Urinary Tract Infection

INTRODUCTION

A urinary tract infection (UTI) is a bacterial infectiont that affects any part of the urinary tract. Although
urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When
bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type
of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection,
known as pyelonphritis, and is much more serious. The major problem here is that urinary tract infection
causes discomfort and pain on urination.

Incidence:
Most common renal disease in children.
Almost 10 times more common in females than in males, except in the neonatal period.
Bladder is the most common site of infection
25% of all women (cystitis)
Men before the age of 50 years

Risk Factors:
Location of the female meatus
Sexual intercourse
Urinary stasis and reflux in pregnant women caused by pressure on the ureters and hormonal
changes.
Tight and synthetic clothing (causes irritation)
Presence of an indwelling catheter.

A. General objectives

At the end my duty in the World Citi Medical Center, I, Aristotle R. Baricaua 3 rd yr.
Bachelor of Science in Nursing student of WCC-QC, will be able to impart my acquired
knowledge and skills towards the patient, through promoting and maintaining, physiologic and
psychologic stability, and health restoration.
 B. Specific objectives

 Establish a trusting relationship to client and his family.

 Perform the assigned task efficiently and dynamically
 Formulate an effective nursing care plan for the client regarding UTI.
 Acquire necessary skills in assessing the signs and symptoms of patient with UTI.
 Internalize the necessary concept or principle regarding UTI.
 Educate the family in the prevention, promotion, and maintenance of healthy lifestyle
as well as to cure and restore health.

C. Theoretical framework

Henderson’s definition of Nursing

In 1966 Virginia Henderson’s definition of the unique functioning of nursing was a major
stepping stone in the emergence of nursing as a discipline separate from medicine. Like
Nightingale, Henderson described nursing in relation to the client, and client’s environment.
Unlike Nightingale, Henderson saw that nurses interact with clients even when recovery may
not be feasible, and mentioned the teaching and advocacy role of nurse.

Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain
independence in meeting 14 fundamental needs.

1. Breathing normally.
2. Eating and drinking adequately.
3. Eliminating body wastes.
4. Moving and maintaining a desirable position.
5. Sleeping and resting.
6. Selecting suitable clothes.
7. Maintaining body temperature within normal range by adjusting clothing and modifying
the environment.
8. Keeping the body clean and well groomed to protect the integument
9. Avoiding dangers in the environment and avoiding injuring others
10. Communicating with others in expressing emotions, needs, fears, or opinions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment
13. Playing or participating in various forms of recreation
14. Learning, discovering, or satisfying the curiosity that leads to normal development and
health, and using available health facilities.

I chose Henderson’s theory because it suites my patient.

The above 14 fundamentals are necessary for a clients recovery as well as healthy
persons.
Breathing normally is essential for a person because it is the most vital needed for our
body. Proper diet is crucial to prevent malnutrition and the occurrence of the disease. Drinking
sufficiently is needed for a sick individual for fluid replacement. Proper elimination is
important to prevent toxicities in our body. Patient needs to reposition on their desirable
position, to promote comfort and to prevent pneumonia. Individuals are required to have
adequate rest in order for their body to regain strength. Proper clothing can promote clients
comfort.
Sick person needs to have a cool and proper ventilated environment because this could
help in their recovery. During patient hospital confinement, nurses are required to observe
safety for the patient by doing safety precautions. Health care provider may also implement
nurse- patient interaction, this will encourage patient to express her or his emotions, fears, or
opinions.
This theory conceptualized both the sick and healthy persons. It is a dynamic care
especially during the stage of illness.

II. NURSING ASSESSMENT

A.Personal Data

Patient’s Name: F.C

Age: 2 yrs. old
Birth date: November 04, 2004
Address: 233 concepcion st. santoln, pasig city
Sex: Female
Religion: Catholic
Civil Status: Child
Father:
Mother:
Date of Admission: April 13, 2007
Time of Admission: 7:11:05 pm
Admitting Diagnosis: Urinary Tract Infection
Notice of Admission: Emergency and Stable
How Admitted: Ambulatory
Admitting Physician: Cruz, Oliver V.
History of Present Illness:

Day 3 fever-intermittent maximum temperature at 40.4 C not relieved by paracetamol

intake at 10 ml dose. Dry non-productive cough and colds also noted. Self-indicated with
lovicol 50ml TID with night relief.

