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NCP Nursing Care Plan For Urinary Tract Infections (UTIs).

Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra the two forms of lower urinary tract infection (UTI) are cystitis (infection of the bladder) and urethritis (infection of the urethra). Urinary tract infection (UTI) more common in females than in males. UTI is prevalent in girls. In adult males and in children, lower UTIs typically are associated with anatomic or physiologic abnormalities and therefore need close evaluation. Most UTIs respond eadily to treatment, but .recurrence and resistant bacteria flare-up during therapy are possible Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even Systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic .renal failure

(Causes for Urinary tract infection (UTI Most lower UTIs result from ascending infection by a single gram-negative, enteric bacterium, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia. In a patient with neurogenic bladder, an indwelling urinary catheter, or a fistula between the intestine and bladder, a .lower UTI may result from simultaneous infection with multiple pathogens Studies suggest that infection results from a breakdown in local defense mechanisms in the bladder that allows bacteria to invade the bladder mucosa and multiply. These bacteria can't be readily eliminated by .normal urination The pathogen's resistance to the prescribed antimicrobial therapy usually causes bacterial flare-up during treatment. Even a small number of bacteria in a midstream urine specimen obtained during .treatment casts doubt on the effectiveness of treatment In almost all patients, recurrent lower UTIs result from reinfection by the same organism or by some new pathogen. In the remaining patients, recurrence reflects persistent infection, usually from renal calculi, chronic bacterial prostatitis, or a structural anomaly that is a source of infection. The high incidence of lower UTI among females probably occurs because natural anatomic features that facilitate Urinary tract .(infection (UTI

(Complications for Urinary tract infections (UTIs If untreated, chronic UTI can seriously damage the urinary tract lining. Infection of adjacent organs and .structures (for example, pyelonephritis) may also occur. When this happens, the prognosis is poor

(Nursing Assessment Nursing care plans for Urinary tract infections (UTIs Patients History. The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. The patient may complain of urinary urgency and frequency,

dysuria, bladder cramps or spasms, itching, a feeling of warmth during urination, nocturia. Other complaints include low back pain, malaise, nausea, vomiting, pain or tenderness over the bladder, chills, and flank pain. Inflammation of the bladder wall also causes hematuria and fever. Ask the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually .(transmitted infection (STI Physical Examination. Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, .and character. Surveillance for STIs is recommended as part of the examination

.(Diagnostic tests Urinary tract infections (UTIs :Several tests are used to diagnose lower UTIs Leukocyte esterase dip test .Clean-catch urinalysis Clean-catch collection is preferred to catheterization, which can reinfect the bladder with .urethral bacteria .Sensitivity testing is used to determine the appropriate antimicrobial drug .Stained smear of urethral discharge can be used to rule out sexually transmitted disease Voiding cystourethrography or excretory urography

.(Nursing diagnosis Nursing care plans for Urinary tract infections (UTIs Acute pain (Deficient knowledge (prevention Disturbed sleep pattern Impaired urinary elimination Risk for infection Risk for injury Sexual dysfunction

(Nursing Key outcomes nursing care plans for Urinary tract infections (UTIs :The patients will

.Report increased comfort Identify risk factors that exacerbate the disease process or condition and modify his lifestyle .accordingly .Verbalize feeling well rested after undisturbed periods of sleep .Remain free from signs or symptoms of infection .Avoid or minimize complications .Reestablish sexual activity at the preillness level .Patient and family will demonstrate skill in managing elimination problem

(Nursing interventions Nursing care plans for Urinary tract infections (UTIs Pain Management Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient. Analgesic Administration Use of pharmacologic agents to reduce or eliminate pain. Environmental Management Comfort Manipulation of the patients surroundings forpromotion of optimal comfort Teaching the patient of a teaching program about UTIs, how to prevent recurrent lower UTIs, .and therapy Learning Facilitation: Promoting the ability to process and comprehend information. Learning Readiness Enhancement: Improving the ability and willingness to receive information Sleep Enhancement to Facilitation of regular sleep/wake cycles. Simple Relaxation Therapy Use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, or anxiety. Environmental Management Manipulation of the patients surroundings for therapeutic benefit Urinary Elimination Management Maintenance of an optimum urinary elimination pattern. Urinary Catheterization Insertion of a catheter into the bladder for temporary or permanent drainage of urine. Perineal Care Maintenance of perineal skin integrity and relief of perineal discomfort Infection Protection to Prevention and early detection of infection in a patient at risk. Infection Control Minimizing the acquisition and transmission of infectious agents. Surveillance Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making Risk Identification Analysis of potential risk factors, determination of health risks, and prioritization of risk reduction strategies for an individual or group. Purposeful and ongoing collection and analysis of information about the patient and the environment for use in promoting and maintaining patient safety Sexual Counseling Use of an interactive helping process focusing on the need to make adjustments to sexual practice or to coping with a sexual event/disorder. Teaching/Assisting

individuals to understand physical and psychosocial dimensions of sexual growth and development
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