Urinary Tract Infection : Nursing Management

Nursing Management

• • Nursing Assessment
    • Subjective Data
      • Important Health Information
        • Past health history:
          • Previous urinary tract infection.
          • Urinary calculi, reflux, strictures, or retention.
          • Neurogenic bladder, pregnancy, benign prostatic hyperplasia, bladder cancer, sexually transmitted infection.
        • Medications: Antibiotics, anticholinergics, antispasmodics
        • Surgery or other treatments:
          • Recent urologic instrumentation (catheterization, cystoscopy)
      • Functional Health Patterns
        • Health perception–health management:
          • Urinary hygiene practices.
        • Lassitude, malaise
        • Nutritional-metabolic:
          • Nausea, vomiting, anorexia. Chills
        • Elimination:
          • Urinary frequency, urgency, hesitancy. Dysuria, nocturia
        • Cognitive-perceptual:
          • Suprapubic or low back pain, costovertebral tenderness, bladder spasms, dysuria, burning on urination
        • Sexuality-reproductive: Multiple sex partners (women), use of spermicidal agents or contraceptive diaphragm (women)
    • Objective Data
      • General
        • Fever, chills, dysuria
        • Atypical presentation in older adults: afebrile, absence of dysuria, loss of appetite, altered mental status
      • Urinary
        • Hematuria. Cloudy, foul-smelling urine. Tender, enlarged kidney
      • Possible Diagnostic Findings
        • Leukocytosis. UA positive for bacteria, pyuria, RBCs, WBCs, and nitrites. Positive urine culture. Ultrasound, CT scan (CT urogram), VCUG, and cystoscopy indicating urinary tract abnormalities
  • Nursing Diagnoses
    • Impaired urinary elimination related to the effects of UTI
    • Infection
    • Risk for urge urinary incontinence
    • Acute pain: dysuria related to inflammatory process in bladder
    • Readiness for enhanced health management
  • Nursing Planning
    • Patient will have
      • Relief from lower urinary tract symptoms (LUTS)
      • No upper urinary tract involvement
      • No recurrence
  • Nursing implementation
    • Health Promotion
      • Recognize individuals at risk
        • Debilitated persons
        • Older adults
        • Underlying diseases (HIV, diabetes)
        • Taking immunosuppressive drug or corticosteroids
      • Emptying bladder regularly and completely
        • Evacuating bowel regularly
        • Wiping perineal area front to back
        • Drinking adequate fluids (person’s weight in pounds/2)
          • 20% of fluid comes from food
      • Cranberry juice or cranberry tablets may reduce number of UTIs
      • Avoid unnecessary catheterization and early removal of indwelling catheters
      • Aseptic technique must be followed during instrumentation procedures
      • Routine and thorough perineal care for all hospitalized patients
      • Answer call lights and offer bedpan or urinal at frequent intervals
    • Prevention of CAUTI
      • Avoidance of unnecessary catheterization
      • Early removal of indwelling catheters
      • Follow aseptic technique for procedures
      • Handwashing before and after patient contact
      • Wear gloves for care of urinary catheters