Past Medical History:

Patient was hospitalized at the age of 1 year old, due to Urinary Tract Infection last
2006.

Chief Complaint: Fever

Diagnosis: Urinary Tract Infection.

C. 13 Areas of Assessment

A. General Appearance:

Skin
Patient has a white complexion with a clear skin.

Head
The head is round and there’s no lesion observed. The patient has smooth, short curly
black hair. It appeared well combed although oily.

Eyes
The patient has rounded eyes with white sclera and pinkish conjunctiva. The pupils were
black and equally rounded.

Nose
The nose is flat and small, there’s no inflammation, flaring or lesion but the internal
mucosa was wet due to her colds.

Ears
The ears are clear and symmetrical to the inner cantus of the eye.
 Mouth
Patient’s lips are dry and pinkish in color, there’s neither lesions nor ulcerations found.
The gums and tongue looked pink in color.

Neck
The neck is symmetrical in shape, no palpable mass along the lymph nodes.

Abdomen
The abdomen is flat and soft upon palpation, and she has a normal abdominal bowel
sound.

Extremities
The patient’s hands and wrists are intact and has a complete set of fingers, She had no
problems extending and flexing his forearm thus she can easily perform range of motion
exercises.

1.) SOCIAL STATUS

Patient’s Name:. F. C
Age: 2 years old
Birth date: No. 6, 2004
Sex: Female
Religion: Catholic
Civil Status: Child
Father:
Mother:
Address: 233 concepcion st. santolan, pasig city

Speech:
 Clear
 Indicates wants (e.g. food)
 Babbles vowels

Source of information: Grand Mother

Reliability: 3 (reliable)

2.) MENTAL STATUS

 Alert
 Conscious
 Can speak “dada” or “mama”, and other nonspecific words.
 Turns toward sounds

3.) EMOTIONAL STATUS

 Calm
 Smiles spontaneously
 Irritable (upon administration of medications)
 Waves bye-bye.
 Initial anxiety towards strangers
4.) SENSORY AND PERCEPTION

Vision:
 Eyes are symmetrical

Smell:

 Absence of nasal drip

 No frequent nose bleeding

Hearing:
 Does not use any hearing aids.
 No discharges from ears, no nodules, lesions, and no pain.
 Ears are symmetrical and were proportionate to his head.

Touch:
 Can distinguish hot from cold (e.g. Warm milk).

Speech:
 Speaks unclearly (baby talks)
 High pitched voice
 Babbles vowels

5.) MOTOR ABILITY

 Muscle mass/ tone: Thin built.

 Creeps on hands and knees
 Sits alone
 Pulls self to standing position
 Takes a rattle by his hands and bangs them
 Able to pass rattle hand by hand ;( makes crude pincer grasps).
 Tries to get a toy out of reach

 ROM: Not Full

 Muscles are flexible, soft, and tender.

 Sat alone at age: 9 months
 Rolled over: 4 months
 Walked: 9 months with support
 Toilet trained: Not practiced yet
 Dressing: Not practiced yet
 Performance: Fair

Decreased performance and reports of weakness (verbalized by the father).

6.) BODY TEMPERATURE

 Body temperature: 37.8C taken via the left axilla as of April 13, 2007.

7.) RESPIRATORY STATUS

 Respiratory rate is 32 cpm;

 Rhythm is regular.
 No wheezes
 No rales.

8.) CIRCULATORY STATUS

 Heart rate: 118 bpm as of April 09, 2007

 Rhythm is regular.
 Pulse: 118 bpm
 Full pulses
 No edema noted.
 Febrile.

Extremities:
 Color: Pink lower extremities
 Capillary refill time: 2 seconds.
 Nails: Pink

Distribution/ Quality of Hair: Fine, thin hair.

Color:
 Overall: Fair complexion
Flushed skin

 Mucous membranes: Pink

 Nail beds: Pink
 Conjunctiva: Pink
 Sclera: White

9.) NUTRITIONAL STATUS

 Breast feed and formula feeding diet: (Enfapro and Aulin)

 No trouble in swallowing
 Able to chew and masticate food.
 Good appetite: he can consume 6 bottles of milk per day, and breastfed during day
and night time.
 He uses distilled drinking water.

 Weight: 20.2 kg.

 Color of tongue is whitish pink

 Lips are pink and not dry

 Condition of teeth and gums: Good, intact, and no bleeding.

