Urinary Tract Infection and Pathophysiology of UTI - Coursework Example

Urinary Tract Infection Name Institution Date Urinary Tract Infection Introduction Mrs. HK is a 78 year old Caucasian female who I had the privilege to take care of on August 22-23, 2013. Her religious affiliation is Lutheran. She graduated high school but did not attend college. Her career choice was homemaker and farmer. HK is married with no children, but enjoys playing with her dogs. HK has Medicare along with BlueCross Blue Shield. HK is considered to be in the middle class of society. HK’s admitting diagnosis was Urinary Tract Infection (UTI). However, HK had an extensive health history of aortic stenosis, encephalopathy, CVA, COPD, ESRD, anemia, sepsis, hyperlipidemia, CHF, and MI. research shows that not less than four million visits to the doctor’s office every year in America is basically for UTIs. Around 50% of women and 12% of men will get a UTI in the course of their lifetime. It is evidence that women are mostly infected by UTI (Epp et al, 2010). This paper discusses various issues related to UTI in relation to Mrs. HK. Pathophysiology of UTI The UTI pathophysiology entails the infection of organs of the urinary tract like bladder, kidneys, ureters, and urethra (Kodner & Gupton, 2010). Even though various microorganisms can bring about UTI, UTI pathophysiology is generally similar for every organism. Standard urine is actually sterile, however, once there is an occurrence of urinary infection that is bacterial, microorganisms penetrate the urethra and might ascend to different urinary system’s parts. It is hence important to manage UTI so that complications can be avoided (Litza & Brill, 2010). Bacterial agents, like Escherichia coli (E. coli), might be moved from a person’s anus to the opening of the urethra, resulting in urethral infection (Epp et al, 2010). One of the organisms that dwells within the colon and comes out during defecation in the stool is E. coli (Litza & Brill, 2010). This is why the relationship involving the urethra and the anus explains why occurrence of UTI is more common in women unlike in men. The urethral and anal openings in women are nearer to one another, and the length of the urethra is shorter. This results in easier translocation as well as ascension of the bacteria to the urinary tract’s upper regions (Litza & Brill, 2010). Various risk factors are responsible for UTI’s pathophysiology. Congenital anatomical anomalies as well as acquired disease, like kidney stones, can put a person at risk of acquiring UTI (Kodner & Gupton, 2010). Among individuals who are sexually active, the regularity of intercourse together with the intercourse mode increases the risk of UTI. Immunocompromised states, like diabetes, can lead to increased risk of UTI since the body’s immune cells do not have the capacity to fight the infection (Litza & Brill, 2010). Clinical Manifestations: Signs and Symptoms The symptoms of UTI vary with regards to the infected region of the urinary tract (Epp et al, 2010). The symptoms of urethritis or urethra infection might be narrowed to increased rate of urination and burning pain in the course of urination, termed as dysuria (Horl, 2011). With cystitis or bladder infection, there might be extra symptoms of pain within the pubic or abdominal regions, and a low-grade fever as well (Litza & Brill, 2010). Symptoms of pyelonephritis, or kidney infection, include chills, fever, vomiting, and nausea. In some situations, blood in the urine as well as loss of appetite might be experienced (Horl, 2011). Diagnosis The UTI’s clinical diagnosis is basically based on the patient’s medical history (Kodner & Gupton, 2010). Definite data might either raise the likelihood of a UTI or decrease it. Some of the factors have actually been ascertained from medical studies. Increased nycturia, pollakisuria, dysuria; increased or present incontinence; increased macrohematuria; increased suprapubic pain; increased turbid urine, offensive smell; increased previous urinary tract infections; and vaginal irritation, new or changed discharge (Kodner & Gupton, 2010). Urine testing is considered the second significant factor during diagnostic testing (Kodner & Gupton, 2010). The gold principle of urine tests is to carry out a bacteriological culture of the urine, with pathogen identification, with sensitivity and quantification testing (Kodner & Gupton, 2010). To analysis whether a patient has UTI, orientating indirect approaches are frequently applied in practice so as to detect inflammation or the bacteria (dip stick) (Litza & Brill, 2010). The count of bacteria might be accessed through urine microscopy as well as culture media immersion. Dip sticks are considered the most commonly used mechanisms for diagnostic examination in case there is clinical proof that a patient has UTI (Horl, 2011). Multistix are commonly used since they detect nitrite (the urinary tract typical pathogens’ metabolic product), blood, protein, and leukocyte esterase (as an inflammation marker). Once there is detection of nitrite, the UTI’s probability is increased, with a possibility ratio of 2.6-10.6. On the other hand, the sensitivity is moderately low (Kodner & Gupton, 2010). On the contrary, leukocyte esterase detection increases the possibility to a lower extent (1.0-2.6). Blood detection is admittedly very sensitive, even thought the specificity is somehow low. Research data are not consistent concerning protein detection’s value in UTI confirmation (Horl, 2011). Medical Management and Nursing Implications The antimicrobial therapy’s goal is to eradicate the infecting microorganisms out of the urinary tract as well as provide the symptoms’ resolution. It is important