URINARY TRACT INFECTIONS(UTIs)

By: Mokoma S. 202100517

objectives
• define urinary tract infection
• discuss the pathophysiology
• outline the predisposing factors
• list sign and symptoms
• describe the gerontologic considerations
• outline the nursing interventions and UTI prevention
• describe the theories of aging related to UTIs
• draw up a nursing care plan
Introduction

Urinary tract infections are defined as infections of any part of the urinary system.
The urinary system includes the kidneys, ureters, bladder, and urethra. They are
classified into two classes depending on their location:
1. lower UTIs, consisting of bladder and structures below the bladder
2. upper UTIs, including the kidneys and ereters.
They are also clssified depending on their complexities, for example;
lower UTIs : cystitis, prostatitis and urethritis
Upper UTIs: acute pylonephritis, chronic pylonephritis, renal abscess, interstitial
nephritis and perirenal abscess.
Pathophysiology

UTIs typically arises from the colonization of the urinary tract by bacteria, most
commonly E.coli from the gut flora, Klebsiella, Proteaus and Enterococcus species.
These pathogens enter the urinary tract via periurethral contamination. These
pathogens adhere to urethelial cells leading to colonization and subsequent
infections. The body’s immune system recognise these bacterial components and
trigger inflammation responses which leads to release of cytokines that contributes
to the symptoms of UTIs .
Predisposing factors
 Decreased immune fuction: aging is associated with a decline in immune system effeciency,
making it harder for the body to fight infections
 hormonal changes: in women, menopause leads to decreased estrogen level which can result in
thinning of vaginal and urethral tissues increasing the susceptibility to infections.
 reduced bladder capacity and function: aging leads to decreased bladder capacity and changes
in bladder function which may result in incomplete bladder emptying and urinary retention,
facilitating bacterial growth.
 female gender: women are at higher risk of UTIs due to their shorter urethra, which allows
bacteria to easily access the bladder.
 indwelling urinary catheter: prolonged catheterization significantly increase the risk of UTIs
due to direct bacterial introduction in to the urinary tract.
cont...
 inadequate hydration: elderly individuals may not drink enough fluids due to mobility issues or diminished
sense of thirst leading to concentrated urine that is more conducive to bacterial growth.
 poor hygiene practices: cognitive decline or physical limitation can affect personal hygiene practices ,
increasing the risk of introducing bacteria into the urinary tract.
 incontinence issues: conditions leading to urinary incontinence can increase the exposure to bacteria and
complicate hygiene, further elevating UTI risk.
 antibiotic resistance: frequent use of antibiotics in this population can lead to resistant strains of bacteria,
complicating treatment options for UTIs when they occur
 underlying health conditions , such as diabetes mellitus, neurological disorders (like multiple sclerosis)
and urinary tract abnormalities can predispose an elderly to UTIs by impairing the bladder function or
immune response
clinical manifestation
 cloudy urine
 foul -smelling urine
 blood in the urine
 frequent urination and incontinence
 fever
 burning sensation
 nausea and vomiting
 flank, back or suprapubic pain and tenderness
 changes in cognitive function
Gerontologic consideration
Aging is associted with decline in immune response, making older people more
susceptible to infections. The body’s ability to fight off infection diminishes due to
reduced production of antibodies. In women, menopause leads to decreased estrogen
level which result in vaginal atrophy and changed in urinary tract flora this leads to
increased risk of infections. Benign prostatic hyperplasia(BPH) can lead to urine
rentention and incomplete bladder emptying creating a conducive environment for
bacterial growth. Older people often have chronic conditions like diebetes mellitus
which further compromises their immune system. Elderly patients are usually
asymptomatic or they may present with nonspecific symptoms like confusion or
delirium rather than the classic signs like dysurea and urgency to urinate.
nursing intervetions
 admininster prescribed analgesics to alleviate discomfort associated with dysurea
and bladder spasm
 encourage fluid intake to dilute urine , flush out bacteria and reduce irritation
 encourage regular voiding to prevent urine stasis
 educate an elderly amd care givers on proper perineal hygiene practices to reduce
the risk of infection
 provide education about the importance of completing antibiotic courses as
prescribed and recognising early symptoms of UTIs for prompt treatment.
 administer antibiotics as prescribed, the following antibiotic are used in treatment
of UTIs; Cephalex, ceftriaxone, nitrofurantoin, fosfomycin, sulfamethoxazole
and doxycycline
prevention of further UTIs
 advise an elderly females to always wipe from front to back after bowl
movement
 educate on estrogen creams, for postmenopausal women, estrogen vaginal
creams may decrease the risk of UTIs by balancing the pH of the vigina
 encouge individuals to wear loose fitting clothing and cotten underwear to avoid
moisture around the urethra.
 for people who require indwelling urinary catheters, implement strict aseptic
technique when inserting them. long term catheterization require regular and
thorough perineal care and catheter care to prevent infections
theories of aging
1. wear and tear theory: suggests that aging results from the cummulative
damage to cells and tissues over time. As individuals age, their immune
response weakens, making them more susceptible to infections. Aging also
leads to anatomical changes in the UT, such as reduced bladder capacity and
weakened pelvic floor muscles which can increase the risk of urine retention
and subsequent infections.
cont...
2. environmental theory: emphasizes the role of external factors in aging such as
lifestyle choices, exposure to pathogens and and living conditions. Poor hygiene
can increase the risks of UTIs in older adults who may have mobility issues
affecting their ability to maintain proper personal hygiene.
3. disease theory: focuses on the role of a diease in the aging process. chronic
conditions common in elderly such as diabetes mellitus and BPH are associated
with increased UTI incidences. For instance, BPH leads to urine rention creating a
conducive environment for bacterial growth.
4. disengagement theory: suggests that older people gradually withdraw from social
interactions as they age. reduced social engagement may lead to neglegence of
personal care and hygiene, increasing the risk of UTI. Socially isolated individuals
may also have limited access to support systems that encourage medical check-ups.
 nursing care plan
assessment diagnosis planning intervetions evaluation

