Ch 55 Management of Patients with Urinary Disorders
Infections of the Urinary Tract
• UTIs are caused by pathogenic microorganisms (the normal urinary tract is sterile above
the urethra)
• Lower UTIs
o Bacterial cystitis: inflammation of the urinary bladder
o Bacterial prostatitis: inflammation of the prostate
o Bacterial urethritis: inflammation of the urethra
• Upper UTIs
o Most common
o Includes acute and chronic pyelonephritis: inflammation of the renal pelvis.
o Interstitial nephritis: inflammation of the kidney
o Kidney abscesses
• The urinary tract is the most common site for nosocomial infection (hospital acquired)
o The use of catheters is the leading cause
Lower Urinary Tract Infections
• For infection to occur, bacteria must gain access, colonize, evade and initiate
inflammation.
• Most UTIs result from fecal organisms. It is important to teach the patient to wipe from
front to back; from clean to dirty.
Factors Contributing to UTI
• Bacterial invasion if the urinary tract
• Reflux
o Urethrovesical reflux: obstruction to free-flowing urine; the reflux (backward
flow) of the urine from the urethra into the bladder. Can be caused by coughing,
sneezing, or straining.
o Ureterovesical or vesicoureteral reflux: refers to the backwards flow of urine
from the bladder into one or both of the ureters.
o Uropathogenic Bacteria
▪ Bacteriuria: bacteria in the urine
▪ A clean-catch midstream urine specimen is used to check for bacteria.
▪ The organism most frequently responsible for UTIs are mostly found in
the lower GI tract, Escherichia coli.
• Routes of Infection
o Bacteria enter the urinary tract in three ways:
▪ Transurethral: most common route; often from fecal contamination;
women have short urethras that offer little resistance to the movement of
bacteria
▪ Bloodstream
, ▪ By means of fistula from the intestine
• Risk Factors (chart 55-2 pg1616)
o Diabetes
o Pregnancy
o Neurologic disorders
o Gout
o Inability or failure to empty the bladder.
Factors that contribute to UTIs in older adults
• Cognitive impairment
• Frequent use of antimicrobial agents
• High incidence of multiple chronic medical conditions
• Immunocompromise
• Immobility and incomplete emptying of bladder
• Obstructed flow of urine
Assessment and Diagnostic Findings
• Pain, burning upon urination, frequency, nocturia, incontinence, hematuria.
• About half are asymptomatic
• Association of symptoms with sexual intercourse, contraceptive practices, and personal
hygiene
• Gerontologic considerations
• Assessment of urine, urinalysis, and urine cultures
o Uti is diagnosed by the amt of bacteria in the urine culture.
o Colony count greater than 100,000 CFU/mL
o Pyuria (WBCs) occurs in all pts with UTI
• Other diagnostic tests
o Test for STIs may be performed because acute urethritis caused by sexually
transmitted organisms (Chlamydia, gonorrhea, herpes simplex) or acute vaginitis
infections (caused by trichomonas or candida) may be responsible for symptoms
similar to UTI.
Diagnoses
• Acute pain related to infection
• Deficient Knowledge about:
o Factors predisposing patient to infection and recurrence
o Detection and prevention of recurrence
o Pharmacological therapy
▪ Anti-effective: nitrofurantoin (Macrodantin, Furadantin); cephalexin
(Keflex
▪ Cephalosporin: cefadroxil (Duricef, Ultracef)
▪ Fluroquinolone: Ciprofloxacin (Cipro), ofloxacin (Floxin)
Infections of the Urinary Tract
• UTIs are caused by pathogenic microorganisms (the normal urinary tract is sterile above
the urethra)
• Lower UTIs
o Bacterial cystitis: inflammation of the urinary bladder
o Bacterial prostatitis: inflammation of the prostate
o Bacterial urethritis: inflammation of the urethra
• Upper UTIs
o Most common
o Includes acute and chronic pyelonephritis: inflammation of the renal pelvis.
o Interstitial nephritis: inflammation of the kidney
o Kidney abscesses
• The urinary tract is the most common site for nosocomial infection (hospital acquired)
o The use of catheters is the leading cause
Lower Urinary Tract Infections
• For infection to occur, bacteria must gain access, colonize, evade and initiate
inflammation.
• Most UTIs result from fecal organisms. It is important to teach the patient to wipe from
front to back; from clean to dirty.
Factors Contributing to UTI
• Bacterial invasion if the urinary tract
• Reflux
o Urethrovesical reflux: obstruction to free-flowing urine; the reflux (backward
flow) of the urine from the urethra into the bladder. Can be caused by coughing,
sneezing, or straining.
o Ureterovesical or vesicoureteral reflux: refers to the backwards flow of urine
from the bladder into one or both of the ureters.
o Uropathogenic Bacteria
▪ Bacteriuria: bacteria in the urine
▪ A clean-catch midstream urine specimen is used to check for bacteria.
▪ The organism most frequently responsible for UTIs are mostly found in
the lower GI tract, Escherichia coli.
• Routes of Infection
o Bacteria enter the urinary tract in three ways:
▪ Transurethral: most common route; often from fecal contamination;
women have short urethras that offer little resistance to the movement of
bacteria
▪ Bloodstream
, ▪ By means of fistula from the intestine
• Risk Factors (chart 55-2 pg1616)
o Diabetes
o Pregnancy
o Neurologic disorders
o Gout
o Inability or failure to empty the bladder.
Factors that contribute to UTIs in older adults
• Cognitive impairment
• Frequent use of antimicrobial agents
• High incidence of multiple chronic medical conditions
• Immunocompromise
• Immobility and incomplete emptying of bladder
• Obstructed flow of urine
Assessment and Diagnostic Findings
• Pain, burning upon urination, frequency, nocturia, incontinence, hematuria.
• About half are asymptomatic
• Association of symptoms with sexual intercourse, contraceptive practices, and personal
hygiene
• Gerontologic considerations
• Assessment of urine, urinalysis, and urine cultures
o Uti is diagnosed by the amt of bacteria in the urine culture.
o Colony count greater than 100,000 CFU/mL
o Pyuria (WBCs) occurs in all pts with UTI
• Other diagnostic tests
o Test for STIs may be performed because acute urethritis caused by sexually
transmitted organisms (Chlamydia, gonorrhea, herpes simplex) or acute vaginitis
infections (caused by trichomonas or candida) may be responsible for symptoms
similar to UTI.
Diagnoses
• Acute pain related to infection
• Deficient Knowledge about:
o Factors predisposing patient to infection and recurrence
o Detection and prevention of recurrence
o Pharmacological therapy
▪ Anti-effective: nitrofurantoin (Macrodantin, Furadantin); cephalexin
(Keflex
▪ Cephalosporin: cefadroxil (Duricef, Ultracef)
▪ Fluroquinolone: Ciprofloxacin (Cipro), ofloxacin (Floxin)