to consider various factors when choosing an antibiotic for UTI, like the allergy history of the patient, the tolerability and cost of treatment, previous therapy of antibiotic, and most imperative, resistance prevalence within the community. One of the antimicrobial agents is trimethoprim-sulfamethoxazole, which for ages has been regarded the typical therapy for recurrent and acute UTI due to its action against the most frequent uropathogens as well as its tolerability and low cost (Litza & Brill, 2010). The synergistic mixture of sulfamethoxazole and trimethoprim operates at two different stages of the folate metabolism of the bacteria, leading to the DNA synthesis inhibition (Litza & Brill, 2010). Patients who have allergy to sulfa can be given trimethoprim alone since studies indicated a similar rate of cure with timethoprim-sulfamethoxazole (Kodner & Gupton, 2010). Fluoroquinolones are considered antibiotics with broad-spectrum that cause inhibition of topoisomerase IV and topoisomerase II (DNA gyrase) (Kodner & Gupton, 2010). Even though the activity’s spectrum differs among fluoroquinolones, all of them have good-excellent action against clinically significant uropathogens that are gram-negative, S saprophyticus, and other Enterobacteriaceae. Levofloxacin and ciprofloxacin are considered the most frequently used fluoroquinolones for UTIs and cause least side effects like diarrhea, photosensitivity, dizziness, nausea, and headache (Kodner & Gupton, 2010). The nurse needs to consider the patient’s history of allergy. Additionally, observe the patient for any signs of unwanted effects. Patient History and Physical Examination The patient had a past medical history of aortic stenosis, COPD, CAD, CHF, Hyperlipidemia, CVA, ESRD, anemia, MI, sepsis, diabetes II, and dimentia. The patient is allergic to sulfa and vasotec. Her medical information was collected from the patient’s chart. She is put on dialysis. Her treatments include IV solution on the left forearm. She has dressings and changes; duoderm on right upper back, duoderm on right forearm, dry dressing bilateral lower extremities, suture on right deltoid area. Her care involves changed dry dressing on r-lower leg and l-lower leg applied 4×4, and kurlex. The patient needs maximum support with regards to ADL; she is considered middle class in the society. Her payment sources are Blue Cross Blue Shield and Medicaid. She was a farmer. She has four dogs that she loves to play with. She graduated from high school. With regards to developmental needs using Erickson’s level: integrity vs. despair; the patient is remorseful concerning unhealthy lifestyle and smoking history. On subjective examination (oxygenation/ventilation) the patient denies smoking within the past year but was a lifelong smoker. She also denies SOB, and does not complain of cough. On objective examination, her respiratory rate is 19bpm. Her O2 saturation is 93%, capillary refill of 1-2secs, muscular weakness, platelete count of 208. The subjective examination on circulation is that she denies chest pain. On objective examination, her mucous membranes of mouth is moist and pink. There is full sensation to palpations and touch on the lower and upper extremities. On nutrition/fluids, the patient asked for her breakfast and lunch tray because she was hungry. Objective examination shows that Mrs. HK weighs 178 lbs, she is on renal diet, consumed 80% of breakfast, her bowel sounds are normal in every 4 quadrants (soft and nondistended abd), no urine voided, and the last bowel was seen on 08/22/2013, which was soft and brown. Subjective assessment on regulation (neurological), the patient denies any fatigue or weakness. On the objective assessment, her temperature is 34.6 degree Celsius. She is able to appropriately answer questions and comment; coordinated enough to assist with ADL’s. She is pleasant, requires maximum assistance, and is confined to bed. On stimulation, subjective assessment indicates that she does not have any problem with hearing/vision. No artificial aids. Subjective examination on comfort (pain) the patient rated her pain as a 3 on a 1 to 10 scale. She also complained of pain when completing dressing change on legs. Objectively, no facial grimacing, her pain was managed by tyenol. The subjective examination on activity/rest, the patient needed maximum assistance with ADLs. She states difficulty getting up and changing positions. Objectively, she took frequent rest periods and naps in-between care. On elimination, the patient states she usually has BM every other day in the morning. Objectively, her bowel sounds are normal, no distension of the abdomen, and BUN is 8.6. On safety, the patient denies any falls in the past few months. Objectively, the patient has redness on her buttocks, a barrier cream was applied. Pt. has tear right lower leg- no drainage- changed dressing cleaned wound with wound cleanser and applied 4*4 with kerlex. The patient has tear left lower leg- changed dressing wound has well defined borders with serousangious drainage- cleaned with wound cleaner applied 4*4 with kerlex. Braden score 15. Side rails up *3, bed in low position. Pt. has Permacath right chest wall covered with transparent dressing. On hygiene, the patient stated that she needed help getting a bath. Objectively, her hygiene is good, no odor or secretions noted, maximum aid with AM care, her skin is warm to touch, dry, and intact. On psychosocial examination, the patient is pleasant and polite. She is cooperative and allowed for physical assessment. Nursing Diagnoses There are various nursing diagnosis that are pertinent to the patient’s condition. One of the nursing diagnoses is impaired tissue integrity related to