Urinary Tract Infection

Urinary Tract Infection

1. Clinical Manifestations

   • Urgency
     • sudden, strong intense desire to void immediately 
     • Nocturia
       • Awakened by urge to void 2 or more times during sleep
   • Frequent Urination (Small Amounts)
     • > 8x in a 24hr period often less than 200ml each voiding. 
   • Dysuria
     • painful or difficult urination
   • Fever
     • Unreliable indicator
   • Suprapubic Pain
   • Costovertebral Tenderness
   • Incontinenance
     • Involuntary or accidental urine loss or leakage. 
     • Nocturnal Enuresis
       • Adult loss of urine during sleep.
   • Fatigue, weakness, Muscle Aches
   • Diagnostics
     • Urinalysis 24-72hrs
       • High in WBC's & High in Nitrates, Leukocyte Esterase
       • Clean Catch
         • Teach to spread labia & wipe front to back with clean swab. then tell them to start voiding and collect the specimen 1 to 2 seconds after voiding starts. 
       • Hematuria, Cloudy, sediment
     • Urine Culture & Sensitivity
       • Culture: Organism Cause
       • Sensitivity which antibiotic is most Effective?
     • Kidney Bladder Ultrasound
     • CT urogram
     • Intravenous Pyelogram
     • CT/IVP
     • Cytoscopy
     • Ultrasound
   • Geriatrics (Confusion & Incontinence)
   • Burning Sensation
   • Itching
   • Hesitancy

2. Complications

   • Peylonephritis
     • Flank Pain
       • Lower Back Pain 
     • N&V
     • Rigors
       • Shaking & Chills
     • High Fever
   • Cystitis
   • Urethritis
   • Urosepsis

3. Causes

   • Hospital Acquired
     • Use CAUTI Tool
     • Cytoscopic Examinations
   • Community Acquired
     • E. coli (Perineal Care)
     • Most Orginate from the GI tract
     • Sexual Intercourse "milking of the Bladder"
     • Spermacide
     • Diagphragm as a form of Birth control
     • Diagphragm "Birth Control"
   • Patients at High Risk
     • Female
     • Older Adults
     • SCI/Nerve damage to Bladder
     • Pregnancy
     • Suppressed Immunity
     • Structural Abnormalities/Obstruction
     • Diabetes

4. Interventions

   • Prevention
     • Stay Hydrated 2L-3L
       • Divide Weight & that is the # of oz of fluid to drink in a day. 
     • Underwear "Cotton"
     • Wiping front to Back
     • Aseptic Technique & Urinary Catheterization
     • Cranberry/prune Juice (Unsweetened), Vitamin C 500-1000mg/day
       • Theory: Enzyme found in Cranberries inhibit attachment of urinary pathogens to the bladder wall. 
     • Void before & After Sex
     • Limit Indwelling Catheter Use for incontinence
     • Shower preferred Over Tub
     • Aseptic Technique
     • Bedridden: Answer Call bell light quickly & offer bedpan at frequent intervals
     • Probiotics
   • Urinary Tract infections
     • Cloudy Urine should become Clear & cessation of Symptoms
     • Antibiotic Therapy (Finish the Full Course)
     • Sterile vs. Clean Catch?
     • Regular Toileting Patters: Every 2-3hrs Completely Empty Bladder
     • Pain Management
       • Sitz Bath
       • Heat Pad (Suprapubic)
         • Lowest Setting
       • Analgesic & Antispasmodic
     • Adequate Hydration IF not Contraindicated
       • Anticipate Difficult? Because pt. perception that fluid intake will worsen Discomfort
         • Teach will increase frequency initially but will make the bladder less irritable. 
     • avoid caeffine, alcohol, citrus juices, chocolate, and highly spice foods or beverages
       • Bladder Irritants
   • Medications
     • Phenazopyridine (Pyridium)
       • Urinary Analgesic (may relieve Discomfort from Sever dysuria). Azo Dye excreted in the Urine.  
       • Orange Pee
     • Other Uncomplicated UTI: Amoxacillin, Ampicillin & Cephalosporins
       • Cipro,Levaquin, Noroxin, floxin, Tequin
     • Antibiotics makes birth control ineffective
       • Need a Back Up
     • Trimethoprim/Sulfamethoxazole (TMP/SMX) (Bactrim, Septra)
       • Can be treated with just trimethoprim if the patient has sulfa allergy. 
       • E. Coli Resistance
     • Nitrofurantin (Macrodantin)
       • 3-4x daily or Macrobid 2x daily
       • Avoid Sunlight, Noftify HCP sTAT If fever, chills, cough, chest pain, dyspnea, rash or Numbness or tingling of fingers or Toes develops!!
     • Fosfomycin (Monural)
     • Complicated: Flouroquinolones
       • Ciprofloxacin, Levofloxacin, Ofloxacin, & Gatifloxacin
     • Fungi? Amphotericin or Fluconazole
       • Diflucan

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