Pyelonephritis most often occurs as a result of urinary tract infection, particularly when there
is occasional or persistent backflow of urine from the bladder into the ureters or an area called
the kidney pelvis. Pyelonephritis can be sudden (acute) or long-term (chronic). Acute
uncomplicated pyelonephritis is the sudden development of kidney. Chronic pyelonephritis is a
long-standing infection that does not go away. Pyelonephritis occurs much less often than a
bladder infection although a history of such an infection increases your risk. There is an
increased risk for a kidney infection if you have any of the following conditions: backflow of
urine into the ureters or kidney pelvis, kidney stones, obstructive uropathy, and renal papillary
necrosis
Gender
Diet
Poor hygiene
Immunosuppression
Fatigue
Fever
Skin changes (flushed or reddened skin, moist skin - diaphoresis, warm skin)
And mental changes or confusion may be the only signs of a urinary tract infection in the elderly
Left untreated, pyelonephritis can lead to further kidney infections, scarring, chronic kidney disease, or
permanent damage. Serious infections can spread to other parts of the body, including the blood (sepsis).
Urinalysis - which is commonly reveals white or red blood cells in the urine,
other urine tests can reveal the type of bacteria that is involved, and
Additional tests and procedures that may be done include kidney biopsy,
kidney scan, kidney ultrasound, and voiding cystourethrogram.
Treatment
The goals of treatment are to control the infection and relieve symptoms. Due to the high
death rate elderly population and the risks of complications, prompt treatment is
recommended. Sudden (acute) symptoms usually go away within 48-72 hours after
appropriate treatment. Intravenous fluids, pain medications, anti-nausea medications and
antibiotics are the mainstay of therapy. In acute case, the course of treatment for antibiotics
is up to 10 to 14 days while severe infections may be given through intravenously. Patients
with severe infections or with depressed immune systems will be admitted to the hospital.
Prompt and complete treatment of bladder infections may prevent development of many
cases of pyelonephritis. Chronic or recurrent urinary tract infection should be treated
thoroughly. In preventing kidney infections by taking the following steps such as keep the
genital area clean. Wiping from front to back help reduce the chance of introducing bacteria
from the rectal area to the urethra, urinating immediately after sexual intercourse which
may help eliminate any bacteria that may have been introduced during sexual activity, drink
more fluids (64 to 128 ounces per day) which encourages frequent urination and flushes
bacteria from the bladder and drink cranberry juice in which prevents certain types of
bacteria from attaching to the wall of the bladder and may lessen your chance of infection.
Biographical Data
Name
: Patient X
Birthday
Age
: 34
Sex : Female
Address : San Isidro, Cabangan, Zambales
Civil Status : Married
Number of Children
: 4
: Filipino
Blood Type
: Type B, RH+
Height
: 411
Weight : 42 kgs
Date of Admission
Time of Admission
: 3:08 PM
Chief of Complaint
: Body Weakness
Diagnosis
: Acute Pyelonephritis
Obstetric History
Patient
Physical Assessment
Body Part
Technique Used
Normal Findings
Actual Findings
Interpretation
Body Part
Technique Used
Normal Findings
Actual Findings
Interpretation
Skin
Skin color
Inspection
Deep brown
Normal
Inspection
General Uniformity
General Uniformity
Normal
Skin lesions
Skin moisture
Inspection
Inspection/ Palpation
Warm/ smooth
Normal
Skin turgor
Inspection/ Palpation
Normal
Nail
Nail texture
Nail plate shape
Inspection
Inspection
Smooth Texture
Convex Curvature
Smooth
Convex
Normal
Normal
Inspection
Light Brown