diabetes, anemia, hemodialysis, and impaired immobility and altered circulation, as evidenced by quarter size slow healing left leg ulcer, skin tear on right lower leg, skin tears bilaterally on both arms, skin tear on upper back. The second nursing diagnosis is infection related diabetes, anemia, ESRD, impaired immobility and altered circulation, hemodialysis as evidenced by quarter size slow healing left leg ulcer, skin tear in right lower leg, skin tears bilaterally on both arms, skin tear on upper back. The last nursing diagnosis is impaired urinary elimination related to UTI, ESRD, dialysis as evidenced by no urine output. Nursing Interventions One of the nursing interventions for Mrs. HK is to monitor signs that indicate adequacy of tissue perfusion. The rationale behind this is to establish the early impaired perfusion’s signs such as reduced body temperature. Her examination indicates 34 degrees Celsius, referred to as hypothermia. In order to manage hypothermia, it is important for the nurse to make sure that the patient gets sufficient fluids because fluid loss leads to hypothermia (Gulanick & Myers, 2013) and is kept warm as well. The rationale of managing hypothermia is to prevent shock. Provision of oxygen is essential so as to maintain O2 above 95% on RA. With regards to the second nursing diagnosis, skin care should be mandatory in reference to performing good technique of hand washing and aseptic technique during dressing. The rationale behind this is to prevent nosocomial infections (Gulanick & Myers, 2013). Additionally, glucose levels within the blood provide the optimum medium for germs’ development (Gulanick & Myers, 2013). Collaboration antibiotics should be administered as indicated to prevent sepsis onset (Gulanick & Myers, 2013). With respect to the last nursing diagnosis, it is important to assess elimination pattern of the patient. This provides a foundation for interventions’ determination. It is also essential to encourage Mrs. HK to take a lot of water and decrease intake during afternoon. The rationale is to support the flow of renal blood as well as make the urinary tract clean without bacteria (Gulanick & Myers, 2013). Nutritional/Dietary Concerns Nutrition has a significant role in determining the health of people who are above 65 years of old (Litza & Brill, 2010). With regards to Mrs. HK’s diagnosis, it is pertinent to advice for proper vitamins and nutrients. The rationale behind this is that the balance of proper diet entails proteins as well as sufficient hydration, required for the healing process. The patient should take sufficient fluids, like water and herbal teas. Avoiding sweetened drinks is important. Blueberries and cranberries entail substances that cause inhibition of bacteria binding to the tissue of bladder (Guay, 2009). These fruits are also rich in antioxidant essential to the body. Refined foods like pasta, white breads should be avoided. Foods rich in high fiber like oats and beans should be encouraged. Psychosocial/Spiritual and Physical Reactions Mrs. HK is pleasant and polite. She was cooperative and allowed for physical assessment to be carried out and VS to be obtained. She was very cooperative and willing to share information. With her religious background, she was able to appreciate that her condition is just a normal situation in old age and was positive about recovery. However, she cited some of the factors that might hinder her healing process such as total dependence because she is not able to carry out her daily activities normally. She is also remorseful about smoking history and unhealthy lifestyle. The good thing is that she is not giving up on this battle just yet. Discharge Plan Mrs. HK lives with her husband although her husband has not come to visit because he is physically not able to do so. The hospital is currently looking into DSS since neither the patient nor the husband can adequately care for themselves. The patient states that she understands the significance of taking all of her medication. She can also state that the signs and symptoms of a UTI are; urge to urinate, burning upon urination, urine that appears cloudy, strong smelling urine, and pelvic pain. Mrs. HK is ready to join any rehabilitation facility that the hospital will help her find. Summary The knowledge that I have acquired from this paper has changed my attitude, particularly for aged patients with multiple illnesses. For instance, Mrs. HK had various diseases with regards to her past medical history. But, she still has a positive attitude towards getting healed. Despite her need to have maximum assistance with regards to ADL, she still wishes to go home and play with her dogs that she loves. This implies her positive passion for life. Mrs. HK was so pleasant, polite, and cooperative making it very easy to work with her. When taking care of a patient, I have learnt that it is important to look beyond the patient’s disease because that is what a comprehensive care is all about. Reference Epp, A., Larochelle, A., Lovatsis, D., Walter, J., Easton, W. & Farrell, S. (2010). Recurrent urinary tract infection. J Obstet Gynaecol Can, 32(11):1082-101. Guay, D. (2009). Cranberry and urinary tract infections. Drugs, 69(7):775-807. Horl, W. (2011). Urinary Tract Infections. Internist, 52(9):1026,1028-31. Kodner, C. & Gupton, E. (2010). Recurrent urinary tract infrections in women: diagnosis and management. Am Fam Physician, 82(6):638-43. Litza, J. & Brill, J. (2010). Urinary Tract Infactions. Primary Care: Clinics in Office Practice. Philadelphia, PA: WB Saunders Company. 37(3). Gulanick, M. & Myers, J. (2013). Nursing Care Plans: Nursing Diagnosis and Intervention. New York: Elsevier Health Sciences. Read More