Urinary Tract Infection Mind Map

Urinary Tract Infection Mind Map

1. Diagnostic Studies (National Kidney Foundation, 2010).

   • Laboratory & Imaging Findings (American Association for Clinical Chemistry, 2019).
     • Nitrates
     • White Blood Cells
     • Leukocyte Esterase Enzyme
     • Structural Abnormalities
     • Blockages
   • Urinalysis
     • Dipstick (Johnson & Jansen, 2014).
     • Microscopic (Johnson & Jansen, 2014).
     • Collecting a urine sample (NHS, 2019).
       • HEALTH TEACHING: Health care provider should label an unopened, sterile container and give to the patient. Instruct patient to wash their hands, sit on the toilet, and open the container without contaminating the inside or outer rim. Begin urinating and collect a sample of urine in the container "midstream". Screw the container lid shut and perform hand hygiene again.
         • Store sample in the refrigerator
         • Midstream = Do not collect the first or last part of the stream of urine, but collect everything else
           • This reduces cross contamination of urine from the bladder with microorganisms found on the skin around the urethra
   • Urine Culture & Sensitivity Testing
   • Ultrasound Examination
     • Use of sound waves to obtain photo of kidneys and bladder
   • Cytoscopic Examination
     • Insertion of tube into urethra to visualize the bladder
   • Urodynamic Testing
     • Determines bladder functioning
   • Intravenous Pyelogram
     • The injection of dye into a vein to obtain images of kidney and bladder
   • Follow Up Testing if UTI is Still Present (American Association for Clinical Chemistry, 2019).
     • Blood Culture
       • To see if the infection has spread into the blood stream
     • STD Testing
       • To see if symptoms are due to a sexually transmitted disease
     • Glucose
     • Hemoglobin A1C
       • To check for diabetes
     • BUN
     • Creatinine
       • To evaluate kidney functioning
         • Figure j
   • Figure a
   • Figure h

2. Treatment

   • Collaborative Care (Johnson & Jansen, 2014).
     • Medication
       • Short course of antibiotics for 1-3 days for uncomplicated UTI
         • Trimethoprim-sulphamethoxazole
         • Fluoroguinolones
         • Nitrofurantoin
       • Longer course of antibiotics for 7-14 days for complicated UTI
         • Figure d
       • Urinary Analgesics
         • Phenazopyridine
           • Avoid long term use
           • Risk of anemia
           • May produce red-orange urine colour
       • Prophylactic antibiotics for recurrent UTI
         • Can create antibiotic resistance
     • Adequate or increased fluid intake
   • Nursing Management
     • Acute Intervention (Johnson & Jansen, 2014).
       • Adequate or increased fluid intake
         • Client may be scared to do this because will increase frequency of urination, which is painful for the client
           • HEALTH TEACHING: Increased fluid intake will actually reduce pain over time, as it dilutes the urine, which will make the bladder much less irritable.
         • HEALTH TEACHING: Client should be informed to avoid caffeine, alcohol, juice, chocolate, and foods or fluids that are spicy. These fluids can all upset the bladder and make it more irritable; therefore, increasing the pain experienced during urination.
       • Heat application to lower abdomen or lower back can relieve pain
       • Warm showers can also help relieve some pain
       • HEALTH TEACHING: Client should be informed about the importance of completing the full course of antibiotics, even when symptoms start to or completely disappear. If the course of antibiotics is stopped prematurely, the infection can recur or antibiotic resistance can develop.
       • HEALTH TEACHING: Client should be informed to notify their practitioner if they notice changes in their urine, such as colour or consistency. Flank pain and presence of fever should also be immediately reported to their practitioner.
     • Health Promotion (Johnson & Jansen, 2014).
       • Recognizing at Risk Individuals
         • Weakened or Frail Individuals
         • Older Adults
         • Immunocompromised Individuals
         • Individuals taking immunosuppressive drugs
         • Individuals taking corticosteroids
       • Providing Education Regarding Preventative Measures
         • Regularly emptying the bladder and bowel fully
         • Wiping from front to back after emptying bladder and bowel
         • Drinking an adequate amount of fluid everyday - usually 33mL of liquid per kilogram of body weight
           • Dilutes urine and maintains movement of urine through the urinary tract, preventing stasis (American Association for Clinical Chemistry, 2019).
         • Daily consumption of cranberry in the form of juice or tablets (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
           • Cranberry products are shown to inhibit bacterial adhesion to specific cells on the mucosal surface of the urinary tract
             • Recommendations regarding cranberry consumption are mainly directed at women
             • More research needs to be done on this preventative measure to prove its true effectiveness in UTI prevention
             • Figure b
         • Urinating after intercourse (American Association for Clinical Chemistry, 2019).
         • Avoidance of spermicidal foams and jellies (American Association for Clinical Chemistry, 2019).
         • Use of probiotics for women to maintain a healthy microbiota (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
           • Useful because the vaginal can be a reservoir for the growth of UTI-causing bacteria
             • Figure f
         • Use of estrogen for women, especially post-menopausal women (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
           • Can reduce risk of recurrent UTI
           • Decreases vaginal pH
           • Enhances antimicrobial capabilities and integrity of epithelium in urinary system
           • Inhibits bacterial proliferation
       • Taking Action as a Nurse to Prevent Patient Exposure to UTIs
         • Avoiding unnecessary catheterization
         • Prompt and early removal of indwelling catheters
         • Strict maintenance of aseptic technique during sterile procedures
         • Following routine practices such as HANDWASHING
         • Thorough perineal hygiene care at regular intervals and after urination or bowel movement
         • Assisting clients with emptying their bladder and bowels as needed