Normal
Evenly distributed
Evenly distributed
Normal
Head or Hair
Hair over the scalp
Inspection
Hair evenness
Inspection
Inspection
Silky Hair
Normal
Inspection
Thick hair
Thick Hair
Normal
Infection and
infestation
Inspection
No infection or infestation
No infection or
infestation
Normal
Rounded
Normal
Uniform consistency,
absence of nodule
Symmetrical facial
movement
Normal
Inspection/ Palpation
Inspection/ Palpation
Inspection
Skin intact
Skin intact
Normal
Inspection
Inspection
Inspection
Normal
Normal
Normal
Reaction to
accomodation
Inspection
Auricles-color
symmetry
Auricles of elasticity/
tenderness
Inspection
Normal
Palpation
Normal
Hearing acuity:
respond to normal
voice
Palpation
Audible
Audible
Normal
Inspection/ Palpation
Inspection
Inspection
Normal
Normal
Normal
Normal
Audible
Audible
Normal
Normal
Inspection
Nose
Symmetric/ straight, no discharge, Symmetric/ straight, no
uniform color
discharge, uniform color
Palpation
Palpation
Inspection
Inspection
Mouth
Uniform pink color
Brownish
Normal
Normal
Normal
Abnormal
Pinkish
Normal
Central position
Normal
Tongue movement
Inspection
Normal
Inspection
Normal
Inspection
Neck
Muscle equality in size, head
centered
Normal
Normal
Palpation
Inspection
Thorax
Symmetrical chest
Symmetrical chest
Normal
Neck muscles
Normal
Posterior thorax
Palpation
Normal
Palpation
Inspection
Normal
Auscultations
Normal
Normal
Normal
Abdomen
Abdomen for skin
integrity
Abdomen for contour
and symmetry
Inspection
Inspection
Auscultations
Normal
Palpation
Normal
Normal
Normal
Musculo-Skeletal
Muscles
Inspection
Inspection
Palpation
No swelling/ tenderness/
nodules
No swelling/ tenderness/
nodules
Normal
Locate edema/
tenderness
Palpation
No swelling/ tenderness
No swelling/ tenderness
Normal
Normal
Normal
Neurological
Bicep reflex
Percussion
Tricep reflex
Percussion
Contraction of
triceps can be seen
or felt
Contraction of
triceps can be
seen or felt
Normal
Knee
Percussion
Contraction of the
quadriceps causes
knee to extend
Contraction of the
quadriceps causes
knee to extend
Normal
Ankle
Percussion
Normal
Plantar
Percussion
Normal
Vital Signs
Temperature
Technique
-
Normal findings
35.6-37.7c
Actual findings
Interpretation
38.7C
Due to presence of
Pulse rate
Palpation
80 bpm
infection
Normal
Respiratory
Inspection
14-20 bpm
24 bpm
Slightly Above
Rate
Normal Respiratory
rate
Blood Pressure
Palpation and
100/60-
auscultation
<120/<80mmhg
130/90 mmHg
Slightly Elevated
Blood pressure
Laboratory Procedures
A. Urinalysis
Date: August 29, 2015
Time:
Color
Normal Range
Results
Interpretation
Yellow
Transparency
Slightly turbid
Ph
Albumin
Sugar
Specific gravity
Blood
Ketone
Bilirubin
Nitrate
Urobilinogen
7.35-7.45
6.0
Negative.
Negative. Glycosuria generally means
1.015
normal
diabetes mellitus.
Normal.
NA.
NA.
NA.
NA.
Normal. When hemoglobin breaks down,
1.015-1.025
0-0.02
Leukocytes
Trace
A. BLOOD CHEMISTRY
Date: September 1, 2015
Time:
Normal Range
Results
Interpretation
Sodium
138-145mEq/L
138
Normal.
Potassium
3.5-5.3mEq/L
3.49
Low.
Normal Range
Results
Interpretation
70-105mg/dL
120
High.
Total Cholesterol
Up to 200mg/dL
141.7
Low.
Triglycerides
35-165mg/dL
71.9s
Normal.
A. HEMATOLOGY
Date: September 2, 2015
Time:
Normal Range
Results
Interpretation
Hematocrit
36-48%
38.4%
High.
Hemoglobin
120-160g/L
128g/L
Normal.
WBC count
5.10x10g/L
12.1x10gL
High.
Neutrophils
50.0-70.0%
89%
High.
Lymphocytes
20.0-40.0%
11%
Low.
Platelet Count
150-450x10g/L
346x10g/L
Normal.
A. Urinary system
The urinary system consists of the kidneys, ureters, urinary
bladder, and urethra. The kidneys filter the blood to remove wastes
and produce urine. The ureters, urinary bladder, and urethra together
form the urinary tract, which acts as a plumbing system to drain urine
from the kidneys, store it, and then release it during urination.
