Nursing Interventions for UTI; Care Plans- A Student’s Guide

Introduction

Nursing interventions for UTI are actions nurses takes to implement their patient care plan, including any treatments, procedures, or teaching moments intended to improve the patient’s comfort and health.

This blog post discusses various nursing diagnoses, signs and symptoms, preventions, care plans and nursing interventions for UTI. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor if you’re looking for medical advice.

Urinary Tract Infection

A urinary tract infection is an infection of the lower respiratory tract caused by bacteria travelling from the anus to the urethra and bladder. Because germs may travel a shorter distance in women, UTIs are more common than in men.

The urinary system provides a pathway for urine created by the kidneys to be drained. It should be fully functional because injury to this system could quickly influence other body systems.

The kidneys, bladder, ureters, and urethra make up the urinary tract. The kidneys filter waste from the bloodstream and excrete it in urine. Urine travels through the ureter to reach the bladder shortly after leaving the kidney. Urine will stay in the bladder until it is time to urinate.

The bacterium Escherichia coli (E. coli), which is generally prevalent in the digestive system, is responsible for most UTIs. The body usually eliminates bacteria that enter the urinary tract before causing symptoms. However, bacteria can sometimes overwhelm the body’s natural defences, resulting in illness. Infections in the upper or lower urinary tract are commonly referred to as UTIs. Urethritis is an infection of the urethra. Cystitis is the medical term for a bladder infection. Bacteria may enter the ureters and multiply, resulting in kidney infection (pyelonephritis). Fever, chills, a strong, continuous urge to urinate, burning sensation when urinating, murky, foul-smelling urine, and pelvic pain in women are all signs and symptoms of urinary tract infections.

Classification of UTIs

UTIs are categorised based on their location and then further classified based on other characteristics and situations.

1. Lower UTIs – Bacterial cystitis, prostatitis, and urethritis are examples of lower UTIs.
2. Upper urinary tract infections (UTIs) – Upper UTIs, including acute and chronic pyelonephritis, interstitial nephritis, and renal nephritis, are far less prevalent.
3. Uncomplicated Lower or Upper UTIs – Most simple UTIs are acquired in the community and are frequent in young women, but they are rarely recurrent.
4. Lower or upper urinary tract infections that are complicated. Complicated UTIs are most commonly acquired in persons with urologic abnormalities or recent catheterisation after hospitalisation.

 Causes of UTIs

• Bacteria that have infiltrated the urinary tract are the primary cause of UTIs. Frequent sexual intercourse, poor hygiene or wiping from back to front, and the use of spermicidal foams are all common risk factors.
• The most common causes include:
• Failure or inability to empty the bladder. Stasis of urine in the urinary bladder stimulates microorganisms to enter the tract.
• The urinary tract’s instrumentation. Bacteria could be introduced into the urinary tract during catheterisation or cystoscopy.
• Urinary flow is obstructed. Anomalies in the urinary tract’s anatomy might restrict urine flow, making it impossible to empty the bladder.
• Natural host defences are weakened. Immunosuppression, or the body’s inability to produce its own defences, makes the patient vulnerable to UTI.
• Unprotected sexual intercourse
• Constipation
• A recent pregnancy, a miscarriage, an abortion, or labour and delivery
• Having a history of urinary tract infections (UTIs), diabetes, or any other ailment that compromises your immune system 

Pathophysiology

Bacteria must obtain entry into the system to infect it.

• Access – The bacteria get entrance to the urinary tract and cause infection.
• Attachment – To avoid being rinsed away by voiding, the bacteria cling to the epithelium of the urinary system and colonise it.
• Evasion – The host then eludes the defence mechanisms.
• Inflammation – As the body’s defensive mechanisms react to the bacteria, inflammation and other symptoms of infection emerge.

Signs and Symptoms of Urinary Tract Infections

The following are some of the most common signs and symptoms:

1. Fever (elevated body temperature)
2. Urinary tract pain, both lower and upper
3. Urinating with a burning sensation
4. Urination regularly
5. Having trouble initiating urine flow or experiencing painful spasms during ejaculation (in men)
6. Cloudy urine
7. Urine with a strong odour
8. Feeling feverish for no apparent reason
9. Urine with blood

Clinical Manifestations

• Urination causes a burning sensation. The patient may have pain while urinating, which they describe as a burning sensation.
• Frequency. Every three hours, the patient voids more than usual.
• Nocturia. Urinating in the middle of the night is also an indication of a UTI.
• Suprapubic or pelvic pain is a common complaint. The patient may have pain in the suprapubic or pelvic area.
• Urgency. There is also a fear that the patient will no longer be able to control the urge and will rush to expel it.

