University of Perpetual Help System Laguna College of Nursing

Urinary Tract Infection

Group 8 Almacen, Bryan Cabagua, Rachelle Carandang, Rhoxlee Dolleton, Kristine Fernandez, Kathie Hermogeno, Justin Matabang, Charles Oes, Jerome Reyes, Patrixia Turallo, Jonathan

Introduction
A urinary tract infection is an infection that affects part of the urinary tract. An infection of the lower part of the urinary tract is referred to as cystitis, while an infection of the upper part of the urinary tract is referred to as pyelonephritis. Most UTIs are caused by a bacterial infection of the urinary tract, which is made up of the kidneys, ureters, the urinary bladder, and the urethra. Each of these plays a role in removing liquid waste from the body. The kidneys filter the blood and produces urine, the ureters carry the urine from the kidneys to the bladder, the bladder stores the urine until it is eliminated from the body through the urethra. Although bacteria arent normally found in urine, they can easily enter the urinary tract from the skin around the anus (the intestinal bacteria E. coli is the most frequent cause of UTIs). Many other bacteria, and some viruses, can also cause infection. In rare cases, bacteria can reach the bladder or kidneys through the blood. Bacterial UTIs are not contagious. Urinary tract infections (UTIs) are common among children. By the age of five years old, about 8% of girls and 1-2% of boys have had at least one. In older children, UTIs may have obvious symptoms, such as a burning sensation with urination. In infants and young children, however, UTIs may be more difficult to detect because symptoms are not as obvious. In infants, fever is often the only sign. UTIs occur much more frequently in girls, particularly those around the age of toilet teaching, because the female urethra is much shorter than that of the male. The proximity to the anus also contributes to the risk of a UTI. Uncircumcised boys younger than one year of age also have a slightly higher risk of developing UTIs. An abnormality in the structure or function of the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow) can also contribute to the development of a urinary tract infection.

Patients Profile
Name: Gender : Age: Civil Status: Nationality: Religion: Admission Date: Hospital Name: Diagnosis: Attending Physician: M.M Female 6 months Child Filipino Catholic Jan 14, 2012 JONELTA, Pediatrics Ward UTI Probable Dr. M

Growth and Development

Age 6 months Activities Rolls from back to stomach Sits with support Holds bottle well Eruption of 1st temporary teeth Exhibits stranger anxiety Can be pulled from sitting to standing Observed Yes Yes Yes No Yes Yes

Patients History
Immunization Record Vaccine BCG DPT OPV Hepatitis B Minimum Age at First Dose Birth or any time after birth Six weeks Six weeks At birth Interval None Four weeks Four weeks Six weeks between 1st and 2nd dose, 8 weeks between 2nd and 3rd dose None Administered Complete (1 Dose) Complete (3 Doses) Complete (3 Doses) Complete (3 Doses)

Measles

Nine months

No

Chief Complaint Intermittent high grade fever 3 days prior to admission

Present Medical History 3 Days PTA, with fever 40C, and rashes on perineal area Self-managed with paracetamol (Tempra) for fever;

Family History Diabetes Mellitus on the Maternal Side (From grandmother)

Physical Assessment

Area of assessment Skin color texture skin turgor

Normal findings

Actual findings

Interpretation

-fair; no rashes

-(+) perianal macules

-abnormal -abnormal -normal

-smooth;without lesions -smooth;with lesion -elastic;springs back immediately when pinched -withing the range of 36.5-37.5 -symmetrical -audible bowel sounds -Midline at lateral area -elastic;springs back immediately when pinched -warm to touch (39.9C) -abdomen is flat -audible bowel sounds

temperature Abdomen Contour bowel sounds Umbilicus

-abnormal

-normal -normal

-umbilicus is midline at -normal lateral are

Female Genital area Labia majora -equal in size;free of and perianal area lesions -smooth -equal in size;presence macules from the labia majora to the perianal area -abnormal

Labia minora

Urethral meatus and vaginal opening

-normal symmetric;darkpink;moi st symmetric;darkpink;moi st -normal -small and slitlike -small and slitlike -no -no lesions;noswelling;no lesions;noswelling;no bulging in the vaginal bulging in the vaginal opening;no discharge opening;no discharge

Anatomy and Physiology

The Urinary System

The Parts and Function of the Urinary System Our body is like a machine. Machine needs oil or gasoline to work. Our body needs food in order to carry out its activities. Once the food has reached the body systems, they are quickly used for energy. In the process, wastes materials are produced which need to be removed from the body. The solid waste material comes out through the anus, while the fluid material is eliminated through the urinary system. The Urinary System and Its Major Parts 1. Kidneys- the kidneys are two brownish, bean shaped organs about the size of a fist. They weigh about 5 ounces. They are located in the upper right and left back part of the abdominal cavity. Each kidney contains about 1,200,000 microscopic filters called nephrons. Nephrons are smaller than the smaller dots. The main function of the kidneys is to maintain the water balance and to eliminate waste materials from the blood. 2. Ureters the left and the right ureters are long muscular tubes. They are about 12 inches long with a diameter of 2 to 3 millimetres. The ureters connect pelvis of each kidney to urinary bladder. They carry urine from each kidney to the urinary bladder. 3. Urinary Bladder the urinary bladder is a muscular sac that holds urine. It is located in front of the pelvis and behind the pubis. As the bladder fills, walls stretch signalling the desire to urinate. 4. The Urethra- the urethra is a muscular tube which carries urine from the bladder to the outside part of the body. In the female, it is a one inch long from the bladder to the cleft of the labia. In the male, it is several inches long from the prostate gland to the penis. When one is about to urinate, a valve in the urethra relaxes to allow the urine to flow out.