Besides filtering and eliminating wastes from the body, the urinary
system also maintains the homeostasis of water, ions, pH, blood
pressure, calcium and red blood cells.
Urinary Bladder
The urinary bladder is a sac-like hollow organ used for the storage of urine.
The urinary bladder is located along the bodys midline at the inferior end of the
pelvis. Urine entering the urinary bladder from the ureters slowly fills the hollow
space of the bladder and stretches its elastic walls. The walls of the bladder allow
it to stretch to hold anywhere from 600 to 800 milliliters of urine.
Urethra
The urethra is the tube through which urine passes from the bladder to the
exterior of the body. The female urethra is around 2 inches long and ends inferior
to the clitoris and superior to the vaginal opening. In males, the urethra is around 8
to 10 inches long and ends at the tip of the penis. The urethra is also an organ of
the male reproductive system as it carries sperm out of the body through the penis.
The flow of urine through the urethra Urinary system cross-secrion is controlled by
the internal and external urethral sphincter muscles. The internal urethral
sphincter is made of smooth muscle and opens involuntarily when the bladder
reaches a certain set level of distention. The opening of the internal sphincter
results in the sensation of needing to urinate. The external urethral sphincter is
made of skeletal muscle and may be opened to allow urine to pass through the
urethra or may be held closed to delay urination.
Blood Pressure. The kidneys monitor the bodys blood pressure to help maintain
homeostasis. When blood pressure is elevated, the kidneys can help to reduce blood pressure by
reducing the volume of blood in the body. The kidneys are able to reduce blood volume by
reducing the reabsorption of water into the blood and producing watery, dilute urine. When
blood pressure becomes too low, the kidneys can produce the enzyme renin to constrict blood
vessels and produce concentrated urine, which allows more water to remain in the blood.
Filtration
Inside each kidney are around a million tiny structures called nephrons. Thenephronis the
functional unit of the kidney that filters blood to produce urine. Arterioles in the kidneys
deliver blood to a bundle of capillaries surrounded by a capsule called a glomerulus. As blood
flows through the glomerulus, much of the bloods plasma is pushed out of the capillaries and
into the capsule, leaving the blood cells and a small amount of plasma to continue flowing
through the capillaries. The liquid filtrate in the capsule flows through a series of tubules lined
with filtering cells and surrounded by capillaries. The cells surrounding the tubules selectively
absorb water and substances from the filtrate in the tubule and return it to the blood in the
capillaries. At the same time, waste products present in the blood are secreted into the
filtrate. By the end of this process, the filtrate in the tubule has become urine containing only
water, waste products, and excess ions. The blood exiting the capillaries has reabsorbed all of
the nutrients along with most of the water and ions that the body needs to function.
Calcitriol. Calcitriol is the active form of vitamin D in the human body. It is produced by the kidneys
from precursor molecules produced by UV radiation striking the skin. Calcitriol works together with
parathyroid hormone (PTH) to raise the level of calcium ions in the bloodstream. When the level of
calcium ions in the blood drops below a threshold level, theparathyroid glands release PTH, which in
turn stimulates the kidneys to release calcitriol. Calcitriol promotes thesmall intestine to absorb
calcium from food and deposit it into the bloodstream. It also stimulates the osteoclasts of theskeletal
systemto break down bone matrix to release calcium ions into the blood.
Erythropoietin. Erythropoietin, also known as EPO, is a hormone that is produced by the kidneys to
stimulate the production of red blood cells. The kidneys monitor the condition of the blood that passes
through their capillaries, including the oxygen-carrying capacity of the blood. When the blood becomes
hypoxic, meaning that it is carrying deficient levels of oxygen, cells lining the capillaries begin
producing EPO and release it into the bloodstream. EPO travels through the blood to the red bone
marrow, where it stimulates hematopoietic cells to increase their rate of red blood cell production. Red
blood cells contain hemoglobin, which greatly increases the bloods oxygen-carrying capacity and
effectively ends the hypoxic conditions.
