8/3/2019 AGE UTI

1/8

Acute Gastro Enteritis

-Also known as gastro, gastric flu, and stomach flu, although unrelated toinfluenza is inflammation of the gastrointestinal tract, involving both the

stomach and the small intestine (see also gastritis and enteritis) and resultingin acute diarrhea. The inflammation is caused most often by infection withcertain viruses, less often by bacteria or their toxins, parasites, or adversereaction to something in the diet or medication. Worldwide, inadequatetreatment of gastroenteritis kills 5 to 8 million people per year, and is aleading cause of death among infants and children under 5.

At least 50% of cases of gastroenteritis as foodborne illness are due tonorovirus. Another 20% of cases, and the majority of severe cases in children,are due to rotavirus. Other significant viral agents include adenovirus andastrovirus.

Different species of bacteria can cause gastroenteritis, including Salmonella,Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli,Yersinia, and others. Some sources of the infection are improperly preparedfood, reheated meat dishes, seafood, dairy, and bakery products. Eachorganism causes slightly different symptoms but all result in diarrhea. Colitis,inflammation of the large intestine, may also be present.

Risk factors are consumption of improperly prepared foods or contaminatedwater and travel or residence in areas of poor sanitation. The incidence is 1 in1,000 people.

Signs and Symptoms:

Gastroenteritis often involves stomach pain or spasms (sometimes to the pointof being crippled), diarrhea and/or vomiting, with noninflammatory infectionof the upper small bowel, or inflammatory infections of the colon.

It usually is of acute onset, normally lasting fewer than 10 days and self-limiting.

Nausea and vomiting Diarrhea Loss of appetite Abdominal pain Abdominal cramps Bloody stools (dysentery - suggesting infection by amoeba,

Campylobacter, Salmonella, Shigella or some pathogenic strains ofEscherichia coli)

Fainting and Weakness

http://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Gastritishttp://en.wikipedia.org/wiki/Enteritishttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Astrovirushttp://en.wikipedia.org/wiki/Salmonellahttp://en.wikipedia.org/wiki/Shigellahttp://en.wikipedia.org/wiki/Staphylococcushttp://en.wikipedia.org/wiki/Campylobacter_jejunihttp://en.wikipedia.org/wiki/Clostridiumhttp://en.wikipedia.org/wiki/Escherichia_colihttp://en.wikipedia.org/wiki/Yersiniahttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Small_bowelhttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Acute_(medical)http://en.wikipedia.org/wiki/Self-limiting_(biology)http://en.wikipedia.org/wiki/Self-limiting_(biology)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Gastritishttp://en.wikipedia.org/wiki/Enteritishttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Astrovirushttp://en.wikipedia.org/wiki/Salmonellahttp://en.wikipedia.org/wiki/Shigellahttp://en.wikipedia.org/wiki/Staphylococcushttp://en.wikipedia.org/wiki/Campylobacter_jejunihttp://en.wikipedia.org/wiki/Clostridiumhttp://en.wikipedia.org/wiki/Escherichia_colihttp://en.wikipedia.org/wiki/Yersiniahttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Small_bowelhttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Acute_(medical)http://en.wikipedia.org/wiki/Self-limiting_(biology)http://en.wikipedia.org/wiki/Self-limiting_(biology)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Dysentery

8/3/2019 AGE UTI

2/8

The main contributing factors include poor feeding in infants. Diarrhea iscommon, and may be (but not always) followed by vomiting. Viral diarrheausually causes frequent watery stools, whereas blood stained diarrhea may beindicative of bacterial colitis. In some cases, even when the stomach is empty,bile can be vomited up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, run a lowfever, have signs of dehydration (which include dry mucous membranes),tachycardia, reduced skin turgor, skin color discoloration, sunken fontanelles,sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion andultimately shock.

Symptoms occur for up to 6 days on average. Given appropriate treatment,bowel movements will return to normal within a week after that.

Treatment:

The objective of treatment is to replace lost fluids and electrolytes. Oralrehydration is the preferred treatment offluid and electrolyte losses caused bydiarrhea in children with mild to moderate dehydration .

