Urinary Tract Syndrome

Infection involving urethra, bladder, ureters, renal pelvis, renal clyces, and
renal parenchyma, either isolated or compromising the entire urinary tract.
commonly seen in children between age 2 to 6 years
e-coli is the most common bacterial cause of UTIs with other gram-negative
organisms secondary
Assessment (clinical presentation)- vague symptoms
o Fever
o Vomiting
o Abdominal pain
o Flank pain
o Back pain
o Dysuria (painful urination)
o Frequency (urinating at frequent intervals not associated with
increased volume)
o Urgency (an unstoppable urge to urinate)
o Hematuria (blood in the urine)
o Jaundice (yellow discoloration of the skin and sclera due to increased
bilirubin levels)
o Poor oral intake
o Hyperthermia
o Hypothermia
o Failure to thrive (failing to have adequate growth)
Diagnostic tests
o Urinalysis to test for nitrates, leukocyte esterase. Urinalysis may raise
suspicion of a UTI but is not diagnostic. However, the presence of urine
nitrate is a strong indicator of a UTI.
o Prevention of contamination in urine culture- a bag urine specimen is
never an appropriate collection tool for a urine culture.
o urine culture : specific bacterium
o renal ultrasonography: structural anomalies or vascular compromise
o voiding cystourethrogram (VCUG) : vesicoureteral reflux
o DTc- dimercaptosuccinic acid scan (DMSA): renal scarring
Nursing Intervention
o emergency care
stabilize circulatory status by giving IV fluid bolus of normal
saline 20 cc/kg
give broad spectrum IV antibiotics
Ceftriaxone
Cefotaxime
Any infant less than 2 months of age with UTI needs a
septic workup, hospitization, and the administration of IV
antibiotics until cultures and sensitivities have been
completed.
o acute hospital care
Broad-spectrum antibiotic started right after obtaining urine
specimen for culture.

antibiotics are tailored as IV or oral medication as soon as

susceptible culture is known.
amoxicillin
co-trimoxazole
strictly monitor vital signs, especially temperature and BP
o chronic hospital care
UTI are number one hospital acquired infection
good hand hygiene
aseptic technique
avoidance of indwelling Foley catheter
o when inserting urinary catheters, sterile technique
is essential to decrease the introduction of a
secondary or nosocomial infection
o chronic home care
complete antibiotic course
educate family and patient on importance of follow-up
educate family and patient on prophylactic antibiotic
co-trimoxazole
amoxicillin
nitrofurantoin
cephalexin
ampicillin
encourage liquid intake for age and weight
promote regular voiding
avoid perineal irritants
correct constipation high fiber diet, postprandial stooling
attempts
cranberry juice used as preventative therapy for UTI
caregiver education
o emergency care
seek medical attention immediately for fever in infants less than
3 months of age
o acute hospital care
family participation in daily care of hospitalized childe
educate family and patient on medication admin., route, reason,
and side effects
use aseptic technique to prevent hospital-acquired infection
o chronic home
teach family/patient on home medication admin and side effects
teach family/patient on importance of follow up studies
teach family/patient on any home procedures- in and out
catheterization
o complementary and alternative therapies
teach family/patient on reliable sources of info
high fiber diet and ample water intake- for constipation
avoid tight clothing and diaper to prevent local irritation

avoid bubble baths or essential oils in baths to prevent local

irritation
Encourage adults to practice postcoital urination to decrease
chances of UTI.
Reoccurring UTIs can cause permanent renal damage.
any pre- pubescent child with repetitive UTIs w/o a known
etiology should be considered for sexual abuse.
Vesicoureteral reflux

Nephrotic syndrome
Massive proteinuria, hypoalbunemia edema, and hyperlipidemia of unknown
etiology.