Preventions

Bathtubs should be avoided. Because bacteria in bath water can enter the urethra, it’s best to shower rather than bathe.

Perineal hygiene. Clean the perineum and urethral meatus from front to back after each bowel movement to lower pathogen concentrations near the urethral aperture.

Increase your water consumption. To flush out bacteria, drink enough water on a daily basis.

Avoid urinary tract irritants. UTI is caused by beverages such as coffee, tea, colas, alcohol, and others.

Voiding habit. During the day, void at least every 2 to 3 hours and totally empty the bladder.

Medications. Follow the directions on your prescription carefully.

Don’t drink fluids instantly before or after intercourse. Instead, it is advised that you urinate first. Bacteria can migrate up the urethra (which goes to the bladder) more easily than bacteria can flow down it (from your bladder).

Urinate as soon as possible after having sex. The same logic applies here: bacteria have more time to proliferate inside your urinary tract if you wait too long between having sex and urinating.

Get gynaecological screenings regularly. Make an appointment with your doctor at least once a year or if you have any symptoms that could indicate a UTI infection. Your doctor will do tests to determine the root of the problem and prescribe medication.

Nursing Diagnosis for UTI

Urine cultures.

Urine cultures are the definitive diagnostic test for UTIs and are valuable in identifying the organism present.

A urine culture is the most reliable approach to check for a bladder infection. This entails sending a sample of your urine to the lab, where it will be put in a particular nutrient solution to allow bacteria to grow and be identified.

The lab technician will examine how bacteria react to specific dyes that allow them to be seen under a microscope. The germs will then be examined under a microscope by the technician, who will compare your sample to samples from other people who have the condition. This can assist you to figure out if you have a UTI or not.

STD tests

 Because UTIs can be spread sexually, STD tests may be conducted.

Urinalysis

Girls who are prone to UTI should have a urinalysis done. It involves testing bacteria, white blood cells, and pH levels in a urine sample. Protein levels in the urine are also measured since too much protein can harm the kidneys.

Doctors frequently test for a protein called albumin as part of a urinalysis. When we have an illness, albumin is found in our blood and naturally makes its way into our urine. A dipstick test, which is performed on a little sample of your urine, can reveal this. The presence of albumin in your urine is vital to know since high albumin levels can signal renal impairment.

CT scan.

This scan produces two-dimensional images that help you understand the size and structure of your organs, as well as any anomalies that may be present. The key advantage is that no X-rays are required, and you are not exposed to radiation.

 A CT scan can detect abscesses or pyelonephritis.

Retention of Urine

Urinary retention can be caused by abruptly terminating ureteral catheters without a gradual decline in flow rate or by using a ureteral catheter with a clogged drainage system.

MRI

It’s used to see the parts of your body that aren’t working properly. The MRI scan creates images of organs using a magnetic field and radio waves, and it can be used to inspect the inside of your bladder. However, because it needs you to lie still for an extended amount of time, it may not be realistic in some instances.

Ultrasonography

Sound waves are used in a new imaging technique to create a three-dimensional image of the kidneys, ureters, and bladder (called ultrasound). It enables a doctor to see any anomalies inside these structures. This can assist your doctor in determining whether a patient has a urinary tract infection creating inflammation.

Obstacles, abscesses, tumours, and cysts can be detected with remarkable sensitivity using ultrasound.

Cystoscopy

A cystoscope is a small, flexible tool with a light source at the end that a doctor might use to check the bladder. This allows them to see any irregularities in the bladder and look directly at the locations where urine is coming from (ureters). The doctor can reach into the bladder or ureters and remove the infected area if there are abnormal spots there.

Medical Management

Management of UTIs typically involves pharmacologic therapy and patient education.

Acute pharmacologic therapy – is a type of treatment used for a short period of time. An antibiotic drug that eliminates germs from the urinary system while having little effect on faecal and vaginal flora is the best treatment for UTI.

Long-term pharmacologic therapy -recurrence is caused by reinfection with new germs. Patients with recurrence are told to start therapy independently as soon as symptoms appear and to call their doctor only if symptoms persist.