Rehydration

Regardless of cause, the principal treatment of gastroenteritis (and of all otherdiarrheal illnesses) in both children and adults is rehydration, i.e.replenishment of water lost in the stools. Depending on the degree ofdehydration, this can be done by giving the person oral rehydration therapy

(ORT) or through intravenous delivery. ORT can begin before dehydrationoccurs, and continue until the person's urine and stool output return to normal.

People taking diuretics ("water pills") need to be cautious with diarrhea andmay need to stop taking the medication during an acute episode, as directed bythe health care provider.

Dietary therapy

Centers for Disease Control and Prevention recommendations for infants andchildren include: Breastfed infants should continue to be nursed on demand.

Formula-fed infants should continue their usual formula immediately uponrehydration in amounts sufficient to satisfy energy and nutrient requirements,and at the usual concentration. Lactose-free or lactose-reduced formulasusually are unnecessary. Children receiving semisolid or solid foods shouldcontinue to receive their usual diet during episodes of diarrhea. Foods high insimple sugars should be avoided because the osmotic load might worsendiarrhea; therefore, substantial amounts of soft drinks (carbonated or flat),juice, gelatin desserts, and other highly sugared liquids should be avoided.

http://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)http://en.wikipedia.org/wiki/Fluidhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Fluidhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Diureticshttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)http://en.wikipedia.org/wiki/Fluidhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Fluidhttp://en.wikipedia.org/wiki/Electrolytehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Rehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Oral_rehydration_therapyhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Diureticshttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Osmosis

8/3/2019 AGE UTI

3/8

Fatty foods should not be avoided, because maintaining adequate calorieswithout fat is difficult, and fat might have an added benefit of reducingintestinal motility. The practice of withholding food for more than 24 hours isinappropriate.

The BRAT diet is recommended to lessen the severity of diarrhea (Bananas,Rice, Applesauce, Toast (and Tea)).

Probiotics

Probiotics have been shownto be beneficial in preventing and treating variousforms of gastroenteritis.

Zinc

The World Health Organization recommends that infants and children receive a

dietary supplement ofzinc for up to 2 weeks after onset of gastroenteritis.[17]

Drug therapy

Antibiotics

When the symptoms are severe one usually starts empirical antimicrobialtherapy, i.e. a fluoroquinolone antibiotic. Pseudomembranous colitis is treatedby discontinuing the causative agent and starting with metronidazole orvancomycin.

Antibiotics usually are not given for gastroenteritis, although they may be givendue to some bacteria.

Antidiarrheal agents

Loperamide is an opioid analogue commonly used for symptomatic treatment ofdiarrhea. It slows down gut motility, but does not cross the mature blood-brainbarrier to cause the central nervous effect of other opioids. In too high doses,loperamide may cause constipation and significant slowing down of passage offeces, but an appropriate single dose will not slow down the duration of thedisease. Although antimotility drugs have the risk of exacerbating the

condition, this fear is not supported by clinical experience. Nevertheless,others discourage the use of antiperistaltic agents and opiates in febriledysentery, since they may mask, or exacerbate the symptoms. All these sourcesagree that in severe colitis antimotility drugs should not be used.

Loperamide prevents the body from flushing toxins from the gut, and shouldnot be used when an active fever is present or there is a suspicion that the

http://en.wikipedia.org/wiki/Caloriehttp://en.wikipedia.org/wiki/Motilityhttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Dietary_supplementhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-16http://en.wikipedia.org/wiki/Fluoroquinolonehttp://en.wikipedia.org/wiki/Pseudomembranous_colitishttp://en.wikipedia.org/wiki/Metronidazolehttp://en.wikipedia.org/wiki/Vancomycinhttp://en.wikipedia.org/wiki/Loperamidehttp://en.wikipedia.org/wiki/Opioidhttp://en.wikipedia.org/wiki/Peristalsishttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Caloriehttp://en.wikipedia.org/wiki/Motilityhttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Dietary_supplementhttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-16http://en.wikipedia.org/wiki/Fluoroquinolonehttp://en.wikipedia.org/wiki/Pseudomembranous_colitishttp://en.wikipedia.org/wiki/Metronidazolehttp://en.wikipedia.org/wiki/Vancomycinhttp://en.wikipedia.org/wiki/Loperamidehttp://en.wikipedia.org/wiki/Opioidhttp://en.wikipedia.org/wiki/Peristalsishttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Dysentery