Pain(flank pain) Acute pain related to • Goal- To relieve patients pain in • Administer prescribed analgesics The patient is free of
painful urination inflammation of the hours such as aspin to relieve pain and pain after 8 hours
urinary tract structures • Outcome- The patient report the spasm, and antispasmodic agents
as verbalised by the abscence of pain after taking to relieve bladder irritability and
patient analgesics pain
• Advice the patient to apply heat to
the perineum to relieve pain

Frequent urination Risk for fluid-volume • Goal-maintain the patients • Advise the patient to drink more The patient is free of
deficit related to hydration status adequate fluids to replace the water that has dehydration after the
frequent urination • Outcome- The patient will remain been lost through urination interventions
hydrated afterdrinking atleast 8-10 • Administer IV fluids as per
glasses of water after 24 hours & prescription to prevent dehydration
voids after every 2-3 hours
incontinence, impaired comfort related • goal- improve patient comfort. • educate a patient about pelvic floor The patient will
urinary urgency to incontinence and • outcome - the patient will achieve exercises such as kegel exercises report increased
frequent urgency to a normal urinary elimination after to tone pelvic floor muscles thus ability to control
urinate as reported by initiating treatment improving bladder control ability urine urgency and
references
 Nigam L., et al, 2018. Urinary Tract Infection. accessed from : http://www.sematicscholar.org.DOI:
10.5772/intechopen.77171.
 Casuro S. 2023. Urinary tract infections: Nursing Diagnosis, Care Plans, Assessment & Intervetions.Accessed
from: http://www.nursestogether.com
 Vera M. 2024. Urinary Tract Infection Care Plans. Accessed from: http://www,nurseslabs.com
 Eliopoulos C. (2005) Gerontological Nursing 6th ed, Lippincott William & Wilkins, Philadelphia.
 Suzanna C. Smeltzer Brunner_and_Suddarths_Textbook_of_Medical and surgical nursing volume1.