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Risk Factors

  • Pregnancy
  • Structural problems in the urinary tract (i.e. enlarged prostate)
  • Previous UTI
  • Changes in vaginal bacteria or flora
  • Menopause
  • Age (Occures more frequently in older aduts)

Urinary Tract Infection

Causative Factors

  • Frequent pelvic exams
  • Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder
  • The use of spermicidal lubrication can potentially cause bacterial changes
  • Poor Hygeine
  • Catheterization of the bladder

Signs & Symptoms

Symptoms of uncomplicated UTIs are painful urination, increased frequency of urination, inability to start the urine stream, pressure or cramping, sudden emergent need to urinate, cloudy or malodorous urine, and bloody urine (Norris & Tuan, 2020).

More complicated UTIs usually present with fever, chills, nausea, vomiting, or back pain, which are signs indicative of kidney involvement or upper tract disease/pyelonephritis.

Symptoms can overlap, and in some cases, it can be hard to distinguish an uncomplicated UTI from a kidney or ore serious infection (Leslie et al., 2022).

Pathophysiology

Harmful bacteria infiltrate the mucosal wall of the bladder causing an inflammatory response known as cystitis. Typically, the organisms causing the urinary tract infection are enteric coliforms which inhabit the periurethral vaginal introitus. These coliforms travel up the urethra and into the bladder; therefore, causing a UTI (Leslie et al., 2022).

Medical Treatments

Laboratory and/or

Diagnostic Testing

Treatment varies from 3 days to 6 weeks. There are excellent rates with small and frequent doses of antibiotics administered over three days of treatment. If an E. coli resistance rate is noted to be greater than 50%, a new drug should be implemented. When in doubt, treat aggressively for possible upper urinary tract disease.

Trimethoprim/Sulfamethoxazole for 3 days is good mini-dose therapy, but resistance rates are high in many areas. First generation cephalosporins are good choices for mini-dose therapy (Leslie et al., 2022).

Nitrofurantoin is a good choice for uncomplicated UTI, but it is bacteriostatic, not bacteriocidal, and must be used for 5 days to one week. Fluoroquinolones have high resistance; however, recent precautions from the FDA about fluoroquinolone side effects and low evidence make this drug less favorable.

Fosfomycin trometamol is a stong one-time administration with a high level of evidence (Kang et al., 2018).

Casi L. Pennington

University of West Florida

NUR4125: Pathophysiology

Professor Jake Bush

The presence of nitrites or leukocyte esterase will automatically trigger a microscopic evaluation of the urine for bacteria, WBCs, and RBCs. On microscopy, there should be no bacteria in uninfected urine, so any bacteria on a gram-stained urine under microscopy is highly correlated to UTI. A good urine sample with greater than 5 to 10 WBC/HPF is abnormal and highly suggestive of UTI in symptomatic patients (Leslie et al., 2022).

Classic teaching on urine culture sets the gold standard for infected urine at greater than 10 colony forming units (CFU). Recent literature states that a patient who presents with symptoms and greater than 10 CFU is diagnostic of infection (Kang et al., 2018).

Nursing Intervention

  • Assess the symptoms of UTI
  • Encourage patient to drink fluids
  • Administer antibiotic as ordered
  • Encourage patient to void frequently
  • Educate patient on proper wiping (from front to the back)
  • Educate patient on drinking acidic juices which help deter growth of bacteria

References

References

Kang, C. I., Kim, J., Park, D. W., Kim, B. N., Ha, U.-S., Lee, S. J., Yeo, J. K., Min, S. K., Lee, H., Wie, S. H. (2018, March 21). Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. Infection & Chemotherapy, 50(1). https://doi.org/10.3947/ic.2018.50.1.67

Leslie, S., Raygaert, W., Doerr, C. (2022, November 28). Urinary tract infection (nursing) - statpearls - NCBI bookshelf. National Library of Medicine. Retrieved April 24, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK568701/

Norris, T.L. & Tuan, R.L. (2020). Disorders of renal function. In Porth’s Essentials of Pathophysiology (5th ed.) (pp. 860-889). Philadelphia: Wolters Kluwer.

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