URINARY TRACT

INFECTION
Case Study by Group 1
URINARY TRACT
INFECTION
UTIs are common infections that happen
when bacteria, often from the skin or
rectum, enter the urethra, and infect the
urinary tract. The infections can affect
several parts of the urinary tract.
CAUSATIVE ORGANISMS:
•Bacterial •Fungal
•Viral •Protozoal
 •URETHRITIS - is an infection of anterior urethral
tract dysuria, urgency and frequency of micturition.
•CYSTITIS - is an infection if urinary bladder dysuria,
frequency, pyuri and haematuria.
•KIDNEY INFECTION (PYELONEPHRITIS)- is
another type of UTI. They're less common, but more
serious than bladder infections.
•PYURIA - presence of pus in urine ( more than 10
cells/HPF).
 CAUSES OF URINARY
TRACT INFECTION
Infection of the bladder and kidneys may occur because of poor hygiene in
the area of the urethra, especially in women due that the female urethra is
shorter and closer to the rectum permitting bacteria to enter in the bladder
more easily. Congenital defects in the urinary tract or by the insertion of
instruments used to diagnose a urinary problem may also be a cause of it.
Sometimes bacteria in the bloodstream can settle in and infect the kidneys.
Patients with diabetes seem to be more prone to urinary infections than
other people. Obstruction to the flow of urine in the urinary tract, such as
kidney stone, increases in the possibility of infection in the area behind the
obstruction. Also damage to the nerves controlling the bladder is an other
condition that increases the chances of infection in that area.
 • A previous UTI
• Sexual Activity
•Changes in the bacteria

FACTORS THAT that lives inside the

vagina, or vaginal flora
INCREASE THE •Pregnancy
•Age ( older adults and
RISK OF GETTING young children are more
likely to get UTIs
UTI •Structural problems in
the urinary tract, such as
enlarged prostate.
•Poor hygiene
 •Holding your pee and not going to the bathroom when you
have to or not emptying your bladder completely.
•Kidney stones can obstruct your urinary tract and block the
normal flow of urine.
•Diabetes can cause higher sugar levels in the blood and urine.
Higher sugar levels can promote the growth of bacteria
RISK FACTORS
FOR WOMEN
 • BEING SEXUALLY ACTIVE. The bacteria that causes
UTIs live in the area around your anus. Having sex can
move the bacteria toward the front where it can more easily
enter your urethra and travel to your bladder.

•USING SPERMICIDES OR A DIAPHRAGM. These forms

of birth control can make it easier for harmful bacteria to
enter the urinary tract. Spermicides may kill off good
bacteria in and around the vagina making it easier for
harmful bacteria to thrive.
• PREGNANCY. Pregnancy leads to changes in
the urinary tract, which can make it harder to
fully empty your bladder. Hormones may also
change the chemical make up of your urine in
ways that could encourage bad bacterial growth.

•MENOPAUSE. The increase vaginal dryness

that often result from a drop in estrogen level
when transitioning to menopause can increase
your odds to getting UTI.
 •WEARING TINY LINGERIE. There's not much
space between opening to your urethra, vagina, and
rectum. Wearing a thong, a teddy, string-bikini
underwear can trap bacteria in vaginal area.

•WIPING THE WRONG WAY. Wiping from back to

front can introduce bacteria into the urinary tract after
using the toilet. Wipe from front to back instead.
RISK FACTORS
FOR MEN
• ENLARGED PROSTATE. An enlarged prostate, also known as
benign prostatic hyperplasia(BPH), can make it harder to fully
empty the bladder. An enlarged prostate also may block the flow
of urine out of the bladder.

•OLDER AGE. UTIs are more common in men over 50.

• UNPROTECTED ANAL SEX. The harmful bacteria that causes

UTIs can be found in and around the anus.
PATIENT INFORMATION
PATIENT NAME: Juana Dela Cruz IP NO: 12345
AGE: 30 years old SEX: Female
ADMISSION DATE: 2/15/23 DISCHARGED DATE: 2/18/23

DEPARTMENT: General Medicine

COMPLAINTS: Fever from 1 month on and off. Abdominal pain during micturition.

HISTORY OF PRESENT ILLNESS:

• Dysuria and myalgia since for 1 month
• No H/O bleeding, rashes, loose stools, vomiting
• No H/O cough with expectoration
PAST MEDICAL HISTORY:
Nothing significant.
ALLERGY (food/drugs/other):
No known allergies
PERSONAL HISTORY AND HABITS:
DIET: mixed
SLEEP: normal
APPETITE: normal
BOWEL AND BLADDER: burning sensation and pain during micturition

FAMILY HISTORY:
Nothing significant.
GENERAL EXAMINATION:
Conscious and coherent.
1. PHYSICAL EXAMINATION:
VITAL SIGNS:
TEMPERATURE: 36.5 C
RESPIRATORY RATE(/min): 20
PULSE RATE: 87
BLOOD PRESSURE( mm of Hg): 120/80

