A brief description about urinary teact infection(ppt)

Urinary tract infection
INTRODUCTION:
A urinary tract infection (UTI) is an infection of renal system. The renal or urinary system includes the 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. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
Definition :-
A condition in which bacteria invade and grow in the urinary tract (the kidneys, ureters, bladder, and urethra). Most urinary tract infections occur in the bladder or urethra.
TYPES :
An infection can happen in different parts of your urinary tract. Each type has a different name, based on where it is.
• Cystitis
• Pyelonephritis
• Urethritis
• Uretritis
Incidence: . Every year about 150 million people are being diagnosed with urinary tract infection worldwide. Each and every woman has a lifetime risk of developing UTI is 60%; by contrast, men have a lifetime risk of only 13%. .

Risk Factors/causes:
UTIs are more common in females because their urethras are shorter and closer to the rectum. This makes it easier for bacteria to enter the urinary tract.
Other factors are:-
• A previous UTI
• Sexual activity
• Pregnancy
• Age (older adults and young children are more likely to get UTIs)
• Poor hygiene,
Pathophsiology:

Clinical manifestation:
Pain or burning while urinating
• Frequent urination
• Feeling the need to urinate despite having an empty bladder
• Bloody urine
• Pressure or cramping in the groin or lower abdomen
Symptoms of a kidney infection can include:
• Fever
• Chills
• Lower back pain or pain in the side of your back
• Nausea or vomiting
Diagnostic /evaluation:
History and physical examination
• Urinalysis:
• Urine culture:
• Imaging your urinary tract:
• Cystoscopy:
• Blood tests:
• Pelvic exam:
• Rectal exam:
Medical management:
Symptomatic treatments includes :
• Urinary analgesic to control pain such as urspass,pyridium.
• P.C.M to control fever and high temperature.
• Anti emetics such as emeset .perinorm to control vomiting.
• Plenty of water and fluids.

Commonly used antibiotics are
• Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid, Furadantin)
• Cephalexin
• Often, UTI symptoms clear up within a few days of starting treatment. But may need to continue antibiotics for a week or more
• For an uncomplicated UTI , may recommended a shorter course of treatment. That may mean taking an antibiotic for 1 to 3 days.
• If you have frequent UTIs, may get recommended :Low-dose antibiotics. might be taken for six months or longer.
• And other measures includes :Taking a single dose of antibiotic after sex if UTIs are related to sexual activity.Vaginal estrogen therapy if you've reached menopause.
. Prevention
• Should void or Urinate after

1. Urinary tract infection  Mr. Jitendra Singh Associate professor  Nims college of nursing 

2. Introduction   A urinary tract infection (UTI) is a bacterial infection in part of the urinary tract. When it affects the lower urinary tract, it is known as lower urinary tract infection eg.Cystitis,urethritis ). When it affects the upper urinary tract, it is known as upper urinary tract infection eg . Pylonephritis and ureteritis . UTI is 50 times more common in women.UTI is uncommon in men below 60 years of age, but the frequency is similar in men and women in older age groups.

3. Renal system:-

4. Classification:-    1 .Upper urinary tract infection :-it is infection of upper urinary tract such as        pyelonephritis ,glomerulonephritis ,and ureteritis .    2.Lower urinary tract infection:- it is the infection of lower urinary tract .such as cystitis ,                                                    Urethritis etc.                                                          Or     1.Acute urinary tract infection:- sudden and immediate onset of UTI.     2.Chronic urinary tract infection:- persisting for a long time or constant recurring.

5. Causes:- Bacterial infection .  Escherichia coli [ causes 80% of cases ]   Enterococcus  Klebsiella   Enterobacter  Proteus  Pseudomonas etc. Failure to empty urine completely  Decreased immunity  Instrumentation of urinary tract . Obstruction in urinary flow .

6. Clinical features :-  A strong, persistent urge to urinate   A burning sensation when urinating (dysuria)  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(hematuria)   Strong-smelling urine   Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

7. Diagnostic evaluation:- .History taking with detailed clinical manifestations  Physical examination   Urinalysis-  Urine Culture-   Ultrasound- Ultrasound is a noninvasive imaging test that can be used to screen for hydronephrosis (obstructions of the flow of urine).   X-Rays- Special x-rays can be used to screen for structural abnormalities, urethral narrowing, or incomplete emptying of the bladder. Due to the possible risks to the fetus, x-rays are not performed on pregnant women.  Voiding cystourethrogram- It is an x-ray of the bladder and urethra.To obtain a cystourethrogram, a dye, called contrast material, is injected through a catheter inserted into the urethra and passed through the bladder.  An intravenous pyelogram (IVP)- It is an x-ray of the kidney. For a pyelogram, the contrast matter is injected into a vein and eliminated by the kidneys. In both cases, the dye passes through the urinary tract and reveals any obstructions or abnormalities on x-ray images.

