Nursing Care of Lower

Urinary Tract Infections

By Efris Kartika Sari

 The urinary tract is the most

common site of nosocomial
infections and urinary tract infections
(UTIs) account for approximately
40% of all hospital-acquired
infections (HAIs) in the US.
More than 80% of HAIs are
associated with an indwelling urinary
catheter.
(Newman, 2010)

Definition
Urinary tract infections (UTIs) are
caused by pathogenic microorganisms
in the urinary tract (the normal
urinary tract is sterile above the
urethra).
UTIs are generally classified as
infections in-volving the upper or
lower urinary tract.
(Smeltzer., Bare., Cheeve, 2010)

Risk Factors

Female anatomy

Potential causes
Escherichia coli (E. coli) is the most
common organism in 80-90% of
cases
Staphylococcus saprophyticus
Pseudomonas
Other enterobacteria

Three main CaUTI entry points for

bacteria:
Urethral meatus
The junction of catheter-bag
connection
The drainage port of the collection
bag

Urethro and Ureterovesical

Reflux

 By increasing the normal slow

shedding of bladder epithelial cells
(resulting in bacteria removal), the
bladder can clear itself of even large
numbers of bacteria.
Glycosaminoglycan (GAG), forming a
water barrier that serves as a
defensive layer be-tween the bladder
and the urine.

The routes by which bacteria enter the

urinary tract:
Up the urethra (ascending infection)
Through the bloodstream
(hematogenous spread)
By means of a fistula from the
intestine (direct extension).

 For infection to occur, bacteria must

gain access to the bladder, attach to
and colonize the epithelium of the
urinary tract to avoid being washed
out with voiding, evade host defense
mechanisms, and initiate
inflammation.

Clinical Manifestations
Cardinal Symptoms
Frequency
Dysuria
Urgency
Other
Nocturia
Incontinence
Suprapubic discomfort
Low back pain
Fever
Hematuria
Burning on urination
Painful urination

Diagnostic Tests

Urinalysis
Urine Cultures
USG
CT Scan
Cystoscopy

Pharmacologic Therapy

Nursing Care
Nursing care of the patient with lower
UTI focuses on treating the underlying
infection and preventing its
recurrence.
Major goals for the patient may
include relief of pain and discomfort;
increased knowledge of preventive
measures and treat-ment modalities;
and absence of complications.

 Based on the assessment data, the

nursing diagnoses may include the
following:
Acute pain
Impaired urinary elimination
Hyperthermia
Deficient knowledge

If an indwelling catheter is necessary, however, specific

nursing interventions are initiated to prevent infection:
Using strict aseptic technique during insertion of the
small-est catheter possible
Securing the catheter with tape to prevent movement
Frequently inspecting urine color, odor, and consistency
Performing meticulous daily perineal care with soap and
water
Maintaining a closed system
Using the catheters port to obtain urine specimens

Expected patient outcomes may

include:
1. Experiences relief of pain
2. Reports no symptoms of infection
(fever, dysuria, frequency) or renal
failure (nausea, vomiting, fatigue,
pruritus)
3. Explains UTIs and their treatment

 Cutaneous ureterostomy: procedure

in which the distal ureter is detached
from the bladder, brought through
the abdominal wall, and attached to
an opening in the skin.