It is not uncommon for patients to present with urinary tract infection symptoms. Medical practitioners must be able to identify the signs and symptoms of this condition to provide appropriate treatment. This post will discuss UTI symptomatology, classifications, nursing diagnosis, and a care plan to guide you as a nursing student.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
A urinary tract infection (UTI) is a lower respiratory tract infection that occurs when bacteria travel from the anus to the urethra and bladder. UTIs are more common in women than men because of the shorter distance for bacteria to travel.
The urinary tract is made up of the kidneys, bladder, ureters, and urethra. The renal system filters waste from the bloodstream and remove it in a fluid known as urine. Immediately after leaving the kidney, this urine travels through the ureter to reach the bladder. Urine will remain in the bladder until urination occurs.
There are several types of UTIs. The most common type is bladder infection (cystitis), accounting for 90% of all UTI cases. The remaining 10% is split between kidney infections (pyelonephritis) and ureters, which connect the kidneys to the bladder.
Cystitis often presents with symptoms of pain or pressure in the lower abdomen, frequent urination, and dark yellow urine.
There are many causes that can contribute to a urinary tract infection. Common risk factors include frequent sexual intercourse, poor hygiene or wiping from back to front, using spermicidal foams.
Other infections in the urinary tract are usually caused by the bacteria Escherichia coli (E.coli). E.coli occurs especially for girls and women when they wipe from back to front when they visit the toilet. Wiping should be front to back. The bacteria can then spread to any part of the urinary tract, both the upper urinary and lower urinary tract.
The frequent causes of urinary tract infections include:
- Unprotected sexual intercourse
- Not emptying your bladder properly
- Having a new sexual partner or multiple sex partners (it can cause vaginal irritation)
- A recent pregnancy, miscarriage, abortion, or labor
- Having a history of UTI’s
- Diabetes or other illness that affects your immune system (for example, HIV)
Cystitis is different from an infection in the lower urinary tract. It is also known as Interstitial Cystitis or Urethritis.
Some of the most common symptoms include:
- Fever (elevated body temperature)
- Pain in the lower and upper urinary tract
- Burning while urinating
- Frequent urination
- Difficulty in starting urine flow or painful spasms during ejaculation (in men)
- Cloudy urine
- Strong-smelling urine
- Feeling feverish without having a known cause
- Blood in urine
- Abdominal cramps accompanied by nausea and vomiting (in adults)
In infants and children, UTI symptoms are often nonspecific and relate to pain. Often, an infant will experience a fever with other symptoms, such as abdominal pain or discomfort, colic, irritability, restless sleep, or poor feeding.
The easiest way to prevent UTIs is to maintain proper hygiene.
Other ways include;
It helps flush bacteria from the body before it has time to multiply and infect you. Be careful not to drink too much water as it can lead to a different type of infection called water intoxication.
Instead, it is recommended to urinate first. It is easier for bacteria to move up through the urethra (which leads to the bladder) than down (from your bladder).
The same reasoning applies here as bacteria have more time to grow inside your urinary tract when you wait too long between having sex and urinating.
Make sure you visit your doctor at least once a year or if experiencing any symptoms which might indicate UTI infection. Your doctor will be able to perform tests that can help identify the source of the problem and medicate.
To confirm whether you have an infection, a doctor will perform:-
A physical exam and ask some questions about your medical history. They may also take some samples of your urine to send to the lab so that they can see what is causing the problem with color change, odor, or appearance.
Risk for injury related to indwelling bladder catheter, presence of a urinary tract infection, or alterations in physical and/or cognitive status secondary to a high-risk patient population at nursing home facilities, including elderly patients with multiple medical problems.
Urinary retention related to abrupt termination of ureteral catheters without gradual reduction in flow rate; use of a ureteral catheter with a drainage system that is easily clogged.
A urinalysis should be performed on girls who are prone to UTI. It includes a urine sample test for the presence of bacteria, white blood cells (a sign of infection), and pH levels (an indicator of how acidic your urine is). In addition, protein levels in the urine are also measured as too much protein can cause kidney damage.
As part of the urinalysis, doctors often test for a protein called albumin. Albumin is found in the blood and naturally makes its way into the urine when we have an infection. This can be detected by performing a dipstick test, which is done on a small sample of your urine. The presence of albumin in your urine is important to know as it can indicate kidney damage if found in large amounts.
A urine culture is the most reliable way to test for an infection in your bladder. This involves a sample of your urine being sent to the lab and then grown in a special nutrient solution so that bacteria can grow and be identified.