 No food allergy.
  Eruption – upper lateral incisors

Immunization:
 BCG
 DPT I, II, III
 OPV I, II, III
 Hepa B I, II, III
 Hib I, II, III

10.) ELIMINATION STATUS

 Bowel function in regular pattern

 Usual bowel pattern: Morning
 Character: Soft formed stool.
 Bladder function in irregular pattern.
 Urgency
 Color of urine: Pale yellow.
 Diaper changes: 3-4 per day.
 Dysuria

Pain in urination [“Often times he cries during pee time” as verbalized by the father.]

11.) REPRODUCTIVE STATUS

 Male
 Uncircumcised

12.) STATE OF PHYSICAL REST AND COMFORT

 Usual Activities: playing (e.g. rattle, cubes)

 Sleep: 16-18 hours

13.) STATE OF SKIN AND APPENDEGES

Skin:
 Fair complexion
 Flushed skin, warm to touch.
 Warm upper and lower extremities.
 Preferred time of bath: Morning
 Good skin turgor.

Hair:
 Wavy and clean cut
 Dark brown in color
 Fine and thin

Scalp:
 Intact
 No flaking noted
 No scalp lesions
  Anterior fontanel remains open and posterior fontanel is closed.

Nails:
 Fingernails are short cut and pink in color
 Toenails are cut short and well trimmed

IV. ANATOMY AND PHYSIOLOGY

How does the urinary system work?

The body takes nutrients from food and converts them to energy. After the body has taken the food that it
needs, waste products are left behind in the bowel and in the blood.

The urinary system keeps the chemicals and water in balance by removing a type of waste, called urea,
from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain
vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.

Urinary system parts and their functions:

 two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the
back. Their function is to:
  remove liquid waste from the blood in the form of urine.

 keep a stable balance of salts and other substances in the blood.

 produce erythropoietin, a hormone that aids the formation of red blood cells.

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron
consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a
renal tubule. Urea, together with water and other waste substances, forms the urine as it passes
through the nephrons and down the renal tubules of the kidney.

 two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter
walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs
up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small
amounts of urine are emptied into the bladder from the ureters.
 bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by
ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand
to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult
bladder can store up to two cups of urine for two to five hours.
 two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly
like a rubber band around the opening of the bladder.
 nerves in the bladder -alert a person when it is time to urinate, or empty the bladder.
 urethra - the tube that allows urine to pass outside the body. The brain signals the bladder
muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the
sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur
in the correct order, normal urination occurs.

V. PATHOPHYSIOLOGY

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. Most UTIs result from fecal organisms that ascend from the perineum to the urethra and the
bladder and then adhere to the mucosal surfaces.

Bacterial Invasion of the Urinary Tract

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), a hydrophilic
protein, normally exerts a nonadherent protective effect against various bacteria. The GAG molecule
attracts water molecules, forming water barrier that serves as defensive layer between the bladder and the
urine. GAG may be impaired by certain agents (cyclamate, saccharin, aspartame, and trytophan
metabolites). The normal bacterial flora of the vagina and urethral area also interfere with adherence of
Escherichia coli (the most common microorganisms causing UTI). Urinary immunoglobulin A (IgA) in the
urethra may also provide a barrier to bacteria.

Reflux
An obstruction to free-flowing urine is a problem known as urethrovesical reflux, which is the reflux
(backward flow) of urine from the urethra into the bladder. With coughing, sneezing, or straining, the
bladder pressure rises, which may force urine from the bladder into the urethra. When the pressure returns
to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior
portions of the urethra. urethrovesical reflux is also caused by dysfunction of the bladder neck or urethra.
The urethrovesical angle and urethral closure pressure may be altered with menopause, increasing the
incidence of infection in postmenopausal women. Reflux is most often noted, however, in young children.
Treatment is based on its severity.
Ureterovesical or vesicoureteral reflux refers to the backflow of urine from the bladder into one or
both ureters. Normally, the ureteroveical junction prevents urine from traveling back into the urether. The
ureters tunnel into the bladder wall so that the bladder musculature compresses a small portion of the ureter
during normal voiding. When the ureterovesical valve is impaired by congenital causes or ureteral
abnormalities, the bacteria may reach and eventually destroy the kidney

Loss of integrity of the mucosal lining (caused by in indwelling catheter, tumor, parasites, or
calculus)

Decreased resistance to invading organisms

Inflammatory changes occur in the affected portion of the Urinary tract.