8/3/2019 AGE UTI

4/8

diarrhea is associated with organisms that can penetrate the intestinal walls,such as E. coli O157:H7 or Salmonella.

Loperamide is also not recommended in children, especially in children youngerthan 2 years of age, as it may cause systemic toxicity due to an immature blood

brain barrier, and oral rehydration therapy remains the main stay treatment forchildren.

Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth andsalicylate, is another drug that can be used in mild-moderate cases.

Combining an antimicrobial drug and an antimotility drug, seems to beeffective more rapidly.

Antiemetic drugs

If vomiting is severe, antiemetic drugs may be helpful. Ondansetron has someclinical utility in this condition with a single dose associated with reduced useof intravenous fluids, fewer hospitalizations, and decreasing nausea andvomiting.

Nursing Responsibilities:

Ensure adequate hydration.Encourage to increase fluid intake.Encourage to consume fruits rich in Vitamins and minerals.Encourage to have a adequate sleep.

Marwin E. ObmergaBSN-IIIGroup 17

http://en.wikipedia.org/wiki/E._coli_O157:H7http://en.wikipedia.org/wiki/Salmonellahttp://en.wikipedia.org/wiki/Bismuth_subsalicylatehttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Ondansetronhttp://en.wikipedia.org/wiki/E._coli_O157:H7http://en.wikipedia.org/wiki/Salmonellahttp://en.wikipedia.org/wiki/Bismuth_subsalicylatehttp://en.wikipedia.org/wiki/Antiemetichttp://en.wikipedia.org/wiki/Ondansetron

8/3/2019 AGE UTI

5/8

Urinary Tract Infection

A urinary tract infection (UTI) is a bacterial infection that affects any part ofthe urinary tract. Although urine contains a variety of fluids, salts, and wasteproducts, it usually does not have bacteria in it. When bacteria get into the

bladder or kidney and multiply in the urine, they cause a UTI. The mostcommon type of UTI is a bladder infection which is also often called cystitis.Another kind of UTI is a kidney infection, known as pyelonephritis, and is muchmore serious. Although they cause discomfort, urinary tract infections canusually be quickly and easily treated with a short course of antibiotics. Studieshave shown that breastfeeding can reduce the risk of UTI's in infants.

Signs and Symptoms:

For bladder infections

Frequent urination along with the feeling of having to urinate eventhough there may be very little urine to pass.

Nocturia: Need to urinate during the night. Urethritis: Discomfort or pain at the urethral meatus or a burning

sensation throughout the urethra with urination (dysuria). Pain in the midline suprapubic region. Pyuria: Pus in the urine or discharge from the urethra. Hematuria: Blood in urine. Pyrexia: Mild fever Cloudy and foul-smelling urine

Increased confusion and associated falls are common presentations toEmergency Departments for elderly patients with UTI.

Some urinary tract infections are asymptomatic. Protein found in the urine.

For kidney infections

All of the above symptoms. Emesis: Vomiting is common.

Back, side (flank) or groin pain. Abdominal pain or pressure.

Shaking chills and high spiking fever. Night sweats. Extreme fatigue.