3. Signs and Symptoms

   • Clinical Manifestations (Johnson & Jansen, 2014).
     • Emptying Symptoms
       • Weak urinary system
       • Difficulty initiating stream of urine
       • Interruption of urinary system
       • Postvoid dribbling
         • Figure g
       • Urinary retention
       • Dysuria
         • Pain or difficult urination
     • Storage Symptoms
       • Increased desire to void
       • Urgency to void
       • Voiding in small quantities at frequent intervals
       • Incontinence
       • Nocturia
         • Urge to urinate during nighttime
           • Resulting in bedwetting or nocturnal enuresis
     • Additional Symptoms
       • Suprapubic discomfort
       • Hematuria
         • Red blood cells in urine
         • Can cause visible red or brown discolouration of urine
       • Sediment in urine
       • Cloudy urine
       • Flank pain
       • Fever and chills
         • Common to upper UTI
     • Symptoms Specific to the Older Adult
       • UTI can often be asymptomatic
       • Non-localized abdominal discomfort
       • Slight decrease in temperature
       • Fatigue
       • Anorexia
       • Cognitive impairment
         • Delirium
   • Complications (Johnson & Jansen, 2014).
     • Reoccurring UTIs (Johnson & Jansen, 2014).
       • Occur with presence of obstruction due to stones or urinary catheter insertion
       • Occur with previously diagnosed diabetes mellitus or neurological disorder
       • Occur with unresolved bacteriuria
         • Bacterial resistance to antibiotics
         • Antibiotics fail to eliminate bacteria
       • Occur with bacterial persistence
         • Bacteria resistance to antibiotics
         • Foreign body in urinary tract allows pathogens to survive despite antibiotic treatment
     • Complicated Infections (Tan & Chlebicki, 2016).
       • Often result from untreated UTIs
         • Can lead to renal scarring
           • Common when untreated UTI is experienced in infancy and can later lead to adult complications such as hypertension, proteinuria, renal damage, and renal failure
     • Permanent Kidney Damage (Mayo Clinic, 2019).
       • Can be due to pyelonephritis
     • Increased risk of pregnant women delivering premature or low birth weight infants (Mayo Clinic, 2019).
     • Sepsis (Mayo Clinic, 2019).
     • Stricture in males (Mayo Clinic, 2019).
       • Urethral narrowing