8. Diagnostic evaluation:- Cystoscopy- Cystoscopy is used to detect structural abnormalities, interstitial cystitis, or masses that might not show up on x-rays during an IVP.The patient is given a light anesthetic, and the bladder is filled with water.The procedure uses a cystoscope, a flexible, tube-like instrument that the urologist inserts through the urethra into the bladder    ComputedTomography (CT)- A computed tomography (CT) scans may be used to check for kidney stones or other obstructions.  Blood Cultures- If symptoms are severe; the doctor will order blood cultures to determine if the infection is in the bloodstream and threatening other parts of the body.

9. Medical management :- Assess condition . Assess vital signs. Symptomatic treatment involve:- Urinary analgesic for D ysuria . Such as Pyridium , U rispas . Anti emetics for nausea and vomiting . Antipyretics incase of fever. Plenty of water around 3-4litres. Antibiotics such as :- amoxycillin.levofloxacin . Bactrim septra , N itrofurantoin . Note:- incase of Nitrofurantoin urinary insufficiency should not be Less than 50 ml/hours

10. Medical management:-   LongTerm PharmacologicTherapy - The women with recurrent UTIs may be instructed to begin treatment to her own whenever symptoms occur and to contact her health care provider only when symptoms persist, fever occurs, or the number of treatment episodes exceeds four in a 6 month period. If infection recurs after complete antimicrobial therapy another short course (3 to 4 days) of full dose antimicrobial therapy may be prescribed.   After treatment and sterilization of urine low dose preventive therapy (trimethoprim with or without sulfamethoxazole) each night at bed time is often prescribed.

11. Health education:- Patient education-   The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:   Do not delay urination when it is necessary.  A high fluid intake is essential.   Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an ointment containing no active ingredient) does not appear to matter.   Drinking 250 to 500ml of cranberry juice daily and avoidance of bubble baths may also help.  Often long courses of low-dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.

12. Nursing management:- . NURSING DIAGNOSIS Acute pain related to infection within the urinary tract as manifested by pain on urination, suprapubic pain and bladder spasms. GOAL Pain and discomfort will be relieved. INTERVENTION  Assess the onset, duration and level of pain . Provide analgesic drugs. Provide comfortable position. Reassure and provide divertional therapy. Give psychological support. Alert patient that phenazopyridine will color urine orange.  Apply heating pad to painful area. EVALUATION Reports relief of pain.

13. Nursing management:-   2. NURSING DIAGNOSIS Impaired urinary elimination related to UTIs as manifested by urgency, frequency, incontinence or hematuria and verbalization of concern over altered elimination pattern. GOAL Normal urination pattern will be returned. INTERVENTION Assess for changes in usual voiding pattern.  Instruct patient regarding reason for symptoms . Encourage high fluid intake or administer IV fluid as ordered.  Obtain urine for culture and sensitivity . Administer antimicrobial medications as ordered . Instruct patient about good perineal care and cleansing after each bowel movement . Tell patient to observe urine for color, odor,amount and frequency. EVALUATION Exhibits normal urination pattern.

14. Nursing management:- 3. NURSING DIAGNOSIS Hyperthermia related to infection as manifested by elevation in temperature, tachycardia, chills and malaise GOAL Normal body temperature will be returned. INTERVENTION  Assess vital signs 2-4 hourly.  Administer antipyretics and antibiotics as ordered.  Ensure hydration via oral or IV route.  Monitor intake and output.  Cover patient and keep him dry.  Provide cooling sponge baths or compresses. EVALUATION Reports return of normal temperature.

15. Nursing management:-   4. NURSING DIAGNOSIS Risk for reinfection related to lack of knowledge regarding measure to prevent recurrence. GOAL Signs of infection will not be present. INTERVENTION Assess the signs and symptoms of infection. Explain importance of taking all the antibiotics as prescribed. Symptoms will improve after 1-2 days of therapy, but organisms may still be present. Instruct the patient on appropriate hygiene, including- Careful cleansing of perineal region. Wiping from front to back after urinating. Cleansing with soap and water after each bowel movement. Explain the emptying of bladder before and after intercourse . Instruct the patient to urinate when the urge occurs or at least 2-4 hour during the day. Instruct the patient about the need to maintain adequate fluid intake. Advise patient to report symptoms or signs of recurrent UTI. EVALUATION Improves knowledge level of patient.

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