Diagnosis

A patient with dysuria (painful voiding) and urinary frequency generally has aspot mid-stream urine sample sent for urinalysis, specifically the presence of

http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Urinary_tracthttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Urinary_bladderhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Cystitishttp://en.wikipedia.org/wiki/Pyelonephritishttp://en.wikipedia.org/wiki/Frequent_urinationhttp://en.wikipedia.org/wiki/Urinatehttp://en.wikipedia.org/wiki/Nocturiahttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Urinary_meatushttp://en.wikipedia.org/wiki/Urinationhttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Pubichttp://en.wikipedia.org/wiki/Pyuriahttp://en.wikipedia.org/wiki/Hematuriahttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Emesishttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Urinalysishttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Urinary_tracthttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Urinary_bladderhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Cystitishttp://en.wikipedia.org/wiki/Pyelonephritishttp://en.wikipedia.org/wiki/Frequent_urinationhttp://en.wikipedia.org/wiki/Urinatehttp://en.wikipedia.org/wiki/Nocturiahttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Urinary_meatushttp://en.wikipedia.org/wiki/Urinationhttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Pubichttp://en.wikipedia.org/wiki/Pyuriahttp://en.wikipedia.org/wiki/Hematuriahttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Asymptomatichttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Emesishttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Night_sweatshttp://en.wikipedia.org/wiki/Dysuriahttp://en.wikipedia.org/wiki/Urinalysis

8/3/2019 AGE UTI

6/8

nitrites, leukocytes or leukocyte esterase. If there is a high bacterial loadwithout the presence of leukocytes, it is most likely due to contamination. Thediagnosis of UTI is confirmed by a urine culture.

If the urine culture is negative:

symptoms of urethritis may point at Chlamydia trachomatis or Neisseriagonorrheae infection.

symptoms of cystitis may point at interstitial cystitis. in men, prostatitis may present with dysuria.

In severe infection, characterized by fever, rigors or flank pain, urea andcreatinine measurements may be performed to assess whether renal functionhas been affected.

Most cases of lower urinary tract infections in females are benign and do not

need exhaustive laboratory work-ups. However, UTI in young infants mustreceive some imaging study, typically a retrograde urethrogram, to ascertainthe presence/absence of congenital urinary tract anomalies. Males too must beinvestigated further. Specific methods of investigation include x-ray, NuclearMedicine, MRI and CAT scan technology.

Treatment

Most uncomplicated UTIs can be treated with oral antibiotics such astrimethoprim, cephalosporins, nitrofurantoin, o r a fluoroquinolone (e.g.,ciprofloxacin or levofloxacin). Trimethoprim is probably the most widely used

antibiotic for UTIs and is usually taken for 7 days. It is often recommended thattrimethoprim be taken at night to ensure maximal urinary concentrations andincrease its effectiveness. Whilst co-trimoxazole was previously internationallyused (and continues to be used in the U.S.), the additional of the sulfonamidegave little additional benefit compared to the trimethoprim component alone,but was responsible for its high incidence of mild allergic reactions and rarebut serious complications.

If the patient has symptoms consistent with pyelonephritis, intravenousantibiotics may be indicated. Regimens vary, usually Aminoglycosides (such asGentamicin) are used in combination with a beta-lactam, such as Ampicillin or

Ceftriaxone. These are continued for 48 hours after fever subsides. The patientmay then be discharged home on oral antibiotics for a further 5 days.

If the patient makes a poor response to IV antibiotics (marked by persistentfever, worsening renal function), then imaging is indicated to rule outformation of an abscess either within or around the kidney, or the presence ofan obstructing lesion such as a stone or tumor.

