Introduction to Urinary Tract Infections

Urinary Tract Infections (UTIs) of the lower urinary system (bladder) usually affect women more often than men (related to the length of the urethra). UTIs can be caused by bacteria, fungi, or other organisms such as chlamydia and mycoplasma. The hallmark symptom is pain or burning with urination.

UTIs can be treated with prescribed antibiotics and increased fluids unless contraindicated. But an untreated UTI can progress and become pyelonephritis.

Pyelonephritis is an infection when bacteria travel from the bladder to the kidneys. This infection can be acute or chronic and can involve one or both kidneys. Clients with an obstruction in their urinary tract (such as a kidney stone) are at risk for developing pyelonephritis.

UTI Pathophysiology

Most UTIs are caused by Escherichia coli (E. coli), a bacteria found in the intestinal tract. This bacteria can be transferred when cleaning after a bowel movement or from sexual intercourse. The bacteria leads to an infection that causes inflammation and discomfort.

Other causes include:

• Urinary retention
• Benign prostatic hyperplasia (BPH)
• Kidney stones
• Foley catheters

Signs and Symptoms:

• Fever
• Burning during urination (Dysuria)
• Increased urinary frequency

UTI Nursing Assessments and Interventions

When a client presents with signs and symptoms of an infection, the nurse will obtain the appropriate prescribed specimens and cultures. Antibiotics should never be the first course of action before cultures. Interventions include:

Administer antibiotics as prescribed.

Encourage the client to practice proper hygiene and urinate frequently to flush out bacteria. They should also drink plenty of fluids, especially water.

Educate clients on multiple points, such as

• avoid using feminine hygiene products that contain dyes, fragrances, or other chemicals (such as bubble baths). 
• female clients should wipe from front to bad to avoid bacteria
• always urinate after intercourse
• wear cotton underwear

Pyelonephritis Pathophysiology

Pyelonephritis is a more serious infection that affects the kidneys. Most often acute cases result from an ascending route of infection. A previous UTI that is unresolved, poor hygiene, age, instrumentation (such as catheters) or other underlying conditions. In a kidney infection there may be costovertebral tenderness. Other signs and symptoms include:

• Dull flank pain
• Fever
• Chills (shivering)
• Chronic pain or discomfort in the lower back or side (this may be felt as a dull ache or sharp pain)
• Nausea and vomiting

Pyelonephritis Nursing Assessments and Interventions

Assess the client’s fluid intake and urine output 

Monitor the client’s temperature about every four hours and signs of infection.

Administer antibiotics as prescribed. 

Provide pain relief with acetaminophen or ibuprofen if necessary. (If fever occurs with infection, acetaminophen or ibuprofen should not be used before the underlying condition is diagnosed and treatment begins).

UTI Medications

Sulfonamides and fluoroquinolones are medications that are typically used for urinary tract infections. These medications can stop the bacteria and prevent the infection from spreading.

Sulfonamides

Sulfonamides are antibiotics that can be used to treat bacterial infections. They work by blocking the growth of bacteria and killing them.

Memory Trick: 

• Sunburn (client needs to wear sunblock and avoid the sun)
• Urine crystals and specific gravity
• Love water (2-3L per day)
• Folic acid (take daily)

Mechanism of Action: Prevents the synthesis of folic acid. (binding and inhibiting the enzyme)

Fluoroquinolones

Fluoroquinolones are a class of antibiotics that can be used to treat a variety of bacterial infections. They contain a fluorine atom attached to their quinolone ring, which is how they received their drug classification.

Mechanism of Action: They inhibit DNA gyrase, an enzyme that helps DNA unwind when it’s being copied. This inhibition results in cell death.

Phenazopyridine

Phenazopyridine Is a medication used to relieve symptoms caused by urinary tract infections. It is not an antibiotic and does not treat the cause of UTIs. Instead, it’s a dye that soothes the urinary tract lining and offers some pain relief. 

Clients should be aware that it will cause the urine to become an orangish red and will stain clothing.

Nursing Interventions for UTI Conclusion

Bacteria exposure can result in infections in the urinary tract, also known as UTIs. They most frequently cause burning or pain when urinating.  UTIs are typically treatable with medications, but occasionally they worsen and result in pyelonephritis, a kidney infection.

Pyelonephritis is brought on by bacteria that enter the kidneys from the bladder. One or both kidneys may be impacted by this infection, which can be acute or chronic in nature.

UTI medications include sulfonamides,and fluoroquinolones. They function by reducing bacteria in the urinary tract and halting the spread of the infection.

Sources

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/ 

https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447 

https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453 

https://emedicine.medscape.com/article/245559-overview