URINARY TRACT

INFECTION
 DEFINITION
A urinary tract infection (UTI) is an infection in any part of
your urinary system — your kidneys, ureters, bladder and
urethra. Most infections involve the lower urinary tract —
the bladder and the urethra.
Women are at greater risk of developing a UTI than are
men. Infection limited to your bladder can be painful and
annoying. However, serious consequences can occur if a
UTI spreads to your kidneys.
SIGNS AND SYMPTOMS
Symptoms
Urinary tract infections don't always cause signs and symptoms, but when they do
they may include:
• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the
area of the pubic bone
Types of urinary tract infection
Each type of UTI may result in more-specific signs and symptoms, depending on which part of
your urinary tract is infected

Part of urinary tract affected Signs and symptoms

Kidneys (acute pyelonephritis) •Upper back and side (flank) pain

•High fever
•Shaking and chills
•Nausea
•Vomiting

Bladder (cystitis) •Pelvic pressure

•Lower abdomen discomfort
•Frequent, painful urination
•Blood in urine

Urethra (urethritis) •Burning with urination

•Discharge
Risk factors for UTI’s in children
Male gender, especially uncircumcised infants
Poor toilet habits
Poor toilet hygiene: Females should always wipe front to
back to avoid introduction of stool bacteria to the
urethral opening.
Individuals with a compromised immune system or
compromised bladder function (for example, spinal
cord injury victims who require self-catheterization)
DIAGNOSIS

Urinalysis. Urine is tested with a special strips to look

for signs of infection such as blood and white blood
cells. In addition, a microscope may be used to
examine the sample for bacteria or pus.
Urine culture. This laboratory test usually takes 24 to
48 hours. The sample is analyzed to identify the type
of bacteria causing the UTI, how much of it exists,
and appropriate antibiotic treatment.
 Collecting a clean urine sample can be a
challenge for children who aren’t toilet trained. A
usable sample can’t be obtained from a wet diaper.
Your child’s doctor may use one of the following
techniques to get your child’s urine sample:
Urine collection bag. A plastic bag is taped over your
child’s genitals to collect the urine.
Catheterized urine collection. A catheter is inserted
into the tip of a boy’s penis or into a girl’s urethra and
into the bladder to collect urine. This is the most
accurate method.
Complications
Prompt diagnosis and treatment of a UTI in your child
can prevent serious, long-term medical complications.
Untreated, a UTI can result in a kidney infection that
may lead to more serious conditions, such as:
kidney abscess
Reduce kidney function or kidney failure
hydronephrosis, or swelling of the kidneys
sepsis, which can lead to organ failure and death
PATIENTS DEMOGRAPHIC DATA
NAME: X
AGE: 2 y/o
SEX: MALE
ADDRESS: GHAZALA
RELIGION: ISLAM
OCCUPATION: N/A
WEIGHT: 13.1 KG
DATE OF ADMISSION: 07/08/2019 @ 1710H
PHYSICIAN: Dr. Wadah
CC: Bad smell urine, burning sensation upon urination
DIAGNOSIS: URINARY TRACT INFECTION
Discharge date:10-08-19
 PATIENT’S MEDICAL HISTORY
on 7-8-19Patient went to ERwith chief
complaint bad smell from urine for 1 week. Seen
and examined by Dr. Farhana and ordered for
Urinalysis at 1315H and seen the result. She
informed Dr. Wadah and advised for admission.
Mother refused and signed refusal form.
At 1620H patient came back in ER and
advised by dr wadah for admission.father agree
for admission CBC, Chemistry done at ER. D5 ¼
NS 50ml was given.
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
UPON ADMISSION IN UPON ADMISSION IN
ER FEMALE WARD
AUGUST 7, 2019 JUNE 11, 2019

