I.

Definition

• Inflammation and infection of urinary tract structures are classified as upper urinary tract infections
(UTIs) or lower UTIs.

TYPES:

Upper UTIs are known as pyelonephritis (e.g. inflammation of the kidney)

Lower UTIs include:

• Cystitis (e.g. inflammation of the bladder wall), the most common type

• Ureteritis (e.g. inflammation of the ureter)

• Urethritis (e.g. inflammation of the urethra)

II. Risk Factors

• Women because of their shorter urethra (25% of all women experience UTIs

• Aging, men peaks after age 50

• Pathogenic microorganisms (e.g. Escherichia coli, Proteus, Klebsiella, Enterobacter).

• Sexual intercourse

• Indwelling catheterization

• Urinary stasis

• Urinary tract instrumentation

• Residual urine

• Urinary reflux

• Bladder overdistention
• Loss of intact mucosal lining

• Metabolic disorders

III. Pathophysiology

• An Upper UTI is a bacterial infection of the renal pelvis, tubules, and intesrstitial tissue on one or both
kidneys that occurs because of reflux of urine into the ureters.

• A Lower UTI is an infection that typically ascends from the urethra to the bladder and possibly to the
ureter.

IV. Assessment/Clinical Manifestations/Signs and Symptoms

Upper UTI

• Flank pain

• Costovertebral angle tenderness

• Fever and chills

• Dysuria

• Frequency and urgency

• Malaise

• Possibly bloody or cloudy urine

Lower UTI

• Frequency and urgency

• Burning on urination

• Nocturia

• Inflamed, edematous meatus in urethritis

Laboratory and diagnostic study findings

Upper UTI.

• Urinalysis findings reveal elevated white blood cell count, white cell casts, and bacteria.

Lower UTI

• Urinalysis reveals bacteriuria and red blood cells in urine.

• Urine culture identifies the causative microorganism.

V. Medical Management

• Drug therapy and patient education are the key treatment measures. UTIs may require 7 to 10 days of
medication.

• Ideal treatment is an antibacterial agent that eradicates bacteria from urinary tract with minimal
effects on fecal and vaginal flora.

• Medications may include sulfisoxazole (Gantrisin); cotrimoxazole (trimethoprim-sulfamethoxaxole)

[Bactrim] is the drug of choice. Levofloxacin (Levaquin) may be used for short course therapy.

• Occasionally, ampicillin or amoxicillin (but E. coli has developed resistance to these agents)

• If diagnostic evaluation reveals no structural abnormalities, patient may be instructed to begin

treatment on own, testing urine with a dipstick whenever symptoms occur, and to contact health
provider only with persistence of symptoms at the occurrence of fever, of if the number of treatment
episodes exceeds four in a 6-month period.

VI. Nursing Diagnosis

• Pain related to inflammation an infection of the urethra, bladder and other urinary tract structures.

• Infection related to frequency or burning on urination, fever, elevated white blood cell count, foul-
smelling urine, and suprapubic tenderness.
• Impaired urinary elimination related to excessive urgency and pain with bladder filling.

• Impaired comfort related to pain with bladder filling.

• Risk for imbalanced body temperature

• Pain related to ureteral colic.

• Fear in response to the diagnosis of pyeloneprhtitis

• Deficient knowledge related to completion of drug therapy, optimal fluid intake, or need to empty
bladder every four hours to reduce bacterial count.

• Ineffective coping related to anxiety, malaise, and lowered activity level.

VII. Nursing Management

• Provide pain relief. Apply heat to the perineum.

• Promote measures to prevent infection.

• Promote measures to maintain fluid and electrolyte balance.

• Provide client and family teaching. Provide health education on measure to prevent UTIs.

• Administer prescribed medication.