4. Pathophysiology & Etiology

   • Pathology
     • Contamination of the usually sterile urinary tract by microbial organisms
       • Most common bacterial UTI causing pathogens (Bader et al., 2010).
         • Escherichia coli
         • Klebsiella spp
         • Proteus spp
         • Pseudomonas aeruginosa
         • Staphylococcus aureus
         • Streptococcus spp
     • Pyelonephritis - Upper UTI/Kidneys Infection (Riberio, 2015).
       • Bacteria from the lower urinary tract, or from the circulatory system, invades the kidneys
         • Bacterial colonization
           • Inflammation and deterioration of tissue
             • Inflammatory cells cause the kidneys to enlarge
               • Figure c
             • This trauma inflicted upon renal tissues leads to increased risk of recurring infection
               • Figure e
             • Chronic pyelonephritis occurs when this cycle of infection, inflammation, and tissue damage leads to permanent destruction of renal tissue
     • UTIs often present as lower UTIs (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
       • Due to introduction and colonization of bacteria into the urethra
         • Urethritis
       • Women are 14 times more likely to experience this due to having a shorter urethra, as well as a smaller distance between the rectum and vaginal opening
   • Causative Factors
     • Risk Factors
       • Anatomical or Functional Abnormalities (Ribeiro, 2015).
         • Ureterovesical junction compromise, peristalsis of the urinary tract, or bladder spasticity, leading to urinary retention
         • Age related changes
         • Congenital abnormalities
         • Tumor or stone formation leading to obstruction
       • Post-Menopausal Women (Jung & Brubaker, 2019).
         • At higher risk for UTI development due to decreased levels of estrogen production
           • Leads to lowered production of glycogen by vaginal epithelium
             • Glycogen is energy source for Lactobacillus, which produces lactic acid that inhibits colonization by other bacteria
             • Leads to a less competitive environment that fosters a pH conducive for uropathogen colonization
       • Immunocompromising Disorders (Hakeem et al., 2009).
         • Diabetes mellitus inhibits the ability of the immune system in conducting proper defence mechanisms
           • Inhibits leukocyte activity
           • Inhibits cytokine production and efficacy
           • Inhibits production of antioxidants that are meant to act as a barrier to invaders within the urinary system
           • Diabetic neuropathy has also been reported as a common cause of urinary retention, which promotes colonization of pathogens
         • Human Immunodeficiency Virus (Johnson & Jansen, 2014).
           • Suppresses the immune system and inhibits the body's ability to defend against potential pathogens
       • Sexual Activity (Johnson & Jansen, 2014).
         • Intercourse can promote entry to potential pathogens into the urogenital openings
         • Intercourse can introduce trauma to urogenital tissue which can increase risk of colonization and harbour of pathogens
       • Nosocomial Infections
         • 30 to 40% of all hospital-acquired infections are reported to be UTIs and almost 80% of these are catheter-associated UTIs (Parker et al., 2017).
         • Hospital or primary care associated procedures that often lead to UTI development are not only catheterization, but cystoscopic examinations, vaginal hysterectomies, and other gynaecological procedures (Wawrysiuk et al., 2019).
         • Certain hospital procedures must be performed aseptically to prevent against UTIs (Wawrysiuk et al., 2019).
     • Factors that prevent an individual from voiding urine to completion in a unidirectional manner (Johnson & Jansen, 2014).
     • Factors that promote introduction and colonization of bacterial pathogens (Johnson & Jansen, 2014).

5. UTI Classifications

   • Lower UTI (Ribeiro, 2015).
     • Infections affecting the lower part of the urinary tract
     • Cystitis - UTI affecting the bladder
     • Urethritis - UTI affecting the urethra
   • Complicated UTI (Bader, Hawboldt, & Brooks, 2010).
     • Infections resulting from a sequelae of other medical conditions and anatomical dysfunctions of the urinary tract
     • Higher risk for recurrent infections
       • Recurrent UTIs are defined as the experience of three UTI events within a 12 month period OR two UTI events within a six month period (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
       • Can involve unresolved bacteriuria resulting from inadequate antibiotic usage or antibiotic resistance exhibited by the bacterial pathogen (Wawrysluk, Naber, Rechberger, & Mlotla, 2019).
     • Higher mortality rate
   • Upper UTI (Johnson & Jansen, 2014).
     • Infections affecting the ureters, renal parenchyma, and renal pelvis
       • Also known as pyelonephritis
   • Uncomplicated UTI (Johnson & Jansen, 2014).
     • Infections occurring in the absence of anatomical abnormalities or other predisposing factors
     • Often easily resolved with course of antibiotics
   • Figure k

6. Implications for the Older Adult (Rowe & Juthani-Mehta, 2013).

   • Factors which increase risk of UTI development and complications
     • Changes in immune function
     • Exposure to nosocomial pathogens
       • Hospitals
       • Long Term Care Facilities
     • Increased number of comorbidities
     • Urinary retention
       • Can be caused by benign prostatic hypertrophy in male older adults
     • Functional and cognitive impairments
     • Asymptomatic UTIs going undetected

7. Figure i

Images and files in the map