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Introduction
A urinary tract infection is an infection that affects part of the urinary tract. An infection of the lower part of the urinary tract is referred to as cystitis, while an infection of the upper part of the urinary tract is referred to as pyelonephritis. Most UTIs are caused by a bacterial infection of the urinary tract, which is made up of the kidneys, ureters, the urinary bladder, and the urethra. Each of these plays a role in removing liquid waste from the body. The kidneys filter the blood and produces urine, the ureters carry the urine from the kidneys to the bladder, the bladder stores the urine until it is eliminated from the body through the urethra. Although bacteria arent normally found in urine, they can easily enter the urinary tract from the skin around the anus (the intestinal bacteria E. coli is the most frequent cause of UTIs). Many other bacteria, and some viruses, can also cause infection. In rare cases, bacteria can reach the bladder or kidneys through the blood. Bacterial UTIs are not contagious. Urinary tract infections (UTIs) are common among children. By the age of five years old, about 8% of girls and 1-2% of boys have had at least one. In older children, UTIs may have obvious symptoms, such as a burning sensation with urination. In infants and young children, however, UTIs may be more difficult to detect because symptoms are not as obvious. In infants, fever is often the only sign. UTIs occur much more frequently in girls, particularly those around the age of toilet teaching, because the female urethra is much shorter than that of the male. The proximity to the anus also contributes to the risk of a UTI. Uncircumcised boys younger than one year of age also have a slightly higher risk of developing UTIs. An abnormality in the structure or function of the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow) can also contribute to the development of a urinary tract infection.
Patients Profile
Name: Gender : Age: Civil Status: Nationality: Religion: Admission Date: Hospital Name: Diagnosis: Attending Physician: M.M Female 6 months Child Filipino Catholic Jan 14, 2012 JONELTA, Pediatrics Ward UTI Probable Dr. M
Patients History
Immunization Record Vaccine BCG DPT OPV Hepatitis B Minimum Age at First Dose Birth or any time after birth Six weeks Six weeks At birth Interval None Four weeks Four weeks Six weeks between 1st and 2nd dose, 8 weeks between 2nd and 3rd dose None Administered Complete (1 Dose) Complete (3 Doses) Complete (3 Doses) Complete (3 Doses)
Measles
Nine months
No
Present Medical History 3 Days PTA, with fever 40C, and rashes on perineal area Self-managed with paracetamol (Tempra) for fever;
Physical Assessment
Normal findings
Actual findings
Interpretation
-fair; no rashes
-smooth;without lesions -smooth;with lesion -elastic;springs back immediately when pinched -withing the range of 36.5-37.5 -symmetrical -audible bowel sounds -Midline at lateral area -elastic;springs back immediately when pinched -warm to touch (39.9C) -abdomen is flat -audible bowel sounds
-abnormal
-normal -normal
Female Genital area Labia majora -equal in size;free of and perianal area lesions -smooth -equal in size;presence macules from the labia majora to the perianal area -abnormal
Labia minora
-normal symmetric;darkpink;moi st symmetric;darkpink;moi st -normal -small and slitlike -small and slitlike -no -no lesions;noswelling;no lesions;noswelling;no bulging in the vaginal bulging in the vaginal opening;no discharge opening;no discharge
Pathophysiology
Schematic Diagram Non-Modifiable Factors Age UTI has the highest frequency in infancy Gender UTI has a higher incidence rate among females Modifiable Factors Inadequate frequency of diaper change Poor hygienic practices
Bacterial Invasion
Immune response by the body (defense mechanism of the body against foreign bodies)
Increased WBC
Body induces the action of the cytokines and prostaglandins, which are aimed at elevating body temperature
Fever
Medical Management
Diagnostic Test Nursing Responsibility
Inform the patient this test can assist in evaluating the amount of hemoglobin in the blood to assist in diagnosis and monitor therapy. Obtain a history of the patient's cardiovascular, gastrointestinal, hematopoietic, hepatobiliary, immune, and respiratory systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures. Obtain a list of the patient's current medications, including herbs, nutritional supplements, and nutraceuticals Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture. Promptly transport the specimen to the laboratory for processing and analysis. Collect specimens form infants and young children into a disposable collection apparatus consisting of a plastic bag with an adhesive backing around the opening that can be fastened to the perineal area or around the penis to permit voiding directly to the bag. Depending on hospital policy, the collected urine can be transferred to an appropriate specimen container. Cover all specimens tightly, label properly and send immediately to the laboratory. If the specimen cannot be delivered to the laboratory or tested within an hour, it should be refrigerated or have an appropriate preservative added.
CBC
Urinalysis
Fecalysis
If he is taking any medications, these must be screened as some can affect test results. A patient is usually discouraged as well from taking aspirin, alcohol, vitamin C, ibuprofen and certain types of food if his fecal sample will be checked for any sign of blood. Recent travel and X-Ray tests can also affect the results of fecalysis If the patient is suffering from diarrhea, placing a plastic wrap and securing it under the toilet seat could facilitate the collection process Collected samples must be brought to the doctor's office or laboratory as soon as possible. Delays could compromise the quality of the sample. Volume or amount is also important so the patient must be sure he has collected an adequate amount of stool
Medications
Medications Cefuroxime (Ceftin) Paracetamol Rationale To treat bacterial infection of the urinary tract To treat hyperthermia
IV Fluids
IV Fluid D5 IMB 500cc, 30 cc/hr Rationale To prevent dehydration or electrolyte imbalance
Diet
Diet NPO temporarily x4h then start milk feeding with strict aspiration prevention Rationale The patient had an episode of vomiting (only once)
Laboratory Results
Hemoglobin
105
110 140
gm/L
Decreased
Hematocrit
0.30
0.37 0.47
Decreased
RBC Count
3.85
4 5.5
x 10^12/L
Decreased
WBC Count
22.9
5.0 10.0
x 10^9/L
Increased
Segmenters
0.72
0.50 0.70
Increased
Lymphocytes
0.16
0.20 0.40
Decreased
Monocytes
0.12
0 0.05
Increased
MCV
76.5
80 98
fl
Decreased
MCH
27.4
26 32
pg
Normal
MCHC
358
320 360
g/L
Normal
Platelet Count
233
150-400
x 10/L
Normal
Urinalysis, 1/15/2012
Test Name Color Transparency Reaction (pH) Protein Glucose Specific Gravity Pus Cells RBC Epithelial Cells Mucus Threads Actual Findings Light Yellow Slightly Hazy Acidic, 6.0 Negative Negative 1.005 10-15/HPF 1-2/HPF Occasional Few Normal Findings Light yellow to amber Clear to slightly hazy 4.5 8.0 Negative Negative 1.003-1.030 0-5/HPF 2-3/HPF Occasional Few Interpretation Normal Normal Normal Normal Normal Normal in infants Indicates presence of bacteria Normal Normal Normal
Fecalysis, 1/15/2012
Test Name Color Consistency Blood (gross) Occult Blood Bacteria Mucus Bile OVA/Parasite Pus Cells RBC Actual Findings Yellow Green Soft N/A N/A N/A N/A N/A None Found N/A N/A Normal Findings Brown Soft and bulky, depending on the diet 0-3 HPF None Abundant None None None 0-3 HPF 0-3 HPF Interpretation Result of bottle feeding Normal Normal N/A N/A N/A N/A Normal N/A N/A