http://en.wikipedia.org/wiki/Nitritehttp://en.wikipedia.org/wiki/Leukocytehttp://en.wikipedia.org/wiki/Leukocyte_esterasehttp://en.wikipedia.org/wiki/Microbiological_culturehttp://en.wikipedia.org/wiki/Chlamydia_trachomatishttp://en.wikipedia.org/wiki/Neisseria_gonorrheaehttp://en.wikipedia.org/wiki/Neisseria_gonorrheaehttp://en.wikipedia.org/wiki/Interstitial_cystitishttp://en.wikipedia.org/wiki/Prostatitishttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Rigor_(medicine)http://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Renal_functionhttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Computed_Axial_Tomographyhttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Trimethoprimhttp://en.wikipedia.org/wiki/Cephalosporinhttp://en.wikipedia.org/wiki/Nitrofurantoinhttp://en.wikipedia.org/wiki/Fluoroquinolonehttp://en.wikipedia.org/wiki/Ciprofloxacinhttp://en.wikipedia.org/wiki/Levofloxacinhttp://en.wikipedia.org/wiki/Co-trimoxazolehttp://en.wikipedia.org/wiki/Sulfonamidehttp://en.wikipedia.org/wiki/Pyelonephritishttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Aminoglycosideshttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Nitritehttp://en.wikipedia.org/wiki/Leukocytehttp://en.wikipedia.org/wiki/Leukocyte_esterasehttp://en.wikipedia.org/wiki/Microbiological_culturehttp://en.wikipedia.org/wiki/Chlamydia_trachomatishttp://en.wikipedia.org/wiki/Neisseria_gonorrheaehttp://en.wikipedia.org/wiki/Neisseria_gonorrheaehttp://en.wikipedia.org/wiki/Interstitial_cystitishttp://en.wikipedia.org/wiki/Prostatitishttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Rigor_(medicine)http://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Renal_functionhttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Computed_Axial_Tomographyhttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Trimethoprimhttp://en.wikipedia.org/wiki/Cephalosporinhttp://en.wikipedia.org/wiki/Nitrofurantoinhttp://en.wikipedia.org/wiki/Fluoroquinolonehttp://en.wikipedia.org/wiki/Ciprofloxacinhttp://en.wikipedia.org/wiki/Levofloxacinhttp://en.wikipedia.org/wiki/Co-trimoxazolehttp://en.wikipedia.org/wiki/Sulfonamidehttp://en.wikipedia.org/wiki/Pyelonephritishttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Aminoglycosideshttp://en.wikipedia.org/wiki/Abscess

8/3/2019 AGE UTI

7/8

As an at-home treatment, increased water-intake, frequent voiding, theavoidance of sugars and sugary foods, drinking unsweetened cranberry juice,taking cranberry supplements, as well as taking vitamin C with the last meal ofthe day can shorten the time duration of the infection. Sugars and alcohol canfeed the bacteria causing the infection, and worsen pain and other symptoms.

Vitamin C at night raises the acidity of the urine, which retards the growth ofbacteria in the urinary tract. However, if pain is in the back region (suggestingkidney infection) or if pain persists, if there is fever, or if blood is present inthe urine, doctor care is recommended.

In complementary and alternative medicine, D-mannose pills are advocated asa herbal remedy for urinary tract infections. Theoretically, if D-mannose wouldbe present in sufficient concentration in the urine, it could interfere with theadherence of the bacterium E. coli to the epithelial cells lining the urinarytract (similar to the mechanism underlying the effect of cranberry juice). [9][10]

One study showed that it could significantly influence bacteriuria in rats,[11] but

there are no studies showing any effect in humans.

Recurrent UTIs

Patients with recurrent UTIs may need further investigation. This may includeultrasound scans of the kidneys and bladder or intravenous urography (X-rays ofthe urological system following intravenous injection of iodinated contrastmaterial). If there is no response to treatments, interstitial cystitis may be apossibility.

During cystitis, uropathogenic Escherichia coli (UPEC) subvert innate defenses

by invading superficial umbrella cells and rapidly increasing in numbers to formintracellular bacterial communities (IBCs).

Prevention

The following are measures that studies suggest may reduce the incidence ofurinary tract infections. These may be appropriate for people, especiallywomen, with recurrent infections:

Cleaning the urethral meatus (the opening of the urethra) afterintercourse has been shown to be of some benefit; however, whether

this is done with an antiseptic or a placebo ointment (an ointmentcontaining no active ingredient) does not appear to matter.

