Urinary tract infection or UTI is an infection that affect your urinary system including the urethra,bladder,ureters and the kidneys.Most commonly occur in females compared to men due to the anatomical variation. At least one episode of urinary tract infection can experienced by each individual during their entire lifetime and the risk of developing reinfection is higher in these people compared to those who do not experience initial infection before.After menopause, patient with indwelling catheters are also have high risk of getting UTI. Variety of pathogenic organisms mainly E.coli plays a vital role in UTI. Proper management helps to eliminate infection and protect your urinary system from the development of complications such as kidney failure. Prophylactic antibiotic therapy also helps to prevent from the recurrence of infection.

2. URINARY TARCT INFECTION
PRESENTED BY,
CHITHRA.A.VALSAN
FIRST YEAR MSC NURSING

3. DEFINITION
 Urinary Tract Infection (UTI) is
an infection in any part of the
urinary system such as kineys,
ureters,bladder, and urethra.
 Most infections involve in the
lower urinary tract –the bladder,
and the urethra.

4. PREVALENCE
 At least 1 episode of UTI can be seen
among half of all women.
 2nd most common bacterial infection is
UTI and the most common bacterial
infection among women.
 Risk of UTI increases after menopause
and patients with urinary catheters.
 After a UTI 20 to 40 % will have
recurrence due to reinfections.

5. ETIOLOGY
1.Micro- organisms such as bacteria and fungus
 Escherichia coli – 80% of UTI caused
by E.coli. Primarily among women.
 Other organisms are :
 Enterococcus , Klebsiella
 Enterobacter , Staphylococcus
 Proteus , Serratia
 Pseudomonas , Candida albicans

6. PREDISPOSING FACTORS OF UTI
1.Factors increasing urinary stasis
2.Foreign bodies
3.Anatomic factors
4.Factors compromising
immune response
5.Functional disorders
6.Other factors

7. PREDISPOSING FACTORS OF UTI
1.Factors increasing urinary stasis
a) Intrinsic obstruction.
Eg: Stone,BPH,tumor of urinary tract
b) Extrinsic obstruction.
Eg: Tumor,fibrosis compressing urinary tract
c) Urinary retention.
Eg: Neurogenic bladder, low bladder wall compliance
d) Renal impairment

8. 2.Foreign bodies
a) Urinary Tract calculi
b) Catheters
Eg : Indwelling,external condom
catheter,ureteral stent,
intermittent catheterization
c) Urinary tract instrumentation
Eg : Cystoscopy,urodynamics

9. 3.Anatomic factors
 Congenital defects
leads to obstruction or
urinary stasis.
 Fistula
 Shorter female urethra
and colonization from
normal vaginal flora.

10. 4.Factors compromising immune response
 Aging
 Human immunon deficiency
virus infection
 Diabetes mellitus

11. 5.Functional disorders
 Voiding dysfunction
with detrusor
sphincter dyssynergia

12. 6.Other factors
 Pregnancy
 Hypo-estrogenic state
 Multiple sex partners
 Use of spermicidal agents or
contraceptive diaphragm
(women)
 Poor personal hygiene

13. CLASSIFICATION
1.Based on the location of infection within the urinary
system
a) Upper UTI :
* Involving in the renal parenchyma, pelvis and ureters.
* Typically causes fever, chills, and flank pain.
b) Lower UTI
* Involving the bladder,urinary sphincter, urethra and
in men ,the prostate.

14. Classification (cont’d…)
2. Based on the complication
a)Uncomlpicated infections :
Infection occur in an otherwise normal urinary tract
and usually involve in the bladder.
b)Complicated infections :
Co-existing with obstruction, stones, catheters, DM,
neurologic diseases, pregnancy induced changes, or recurrent
infections.
Risk of pyelonephritis, urosepsis, and renal damage.