Urinary Tract Infection Nursing Care Plans

These nursing care plans aim to relieve pain and discomfort, raise the client’s awareness about preventative measures and treatment regimens, and manage potential complications are all part of this nursing care plan for urinary tract infections.

Nursing Care Plans Based on Diagnosis

Nursing diagnoses include:

1. Acute Pain
2. Impaired Urinary Elimination
3. Hyperthermia
4. Deficient Knowledge

Acute Pain

Evidence of acute pain include:

• Burning on urination.
• Facial grimace.
• Guarding behaviour.
• Protective decreased physical activity.
• Spasm in the lower back and bladder area.

Desired goals and outcomes

• The client will employ both pharmaceutical and nonpharmacological pain management techniques.
• On a scale of 0 to 10, the client will report good pain control at a level less than 3 to 4.
• The client will report the absence of pain.

Nursing Evaluation and Rationale

1. Evaluate the client’s pain description, including the pain’s quality, nature, and severity.

Burning when urinating, flank pain, lower abdominal or suprapubic pain are all symptoms of a UTI. Some clients with persistent infections, on the other hand, are asymptomatic. This information will aid in the selection of an intervention. For a more detailed nursing assessment of pain, see our Acute Pain nursing diagnostic.

2. Examine for urinary tract infection signs and symptoms.

Dysuria, urine frequency and urgency, and nocturia are all common indications and symptoms of a urinary tract infection. Excess white cells in the urine and bleeding of the irritated bladder wall can also cause pyuria (bad-smelling or murky urine) or hematuria (bloody urine).

3. Check for UTI risk factors.

UTIs are more likely to occur if you have a history of sexually transmitted infections, catheter use, or past genitourinary tract surgery. Urinary tract blockages, such as those produced by a kidney stone or an enlarged prostate, can reduce urine flow and raise UTI risk. (2019, Storme, Saucedo, and Garcia-Mora).

4. Monitor laboratory and diagnostic studies, as indicated:

• WBC count (number of white blood cells)

An increase in WBC count shows a response to a systemic infection.

• Urinalysis

To assess for pyuria, bacteria and blood cells in the urine are signs of inflammation during infection.

• Bacteria in the urine 

Infection is indicated by a colony count of more than 100,000 CFU/mL of urine during a clean-catch midstream or catheterised specimen, while lower counts may potentially suggest UTI.

• Urine culture and sensitivity 

Used to find the most effective and appropriate antibiotic after identifying the infecting bacteria. If acute urethritis is suspected, a test for sexually transmitted infections is also conducted.

• CT (computed tomography) 

Renal calculi, pyelonephritis, and abscesses can all be detected with this test.

• Ultrasound and kidney scans 

Obstructions, abscesses, tumours, and cysts can all be detected with this technique.

Nursing Interventions and Rationales

1. Apply a heating pad on your lower back or suprapubic area.

Heat applied to the perineum helps reduce pain and spasms.

2. Administer analgesics (such as acetaminophen) or antispasmodics (such as phenazopyridine).

Bladder irritation, spasm, and discomfort can be relieved using antispasmodic and analgesic medications.

3. Unless contraindicated, encourage the patient to increase their oral fluid intake.

Increasing fluid consumption to 2 to 3 litres per day aids urine production, dilutes urine, relieves bladder irritation, improves renal blood flow, and flushes microorganisms from the urinary system.

4. Advise them to stay away from coffee, tea, spices, alcohol, and soft drinks.

These foods irritate the urinary system and are classified as urinary tract irritants.

5. Encouraged the client to go to the bathroom often.

To avoid bladder distention, lower bacterial urine counts, reduce urine stasis and prevent reinfection, frequent voiding every 2 to 3 hours to empty the bladder is recommended.

6. When appropriate, non-pharmacological pain management approaches are used.

Relaxation, massage, guided imagery, and diversion are examples of alternative therapies that can help to relieve pain and bring comfort.

7. As needed, administer antimicrobial agents.

Antibiotics such as trimethoprim (TMP) or cephalexin are usually the initial choices. Short-course therapy with a single antibiotic or a three-day course lowers treatment costs, improves adherence, and reduces adverse effects.

Impaired Urinary Elimination

Evidence of Impaired Urinary Elimination include:

• Dysuria.
• Urinary frequency; urge.
• Urinary hesitancy.

