s age and maturation • Additionally the presenting complaints and their significance vary with maturation • Nausea, vomiting, anorexia, chills, nocturia, urinary frequency, urgency • Suprapubic or lower back pain, bladder spasms, dysuria, burning on urination
Urinary Tract Infection Nursing Assessment—cont’d • Urinary stasisis the single most important host factor that influences the development of UTIs • Urine is usually sterile, but at body temperature provides an excellent growth medium for bacteria • Objective data • Fever • Hematuria; foul-smelling urine; tender, enlarged kidney • Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP
Diagnostic Studies •UA•Urine C&S•BUN• Creatinine • KUB • IVP • VCG/VCUG • Renal scan • Cystogram • Retrograde pyelogram • Ultrasound • CT • MRI • Renal arteriogram
Urinary Tract Infection (UTI) • Is it really that serious? • Concept of “asymptomatic bacteria”in urinary tract Causes • Escherichia colimost common pathogen • Streptococci • Staphylococcus saprophyticus • Occasionally fungal and parasitic pathogens
UTI Classification • Uncomplicated infection • Complicated infections • Stones • Obstruction • Catheters • Diabetes or neurologic disease • Recurrent infections
Types of UTIs • Recurrent—repeated episodes • Persistent—bacteriuria despite antibiotics • Febrile—typically indicates pyelonephritis • Urosepsis—bacterial illness; urinary pathogens in blood The objectives in management of UTIs are to- • (1) eliminate the current infection • (2) identify contributing factors to reduce the risk of recurrence • (3) prevent urosepsis • (4) preserve renal function
UTIs Etiology and Pathophysiology • Physiologic and mechanical defense mechanisms maintain sterility • Emptying bladder • Normal antibacterial properties of urine and tract • Ureterovesical junction competence • Peristaltic activity • Alteration of defense mechanisms increases risk of UTIs • Organisms usually introduced via ascending route from urethra • Less common routes • Bloodstream • Lymphatic system
UTIs Etiology and Pathophysiology— cont’d • Contributing factor—urologic instrumentation • Allows bacteria present in opening of urethra to enter urethra or bladder • Sexual intercourse promotes “milking”of bacteria from perineum and vagina • May cause minor urethral trauma • For kidney infection to occur from hematogenous transmission, must have prior injury to urinary tract • Obstruction of ureter • Damage from stones • Renal scars • A UTI is a common nosocomial infection • OftenEscherichia coli,SeldomPseudomonas
UTIs Clinical Manifestations • Symptoms • Incontinence • Dysuria • Frequent urination (>q 2 h) • Urgency • Suprapubic discomfort or pressure • Urine may contain visible blood or sediment (cloudy appearance) • Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis) • Pediatric patients with significant bacteriuria may have no symptoms or nonspecific symptoms like fatigue or anorexia*
UTIs Diagnostic Studies • Dipstick •
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