15. Classification (cont’d…)
3.Based on the route
of infection
* Ascending
* Descending
4.Based on the localization
of the patient
* Community acquired
* Hospital acquired

16. Classification (cont’d…)
5. Based on the causative agent
* Bacteria * Fungi
* Virus * Parasites
6. Based on the natural history
* Initial infection
* Recurrent UTI

17. Classification (cont’d…)
a) Initial infection
* Also called first or isolated infections.
* It is an Uncomplicated UTI
* Person who has never had an infection
or experiences previous UTI usually
separated by a period of years

18. Classification (cont’d…)
b) Recurrent UTI
* Reinfection caused by a second pathogen in
a person who experienced a previous infection
that was successfully eradicated.
* If a recurrent UTI occurs because the original
infection is not adequately eradicated.
They are classified as
1.Unresolved bacteriuria 2.Bacterial persistence

19. Classification (cont’d…)
1.Unresolved bacteriuria
* When bacteria are initially resistant to
the antibiotic agent used to treat an infection.
* When the antibiotic agent fails to achieve
adequate concentration in the urine or
blood stream to kill the bacteria.
* When the drug is discontinued before the
underlying bacteriuria is completely eradicated.

20. Classification (cont’d…)
2.Bacterial persistence
* When bacteria develop persistent
resistance to the antibiotic agent
selected for treatment.
* When a foreign body in the urinary
system serves as a harbor or anchor
allowing bacteria to survive despite
appropriate therapy.

21. PATHOPHYSIOLOGY OF UTI
4 types of bacterial entry to the urinary tract.
1.Ascending infection
2.Blood borne spread
3.Lymphatogenous spread
4.Direct extension from other organs

22. 1.ASCENDING INFECTION
• Most common route.
• Organism ascend through the urethra into
the bladder.
Organism
Colonize in the perineal and peri-urethral area
Ascend to the bladder and kidneys
Urinary tract infection

23. 2.BLOOD BORNE SPREAD
 Also known as hematogenous spread
 Blood borne spread to the kidneys,
ureters, or bladder.
 Occurs in bacteraemia mostly caused by
Staphylococcus aureus.

24. 3.LYMPHATOGENOUS SPREAD
 Men through rectal and colonic lymphatic
vessels to the prostate and bladder.
 Women through periuterine lymphatics to
the urinary tract.

25. 4. DIRECT EXTENSION FROM OTHER ORGANS
 Pelvic inflammatory diseases
 Genito-urinary tract fistulas

26. PATHOPHYSIOLOGY
 The urinary tract above the urethra is normally sterile
due to the several mechanical and physiologic defense
mechanisms.
 Normal voiding with complete emptying of the bladder,
UVJ competence, and peristaltic activity that propels the
urine toward the bladder.

27. Cont’d…
 Antimicrobial characteristics of urine are maintained
by the acidic nature pH<6.0 ,high urea
concentration, and abundant glycoproteins that
interfere with the growth of bacteria.
 An alteration in any of these defense mechanism
increases the risk of developing UTI.

29. CLINICAL MANIFESTATIONS
 Lower urinary tract symptoms (LUTS) are
experienced in patients who have UTIs of the upper
and lower urinary tracts.
 These symptoms are either related to the bladder
storage or bladder emptying.

30. LOWER URINARY TRACT SYMPTOMS
(LUTS)
1) Emptying symptoms
Weak urinary symptoms
Dysuria
Hesitancy : difficulty starting urine stream resulting in a
delay between initiation of urination by relaxation of the
urethral sphincter and when urine stream actually begins.

31. CLINICAL MANIFESTATIONS (LUTS)
Intermittency :
Interruption of the urinary stream while voiding.
Post void dribbling :
Urine loss after completion of voiding.
Urinary retention or incomplete emptying :
Inability to empty urine from the bladder
which can be caused by the atonic bladder
or obstruction of the urethra. It can be acute or chronic.

32. 2) Storage symptoms
 Urinary frequency : Abnormally frequent (8 times /24hrs)
desire to void ,often of only small quantities.
 Urgency : Sudden,strong,or intense desire to void
immediately usually accompanied by frequency.
 Incontinence : Involuntary /unwanted loss / leakage of
urine.
 Nocturia : Waking up 2 or more times at night due to the
need or urge to void.
 Nocturnal enuresis : Loss of urine during sleep.