Renin. Renin is not a hormone itself, but an enzyme that the kidneys produce to start the reninangiotensin system (RAS). The RAS increases blood volume and blood pressure in response to low blood
pressure, blood loss, or dehydration. Renin is released into the blood where it catalyzes angiotensinogen
from the liver into angiotensin I. Angiotensin I is further catalyzed by another enzyme into Angiotensin II.
Angiotensin II stimulates several processes, including stimulating the adrenal cortex to produce the
hormone aldosterone. Aldosterone then changes the function of the kidneys to increase the reabsorption
of water and sodium ions into the blood, increasing blood volume and raising blood pressure. Negative
feedback from increased blood pressure finally turns off the RAS to maintain healthy blood pressure
levels.
The nephron is the unit of the kidney responsible for ultrafiltration of the blood and
reabsorption or excretion of products in the subsequent filtrate. Each nephron is made
up of:
A filtering unit- the glomerulus. 125ml/min of filtrate is formed by the kidneys as blood
is filtered through this sieve-like structure. This filtration is uncontrolled.
The proximal convoluted tubule. Controlled absorption of glucose, sodium, and other
solutes goes on in this region.
The loop of Henle. This region is responsible for concentration and dilution of urine by
utilising a counter-current multiplying mechanism- basically, it is water-impermeable
but can pump sodium out, which in turn affects the osmolarity of the surrounding
tissues and will affect the subsequent movement of water in or out of the waterpermeable collecting duct.
The distal convoluted tubule. This region is responsible, along with the collecting duct
that it joins, for absorbing water back into the body- simple maths will tell you that
the kidney doesn't produce 125ml of urine every minute. 99% of the water is normally
reabsorbed, leaving highly concentrated urine to flow into the collecting duct and then
into the renal pelvis.
Blood Supply
The renal arteries branch directly from the abdominal aorta and enter the kidneys
through the renal hilus.
Inside our kidneys, the renal arteries diverge into the smaller afferent arterioles of
the kidneys.
Each afferent arteriole carries blood into the renal cortex, where it separates into a
bundle of capillaries known as a glomerulus.
From the glomerulus, the blood recollects into smaller efferent arterioles that
descend into the renal medulla.
The efferent arterioles separate into the peritubular capillaries that surround the
renal tubules.
Next, the peritubular capillaries merge to form veins that merge again to form the
large renal vein.
Finally, the renal vein exits the kidney and joins with the inferior vena cava, which
carries blood back to the heart.
Excretion of wastes
The kidneys excrete a variety of waste products produced by metabolism. These include
the nitrogenous wastes urea, from protein catabolism, and uric acid, from nucleic acid
metabolism.
Acid-base homeostasis
Two organ systems, the kidneys and lungs, maintain acid-base homeostasis, which is
the maintenance of pH around a relatively stable value. The kidneys contribute to acidbase homeostasis by regulating bicarbonate (HCO3-) concentration.
Osmolality regulation
Any significant rise or drop in plasma osmolality is detected by the hypothalamus, which
communicates directly with the posterior pituitary gland. An increase in osmolality
causes the gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption
by the kidney and an increase in urine concentration. The two factors work together to
return the plasma osmolality to its normal levels.
ADH binds to principal cells in the collecting duct that translocate aquaporins to the
membrane allowing water to leave the normally impermeable membrane and be
reabsorbed into the body by the vasa recta, thus increasing the plasma volume of the
body.
There are two systems that create a hyperosmotic medulla and thus increase the body plasma
volume: Urea recycling and the 'single effect.
Urea is usually excreted as a waste product from the kidneys. However, when plasma blood volume
is low and ADH is released the aquaporins that are opened are also permeable to urea. This allows
urea to leave the collecting duct into the medulla creating a hyperosmotic solution that 'attracts'
water. Urea can then re-enter the nephron and be excreted or recycled again depending on whether
ADH is still present or not.
The 'Single effect' describes the fact that the ascending thick limb of the loop of Henle is not
permeable to water but is permeable to NaCl. This means that a countercurrent system is created
whereby the medulla becomes increasingly concentrated setting up an osmotic gradient for water to
follow should the aquaporins of the collecting duct be opened by ADH.
