Urinary Tract Infection (UTI)

bsc/nursing/obg/assignment/uti

Table Of Contents
  1. 1. Introduction
  2. 2. Definition
  3. 3. Anatomy and Physiology Review
  4. 4. Classification
  5. 5. Etiology (Causative Organisms)
  6. 6. Risk Factors
  7. 7. Pathophysiology
  8. 8. Clinical Manifestations
  9. 9. Diagnostic Evaluation
  10. 10. Medical Management
  11. 11. Nursing Management
  12. 12. Complications
  13. 13. Prevention
  14. 14. Prognosis
  15. 15. Conclusion
  16. 16. References

1. Introduction

Urinary Tract Infection (UTI) is one of the most common bacterial infections affecting people of all ages, particularly women due to their shorter urethra. It involves infection of any part of the urinary system — kidneys, ureters, bladder, or urethra.
UTI causes significant morbidity, especially among pregnant women, elderly individuals, and hospitalized patients with indwelling catheters.

2. Definition

According to WHO (2015):
“Urinary tract infection is the presence of significant microbial growth within the urinary tract in the presence of symptoms such as dysuria, frequency, urgency, or suprapubic pain.”

3. Anatomy and Physiology Review

The urinary system consists of:

  • Kidneys – filter waste and form urine.
  • Ureters – transport urine from kidneys to bladder.
  • Urinary bladder – stores urine.
  • Urethra – expels urine outside the body.

A UTI can affect any of these parts. Infections limited to the bladder are called cystitis, while those affecting the kidneys are called pyelonephritis.

4. Classification

A. Based on Site:

TypeSite of InfectionExample
Upper UTIKidneys & uretersPyelonephritis
Lower UTIBladder & urethraCystitis, Urethritis

B. Based on Severity:

  • Uncomplicated UTI – occurs in healthy individuals with no structural or functional abnormality.
  • Complicated UTI – associated with obstruction, catheterization, or renal disease.

5. Etiology (Causative Organisms)

  • Escherichia coli (most common)
  • Klebsiella pneumoniae
  • Proteus mirabilis
  • Pseudomonas aeruginosa
  • Enterococcus faecalis
  • Staphylococcus saprophyticus

6. Risk Factors

  • Poor personal hygiene
  • Short urethra in females
  • Sexual activity
  • Pregnancy
  • Diabetes mellitus
  • Urinary stasis or obstruction (e.g., stones, enlarged prostate)
  • Indwelling catheter or instrumentation
  • Suppressed immunity

7. Pathophysiology

  1. Bacterial entry occurs through the urethra.
  2. Colonization of periurethral area by uropathogenic bacteria.
  3. Ascending infection to bladder → cystitis.
  4. Infection may ascend further to kidneys → pyelonephritis.
  5. The infection triggers inflammatory response, leading to pain, dysuria, and urinary frequency.
  6. Severe cases may progress to bacteremia and sepsis.

8. Clinical Manifestations

Lower UTI (Cystitis):

  • Burning sensation during urination (dysuria)
  • Increased frequency and urgency
  • Suprapubic pain
  • Cloudy or foul-smelling urine
  • Low-grade fever

Upper UTI (Pyelonephritis):

  • High fever and chills
  • Flank or back pain
  • Nausea and vomiting
  • Costovertebral angle tenderness
  • Fatigue and malaise

9. Diagnostic Evaluation

  • Urine Routine Examination:
    • Presence of pus cells, RBCs, and bacteria.
  • Urine Culture and Sensitivity:
    • Confirms causative organism and antibiotic sensitivity.
  • Urinalysis (Dipstick test):
    • Positive for nitrites and leukocyte esterase.
  • Ultrasound of kidneys and bladder:
    • Detects obstruction or stones.
  • Blood tests:
    • CBC, renal function tests (BUN, creatinine) for systemic involvement.

10. Medical Management

A. Pharmacological Management

  1. Antibiotics:
    • Nitrofurantoin
    • Trimethoprim-sulfamethoxazole
    • Ciprofloxacin (for complicated cases)
    • Amoxicillin–clavulanic acid
  2. Analgesics and Antipyretics:
    • Paracetamol for fever and pain.
  3. Urinary Alkalizers:
    • Sodium citrate or potassium citrate to relieve dysuria.
  4. Fluid therapy:
    • Encourage 2–3 liters/day to flush bacteria.

B. Surgical Management

  • Correction of underlying obstruction (e.g., stones, strictures).
  • Catheter removal or replacement under aseptic conditions.

11. Nursing Management

Assessment

  • Monitor vital signs and temperature.
  • Assess urinary symptoms and pain.
  • Observe urine color, odor, and amount.
  • Maintain input–output chart.

Nursing Diagnoses

  1. Acute pain related to inflammation of the urinary tract.
  2. Impaired urinary elimination related to infection.
  3. Knowledge deficit regarding disease process and prevention.
  4. Risk for deficient fluid volume related to fever and frequency.
  5. Anxiety related to illness and discomfort.

Nursing Interventions

  • Encourage liberal oral fluids unless contraindicated.
  • Administer antibiotics and analgesics as prescribed.
  • Maintain perineal hygiene — front to back cleaning.
  • Encourage frequent voiding every 2–3 hours.
  • Avoid use of irritants (bubble baths, perfumed soaps).
  • Educate the patient about completing full course of antibiotics.
  • Provide comfort measures — warm compresses to abdomen.
  • Monitor for signs of complications such as fever, flank pain, or hematuria.

Health Education

  • Drink 8–10 glasses of water daily.
  • Empty bladder before and after sexual intercourse.
  • Avoid tight clothing and synthetic undergarments.
  • Maintain genital hygiene during menstruation and postpartum period.
  • Seek medical attention for recurrent symptoms.

12. Complications

  • Pyelonephritis
  • Renal abscess
  • Septicemia
  • Chronic kidney disease (CKD)
  • Urosepsis
  • Recurrent UTI

13. Prevention

  • Adequate hydration
  • Proper perineal care
  • Avoid unnecessary catheterization
  • Aseptic technique during urinary procedures
  • Early treatment of urinary infections
  • Health education for women and elderly patients

14. Prognosis

With early diagnosis and appropriate antibiotic treatment, the prognosis is excellent. Delay in management or recurrent infections can lead to renal scarring and long-term complications.

15. Conclusion

Urinary Tract Infection is a common and preventable condition that can lead to severe complications if untreated. Nurses play a vital role in early detection, patient education, and maintaining aseptic technique during care. Promoting personal hygiene and adequate hydration are key measures to prevent recurrence.

16. References

  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition.
  2. Lewis, S.M. Medical-Surgical Nursing, Elsevier.
  3. Park, K. Textbook of Preventive and Social Medicine, 27th Edition.
  4. WHO Guidelines on UTI Management, 2015.
  5. Dutta’s Textbook of Obstetrics and Gynecology (for pregnancy-related UTIs).