Desired Outcomes

• The client’s urine elimination pattern will return to normal, as shown by the lack of signs of urinary problems (urgency, oliguria, dysuria).
• The client will exhibit behavioural approaches for avoiding urine infections.

Nursing Interventions and Rationales

1. Examine the patient’s elimination pattern.

It can assist in identifying characteristics that may predispose a patient to a urinary tract infection (UTI) and serve as a foundation for choosing appropriate therapies. The following items may be included in an assessment and physical examination:

• Inquiring about symptoms such as frequency, urgency, dysuria, and nocturia in the client.
• Identifying whether or not there is a pain in the bladder area.
• Identifying the urine’s properties. Take note of the colour, cloudiness, and foul odour.
• Identifying the frequency and volume of urine.

2. Note the client’s age and gender.

UTI is more common in women than in males while younger, but the difference narrows as they get older. A UTI affects about one in every five women at some point in their lives. Because of anatomical defects and decreased bladder tone, older persons are more likely to get UTI caused by inadequate bladder emptying.

3. Have the female client clean her face from front to back.

This method prevents bacteria from spreading from the anal region to the vagina and, eventually, the urethra. Perineal hygiene helps to reduce the risk of contamination and reinfection.

4. Encourage the consumption of cranberry juice.

Cranberry juice helps prevent and control UTI symptoms. Bacterial adhesion to uroepithelial cells in the urine system has been demonstrated to be reduced.

5. To treat incontinence, limit the use of indwelling bladder catheters.

The use of a catheter greatly raises the risk of a urinary tract infection (UTI). Each day that a urinary catheter is inserted, the risk of catheter-associated urinary tract infection rises. Regular toileting, for example, can help avoid illness. If an indwelling catheter is required, adhere to stringent guidelines to avoid infection and urosepsis.

Hyperthermia

Evidence of Hyperthermia include:

• Increase body temperature above the normal range.
• Flushed skin; warm to touch.

Desired Outcomes

• The client’s core temperature will remain within normal limits.

Nursing Assessment and Rationales

1. Assess for any indicators of a rise in body temperature.

Sweating, shivering, headaches, heated skin, and general malaise are all signs of an elevated body temperature.

2. Monitor vital signs, particularly fever, to determine the best course of action.

Nursing Interventions and Rationales

1. Provide a tepid sponge bath. To lower fever, take a tepid sponge bath.

2. Encourage sufficient fluid intake to avoid dehydration brought on by a rise in temperature.

3. Encourage using a hypothermia blanket and the use of bath towels to wrap the extremities. It aids in the prevention of shivering.

4. Stay in bed as much as possible to cut down on metabolic demands and oxygen usage.

5. Use antipyretic medications to lower body temperature.

Deficient Knowledge

Evidence of Deficient Knowledge include:

• Lack of questions.
• Multiple questions.
• Recurrent UTI.
• Verbalising inaccurate information.

Desired Outcomes

• The client verbalises knowledge of UTI causes and treatments, manages risk factors, and completes UTI medical therapy.

Nursing Interventions and Their Rationale

1. Educate the client on the causes, prevention, and treatment of urinary tract infections. UTI recurrences regularly could suggest that the client has trouble understanding the ailment and adhering to the prescribed treatment plan.

2. Instruct the client on how to avoid urinary tract infections.

The purpose of client education is to get rid of the current infection and prevent it from coming again. Interventions may include the following:

• Hygiene precautions (showering rather than bathing in a tub).
• Bacteria in the bathwater can get into the urethra and cause infection.
• Encourage people not to ignore the need to go to the bathroom.
• Urine stasis is a possibility.
• After a bowel movement, perform perineal hygiene.
• This will assist in preventing the infection from migrating into the urethral and vaginal openings in women.
• The significance of bladder emptying regularly.
• Bladder distention and a weakened blood supply to the bladder wall can be avoided by completely emptying the bladder. The consumer is predisposed to UTI as a result of these factors.
• Tampons should be used for periods. Tampons are preferred over sanitary napkins during menstruation because they keep the bladder opening area dry, preventing bacteria growth.
• Wearing non-breathing undergarments that are too tight or restrictive is not a good idea. Such textiles can absorb moisture and offer a breeding ground for bacteria. Cotton fabrics and clotting with a loose fit are preferred.