What are the nursing responsibilities in monitoring urinary tract infection?

Urinary Tract Infection with Nursing Management from Swatilekha Das

Urinary tract infections (UTIs) are the result of pathogens invading the urethra, bladder, and/or kidneys. They are one of the most common hospital-acquired infections. When this type of infection occurs as a result of urinary catheterization it is known as a catheter-associated urinary tract infection (CAUTI.) Many guidelines exist to help prevent nosocomial UTIs and CAUTIs.

Outside of healthcare settings, UTIs are more common amongst women and older adults. Early identification and treatment of urinary tract infections is important to prevent kidney damage and loss of renal function.

Causes

Many pathogens can cause urinary tract infections. These infections can develop when microbes from the perineum enter the urethra and proliferate inside the urinary tract. The bacteria typically responsible for this type of infection is Escherichia coli. However, some viruses and fungi can cause UTIs as well.

Signs and Symptoms

The most common symptoms of urinary tract infections are urinary urgency and frequency, along with painful urination or burning sensations when urinating. Other signs of UTIs are cloudy or foul-smelling urine, or blood in the urine. Flank, back, or suprapublic pain or tenderness may be symptoms of a more severe urinary tract infection. In older adults, cognitive changes or the onset of incontinence could be a sign of a UTI. As with other types of infections, fever, elevated white blood cell count, and fatigue are also indicators of a possible urinary tract infection.

Prevention

Patient education can play a key role in preventing UTIs. Ensuring patients are knowledgeable about proper hygiene and hydration techniques can prevent recurring urinary tract infections.  

For patients in hospitals or other care facilities, avoiding the use of urinary catheters when possible greatly reduces CAUTI rates. Aseptic catheter insertion techniques are also important to prevent nosocomial UTIs. For patients who are catheterized, regular and thorough perineal care and catheter care are vital for infection prevention.

Assessment

It is important to note that urinary tract infection is a medical diagnosis, not a nursing diagnosis. Therefore, nursing care plans should start with an applicable nursing diagnosis based on assessment of the patient and their current needs related to the urinary tract infection. Common nursing diagnoses associated with UTI treatment are pain, hyperthermia, impaired urinary elimination and altered sleep. 

Nursing Care Plans for Urinary Tract Infection

The following are four example nursing care plans for caring for a patient with a urinary tract infection.

Urinary tract infections can vary from mild to life-threatening. Proper nursing assessment and care can identify infections early and improve patient outcomes. Remember, a variety of nursing diagnoses and planned interventions may be appropriate for a patient suffering from a urinary tract infection.

Nursing Care Plan 1

Nursing Diagnosis: Acute pain related to urinary tract infection as evidenced by cloudy, foul-smelling urine, patient reports of burning sensation when urinating, and suprapubic cramping and pain rated 7/10. 

Desired Outcome: Within 4 hours of nursing interventions, the patient will report pain reduced to a 4/10 or less.

Intervention Rationale Apply a heating pad to the suprapubic area. Heat therapy relieves pain and relaxes muscles. Administer the appropriate prescribed analgesic. Analgesic drugs like NSAIDS, reduce acute pain quickly and effectively, and will provide relief from pain caused by a UTI. Teach the patient how to use a sitz bath. Sitz baths may reduce pain and bladder spasms caused by a UTI. Reassess pain level after 30 minutes of interventions. It is important to reassess pain following interventions to determine if those actions were effective, and the patient’s pain control goals have been met. Moving attention away from the painful stimuli by using effective distraction techniques. Provide appropriate and engaging distraction for the patient to redirect their attention. Moving attention away from the painful stimuli by using effective distractors can reduce the amount of pain perceived by the patient. 

Nursing Care Plan 2

Nursing Diagnosis: Hyperthermia related to urinary tract infection as evidenced by oral temperature 100.7 degrees Fahrenheit and flushed skin. 

Desired Outcome: Within 2 hours of nursing interventions, the patient will have core temperature within normal range.

Intervention Rationale Administer antibiotics as ordered. Antibiotics will treat the infection that is causing the fever. Administer antipyretics as ordered. Antipyretics such as acetaminophen will quickly lower body temperature. Encourage the patient to rest. Resting reduces metabolic demands on the body that may increase body temperature. Assess the patient’s vital signs, including core temperature every four hours. Heart rate and blood pressure increase and hyperthermia progresses. Core temperature readings are more accurate than oral thermometers. Encourage the patient to increase oral fluid intake. Oral fluid intake will prevent dehydration. Dehydration can contribute to fever. 

Nursing Care Plan 3

Nursing Diagnosis: Impaired urinary elimination related to urinary tract infection as evidenced by patient reports of dysuria, urinary urgency, and urinary incontinence. 

Desired Outcome: Within 2 weeks of nursing interventions, the patient will demonstrate improvement in urinary patterns and control of urinary elimination.

Intervention Rationale Assess the patient’s urinary elimination patterns Determining a baseline of the patient’s current elimination patterns will help determine appropriate interventions and evaluate their effectiveness. Encourage the patient to finish all prescribed courses of antibiotics. Antibiotics treat the infection that is causing the disruption in their urinary elimination. To maximize effectiveness, it is important that the patient continues to finish their antibiotics even once some of their symptoms have resolved. Instruct the patient to void every 2-3 hours. Proactive voiding will prevent the accumulation of urine and bacteria in the bladder. Scheduled voids can also reduce the number of incontinence episodes the patient experiences. Suggest the patient drink cranberry juice, prune juice, or supplement vitamin C if approved by a physician. These substances acidify urine and create an environment in which it is difficult for bacteria to grow. 

Nursing Care Plan 4

Nursing Diagnosis: Disturbed sleep pattern related to urinary tract infection as evidenced by nocturia, unintentional waking, and patient reports of dissatisfaction with sleep. 

Desired Outcome: Within 2 days of nursing interventions, the patient will report satisfaction with sleep.

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