2. SYSTEMS EXAMINATION:
CVS: S1, S2+
RS: Clear
GU & GI(ABDOMEN): Soft
3. LABORATORY DATA:

1. HB 14.00g (12-15g/dL)
2.WBC 12,100 (4,000-11,000 cells/cu.mm)
3. DC:
N 75 40-70%
L 35 20-40%
E 4 01-06%
B 0 <1%
M 15 2-10%

4. RBS 115 80-120mg/dI

PATHOPHYSIOLOGY
Complicated urinary tract infections (UTIs) occur
in the setting of pre-existing metabolic,
functional, or structural abnormalities of the
urinary tract. They may involve both lower and
upper tracts. Complicated UTIs may significantly
increase the rate of therapy failures and cause
damage that leads to recurrence.
The pathophysiology of • Structural abnormalities
-such as calculi, infected cysts,
complicated UTIs
renal/bladder abscesses, certain forms of
has the following four pyelonephritis, spinal cord injury (SCI),
and catheters
aspects:
• Metabolic/hormonal abnormalities
-such as diabetes and pregnancy
• Impaired host responses
-such as transplant recipients
(especially renal transplants)
and patients with AIDS
• Unusual pathogens
-such as yeast
 A growing number of complicated UTIs are healthcare
associated in origin. Proteus mirabilis (PM) is most
commonly isolated; it may produce a biofilm that promotes
adhesion to the outer and inner surfaces of an urethral
catheter. Other adhesive factors include its pili and
fimbriae.Its production of urease and hemolysins are
additional pathogenic properties.
 Pyelonephritis is almost always the result of bacterial migration
from the bladder to the renal parenchyma that is enhanced by
vesicourethral reflux. In uncomplicated pyelonephritis, the bacterial
invasion and renal damage are limited to the pyelocalyceal-
medullary region. In complicated infection, the entire kidney may
be affected. If the infection progresses, bacteria may invade the
bloodstream, resulting in bacteremia.
PATHOPHYSIOLOGY
 NURSING
CARE PLAN
ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
Short term goal after 9 Independent
SUBJECTIVE:
hours Independent
of the nursing -Encourage frequent voiding Short term goal after 9
Urinary tract infection of any -Increase fluid intake
interventions, -Voiding the every 2-3 hours of nursing interventions,
part of the urinary system. It -Encourage the use of warm
-"Masakit ang pag-ihi ko the patient will be able hours will help the goal is FULLY MET, the
can be urethritis which is bath to the perineum
to: the client to lower urine patient:
kag ma 1 month infected of the urethra, -Avoid irritant such as
-To feel relieved and bacterial counts
cystitis or a bladder infection coffee, tea, colas, and
nako gabatyag sakit sng -Increasing water intake -Is relieved and the infection is
of the kidney. This occurs infection is controlled alcohol
ulo." As verbalized when bacteria enters urinary
flushes controlled
-Slowly, patient will be bacterial and toxins out
by the patient. tract through the urethra and -Patient can now void without
able to void with of the body.
multiples in the bladder. Dependent any discomfort
discomfort -Soaking this area in
OBJECTIVE: Acute pain related to Long term goals after 1 week
warm water relaxes Long term goals after 1 week of
UTIs commonly happen in your anal sphincter,
urinary in women because of the short
of nursing interventions, the the nursing interventions, the
goal is FULLY MET, the which helps
tract infection ( UTI distance from the anus to the goals is FULLY MET, the
patient: -Give increase blood flow
opening of urethra and bladder patient:
-Patient grasping her -Feel relief from pain an
antispasmodicagents
through your anal
discomfort tissues.
lower abdomen and analgesic as -Reported pain and discomfort
-Increased knowledge of
-Facial grimace preventive measures and prescribed by -They are known to irritate the bladder
vanished
-Restlessness treatment
the physician. and worsen bladder infection symptoms. -Have knowledge of the
-Be free from the infection preventive measures and
-V/S taken as follows: -Evaluate and Dependent
treatments modalities
T: 36.5 C COLLABORATIVE: document the -To relieve pain and to eradicate the

-Collaborating with other infection. -Is now free from the infection
RR: 20 effects prior to -To know whether you should decrease
healthcare providers on how or increase the dosage of the said
medication use
PR: 87 to medication.

take properly the medications.