The Urinary System Cleans the Blood

Waste Products During normal activity of the body, waste products are formed. The chief waste products of the body are carbon dioxide, water, urea, and salts. Carbon dioxide is eliminated through the lungs, while water, urea and salts are eliminated through the urine. Urea is a product resulting from the breakdown of protein foods and of protoplasm. It is excreted mainly by the kidneys. Urinary Systems Mechanism 1. Glomerulus each nephron is composed of a glomerulus. The glomerulus is surrounded by hollow capsule known as Bowmans capsule. The capillaries in the glomerulus filter the waste materials of the blood except protein and the cells. 2. Filtered Fluid the filtered fluid enters the Bowmans capsule, where it flows down through its twisted tubes. The walls of the tubes absorb back in to the blood the needed water and blood chemicals. 3. Pathway of Unwanted Chemicals Unwanted chemicals are discharged. The unwanted chemicals are the waste products. They come out in the form of urine. The urine passes into the ureter and on to the urinary bladder, then to the urethra which releases it to the outside of the body. Urine gives valuable clues to the body. Sugar in the urine is an indication of diabetes. Albumin may signify that the kidneys are not functioning properly.

Pathophysiology
Schematic Diagram Non-Modifiable Factors Age UTI has the highest frequency in infancy Gender UTI has a higher incidence rate among females Modifiable Factors Inadequate frequency of diaper change Poor hygienic practices

Bacterial Invasion

Multiplication of bacteria, causing infection in the lower urinary tract

Interruption in the normal homeostatic environment of the urinary tract

Immune response by the body (defense mechanism of the body against foreign bodies)

Increased WBC

Body induces the action of the cytokines and prostaglandins, which are aimed at elevating body temperature

Cytokine and prostaglandin release

Fever

Urinary Tract Infection

Medical Management
Diagnostic Test Nursing Responsibility
Inform the patient this test can assist in evaluating the amount of hemoglobin in the blood to assist in diagnosis and monitor therapy. Obtain a history of the patient's cardiovascular, gastrointestinal, hematopoietic, hepatobiliary, immune, and respiratory systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures. Obtain a list of the patient's current medications, including herbs, nutritional supplements, and nutraceuticals Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture. Promptly transport the specimen to the laboratory for processing and analysis. Collect specimens form infants and young children into a disposable collection apparatus consisting of a plastic bag with an adhesive backing around the opening that can be fastened to the perineal area or around the penis to permit voiding directly to the bag. Depending on hospital policy, the collected urine can be transferred to an appropriate specimen container. Cover all specimens tightly, label properly and send immediately to the laboratory. If the specimen cannot be delivered to the laboratory or tested within an hour, it should be refrigerated or have an appropriate preservative added.

CBC

Urinalysis

Fecalysis

If he is taking any medications, these must be screened as some can affect test results. A patient is usually discouraged as well from taking aspirin, alcohol, vitamin C, ibuprofen and certain types of food if his fecal sample will be checked for any sign of blood. Recent travel and X-Ray tests can also affect the results of fecalysis If the patient is suffering from diarrhea, placing a plastic wrap and securing it under the toilet seat could facilitate the collection process Collected samples must be brought to the doctor's office or laboratory as soon as possible. Delays could compromise the quality of the sample. Volume or amount is also important so the patient must be sure he has collected an adequate amount of stool

Medications
Medications Cefuroxime (Ceftin) Paracetamol Rationale To treat bacterial infection of the urinary tract To treat hyperthermia

IV Fluids
IV Fluid D5 IMB 500cc, 30 cc/hr Rationale To prevent dehydration or electrolyte imbalance

Diet
Diet NPO temporarily x4h then start milk feeding with strict aspiration prevention Rationale The patient had an episode of vomiting (only once)

Laboratory Results

Latest CBC, 1/16/2012

Test Name Result Normal Value Units Interpretation Indication Due to iron deficiency anemia Due to iron deficiency anemia Due to iron deficiency anemia Indicates presence of infection Indicates presence of infection Indicates presence of infection Indicates presence of infection Indication of iron deficiency anemia

Hemoglobin

105

110 140

gm/L

Decreased

Hematocrit

0.30

0.37 0.47

Decreased

RBC Count

3.85

4 5.5

x 10^12/L

Decreased

WBC Count

22.9

5.0 10.0

x 10^9/L

Increased

Segmenters

0.72

0.50 0.70

Increased

Lymphocytes

0.16

0.20 0.40

Decreased

Monocytes

0.12

0 0.05

Increased

MCV

76.5

80 98

fl

Decreased

MCH

27.4

26 32

pg

Normal

MCHC

358

320 360

g/L

Normal

Platelet Count

233

150-400

x 10/L

Normal

Urinalysis, 1/15/2012
Test Name Color Transparency Reaction (pH) Protein Glucose Specific Gravity Pus Cells RBC Epithelial Cells Mucus Threads Actual Findings Light Yellow Slightly Hazy Acidic, 6.0 Negative Negative 1.005 10-15/HPF 1-2/HPF Occasional Few Normal Findings Light yellow to amber Clear to slightly hazy 4.5 8.0 Negative Negative 1.003-1.030 0-5/HPF 2-3/HPF Occasional Few Interpretation Normal Normal Normal Normal Normal Normal in infants Indicates presence of bacteria Normal Normal Normal

Fecalysis, 1/15/2012
Test Name Color Consistency Blood (gross) Occult Blood Bacteria Mucus Bile OVA/Parasite Pus Cells RBC Actual Findings Yellow Green Soft N/A N/A N/A N/A N/A None Found N/A N/A Normal Findings Brown Soft and bulky, depending on the diet 0-3 HPF None Abundant None None None 0-3 HPF 0-3 HPF Interpretation Result of bottle feeding Normal Normal N/A N/A N/A N/A Normal N/A N/A