33. Other clinical features :
* Hematuria
* Sediments or cloudy appearance of urine
* Flank pain ,chills, and the presence of fever indicate an
infection involving the upper urinary tract (pyelonephritis).
* Sometimes these features are absent in older adults.
* In older adults tend to experience non-localized
abdominal discomfort rather than dysuria
and supra-pubic pain.

34. DIAGNOSTIC STUDIES
 History and physical examination
 Urinalysis
 Urine culture and sensitivity
 Imaging studies of urinary tract
 Eg:Intravenous pyelogram (IVP) and
abdominal CT scan recommended if
patients suspected with any obstruction
of the urinary system that cause UTI.

35. Cont’d…
 Renal ultrasound (especially for patient with recurrent UTI,
because it is non-invasive, easy to perform and relatively
inexpensive.
 Dipstick urinalysis- obtained initially to identify the
presence of nitrites(indicating bacteriuria), WBC and
leukocyte esterase (enzyme present in the WBC indicating
pyuria)

36. COLLABORATIVE MANAGEMENT
For uncomplicated UTI
 Antibiotic :trimethoprim –sulfamethoxazole or
trimethoprim alone in patients with sulfa allergy
,nitrofurantoin.
 Urinary analgesics : Phenazopyridine or combination
agent.
 Counselling about the recurrence and reduction of risk
factors.

37. For complicated or recurrent UTI
 Repeat urinalysis
 Urine culture and sensitivity
 Antibiotics :
trimethoprim –sulfamethoxazole,
nitrofurantoin for 3- 5 days.
 Sensitivity guided antibiotics
 Post coital antibiotic prophylaxis
 Encourage for pre and post coital voiding.

38. For complicated or recurrent UTI
 3-6 months trial of suppressive prophylactic antibiotics.
 Adequate fluid intake
 Cranberry or Lingenberry juice (200 – 750 ml or
equivalent tablets daily)
 Urinary analgesics such as phenazopyridine or
combination agent.
 Counselling about the recurrence and reduction of risk
factors.

39. For complicated or recurrent UTI
 Imaging study of urinary tract is recommended for
selected cases.
 Once UTI has been diagnosed, appropriate
antimicrobial therapy is initiated.

40. Prophylactic or suppressive antibiotics
 Recommends of patients with repeated UTIs
 A low dose of trimethoprim –sulfamethoxazole,
nitrofurantoin or another antibiotic are used on a daily
basis in order to prevent recurring UTIs or a single dose
may be taken before an event likely to provoke a UTI,
such as before having sexual contact.

41. NURSING MANAGEMENT

42. NURSING ASSESSMENT
Subjective data
1. Important health information
a)Past health history : Previous UTI,urinary calculi,
stasis, strictures,or retention,tumors etc
b)Medications : Use of antibiotics,
antispasmodics, anticholinergics,etc.
c)Surgery or other treatments : Recent urologic
instrumentation. Eg:cystoscopy,catheterization etc

43. NURSING ASSESSMENT (Cont’d…)
2.Functional health patterns:
 Health perception –health management :urinary hygiene practices,
malaise.
 Nutritional – metabolic : anorexia, nausea, vomiting & chills.
 Elimination : urinary frequency, urgency, hesitancy, dysuria,
nocturia.
 Cognitive –perceptual : supra-pubic or low back pain, bladder
spasms, dysuria, burning on urination.
 Sexuality-reproductive : multiple sex partners, use of contraceptive
diaphragm (women), use of spermicidal agents.

44. NURSING ASSESSMENT (Cont’d…)
Objective data
1.General : Fever, chills, overall clinical deterioration
can be seen among elderly.
2.Urinary : Hematuria, cloudy, foul smelling urine, tender
enlarged kidney.
3.Possible findings : Leukocytosis, Positive urine culture
Urinalysis positive for bacteria, pyuria, RBCs and WBCs
IVP, CT scan, ultrasound, voiding cystourethrogram , and
cystoscopy demonstrating abnormalities of urinary tract.

