Week 7: UTI

UTI: High Risk Groups

• women of reproductive age

• older adults

• pregnant women

• catheter users

• diabetics (bacteria flourish with hyperglycemia)

• structural/functional urinary tract abnormalities

UTI: Sexual Intercourse

• irritation from latex

• urethra has possible exposure to bacteria

• urination after sex flushes bacteria

• correct wiping is needed

UTI: Bacteria

• 75% of cases is E. Coli

UTI: Upper Tract

• affects the kidneys and ureters

• fever, chills, flank pain

UTI: Lower Tract

• starts in the lower tract

• no systemic manifestations

• dysuria (burning during urination)

• frequent/urgent urination

UTIs with Older Adults

• can cause delirium

• new incontinence

UTI: Diagnostic Studies

• urinalysis

• urine culture & sensitivity

Trimethoprim-Sulfamethoxazole (TMP-SMX)

• treats empiric uncomplicated UTI

Phenazopyridine

• soothing effect on the urinary tract mucosa

  • only relieves symptoms, doesn’t treat

• stains urine reddish orange

UTI: Collaborative Management

• fluid intake (flushes out bacteria)

• void after intercourse

• cranberry juice (can help with pH levels)

• avoid caffeine, alcohol, chocolate, citrus juices, and highly spiced foods

Urinary Tract Calculi

• kidney stones

• caused by calcium stones

Urinary Tract Calculi: Clinical Manifestations

• manifestations result from obstruction of urinary flow

  • abdominal or flank pain

  • hematuria

  • cool, moist skin

  • UTI: fevers and chills

Types of Kidney Stones

1. calcium oxalate kidney stones: most common

2. calcium phosphate stones

3. uric acid: from eating too much animal protein

Urinary Tract Calculi: Cautions

• when to seek immediate help:

  • severe pain unrelieved by medication

  • inability to urinate

  • fever

  • heavy bleeding

Urinary Incontinence: Underreported

• embarrassment or stigma

• belief that it’s normal with aging

• lack of provider screening

• limited access to speciality care

Urinary Incontinence: Risk Factors

• caregiver or toilet unavailable

• cognitive disturbances

• diabetes

• immobility

• pelvic muscle weakness

Stress UI

• weakened external sphincter/ pelvic floor

• urine loss during sneezing, laughing, exercise, heavy lifting

• associated with vaginal childbirth, obesity, menopause, and aging

Urge UI

• can’t time bathroom breaks correctly

• older adults are most affected

Functional UI

• physical or psychological factors impair ability to get to the toilet

• associated with nursing home residents, dementia, Parkinson’s

Iatrogenic UI

• involuntary loss of urine

• extrinsic medical factors

  • medications (BP meds)

  • med d/c IU resolves

Mixed UI

• several types

Overflow UI

• overdistended bladder

• continued leakage of urine

• great risk for infection

Incontinence: Assessment/Diagnosis

• physical assessment

  • bladder distention

  • bladder scans

  • bowel habits

• urinalysis

• I&O

Incontinence: Collaborate Management

• smoking cessation

• caffeine and alcohol reduction

• weight reduction

• bowel management

• avoid bladder irritants

• bathroom schedule