Urinary Tract Infection: Nursing Care and Management Study Guide

UTIs are one of the most common infections you will treat, and most of the work is straightforward: confirm the organism, give the right antibiotic, flush the tract, and teach the patient how to keep it from coming back. The recurrence rate is high, so the teaching matters as much as the treatment.

What Is a Urinary Tract Infection?

UTIs are caused by pathogenic microorganisms in the urinary tract. The normal urinary tract is sterile above the urethra. Infections can involve the upper or lower tract and are uncomplicated or complicated depending on other patient-related conditions.

Classification

UTIs are classified by location and by other factors. Lower UTIs include bacterial cystitis, prostatitis, and urethritis. Upper UTIs are much less common and include acute and chronic pyelonephritis, interstitial nephritis, and renal nephritis. Most uncomplicated UTIs are community-acquired, common in young women, and not usually recurrent. Complicated UTIs usually occur in people with urologic abnormalities or recent catheterization and are often acquired during hospitalization.

Pathophysiology

For infection to occur, bacteria must reach the system. Bacteria gain access to the urinary tract, attach to the epithelium and colonize it to avoid being washed out with voiding, evade host defenses, and trigger inflammation along with other signs of infection.

Statistics and Epidemiology

UTI is the second most common infection in the body. Most cases occur in women; one out of five women in the United States will develop a UTI in her lifetime. The urinary tract is the most common site of infection, accounting for greater than 40% of the total reported by hospitals. UTI affects about 600,000 patients each year. More than 250,000 cases of acute pyelonephritis occur in the United States each year, with 100,000 requiring hospitalization. Approximately 11.3 million women are diagnosed with UTIs in the United States annually, at a direct healthcare cost of $1.6 billion.

Causes

Stasis from failure to empty the bladder completely draws bacteria into the tract. Instrumentation such as catheterization or cystoscopy can introduce bacteria directly. Obstructed urinary flow from structural abnormalities leaves the bladder unable to empty. Decreased host defenses, as in immunosuppression, predispose the patient to UTI.

Clinical Manifestations

Expect burning on urination, frequency (voiding more often than every 3 hours), nocturia, suprapubic or pelvic pain, and urgency strong enough that the patient rushes to void.

Prevention

UTI is largely preventable through hygiene. Shower rather than bathe in a tub, since bacteria in bath water can enter the urethra. After each bowel movement, clean the perineum and urethral meatus front to back. Drink liberal fluids to flush out bacteria. Avoid urinary irritants such as coffee, tea, colas, and alcohol. Void at least every 2 to 3 hours during the day and empty the bladder completely. Take medications exactly as prescribed.

Complications

UTIs not treated promptly can spread through the urinary system and cause renal failure. Bacteria invading the system can progress to urosepsis.

Assessment and Diagnostic Findings

Urine cultures identify the organism and are the definitive diagnostic test for UTI. STD tests may be done because some UTIs are sexually transmitted. A CT scan may detect pyelonephritis or abscesses. Ultrasonography is extremely sensitive for obstruction, abscesses, tumors, and cysts.

Medical Management

Management centers on pharmacologic therapy and patient education. Acute therapy uses an antibacterial agent that eradicates bacteria from the urinary tract with minimal effect on fecal and vaginal flora. For long-term therapy, since reinfection with new bacteria drives recurrence, patients with recurrence are taught to begin treatment on their own when symptoms occur and to contact the physician only if symptoms persist.

Nursing Management

Nursing care focuses on treating the underlying infection and preventing recurrence.

Nursing Assessment

Take a history of UTI-related signs and symptoms. Assess changes in urinary pattern such as frequency, urgency, or hesitancy. Assess the patient's knowledge of antimicrobials and preventive measures. Assess the urine's color, concentration, odor, volume, and cloudiness.

Nursing Diagnosis

• Acute pain related to infection within the urinary tract.
• Deficient knowledge related to lack of information about predisposing factors and prevention.

Nursing Care Planning and Goals

Major goals are relief of pain and discomfort, increased knowledge of preventive measures and treatment, and absence of complications.

Nursing Interventions

Relieve pain with antispasmodic agents for bladder irritability, plus analgesics and applied heat for pain and spasm. Encourage liberal fluids to promote renal blood flow and flush bacteria from the tract. Encourage frequent voiding every 2 to 3 hours to empty the bladder completely, which lowers urine bacterial counts, reduces stasis, and prevents reinfection. Have the patient avoid urinary irritants such as coffee, tea, colas, and alcohol.

Evaluation

The patient experiences relief of pain, explains UTI and its treatment, and experiences no complications.

Discharge and Home Care Guidelines

Care continues at home because the recurrence rate is high. Instruct the female patient to wash the perineal area front to back and wear cotton underwear. Increased fluid intake is the single most important intervention to prevent recurrence. Strictly adhere to the prescribed antibiotic regimen.

Documentation Guidelines

Document assessment findings (including the client's description and response to pain, expectations of pain management, and acceptable level of pain), prior medication use, the plan of care and those involved in planning, the teaching plan, responses to interventions and teaching, attainment of or progress toward outcomes, and any modifications to the plan of care.