It has been advocated that cranberry juice can decrease the incidence ofUTI (some of these opinions are referenced in External Links section). Aspecific type of tannin found only in cranberries and blueberriesprevents the adherence of certain pathogens (eg. E. coli) to theepithelium of the urinary bladder. A review by the CochraneCollaboration of randomized controlled trials states "some evidence from

http://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Complementary_and_alternative_medicinehttp://en.wikipedia.org/wiki/D-mannosehttp://en.wikipedia.org/wiki/Herbal_remedyhttp://en.wikipedia.org/wiki/E._colihttp://en.wikipedia.org/wiki/Epithelial_cellhttp://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid6114817-8http://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid2576290-9http://en.wikipedia.org/wiki/Bacteriuriahttp://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid6346629-10http://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Intravenous_urographyhttp://en.wikipedia.org/wiki/Interstitial_cystitishttp://en.wikipedia.org/wiki/Escherichia_colihttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Urinary_meatushttp://en.wikipedia.org/wiki/Urethrahttp://en.wikipedia.org/wiki/Sexual_intercoursehttp://en.wikipedia.org/wiki/Antiseptichttp://en.wikipedia.org/wiki/Placebohttp://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Tanninhttp://en.wikipedia.org/wiki/Blueberrieshttp://en.wikipedia.org/wiki/Adherencehttp://en.wikipedia.org/wiki/Pathogenshttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cochrane_Collaborationhttp://en.wikipedia.org/wiki/Cochrane_Collaborationhttp://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Complementary_and_alternative_medicinehttp://en.wikipedia.org/wiki/D-mannosehttp://en.wikipedia.org/wiki/Herbal_remedyhttp://en.wikipedia.org/wiki/E._colihttp://en.wikipedia.org/wiki/Epithelial_cellhttp://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid6114817-8http://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid2576290-9http://en.wikipedia.org/wiki/Bacteriuriahttp://en.wikipedia.org/wiki/Urinary_tract_infection#cite_note-pmid6346629-10http://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Intravenous_urographyhttp://en.wikipedia.org/wiki/Interstitial_cystitishttp://en.wikipedia.org/wiki/Escherichia_colihttp://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Urinary_meatushttp://en.wikipedia.org/wiki/Urethrahttp://en.wikipedia.org/wiki/Sexual_intercoursehttp://en.wikipedia.org/wiki/Antiseptichttp://en.wikipedia.org/wiki/Placebohttp://en.wikipedia.org/wiki/Cranberryhttp://en.wikipedia.org/wiki/Tanninhttp://en.wikipedia.org/wiki/Blueberrieshttp://en.wikipedia.org/wiki/Adherencehttp://en.wikipedia.org/wiki/Pathogenshttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cochrane_Collaborationhttp://en.wikipedia.org/wiki/Cochrane_Collaboration

8/3/2019 AGE UTI

8/8

trials to show cranberries (juice and capsules) can prevent recurrentinfections in women. Many people in the trials stopped drinking thejuice, suggesting it may not be a popular intervention".

For post-menopausal women, a randomized controlled trial has shownthat intravaginal application of topical estrogen cream can prevent

recurrent cystitis. In this study, patients in the experimental groupapplied 0.5 mg of estriol vaginal cream nightly for two weeks followedby twice-weekly applications for eight months.

Often long courses of low dose antibiotics are taken at night to helpprevent otherwise unexplained cases of recurring cystitis.

Acupuncture has been shown to be effective in preventing newinfections in recurrent cases. One study showed that urinary tractinfection occurrence was reduced by 50% for 6 months. However, thisstudy has been criticized for several reasons. Acupuncture appears toreduce the total amount of residual urine in the bladder. All of thestudies are done by one research team without independent

reproduction of results.

Nursing Responsibilities:

1. Encourage to increase fluid intake.2. Administer prescribed antibiotics and diuretics.3. Encourage to have adequate rest and sleep.4. Encourage to eat foods rich in Vitamins and minerals.5. Encourage to have proper perineal hygiene.6. Encourage to boil foods for at least 15 mins.

http://en.wikipedia.org/wiki/Randomized_controlled_trialhttp://en.wikipedia.org/wiki/Acupuncturehttp://en.wikipedia.org/wiki/Randomized_controlled_trialhttp://en.wikipedia.org/wiki/Acupuncture