URINARY TRACT INFECTIONS

MS. HARPREET KAUR LECTURER

DEFINITION
UTI is the infection of US which can involve lower

UT like bladder, ureter, urethra, and upper UT like upper part of ureter and kidneys

INCIDENCE
In infancy, urinary tract infections occur equally in

boys and girls. After the first year; urinary tract infections are more common in girls than in boys and result frequently from organisms ascending the urethra. In younger children, the classic symptoms of urinary tract infections are not elicited.

CAUSES
Causative agents are:

E- coli
Streptococcus Staphylococcus

Pseudomonas
Route of entry Ascending infections from the urethra or

may be hamotogenous spread

CONTRIBUTING FACTORS
Urinary stasis

Congenital anomlies of UT
Vesico-ureteric reflux (VUR) Poor personal hygiene

Short female urethra

Urinary catheterization Local inflammation

Chronic constipation
Infection anywhere in body

CLINICAL MANIFESTATIONS
Infants and toddlers often present nonspecific

symptoms of unexplained fever, abdominal pain, diarrhea, or irritability. Urinary tract infection should be considered in young children who have unexplained, persistent fever.

CLINICAL MANIFESTATIONS
Urgency frequency of urination Dribbling Enuresis Foul-smelling urine Foul smell urine Bed wetting Anorexia

Fever
Irritability Abdominal pain loss of appetite Vomiting Hematuria.

PATHOPHYSIOLOGY
Many urinary tract infections are bladder infections

caused by Escherichia coli. Recurrent bladder infections produce inflammatory changes that alter the normal anatomic structures of the urethra and eventually lead to incompetence of the vesicoureteral valve. As a result, reflux of urine occurs up the ureter, allowing organisms to enter the upper urinary tract. As this reflux continues, infection of the kidney results. In addition, the short urethra of the female child provides a ready pathway for invasion of the urinary tract by organisms.

DIAGNOSTIC EVALUATION
History and physical examination

Blood examination shows: increase TLC & ESR

If urinalysis reveals bacteria and/or white blood

cells, a urine culture is indicated. Urological studies Renal scan

NURSING MANAGEMENT
Many children with urinary tract infections are treated at

home. Prior to treatment with any drugs, the nurse should collect a urine specimen for culture. Following proper cleansing of the genitalia, a clean voided specimen is obtained. To obtain quantitative bacteria, this specimen must be plated within 30 minutes. Infected urine usually contains over 100,000 colonies/ml, whereas a contaminated urine specimen contains less than 10,000 colonies/ml. One organism is normally found with infection, and two or more organisms are found with contamination.

NURSING MANAGEMENT
Antibiotics like a short-acting sulfonamide or

amoxicillin is prescribed for 10 to 14 days Most children respond to drug therapy within several days. A follow-up urine culture should be done one to two weeks after completion of therapy. If the child does not respond to oral medication, hospitalization and parenteral antibiotic therapy are indicated. Associated congenital anomlies should be detected early for prompt management

NURSING MANAGEMENT
Children who have urinary tract infections should

drink increased amounts of fluids. Children should also complete the full course of drug therapy as prescribed. To reduce fever tepid sponging, antipyretics, rest Improvement of personal hygiene Frequent emptying of bladder should be encouraged to prevent stasis of urine

PREVENTION
Parents should be informed of the factors that

predispose children to urinary tract infections and methods they can use to prevent their occurrence. Female children should be taught to wipe front to back when performing perineal hygiene and to use clean tissue for each wipe. Tub baths, especially with bubble bath should be avoided and showers encouraged. Cotton panties provide for air exchange.

PREVENTION
Children should be encouraged to void frequently

and to avoid holding their urine. They should also be told not to hurry and to empty their bladder completely. Dietary considerations include increased fluid intake, especially those fluids that acidify the urine, e.g., apple or cranberry juice, and fluids that contain animal proteins.

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