TEMPERATURE 36.7 C 36.5

PULSE 106bpm 112 bpm

RESPIRATION 20bpm 22bpm

BLOOD PRESSURE - 81/54mmHg

O2 SATURATION 97% 100%

 PHYSICAL APPEARANCE

 General Appearance
Received patient from ER, ambulatory, weak on appearance with no
apparent distress.
 HEAD: Rounded and symmetrical. The hair is thick, silky hair is evenly
distributed and no signs of infection and infestation observed.
EYES: The sclera appeared white. The pupils of the eyes are black and
equal in size. Symmetrically aligned .
EARS: The auricles are symmetrical and has the same color with his
facial skin. The auricles are aligned with the outer canthus of eye.
NOSE: Symmetric, straight and uniform in color. There
was no presence of discharge or flaring.
CHEST/LUNGS: Full and symmetric expansion with no
increase of accessory muscle and no evidence of
increase work of breathing. Good air movement.
CARDIO- PULMONARY- Normal
GENITALIA- Normal genitalia, symmetrical scrotum,
urine output in diaber with foul smell
EXTREMETIES- No deformities, normal posture, no
deformities
LABORATORY ASSESSMENT
UPON ADMISSION: 7/8/19
UPON ADMISSION: 7/8/19
10/8/19
ANATOMY AND PHYSIOPHYSIOLOGY
URINARY SYSTEM
The urinary system consists of the kidneys, ureters,
urinary bladder, and urethra. The kidneys filter the
blood to remove wastes and produce urine. The
ureters, urinary bladder, and urethra together
form the urinary tract, which acts as a plumbing
system to drain urine from the kidneys, store it,
and then release it during urination. Besides
filtering and eliminating wastes from the body,
the urinary system also maintains the homeostasis
of water, ions, pH, blood pressure.
• KIDNEYS The left kidney is located slightly
higher than the right kidney because the right
side of the liver is much larger than the left
side. The kidneys, unlike the other organs of
the abdominal cavity, are located posterior to
the peritoneum and touch the muscles of the
back. The kidneys are surrounded by a layer
of adipose that holds them in place and
protects them from physical damage.
 The function of the kidneys are as follows:

Filter. Every day, the kidneys filter gallons of fluid from

the bloodstream.

Waste processing. The kidneys then process this filtrate,

allowing wastes and excess ions to leave the body in
urine while returning needed substances to the blood in
just the right proportions.

Elimination. Although the lungs and the skin also play

roles in excretion, the kidneys bear the major
responsibility for eliminating nitrogenous wastes, toxins,
and drugs from the body.
 Regulation. The kidneys also regulate the blood’s
volume and chemical makeup so that the proper
balance between water and salts and between acids
and bases is maintained.

Other regulatory functions. By producing the enzyme

renin, they help regulate blood pressure, and their
hormone erythropoietin stimulates red blood cell
production in the bone marrow.

Conversion. Kidney cells also convert vitamin D to its

active form
• Ureters are a pair of tubes that carry urine from
the kidneys to the urinary bladder. Gravity and
peristalsis of smooth muscle tissue in the walls of
the ureters move urine toward the urinary
bladder. The ends of the ureters extend slightly
into the urinary bladder and are sealed at the
point of entry to the bladder by the
ureterovesical valves. These valves prevent
urine from flowing back towards the kidneys.
• Urinary bladder is a sac-like hollow organ
used for the storage of urine. Urine
entering the urinary bladder from the
ureters slowly fills the hollow space of the
bladder and stretches its elastic walls.
The walls of the bladder allow it to
stretch to hold anywhere from 600 to 800
milliliters of urine.
Pathophysiology
The urinary tract, from the kidneys to the
urethral meatus, is normally sterile and resistant
to bacterial colonization despite frequent
contamination of the distal urethra with
colonic bacteria. The major defense against
UTI is complete emptying of the bladder during
urination. Other mechanisms that maintain the
tract’s sterility include urine acidity,
the vesicoureteral valve, and
various immunologic and mucosal
barriers. UTIs occur when bacteria
ascend the urethra to the bladder
and, in the case of pyelonephritis,
ascend the ureter to the kidney.
Characteristics of Urine
In 24 hours, the marvelously complex kidneys filter some 150 to 180 liters of blood plasma
through their glomeruli into the tubules.
 Daily volume. In 24 hours, only about 1.0 to 1.8 liters of urine are produced.
 Components. Urine contains nitrogenous wastes and unneeded substances.
 Color. Freshly voided urine is generally clear and pale to deep yellow.
 Odor. When formed, urine is sterile and slightly aromatic, but if allowed to stand, it
takes on an ammonia odor caused by the action of bacteria on the urine solutes.
 pH. Urine pH is usually slightly acidic (around 6), but changes in body metabolism and
certain foods may cause it to be much more acidic or basic.
 Specific gravity. Whereas the specific gravity of pure water is 1.0, the specific gravity
of urine usually ranges from 1.001 to 1.035.
 Solutes. Solutes normally found in urine include sodium and potassium ions, urea, uric
acid, creatinine, ammonia, bicarbonate ions, and various other ions.
DRUG STUDY
Generic Brand Frequency Classification Indication Nursing Responsibility:
Name Name

