DISCHARGE PLANNING

Urinary Tract Infection

Najah Musa
 Objection: The goal is to plan a smooth transition for my
patients and their families once they are discharged. The
plan will ensure that my patients that are admitted with
urinary tract infections (UTIs) do not get readmitted for the
same infection again and prevents further complications.

OBJECTIVES AND
CLINICAL PICTURE
Synopsis: ML, 91-year-old male admitted to the emergency
department for a fall, weakness, diarrhea, and confusion.
The pt reported pain when urinating and feeling light-
headed. Number of laboratory tests were done which
prompted a more specific diagnosis that correlated with his
symptoms. He tested positive for urinary tract infection
which could have been he is confused and fell. He also was
diagnosed with Clostridium Difficile Colitis.
SHARE
CONCEPT
MAP
CONNECTIONS
 PATHOPHYSIOLOGY

Urinary tract infections are caused by microorganisms

called e.coli — usually bacteria — that enter the urethra
and bladder, causing inflammation and infection.
Though a UTI most commonly happens in the urethra
and bladder, bacteria can also travel up the ureters and
infect your kidneys (Clevelandclinic.org). UTIs usually
happen more to women than they do for men because
women have shorter urethras. Urinary tract infections
occur at least four times more frequently in females
than males (Sakamoto, Miyazawa, & Tguchi).
• Symptoms include fever, nausea, chills, fever,
weakness, confusion, cloudy urine, foul urine, and
blood in urine.
 STATISTICS

• According to National Healthcare Safety Network:

• UTIs are the most common outpatient infections in the United States (US).
• Urinary tract infections (UTIs) are the fifth most common type of healthcare-associated infection, with
an estimated 62,700 UTIs in acute care hospitals in 2015.
• UTIs additionally account for more than 9.5% of infections reported by acute care hospitals1 .
• Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract.
• Approximately 12%-16% of adult hospital inpatients will have an indwelling urinary catheter (IUC) at
some time during their hospitalization, and each day the indwelling urinary catheter remains, a patient
has a 3%-7% increased risk of acquiring a catheter-associated urinary tract infection (CAUTI).
• Between 50% and 60% of adult women will have at least one UTI in their life, and close to 10% of
postmenopausal women indicate that they had a UTI in the previous year.
 LABS AND
DIAGNOSTICS

• URINALYSIS (UTI
POSITIVE)
• STOOL SAMPLE (C-DIFF
POSITIVE)
• CBC (WBC 17.78-
ELEVATED)
• BUN- 39- ELEVATED
• LOW RBCs 3.34
• Hemoglobin, 10.7
• Prescence of nitrites or
leukocytes in urine
 MEDICATIONS

• Apixaban
• Calcium vitamin D
• Lisinopril
• Melatonin
• metoprolol Tartrate
• Multivitamin with minerals
• Nitrofurantoin
• Nutrisource fiber packet V
• ancomycin
 TREATMENT

• Encourage fluids to flush out all the bacteria

• Administer medications on time. Medications for
UTI for this patient is vancomycin
• Assess vitals to check for signs of fever, chills, and
pain.
• Encourage patient to void frequently,
• Educate patient on certain drinks and food like spicy
food, caffeinated drinks.
 PATIENT VARIABLE/ FINANCIAL
SUPPORT

• Patient has primary insurance and secondary insurance for both medications
and rehab center, specifically Medicare A & B and Medicaid Illinois

• Based on record, the patient is of Christian faith and on a cardiac diet which
will dictate treatment plan.
 • Doctors- provide diagnosis and dictate
treatment plan
• Nurse- provide educational information
focused on prevention of the recurrence of
INPATIENT UTI and readmission

SOURCES OF • Physical Therapy and occupational therapists-

evaluated patient’s ability to do daily
SUPPORT activities and restrictions.
• Infectious Disease- educate family and
patient on importance of perineal care and
checking for signs or symptoms of recurrence
of infection.
 SOURCES OF EMOTIONAL SUPPORT

• Patient lives alone in a single-family home but daughter visits regularly.

Patient has a caregiver 24-hours a day which helps the daughter while she’s at
work. There are also neighbors who check on the father from time to time.
Patient also has another son who visits occasionally but lives in a different city.

• Patient cannot depend on himself alone, he needs a caregiver 24-hours a day.

 • Patient will need to be in the rehab center for
a few months because he needs physical
COMMUNITY therapy. He will not be able to go home
unless there is a caregiver 24 hours a day.
SOURCES OF
SUPPORT • Prescriptions will be dropped off to his house
once discharged from rehab center
 TEACHING

• - Drink plenty of fluids

• Take medications on time
• Encourage patient to empty bladder regularly
• Check for abnormal vital signs
• Follow a cardiac diet as recommended by physician.
• Follow good personal hygiene
• Wipe from front to back
• Take showers instead of baths

Client is stable but does have
potential of having a recurrent UTI
CONCLUSION
This project has helped me
Patient must be monitored q4 to
understand what UTIs are, what to
check signs and symptoms of
look for, how to assess, how to Nursing education can be as simple
infection or worsening infection.
diagnose, and how to provide nursing as proper hand and personal hygiene
Signs and symptoms include pain,
educations and interventions based like wiping from front to back.
fever, difficulty urinating, and
on patient’s health, age, gender, and
confusion.
medical background.
Complication can include recurrent
infections, permanent kidney
damage, if continues as high as risk
of sepsis.
 REFERENCES

• Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet
Gynecol 2018; 219: 40–51. [PubMed] [Google Scholar] [Ref list]

• Health Promotion Board Singapore. Urinary tract infection. [Accessed February 1 2016]. Available at: 
http://www.healthhub.sg/a-z/diseases-and-conditions/210/urinarytractinfection .
• Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028–37.

• Price TK, Dune T, Hilt EE, et al. The clinical urine culture: enhanced techniques improve detection of
clinically relevant microorganisms. J Clin Microbiol 2016;54(5):1216–22.

• Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in
acutely dysuric women. N Engl J Med. 1982;307(8):463–8.

• Sakamoto S, Miyazawa K, Yasui T, Iguchi T, Fujita M, Nishimatsu H, Masaki T, Hasegawa T, Hibi H,

Arakawa T, Ando R, Kato Y, Ishito N, Yamaguchi S, Takazawa R, Tsujihata M, Taguchi M, Akakura K, Hata
A, Ichikawa T. Chronological changes in epidemiological characteristics of lower urinary tract urolithiasis
in Japan. Int J Urol. 2019 Jan;26(1):96-101. [PubMed] [Reference list]