45. PLANNING
Overall goals are :
 Relief from LUTS.
 Prevention of upper urinary tract
involvement.
 Prevention of recurrence.

46. NURSING IMPLEMENTATION
1.Health promotion
Teaching of preventive measures :
 Emptying the bladder regularly and completely.
 Evacuating the bowel regularly.
 Wiping the perineal area from front to back after
urination and defecation.
 Drink adequate amount of fluid – 2to 3 L/day.

47. Teaching of preventive measures
 Prevention of nosocomial infections.
 Avoidance of unnecessary catheterization.
 Using aseptic techniques during insertion.
 Early removal of catheters.
 Maintain routine and thorough perineal hygiene.

48. 2.Acute intervention
 Active management for UTI.
Drug therapy
Application of local heat to the suprapubic
area or lowerback may relieve discomfort
associated with a UTI.
Encouraged for full course of antibiotics

49. Acute intervention (cont’d…)
Counselled for :
 To reduce persistence of bothersome LUTS
beyond the antibiotic treatment course.
 The onset of flank pain
 Fever should be reported promptly to a health care
provider.

50. 3.Ambulatory and home care
 Emphasize the patients compliance with the drug regimen
 Teach the patient and family about UTI including :
 Full course of antibiotic therapy, because symptoms may
improve after 1to 2 days of therapy, but organisms may
still be present.
 Hygienic practices.
 Urinate regularly : every 3 to 4 hours during the day.

51. EVALUATION
 The expected outcome of the patient based on the
clinical features ,such as :
 Maintained improved elimination (urinary) pattern.
 Followed treatment regimen properly.
 Reduction of complications.

52. COMPLICATIONS
 Recurrent infections
 Permanent kidney damage from acute or chronic kidney
infection (pyelonephritis) due to an untreated UTI.
 Low birth weight related with pregnancy
 Urethral narrowing (stricture) in men from recurrent
urethritis, previously seen with Gonococcal urethritis.
 Sepsis
 Multi-organ failure

54. ASSIGNMENT
Mrs.X admitted in the ward with
the complaints of fever , flank pain
and dysuria.
Write down the possible nursing
diagnosis and its intervention and
submitted it on 18.03.2020 at 8am
in I year Msc nursing class room.

55. RELATED RESEARCH STUDIES
 Reducing unnecessary urinary catheter use and other strategies
to prevent catheter-associated urinary tract infection: an
integrative review done by Jennifer Meddings, Mary A M
Rogers, Sarah L Krein.
 The method of this study is meta-analysis regarding
interventions prompting UC removal by reminders or stop
orders. A narrative review summarises other CAUTI prevention
strategies including aseptic insertion, catheter maintenance,
antimicrobial UCs, and bladder bundle implementation.

56. RELATED RESEARCH STUDIES
 Results :30 studies were identified and summarised with
interventions to prompt removal of UCs, with potential for
inclusion in the meta-analyses. By meta-analysis (11
studies),the rate of CAUTI was reduced by 53% (rate ratio
0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or
stop order, with five studies also including interventions to
decrease initial UC placement.
.

57. RELATED RESEARCH STUDIES
Conclusions :UC reminders and
stop orders appear to reduce
CAUTI rates and should be used to
improve patient safety.
.

58. conclusion

59. REFERENCES
STUDENT’S REFERENCES
1.Black joyce.M.Medical Surgical Nursing.
8th edition .volume 1.Elsevier, a division of Reed
Elsevier India Private Limited:2009.
2.Lewis,Heitkemper.MedicalSurgicalNursing.volume1.
Elsevier,a division of Reed Elsevier India
Private Limited:2009.

60. TEACHER’S REFERENCE
1. Linda Williams .S, Hopper Paula.D.
Understanding Medical 4thedition.Jaypee
brother medical publishers(p)Ltd.New Delhi.
2. Brunner and suddharth.Textbook of medical
surgical nursing.12th edition. Volume 1.
Wolter’s Kluwer. New Delhi.2014.