
Risk Factors-

 Preeclampsia
 Caesarean delivery
 Beta streptococcus bacteria
7. Discuss PATHOPHYSIOLOGY Lecture cum LCD
pathophysiology of 3 min discussion
UTI..
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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8. Students will be 5 min CLINICAL MANIFESTATION:- What are the
able to Enumerate Symptomatic manifestation- Lecture cum LCD sign and
clinical discussion symptoms of
manifestations.  Fever UTI?
 Malaise
 Nausea
 Vomiting and urgency of maturation.
 Tenderness at renal angle of the
affected side.
 A strong persistent urge to urinate.
 A burning sensation when urinating.
 Passing frequent small amount of urine.
 Blood in the urine (hematuria) or
cloudy strong smelling urine.

DIAGNOSTIC EVALUATION- Lecture LCD

9. Enlist the diagnostic 2 min
measures.  History collection.
 Physical examination.
 Pelvic examination.
Investigation-

 Blood studies.
 CBC.
 Serum electrolytes.
 Blood urea nitrogen.
 Serum keratinise
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be Urine studies Lecture cum LCD
able to Enlist the discussion
diagnostic measures.  Urine specimen collection
 Urine culture
 Urinalysis
.  Dipstick testing
 Urine cytology
 Renal USG
CT scan and MRI
10. Identify possible 3 min COMPLICATION Lecture cum Pamphlet Enlist the
complications. discussion complication of
Urinary tract infection in pregnancy has been UTI in
associated with other adverse outcome for the pregnancy?
mother and baby.

 Preeclampsia
 Caesarean delivery
 Beta streptococci bacteria
 Preterm delivery
 Pyelonephritis
Other complication

 Perinephri cellulites and abscess,

septic, shock
 Renal dysfunction.
 Hematologic dysfunction.
 Pulmonary injury.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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11. Students will be 8 min MEDICAL MANAGEMENT: Lecture cum LCD Enlist the three
able to Elaborate the discussion antibiotic which
management of UTI Bacteriuria and cystitis: Administration of prescribed
in pregnancy appropriate antibiotics. during UTI?

 Administration of fluid if the patient

dehydrate

 Admission if any indication of

complicated UTI exists.
Antibiotic therapy: Oral antibiotics are the
treatment of choice for asymptomatic bacteria
and cystitis.

Sinus close treatment:

 Amoxicillin – 3g
 Ampicillin – 2g
 Cephalosporin – 2g
 Trimethoprim/sulfamethoxazole
320/1600m

3rd day course:

Amoxicillin – 500mg TDS
Ampicillin – 250mg pair time daily
Cephalosporin – 250mg pair time daily
Levofloxacin – 250mg daily
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be  Treatment for 3 days is sufficient for Lecture cum LCD
able to Elaborate the asymptomatic bacteria. discussion
management of UTI  Regular urine cattle should be taken
in pregnancy following treatment to ensure
eradication of the organism.
 About 15% of woman will have
reagent bacteria during their pregnancy
and require a second course of
antibiotics.
 A test for cure urine culture should
Show negative finding 1-2w after
therapy.
 A non-negative culture result is an Indi
for a 10 to 14 days course of a different
antibiotics followed by suppressive
therapy.
 (B.gNitrofurantoin – 50mg at bed time)

Acute pyelonephritis:
 Hospitalization
 Investigations and monitoring.
 Urine and blood cultures.
 CBC serum keratinise and electrolytes.
 Monitor vital sign pregnancy, urine
output-input
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be  Check radiograph if there is Lecture cum LCD
able to Elaborate the dyspnoea or todhyenea. discussion
management of UTI  Follow up.
in pregnancy  Repeat haematology and chemistry
studies in 48h
 Discharge when febrile 24h
consider antibiotic for 7 to 10 days.

12. Students will be 10 NURSING MANAGEMENT- Lecture cum LCD

able to describe min ASSESSMENT discussion
nursing  History of signs and symptoms related to
management UTI is obtained from the patients with
suspected UTI.

 The presence of pain, frequency,

urgency and hesitancy and changes in
urine are assessed, documentation and
reported.