Clumps of bacteria may be present.

Inflammatory changes in the renal pelvis and throughout the kidney.


Scarring of the kidney parenchyma (occurs in chronic infection), which interferes kidney
function.

Etiology:
Causative organism:
- Escherichia Coli – 90% of UTI in women.
- Enterocobacter
- Pseudomonas
- Serratia
- Staphylococcus saprophyticus
- Candida

Route of entry:
- Ascent from the urethra (most common)
- Circulating blood.

Contributing causes:
 obstruction usually congenital
 vesicoureteral reflux
 infections elsewhere in the body
1.) upper respiratory
2.) gastrointestinal diarrhea
 poor perineal hygiene
 short female urethra
 catheterization
 Inherent defect in the ability of the bladder mucosa to protect it from
microbial infection.
VI. LABORATORY / DIAGNOSTIC EXAMS

PLATELET COUNT
April 14, 2007
RESULT NORMAL VALUES CLINICAL SIGNIFICANCE
Above 150-350 x 9/L
500

COMPLETE BLOOD COUNT

April 14, 2007

EXAMINATION MADE RESULT NORMAL VALUES CLINICAL SIGNIFICANCE

Hemoglobin 116 125.00-160.00 9/L 
RBC Count 4.0 4.50-5.50 12/L 
Hematocrit 0.35 0.38-0.50 
WBC Count 24.0 5.00-10.00 x 9/L 
Neutrophil 0.73 0.40-0.60 Normal
Lymphocyte 0.20 0.02-0.08 
Monocyte 0.01 0.00-0.04 
Eosinophil 0.01 0.00-0.01 Normal

ROUTINE URINALYSIS

April 14, 2007

EXAMINATION MADE RESULT NORMAL VALUES CLINICAL SIGNIFICANCE

Color yellow Amber yellow Normal
Character turbid Clear Infection
Reaction/pH 6.0-Acidic 4.8-8.0 Normal
Specific gravity 1.020 1.015-1.025 Normal
Protein +++ (-) Infection
Sugar (-) (-) Normal
Red blood cells 0-3 hpf (-) Infection
Pus cells Many(>100/h (-) Infection
pf)
Epithelial cells Few (-) Infection
 Amorphous phosphates Few (-) Infection
Bacteria Many Infection

VII. DRUG STUDY

Parenteral Medication:

Cefuroxime (kefox) 200 mg IV q8 ANST (-)

Drug Classification: Cephalosporin

Content: Cefuroxime Sodium

INDICATION DOSAGE CONTRAINDICATION SPECIAL ADVERSE DRUG

PRECAUTION REACTION INTERACTION
Respiratory Children Hypersensitivity to Pronounced Glossitis, Cross allergy of
tract, ENT, and cephalosporin. Acute renal N/V, penicillin
urinary tract, infant: porphyria. insufficiency. diarrhea,
skin and soft 300-100 Patients gastric
tissue, O and mg/kg/ay receiving pyrosis,
G, bone and in 3 to 4 concurrent abdominal
joint divided treatment with pain, very
infections, doses. diuretics e.g. seldom,
surgical furosemide and urticaria or
prophylaxis. aminoglycosides cutaneous
. Anaphylactic rash,
reactions to pruritus and
penicillin. arthralgia.

VIII. NURSING CARE PLAN

1.) Nsg. Dx: Urinary Elimination, altered related to Urinary Tract Infection.

DATA/CUES NURSING PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTIO
N
Subjective: Urinary After 4 hours INDEPENDENT After 4 hours
“Umiiyak siya Elimination of nursing NURSING of nursing
kapag umiihi” , altered intervention FUNCTION: intervention,
as verbalized related to , the patient goal is met.
by the Grand Urinary will achieve * Assess Patient
mother. Tract normal causative or achieved
Infection. elimination contributing normal
Objective: pattern. factors. elimination
Urgency pattern.
* Inspect * To detect urinary
stoma for diversion.
edema,
scaring,
presence of
congealed
mucus.
* Review drug * Some drugs may
regimen (note result in urinary
use of drug retention.
which are
nephrotoxic)

* Note age/sex * UTI are more

of patient. prevalent in women
and older men.