Long-term regulation of blood pressure predominantly depends upon the kidney. This primarily
occurs through maintenance of the extracellular fluid compartment, the size of which depends on
the plasma sodium concentration. Although the kidney cannot directly sense blood pressure,
changes in the delivery of sodium and chloride to the distal part of the nephron alter the kidney's
secretion of the enzyme renin. When the extracellular fluid compartment is expanded and blood
pressure is high, the delivery of these ions is increased and renin secretion is decreased. Similarly,
when the extracellular fluid compartment is contracted and blood pressure is low, sodium and
chloride delivery is decreased and renin secretion is increased in response.
Renin is the first in a series of important chemical messengers that comprise the
renin-angiotensin system. Changes in renin ultimately alter the output of this system,
principally the hormones angiotensin II and aldosterone. Each hormone acts via multiple
mechanisms, but both increase the kidney's absorption of sodium chloride, thereby
expanding the extracellular fluid compartment and raising blood pressure. When renin
levels are elevated, the concentrations of angiotensin II and aldosterone increase, leading
to increased sodium chloride reabsorption, expansion of the extracellular fluid
compartment, and an increase in blood pressure. Conversely, when renin levels are low,
angiotensin II and aldosterone levels decrease, contracting the extracellular fluid
compartment, and decreasing blood pressure.
Hormone secretion
The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin.
Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the
renal circulation. It stimulates erythropoiesis (production of red blood cells) in the
bone marrow. Calcitriol, the activated form of vitamin D, promotes intestinal absorption of
calcium and the renal reabsorption of phosphate. Part of the
renin-angiotensin-aldosterone system, renin is an enzyme involved in the regulation of
aldosterone levels.
Pathophysiology
Modifiable Factors:
Lifestyle
Nature of Occupation
Non- modifiable Factors:
Age
Sex
Heredity
Etiology
Bacteria: Escherichia Coli
Urethritis
Urethrovesical reflux
Cystitis
Urethrovesical reflux
Ureteriitis
Acute Pyelonephritis
Drug Study
Diagnosis
Impaired urinary
"nahihirapan po ako
inflammation of
investigate sudden
obstruction/
bladder mucosa as
patient.
evidence by the
flow
subjective cues.
clients condition.
stones
Frequency
Hesitancy
Indicators of fluid
balance
Vital Signs:
T: 38.7
the bladder.
Assist in maintaining
PR: 80
Dependent:
hydration/adequate
RR: 24
Administer IV fluids as
indicated
urinary flow.
Objective:
Distended abdomen
Planning
Intervention
Plan of care to meet the Independent:
client.
Make a teaching plan
Rationale
Evaluation
Sudden decrease in urine After 8 hours of nursing
Subjective:
"nilalamig at
Risk for
after 8 hours of
Intervention:
After 2 hours of
aid in diagnosis.
nursing intervention
nanginginig po ang
temperature
katawan ko dahil sa
core temperature
Monitor
Room temperature
temperature is
lagnat koas
environmental
number of blankets
decreased to a
temperature,
should be altered to
normal range.
verbalized by the
patient.
Objective:
Chills
Warm to touch
alcohol
fever
Flushed skin
Dependent:
Administer
Used to reduce
antipyretics
action on the
Provide cooling
hypothalamus.
Vital Signs:
T: 39.2
BP: 120/80
PR: 80
RR: 22
blankets
Subjective:
"Nung nakaraang
to Acute
renal tissues as
verbalized by the
patient.
Objective:
After 4 hours of
infection.
of pain will be
Encourage patient to
pain,guarding
verbalize concerns
behavior,nausea and
pain
guarding behavior
diaphoresis
acceptance,remaining
environment promote
appropriate.
Independent:
Promote quiet
T: 38.2
environment
techniques distraction.
BP:130/100
Dependent:
PR:85
Give analgesics
RR:22
according to the
treatment. .program
path of pain
rate of 3.
Focus
Doctor's Order
Admission
Monitor VS q 4
Nurse's Note
D Admitted a 54 years old female
due to acute pyelonephritis
Consent for admission and
management signed
Seen and examined by Dra.