Paracet ADOL q6h/PRN Analgesics, Temporary relief of  Assess patient’s

amol Supposit Antipyretic pain and discomfort temperature before therapy
ory from headache, and regularly thereafter to
fever, colds, flu, indicate baseline data and
minor muscular monitor drug’s effectiveness.
aches, overexertion,  Assess patient’s drug history
menstrual cramps, and calculate total daily
toothache, minor dosage accordingly to
arthritic pain. prevent over dosage that
could lead to toxicity and
liver damage.
 Be alert for signs of reactions
and drug interactions to
establish proper
precautionary measures and
management for possible
adverse effects of the drug.
 Drug Classific Mechanism of Indication Contraindicati Nursing Responsibility
Name ation Action ons

Generic 3rd Semisynthetic Susceptible Contraindicat BEFORE:

Name: generati third generation ed with allergy  Skin test to the intradermal skin.
on
bacterial
Ceftriaxon cephalosporin infections of the to  Protect the drug from the light
Cephalo
e Sodium antibiotic. cephalosporin  Do not mix with other
sporin lower respiratory
Preferentially s or penicillin. antimicrobial drug
Brand binds to one or tract, skin and skin Use cautiously DURING:
Name: more of the structure, bone with renal  Use separate syringe when
Forgram penicillin-binding and joint, acute failure, giving this syringe
500mg IV proteins (PBP) otitis media, UTIs, lactation and AFTER:
located on cell septicemia, pelvic pregnancy  Discontinue if hypersensitivity
walls of inflammatory occurs.
susceptible disease (PID),  Reports sign such as
organisms. This petechiae, ecchymostic
intraabdominal
inhibits third and areas, epistaxis or other forms
final stage of infections, of unexplained bleeding.
bacterial cell meningitis,  Monitor hematologic,
wall synthesis, electrolytes, renal and hepatic
thus killing the functions.
bacterium
NURSING CARE PLAN
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Infection related to Expected Outcome:  Established Rapport  To gain trust and Goal met
“Hada walid ana sawi improper toileting as The patient will be free decrease After 3 days of
bol hafada reha mafi evidenced by foul of urinary tract Anxiety interventions the patient
kweyis” as verbalized smelling urine infection as  Instructed mother to  Increased was free of infection as
by the mother evidenced by clear increase oral fluid of the hydration flushes evidenced by
non-foul smelling patient bacteria and Urinalysis result
urine, unsoiled diaper toxins RBC- 0
Objective: and a normal WBC WBC- 0-1
 Foul smelling urine count. Epith- rare
 Soiled diaper noted  Monitor Laboratory results:  Increased WBC  clean and unsoiled
 Rbc- 0-2 • WBC Count count is a diaper
 WBC- 20-40 systemic response  Non-foul smelling
 Epith cells: few to infection. urine
• Urinalysis  The presence of
RBCs and WBCs in
the urine is
associated with
• Bacteria in the the inflammation
urine process during an
infection.
 Bacterial counts of
105 are usually
considered
diagnostic for UTI,
although lower
counts may also
indicate UTI.
 Client’s should finish
 Encouraged the mother to the prescribed
complete the whole duration duration of the
of the antibiotic of the antibiotics, even if
patient. (The usual length of the symptoms
antibiotic therapy is 7 to 10 disappear,
days). because not
finishing a course of
antibiotics may
 NURSING DISCHARGE PLAN
1. MEDICATION
Trimol Tab- This medication is a combination of two antibiotics: sulfamethotaxole and trimetropin. It is used to
treat a wide variety of bacterial infections.
Route: Oral
Frequency: BID for 7 days
Dosage: 6 ml
Health Teaching
 Advised to increase oral fluid intake.
 Advised mother to change patient’s diaper regularly.
 Instructed mother to encouraged patient to have regular bathroom visits (urinate every two to three hours)
 Advised mother to complete the antibiotic therapy ( 7 days as prescribed)
 Encouraged to avoid constipation to prevent recurrence of UTI.