* Review lab * To detect

tests. hyperparathyroidism,
changes in Renal
function.

* Determine * To assess degree of

patient’s interference.
previous
pattern of
elimination.

* Palpate * To assess
bladder. retention.

* Determine * To assess condition

patient’s usual of skin and mucous
daily intake. membranes.

* Encourage * To help maintain

fluid intake renal function,
including prevent infection
cranberry and formation of
juice. urinary stones.

* Assist in * To help achieve

developing regular urination
toileting pattern.
routines as
appropriate.

* Monitor * To identify
medication patient’s response in
regimen and treatment.
antimicrobials.

* Maintain * To discourage
acidic bacterial growth
environment when appropriate.
of the bladder
by use of
agents such as
vitamin C.

* Keep diaper * To prevent rash

area clean and formation, and to
 dry. emphasize the
importance of
reducing risk of
infection or skin
breakdown.

* Encourage * To recognize
significant complication,
others to necessitating
participate in medical
routine of intervention.
care.

* Recommend * To promote odor

avoidance of control.
gas forming
foods or
medications
that produce
strong odor.

2.) Nsg. Dx: Hyperthermia related to increased metabolic rate, due to illness
or trauma.

DATA/CUES NURSING PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTION
Subjective: Hyperthermi After 8 INDEPENDENT After 8 hours
a related to hours of NURSING of nursing
Objective: increased Nursing FUNCTION: intervention,
* Temperature: metabolic Interventio goal is met.
38.3 C rate, due to n, patient * Identify The patient
illness or will underlying cause. maintained
* flushed skin, trauma. maintain his core
warm to touch. core * Note age of * Very young temperature
temperatur patient. children are at within
e within particular risk for normal range
normal permanent of 36.4C.
range. neurologic
damage.

* Monitor core * To evaluate

temperature ranges of
(rectal and temperature.
tympanic
temperature
most closely
approximate core
temperature.
* Assess * To note level of
neurologic consciousness.
response.

* Monitor Heart * Cardiac rate and

Rate and Rhythm. ECG changes occur
due to electrolyte
imbalance.

* Monitor * Hyperventilation
respiration may initially be
present.

* Monitor/record * Oliguria or Renal

all sources of failure may occur
fluid loss such as due to
urine, or other hypotension.
insensible losses.

* Note presence * Body attempts to

or absence of increase heat loss.
sweating.

* Provide cool * To promote

environment, surface cooling.
sponge baths.

* Maintain bed * To reduce

rest. metabolic
demands or
oxygen
consumption.

DEPENDENT
NURSING
FUNCTION:

* Administer * For Fever.

Antipyretics:
Paracetamol
(Calpol) 1.2 mL,
TID. As ordered

* Administer * For Infection.

Antibiotics:
Cefuroxime
(kefox) 200 mg IV
q8 ANST (-). As
ordered.

* Administer * To support
replacement circulating volume
Fluids and and tissue
electrolytes: perfusion.
 D5 0.3 Na Cl
500cc x 27
ugtts/min. As
ordered.

IX. EVALUATION

Prognosis
3.) Generally good in uncomplicated cases.
4.) There is a tendency for recurrent infection.
5.) Children with obstructive lesions of the urinary tract and those with severe
vesicoureteral reflux are at the highest risk for kidney disease.

Health Education
1.) Long term therapy is often prescribed to prevent recurrence of urinary
tract infections. Schedules or prolonged therapy vary for several months to
continuous prophylaxis.
2.) The child should be kept under continued medical surveillance because of
possibility of disease recurrence.
a. Emphasis should be placed on the fact that even though this
disease may have few symptoms, it can lead to very serious,
permanent disability.
b. Periodic urine cultures are indicated for two years following the
acute infection.

Prevention

1.) Spread of bacteria from the anal and vaginal areas to the urethra can be minimized
in female children by cleansing the perineal area from the urethra back toward the
anus.
2.) Bubble baths should not be used because of the bladder irritant effect of these
solutions.
3.) Encourage adequate fluid intake, especially water.
4.) Acidify the urine with juices (e.g. cranberry juice).
5.) Encourage the child to void frequently and to empty the bladder completely with
each voiding.
6.) Wearing cotton underpants
7.) Taking showers versus baths.
8.) Avoiding wearing pantyhose with slacks.
9.) Washing the perineal area before intercourse and voiding immediately after.