Cayabyab
BP: 120/ 80
PR: 89
D5LR
RR: 23
T: 36.7
3:30 PM
Post
Endosemen
t
Assessment
D
In from ER/ wheelchaired
relatrively acccompanied
Afebrile
A Placed comfortably on bed
6:00
Post
Endorsemen
t assessment
D GCS 15
A Endorsed
Diet
regimen instructed
30-Aug-15
6:00 AM
Preendorsement
Assessment
8:00 AM
Home Meds:
Cefuroxime 50g q8
Omeprazole 4g
Hyosine 1g
Afrebrile
(-) DOB
A IVF Checked
Meds Checked
D Seen in rounds
Kept comfortable
Endorsed
31-Aug-15
6:00 AM
2:00 PM
Post
Endorsemen
t
Assessment
Nebulize q6
D Received on bed
GCS 15
(-) DOB
Afebrile
A IV patency Checked
Meds Checked
VS taken
Endorsed
Preendorseme
nt
Assessment
D
On bed
(-) Vomiting
2:15 PM
Post
Endorsemen
t Assessment
A Endorsed
D
On bed
Afebrile
(-) DOB
A IVF Checked
Meds given
1-Sep-15
6:00 AM
6:00 AM
Post
Refer to opthalmologist for
Endorsement
further evaluation and
Assessment
management Re: Infernal
strabismus
D Received patient on bed
IVF: D5LR 1L x 16 D5NM 1L x GCS 15
(-) DOB
16
Afebrile
A IV patency checked
Meds Checked
Endorsed
Post
A > Left lateral rectus palsy L
D Received patient on bed
Endorsement P > May give oral steroids if total
Assessment cholesterol and triglycerides normal GCS 15
Suggest CT-Scan
Afebrile
Suggest oral Vitamin B complex A IV patency checked
Carry out orders of Dra.
Meds Checked
Labrador
D Seen in rounds by Dr. Ramos
with new order made and carried
out
D Seen in rounds by Dr. Labrador
with new order made and carried
out
D On bed
GCS 15
6:00 AM
TBS,Total cholesterol,
Post
Endorsemen
triglycerides
Alternate eye patching
t
Assessement Vit. B complex capsule
2-Sep-15
Post Endorsement Assessment Facilitate cranial CT-Scan
(plain)
IVF: D5LR 1L x 16
D5NM
1L x 16
Give Ketorolac 30mg/amp
PRN for sevre pain
Doctor
Rounds
Endorsed
Received patient on bed
GCS 15
Afebrile
A IV patency checked
Meds Checked
D
Seen on rounds by Dr.
Echipare
> New order made and carried
out
6:00 PM
Preendorseme
nt
Assessmen
t
D On bed
GCS 15
A Meds given
Endorsed
3-Sep-15
6:00 AM
IVF: D5LR 1L x 16
Post
Endorsement
D5NM 1L x 16
Assessment Awaiting CT-Scan result
Omeprazole 20mg OD
pre-breakfast
Prednisone 10mg/tab TID
6:00 AM
Doctor
Rounds
D Received on bed
GCS 15
Afebrile
A IV patency checked
Meds Checked
D Seen in rounds by Dr.
Ramos with new order
made and carried out
Discharge Plan
Medication
Antibiotics will treat your infection.
Prescription pain medicine can help decrease your pain. Do not wait until the pain is severe before
you take this medicine.
Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to
take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken
correctly.
NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with
or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If
you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label
and follow directions. Do not give these medicines to children under 6 months of age without direction
from your child's healthcare provider.
Take your medicine as directed. Contact your PHP if you think your medicine is not helping or you
have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins,
and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill
bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Exercise/Environment
Instruct the client on ways how to maintain the cleanliness of their environment.
Treatment
Practice Kegel exercise (only applicable in women)
Health Teaching
Ask your PHP how much liquid to drink each day and which liquids are best for you.
Do not delay urination when it is necessary. Urinate as soon as you feel the urge. This will
help flush bacteria from your urinary system. Do not wait or hold your urine for too long.
Clean your perineal (genital) area every day with soap and water. Wipe from front to back
after you urinate or have a bowel movement. Wear cotton underwear. Fabrics such as nylon and
polyester can stay damp. This can increase your risk for infection. Urinate within 15 minutes
after you have sex.
Drink more fluid 54-128 ounces. This encourages frequent urination and flushes bacteria from
the bladder.
Encourages proper food handling preparation
Do hand-washing before and after urinate
Thank you!