BP: 120/80
 DRUG LITERATURE
DRUG NAME MECHANISM OF INDICATION/ ADVERSE DOSAGES AND
ACTION CONTRAINDICATION EFFECT ADMINISTRATION
The bactericidal action of
INDICATION: Norfloxacin is a
GENERIC: Norfloxacin results from
Headache, dizziness,
inhibition of the enzymes Norfloxacin is a quinolone fluoroquinolone antibiotic
weakness
Norfloxacin topoisomerase II (DNA antibiotic used to treat used to treat urinary tract
gyrase) and topoisomerase bacterial infections, infections. The usual adult
BRAND: IV, which are required for particularly urinary tract Nausea, abdominal cramping, dose for uncomplicated
bacterial DNA replication,
and sex organ infections. diarrhea, vomiting urinary tract infections is
NOROXIN transcription, repair, and
recombination. Norfloxacin It kills or stops bacteria 400 mg orally every 12
CLASS: is a broad-spectrum antibiotic growth, but not viral ones. hours for 3 days. For other
agent that is shown to be Increased or decreased levels infections, the dose may
Fluoroquinolone antibiotics effective against various of certain enzymes or blood vary from 400 mg orally
Gram-positive and Gram- cells every 12 hours for 7 to 10
negative bacterial species. days to 400 mg orally
PHARMACOLOGIC: The fluorine atom at the 6 every 12 hours for 10 to 21
position increases potency
CONTRAINDICATION: Muscle damage, usually in the days. The drug should be
Bactericidal against gram-negative ankle
organisms, and the piperazine
taken at least 1 hour before
• Hypersensitivity
ROUTE: moiety at the 7 position is or 2 hours after a meal,
• Pregnancy
responsible for anti- milk, or other dairy
• Breastfeeding Hypersensitivity reactions,
ORAL pseudomonal activity products.
• Prolonged QT interval such as rash, itching, or
• Hypokalemia swelling
 DRUG TO DRUG
INTERACTION:
Quinolones, including
norfloxacin, can inhibit
CYP1A2, causing increased
substrate drug concentrations
when used with drugs
metabolized by CYP1A2.
Elevated plasma levels of
theophylline have been
reported, and cyclosporine
levels have been elevated
when used with norfloxacin.
Quinolones may also
enhance the effects of oral
anticoagulants, so
monitoring prothrombin time
or other coagulation tests is
crucial when used
concomitantly.
 DIAGNOSTIC TEST
COMMON TESTS
• OTC Dipstick – to detect substances that are typically found in
the urine.
• Urinalysis – to test the urine and detect the range of disorders.
Also to check the appearance concentration and content of
urine.
• Urine culture – check for the bacteria or others germs in the
urine sample.
TREATMENT
 TREATMENT
On Day-1:
-Tab. Norflaxacin 500mg P/O BID is used as an antibiotic. Which may reduce microbial
action.
-Inj. Ranatidine 25mg IV BID is used as an anti-ulcerative drug. Reduce stomch
irritation, do not take more than two weeks.
-Inj Paracetamol 150mg IV BID is an opioid analgesic given to reduce the pain. Use
twice daily.
-Inj. Tramadol 50mg IV BID is an opiod analgesic given to reduce the pain. Use twice
daily.
-Tab. B-complex 63mg P/O OD used as a vitamin supplement. Use one tablet in
morning and night.
 TREATMENT
On Day-2 & On Day-3:
Continue some medicine
On Day-4:
On fourth day patient was continued with the same medication because of no fresh complaints.
As the patient was symptomatically better, he was discharged with the following medications and asked
to review
after 1 week.
1. T. Norfloxacin 500mg BID
2. TRanitidine 150mg BID
3. T. Paracetamol 500mg TID
4. T. Tramadol 100mg BID
5. T. B-complex 63mg OD
 PREVENTION
•There are several ways you can Bubble baths do mot cause a UTI, but
prevent UTIs. You should keep your they can irritate the urinary tract.
genital area clean and wear clean, dry •You should urinate after sexual
cotton underwear. You should wip intercourse. Some women consistently
from front yo back after urinating or develop UTIs after sexual intercourse.
bowel movement. You should drink In these cases, doctors can prescribe
plenty of fluids. Drinking cranberry an antibiotic taken after sexual
juice may be helpful. intercourse as a preventative measure.
• Women prone to UTIs should avoid
using birth control method such as a
contraceptive diaphragm and
spermicidal jelly. Women should not
douche or using similar feminine
hygiene products.
 PREVENTION
Regarding Life Style Modifications:

•Patient is advised to maintain properl hygiene

•Advised to drink plenty of water
•Citrus juices should be taken
•Limit caffeine intake
•Avoid OTC preparations
•The patient given appropriate advice regarding transmissions
and reinfection.
 REFERENCES
DISEASE : https://www.cdc.gov/antibiotic-use/uti.html#:~:text=What%20is%20a%20urinary%20tract,a
%20bladder%20infection%20(cystitis)
CAUSES : (Wagman, 1987, J.G Ferguson Company/Chicago; The New Complete Medical and Health
Encyclopedia, vol.2, p.541)
RISK FACTORS : https://www.cdc.gov/antibiotic-use/uti.html, https://www.everydayhealth.com/urinary-
tract-infection/causes-and-risk-factors-of-utis/
PATHOPHYSIOLOGY : https://emedicine.medscape.com/article/2039975-overview#:~:text=The
%20pathophysiology%20of%20complicated%20UTIs,such%20as%20diabetes%20and%20pregnancy
NURSING CARE PLAN :
DRUG LITERATURE :
DIAGNOSTIC TEST : https://www.mountsinai.org, https://www.mayoclinic.org, https://www.testing.com
TREATMENT :
THANK
YOU!
ANY QUESTIONS?