The lab technician will look at how the bacteria react with special dyes, which makes them visible under a microscope. The technician will then examine the bacteria under a microscope, comparing your sample with samples from other patients with the infection. This helps confirm whether or not you have UTI.
Imaging tests – A new kind of imaging technology uses sound waves to create a three-dimensional image of the kidneys, ureters, and bladder (this is called ultrasound). It allows your doctor to visualize any abnormalities that might be present within these structures. This can help your doctor determine whether you have an infection causing inflammation of the urinary tract.
Your doctor can examine your bladder using a small, flexible instrument with a light source at the end called a cystoscope. This allows them to visualize your bladder for any abnormalities and look directly at areas where urine is coming from (ureters). If there are abnormal spots in your bladder or ureters, your doctor can reach in and remove the infected area.
This type of scan provides two-dimensional images to get a better idea about the size and shape of the organs and any abnormalities that may be present. The main benefit is that it does not require any X-rays or expose you to radiation.
It is used to visualize the areas of your body where there are problems. The MRI scan uses a magnetic field and radio waves to create images of organs and can be used to view the inside of your bladder. However, it may not be practical in some cases as it requires you to lie still for an extended period of time.
Which Priority is Nursing Diagnosis Applicable for a Patient With Indwelling Urinary Catheter?
The patient may feel pain and discomfort, which is related to the procedure of inserting a urinary catheter inside the body. Therefore, the patient may have an altered sense of wellbeing due to fear, anxiety, and emotional shock from being subjected to perform such a procedure. Other than this factor, the patients can also experience adverse effects from being given certain medications for pain as well as side effects from antibiotics which was used to treat the underlying urinary tract infection.
-The nursing team should educate the patient about the management of UTI. This includes lifestyle changes, diet modification, eating habits, consumption of antibiotics, alternative medication, and dietary supplements, which can aid in the prevention of infection. The medical practitioner should also educate the patient on prevention strategies and implications of further infection.
-Encourage patients to drink more water (this helps clean the infection).
-Educate clients on how to wipe from front to back after visiting the rest room to prevent Escherichia coli (E.coli) which is mostly found in the feces, from entering to the urinary system. E.coli is a major source of urinary tract infection.
-Encourage antibiotic intake (taking antibiotics as prescribed prevents a possible complication called superinfection, which is when the bacteria mutates and becomes resistant to medication).
The goal of the nursing care plan for urinary tract infection (UTI) is to educate patients on what they need to do after being treated at home so that they don’t get recurrence or complications from their infection.
There are many things nurses can do to help patients with UTI. A nurse’s goal is to treat the patient and prevent them from getting any further complications.
Nursing interventions for UTI include;
An important aspect of the treatment is patient and caregiver knowledge. Educate patients about home care, prevention measures, modification in lifestyle (i.e., diet), expected signs and symptoms of recurrence, the importance of taking prescribed antibiotics, and alternative medications that can help prevent a UTI from coming back. Encourage regular visits to the doctor (at least once a year) to check on the current status of UTI infection.
As mentioned, antibiotics are taken by patients when they have UTI. The antibiotics help eliminate the bacteria before it spreads to other areas in the body and causes further damage. The patient should take these medications as prescribed by their physician. If they do not feel any improvement after taking the prescribed antibiotics, they should discuss it with their physician.
A patient needs to maintain an adequate diet during the treatment of UTI. Food containing Vitamin C helps promote healing and prevent complications like kidney stones or calcium oxalate crystals in male patients. Drinking plenty of water helps to flush out the toxins from the body.
Giving the patient pain medicine to ease their pain and discomfort.
The bladder training exercise is done by patients who have recurrent UTIs. It is an exercise sheet that has been developed for patients to do around three times per week. These exercises are aimed at increasing blood flow in the area to help prevent further urination from occurring after eliminating urine and thus possibly removing bacteria and germs that may be left in the urethra. Also, encourage the patient to completely void when urinating.
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Treatment of Urinary Tract Infections (UTI’s)
The treatment of urinary tract infection is dependent on the severity of the symptoms and what type of UTI has been contracted.
They are either treated with an antibiotic, or a catheter is passed to drain the infected urine from the bladder. A CT scan may also be required to diagnose the patient’s condition more accurately or for post-surgery purposes.
The important thing to do when treating a UTI is to make the patient relaxed. Also, the patient needs to follow instructions given by a doctor and take all the medications as prescribed.
The patient should take enough fluids to help flush out the infection and to keep hydrated. To ensure the patient does not get dehydration, the medical practitioner should assess the frequency of fluids intake and the urine output frequency (how much urine is being released when urinating).