 Patients’ knowledge about prescribed

antibacterial medication and prevention
health care measures is also assessed
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be NURSING DIAGNOSIS- Lecture cum LCD
able to Enlist the 1. Acute pain related to infection in discussion
prevention of UTI. urinary tract as evidenced by pain
during urination, suprapubic and
bladder spasm
Goal- Pain and discomfort will be
relieved
Intervention –
o Assess the onset, duration and level of
pain
o Provide analgesic drug
o Provide comfortable position
o Give psychological support
o Provide heating pad to painful area

Evaluation – Report relief of pain

2. Impaired urine elimination related to

UTI as evidenced by urgency,
frequency, incontinence or haematuria
over altered elimination pattern
Goal- Normal urination pattern will be
returned
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be Interventions- Lecture cum LCD
able to describe o Assess for the changes is usual voiding discussion
nursing pattern
management o Instruct patient regarding reason for
symptom
o Encourage high fluid intake and
administer IV fluid as ordered
o Obtain urine for culture and sensitivity
o Tell patient to observe urine for colour,
odour, amount and frequency
o Administer antimicrobial drug as
observed
Evaluation – Exhibits normal urine pattern

3. Hyperthermia related to infection as

evidenced by elevation in temperature,
tachycardia, chill and malaise
Goal-
Normal body temperature will be returned
Intervention-
 Asses vital sign 2-4 hourly
 Administer antipyretics and antibiotics
as ordered
 Ensure hydration via oral or IV route
 Monitor intake and output
 Cover patient and keep him dry
 Provide cooling sponge baths or
compresses.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be Evaluation –Reports return of normal Lecture cum LCD Which steps
able to describe temperature discussion nurse should take
nursing 4. Risk for reinfection related to lack of for the
management knowledge regarding measure to management of
prevent recurrence. the disease?

Goal-
Signs of infection will not be present

Intervention –
 Asses the signs and symptoms of
infection
 Explain the importance of taking all the
antibiotics as prescribed. symptom will
improve after 1-2 days of therapy, but
organisms may still be present.
 Instruct the patient to urinate when the
urge occur at least 2-4 hour during the
day
 Advise patient to report symptom and
sign of the current UTI

Evaluation – Improve knowledge level of the

patient
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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13. Students will be 3 min PREVENTION: To ensure good hygiene and Lecture cum LCD What advice we
able to Enlist the reduce bacterial contamination. discussion will give to the
prevention of UTI. patient?
 Avoid tub bath
 Wipe front to back after urinating
or defecating.
 Wash hands before using the toilet.
 Use wash cloths to clean the
perineum
 Use liquid soap to prevent
colonization from her soap.
 Clean the urethral meat us first
when bathing.
 Avoid alcohol, citrus juices, spicy
food and caffeinated drink, which
can irritate her bladder
 Drink cranberry juice- Although
studies are not conclusion that
cranberry juice prevents UTIs, it is
likely not harmful.
 Wipe from front to back- Doing so
after urinating and after a bowel
movement helps prevent bacteria in the
anal region from spreading to the
vagina and urethra.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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Students will be  Empty your bladder soon after Lecture cum LCD
able to Enlist the intercourse- Also, drinks a full glass discussion
prevention of UTI. of water to help flush bacteria.
 Change birth control method –
Diaphragm, or spermicidal treated
condoms, can all contribute to bacteria
growth.

1 min CONCLUSION- Lecture

Reagent bacteria pregnancy is common and a

series cause of maternal and prenatal morbidity
and mortality. Clinical preservation includes
asymptomatic bacteria acute cystitis and
pyelonephrities. Screening urine culture at 1st
visit at 12 week of pregnancy. Simple
behavioural changes and continuous antibiotic
prophylaxis can prevent recurrent of UTI in
pregnancy.
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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1 min Summarization: Lecture cum LCD
discussion
 Describe anatomy and physiology of
urinary system
 Definition of UTI in pregnancy
 Epidemiology.
 Etiologic of UTI.
 Pathophysiology of UTI..
 Clinical manifestations.
 Diagnostic measures.
 Complications.
 Management of UTI in pregnancy.
 Nursing management.
 Prevention of UTI.
What are the
Summative evaluation causative factors
By asking question of UTI during
pregnancy?

How we will
prevent UTI in
pregnancy?
SR. CONTRIBUTOR TIME CONTENTS TEACHING LEARNING EVALUATION
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References:
From book:
1. Dutta’s D.C.; Textbook of Obstetrics.
7th edition; Hiralalkonar; new central
book agency publication:2013;602-608

From journal:
1. Kavitha. V. Lamaze Method on
Primigravida Women during First
Stage of Labour. Asian J. Nur. Edu. &
Research [online] 2011. [cited 2
December 2017]; 1 (1):25-27.
Available from www.asian Journal of
Noursing Education and Research.in.
From internet sources:
1. Stages of labour. Available from
https://www.gfmer.ch /Obstetrics_
simplified/normal_labour.html