JenniferLee DiBernardoPathophysiology Project

Urinary Tract Infection

OBJECTIVESBy the end of this presentation the learner should be able

to identify:• The basic structures and functions of the Urinary

System.• The most common microorganisms that cause Urinary

Tract Infections.• Risk factors for Urinary Tract Infections.• The most common laboratory tests in diagnosing

Urinary Tract Infections.• Treatments and prevention measures for Urinary Tract

Infections.

Basic Structures of the Urinary System

• The urinary system consists of: – two kidneys– two ureters– one urinary bladder– one urethra

Functions of the Basic Structures of the Urinary System

• Kidney – small, dark red kidney bean shaped structures. The kidneys are responsible for continuously cleansing the blood and adjusting its composition, urine formation, excretion of Nitrogen containing wastes, maintaining water and electrolyte balance of the blood, maintaining the acid – base balance of the blood and the formation of urine.

• Ureters – slender tubes each 10 to 12 inches in long and ¼ inch in diameter. Each ureter runs from the kidney down to the urinary bladder and attaches itself to the posterior aspect of the bladder on a slight angle. The ureters are passageways to carry urine from the kidneys to the bladder.

• Urinary Bladder – is a smooth, collapsible, muscular sac with 3 openings, the 2 ureter openings and the urethra opening. When the bladder is empty, it is collapsed and it is 2 to 3 inches long at most, when the bladder is moderately full about 500ml it is about 5 inches long. The bladder is able to hold twice that amount though. The main function of the urinary bladder is to provide a temporary storage tank for urine.

• Urethra – is a thin walled tube that carries urine by peristalsis from the bladder to the outside of the body. The length and relative function of the urethra differs in both sexes.

Functions of the Urinary System

• The principal function of the urinary system is to maintain the volume and composition of body fluids within normal limits. One aspect of this function is to rid the body of waste products that accumulate as a result of cellular metabolism.

• The urinary system maintains an appropriate fluid volume by regulating the amount of water that is excreted in the urine. Other aspects of its function include regulating the concentrations of various electrolytes in the body fluids and maintaining normal pH of the blood

• In addition to maintaining fluid homeostasis in the body, the urinary system controls red blood cell production by secreting the hormone erythropoietin. The urinary system also plays a role in maintaining normal blood pressure by secreting the enzyme renin.

Differences Between the Male and Female Urinary System

Male Urethra

Female Urethra

Approx 8 inches long

Approx 1.5 inches long

Located further from anus

Located more proximate to anus

Has two functions, urination & passageway for sperm

Has one function, urination

Definition of Urinary Tract Infection (UTI)

• Is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract.

Most Common Organisms Which Cause UTIs

• Escherichia coli• Enterobacter• Pseudomas• Serratia• Staphylococcus

saprophyticus• Candida

Signs and Symptoms of UTIs

• Dysuria (burning pain upon urination)• Frequency• Urgency• Voiding in small amounts• Inability to void• Incomplete emptying of bladder• Low back / Suprapubic pain

Assessment Findings in UTIs

• Hematuria (bloody urine)

• Cloudy urine

• Flank pain

• Abdominal pain

• Fever

•

• Nausea

• Vomiting

Most Common Laboratory Tests Used in Diagnosing UTIs

• Urinalysis ( U/A )– Dip Stix

• Culture and Sensitivity ( C & S )

Urinalysis Laboratory FindingsNormal Findings• pH - 4.6 – 8.0• Appearance – clearAppearance – clear• Color – pale yellow to amber

yellow• Odor – aromatic• Specific Gravity – 1.005 – 1.030• Protein - none• Glucose – none• Ketones – none• Blood – none• Leukocyte esterase (WBCs) – none

• pH – Alkaline ( increases)

• Appearance – cloudy

• Color - deep amber

• Odor – foul smelling

• Specific Gravity – may change

• Protein – maybe present

• Glucose – maybe present

• Ketones - maybe present

• Blood – maybe present

•Leukocyte esterase (WBCs)- present

Urinalysis Laboratory Findings Microscopic Examination

Normal Findings• Red Blood Cells

(RBCs) – none• White Blood Cells White Blood Cells

(WBCs) – none(WBCs) – none• Casts – none• Crystals – none• Bacteria - none

• Red Blood Cells (RBCs) – present

• White Blood Cells White Blood Cells (WBCs) – present(WBCs) – present

• Casts – none• Crystals – present• Bacteria - present

Culture & Sensitivity Laboratory Findings

Normal Findings• No bacteria present in

urine.

• Bacteria present in urine.

Treatment of UTIs

• Antibiotics• Analgesics• Increase fluids (ex.

Cranberry Juice)• Repeat urine culture

and sensitivity after antibiotics are finished

Risk Factors in UTIsFemales• Sexual intercourse

– poor fitting diaphragms– use of spericide– Pregnancy/Menopause

• Clothing– tight jeans– wet bathing suits– pantyhose– synthetic underwear

• Allergens/Irritants– feminine hygiene sprays– bubble baths– perfumed toilet paper / soap– sanitary napkins

• Presence of indwelling catheter– Foley

Males• Age

• Loss of bactericidal properties of prostatic secretions

– sperm

• Obstructive Uropathy

– BPH

– Presence of indwelling catheter

– Foley

Prevention of UTIs

• Encourage menopausal women to use estrogen vaginal creams to restore vaginal pH

• Teach women to use water soluble lubricants for intercourse, especially after menopause

• Maintain closed drainage system for hospitalized patients with an indwelling catheter and provide meticulous catheter care

• Ensure that patients understand the importance of taking all antibiotics and having repeat culture and sensitivities done

• Monitor older male patients, especially those with BPH, for the presence of infection

Prevention of UTIs Continued• Teach female patients good perineal hygiene

• Teach women proper way to wipe after urination ( front to back )

• Teach women to shower instead of bathing in tub.

• Teach women to avoid using feminine hygiene sprays and other irritants

• Teach women to wear cotton underwear

• Avoid tight jeans, sitting around in wet bathing suits

• Teach pregnant women to void every 2 hours

• Teach patients the signs and symptoms of UTIs

•

References

• Black, Joyce M.& Matassarin – Jacobs, Esther. (2001) Medical- Surgical Nursing: Clinical Management for Continuity of Care (5th ed.) W.B. Saunders Company

• Christensen, Barbara & Kockrow, Elaine. (2000) Foundations of Nursing (2nd ed.) St. Louis: Mosby

• Harkness, Gail A. & Dincher, Judith R. (2000) Medical –Surgical Nursing: Total Patient Care (9th ed.) St. Louis: Mosby

• Marieb, Elaine N. (2001) Essentials of Human Anatomy & Physiology (4th ed.) Redwood City, California: The Benjamin/Cummings Publishing Company, Inc.

• Pagana, Kathleen Deska & Pagana, Timothy James (2002) Diagnostic and Laboratory Test Reference (2nd ed.) St.Louis: Mosby

• Timby, Barbara K. (2000) Fundamental Skills and Concepts in Patient Care (6th ed.) Philadelphia: Lippincott

• All Images, www.google.com