Sunday, May 16, 2010

Urinary Tract
Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra The two forms of lower urinary tract infection (UTI) are cystitis (infection of the bladder) and urethritis (infection of the urethra). Urinary tract infection (UTI) more common in females than in males. UTI is prevalent in girls. In adult males and in children, lower UTIs typically are associated with anatomic or physiologic abnormalities and therefore need close evaluation. Most UTIs respond eadily to treatment, but recurrence and resistant bacteria flare-up during therapy are possible. 
“Urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. The main etiologic agent is Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it does not usually have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they may cause a UTI. “Pathogenesis 
The most common organism implicated in is E. coli and Staphylococcus. The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. As binding is an important factor in establishing pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues.[clarification needed] Moreover, the unbound bacteria are more easily removed when voiding. The use of urinary catheters (or other physical trauma) may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium. During cystitis, uropathogenic Escherichia coli (UPEC) subvert innate defenses by invading superficial umbrella cells and rapidly increasing in numbers to form intracellular bacterial communities (IBCs). By working together, bacteria in biofilms build themselves into structures that are more firmly anchored in infected cells and are more resistant to immune system assaults and antibiotic treatments This is often the cause of chronic urinary tract infections. 

Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic renal failure. 

Causes for Urinary tract infection (UTI) 
Most lower Urinary tract infection (UTI) result from ascending infection by a single gram-negative, enteric bacterium, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia. In a patient with neurogenic bladder, an indwelling urinary catheter, or a fistula between the intestine and bladder, a lower UTI may result from simultaneous infection with multiple pathogens. 
Studies suggest that infection results from a breakdown in local defense mechanisms in the bladder that allows bacteria to invade the bladder mucosa and multiply. These bacteria can’t be readily eliminated by normal urination. 
The pathogen’s resistance to the prescribed antimicrobial therapy usually causes bacterial flare-up during treatment. Even a small number of bacteria in a midstream urine specimen obtained during treatment casts doubt on the effectiveness of treatment. 
In almost all patients, recurrent lower Urinary tract infection (UTI) result from reinfection by the same organism or by some new pathogen. In the remaining patients, recurrence reflects persistent infection, usually from renal calculi, chronic bacterial prostatitis, or a structural anomaly that is a source of infection. The high incidence of lower UTI among females probably occurs because natural anatomic features that facilitate Urinary tract infection (UTI). 
Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra 

Nursing Assessment 
Patients History. The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. The patient may complain of urinary urgency and frequency, dysuria, bladder cramps or spasms, itching, a feeling of warmth during urination, nocturia. Other complaints include low back pain, malaise, nausea, vomiting, pain or tenderness over the bladder, chills, and flank pain. Inflammation of the bladder wall also causes hematuria and fever. Ask the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI). 
Physical Examination. Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination. 

Diagnostic tests
Several tests are used to diagnose lower UTIs: Leukocyte esterase dip test Clean-catch urinalysis. Clean-catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria. Sensitivity testing is used to determine the appropriate antimicrobial drug. Stained smear of urethral discharge can be used to rule out sexually transmitted disease. Voiding cystourethrography or excretory urography 

Nursing diagnosis
  • Acute pain 
  • Deficient knowledge (prevention) 
  • Disturbed sleep pattern 
  • Impaired urinary elimination 
  • Risk for infection 
  • Risk for injury Sexual dysfunction 

Nursing Key outcomes Nursing care plans for Urinary tract infections (UTIs) 
The patients will: Report increased comfort. Identify risk factors that exacerbate the disease process or condition and modify his lifestyle accordingly. Verbalize feeling well rested after undisturbed periods of sleep. Remain free from signs or symptoms of infection. Avoid or minimize complications. Reestablish sexual activity at the preillness level. Patient and family will demonstrate skill in managing elimination problem. 

Nursing interventions 
Administer antibiotics specific to the invading organism as ordered Watch for GI disturbances from antimicrobial therapy. If ordered, administer nitrofurantoin macrocrystals with milk or meals to prevent such distress. If the patient experiences perineal discomfort, sitz baths to the perineum may increase comfort. If sitz baths don’t relieve perineal discomfort, apply warm compresses sparingly to the perineum, but be careful not to burn the patient. Apply topical antiseptics on the urethral meatus as necessary. Collect urine specimens for culture and sensitivity testing carefully and promptly. Encourage patients to increase fluid intake to promote frequent urination 

Patient Teaching and Home Healthcare Guidelines
Teach the patient an understanding of the proposed therapy, including the medication name, dosage, route, and side effects, Emphasize the importance of completing the prescribed course of therapy or, with long-term prophylaxis, of strictly adhering to the ordered dosage. Explain that an uncontaminated midstream urine specimen is essential for accurate diagnosis. Teach the female patient to clean the perineum properly and to keep the labia separated during urination. To prevent recurrent lower UTIs, teach a female patient to carefully wipe the perineum from front to back and to thoroughly clean it with soap and water after bowel movements. Teach to the patients never to postpone urination and to empty her bladder completely. Tell the male patient that prompt treatment of predisposing conditions such as chronic prostatitis helps prevent recurrent UTIs. Urge the patient to drink about 2 qt (2 L) of fluid a day during treatment.

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