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A Case Study:
UrinaryTract
Infection
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INTRODUCTION
A Urinary Tract Infection (also called a UTI for short) is an infection of the body's system
involved in excreting urine. This can take place in the kidneys, the ureter the bladder or the
urethra. Most often this occurs in the urethra and bladder. Studies are inconclusive on this
point. Some doctors theorize that as the uterus grows its increased weight can block the drainage
of urine from the bladder, causing an infection.
Urinary tract infections (UTIs) are one of the most common bacterial infections during
pregnancy. UTIs are associated with risks to both the fetus and the mother, including
pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality. The prevalence
rates of bacteriuria in pregnant women and nonpregnant women are essentially the same. UTIs
are more common in women when compared with men, primarily because of the anatomic
differences of the shorter urethra and its proximity to the vagina and the rectum. However, when
pregnant women have a urinary tract infection, they have a higher risk for and increased
occurrence of upper tract UTIs when compared with lower tract UTIs.
Several physiologic changes occur during pregnancy that cause otherwise healthy women to be
more susceptible to serious sequelae from urinary tract infections.The infections can be
symptomatic or asymptomatic. Asymptomatic bacteriuria, as the name implies, is a positive
urine culture without specific symptoms. Asymptomatic bacteriuria increases the risk for an
upper tract UTI, also known as pyelonephritis. Treatment of asymptomatic bacteriuria reduces
the risk of a symptomatic infection.
The frequency of asymptomatic bacteriuria occurs in 2-7% of pregnancies, similar to the
nonpregnant population. However, up to 40% of these may progress to symptomatic upper tract
UTI or pyelonephritis, significantly more than in nonpregnant women.4
Several factors are
associated with an increased frequency in various patient populations. Indigent patients have a 5-
fold increased incidence of bacteriuria compared with that of nonindigent patients. The risk is
doubled in women with sickle cell trait. Other risk factors for bacteriuria include diabetes
mellitus, neurogenic bladder retention, and a history of previous urinary tract infections.
http://emedicine.medscape.com/article/245559-overviewhttp://emedicine.medscape.com/article/127547-overviewhttp://emedicine.medscape.com/article/127547-overviewhttp://emedicine.medscape.com/article/453539-overviewhttp://emedicine.medscape.com/article/453539-overviewhttp://emedicine.medscape.com/article/127547-overviewhttp://emedicine.medscape.com/article/127547-overviewhttp://emedicine.medscape.com/article/245559-overview7/27/2019 Urinary Tract Infection Case Study
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PATIENTS PROFILE
Name : Mrs. UTI
Age : 28 years old
Sex : Female
Civil Status : Married
Nationality : Filipino
Address : Cabilang Baybay, Carmona, Cavite
Occupation : Housewife
Birthday : May 22, 1982
Birthplace : Carmona, Cavite
Date of Admission : 10:36 am, August31, 2010
Admitting Physician : Dr. Salayog, Benjamin Jorge
Attending Physician : Dr. Elefante-Delacruz, Vilma
Admission Diagnosis : PU 34 3/7 weeks AOG by LMP G2P1 T/C UTI
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PAST MEDICAL HISTORY
It was hersecond hospitalization in Binan Doctors Hospital after she delivered her 1st
child via
normal spontaneous vaginal delivery last November 7, 2007. She has no known cause of
allergies, and doesnt have any habits of smoking and alcohol consumption. She actually no
known family medical history of hypertension, diabetes mellitus and etc. She was now at her
second pregnancy PU 34 3/7 weeks AOG by her last menstrual period of January 01, 2010 and
possibly via normal delivery. She is currently not taking any medications but she was having
monthly and weekly prenatal check-ups in their Barangay health center and also for
immunization.
HISTORY OF PRESENT ILLNESS
Three days prior to patients admission, Mrs. UTI noted having hypogastric tenderness with pain
and discomfort with no associated signs and symptoms until one day of prior to admission
patient felt hypogastric pain and tenderness which is now associated with inability of walking
which was her chief complaint. She was on her second pregnancy after a number of tests and
examination by her admitting physician Dr. Dr. Salayog, Benjamin Jorge she as admittedly
diagnosed with UTI, she was referred to her now attending physician/OB-gyne to supervise her
now condition. She was transferred to the labor room for monitoring of fetal heart rate as well as
to alleviate uterine contraction through tocolysis.
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PHYSICAL ASSESSMENT
Physical examination follows a methodical head to toe format in the Cephalocaudal assessment.
This is done systematically using the techniques of inspection, palpation, percussion and
auscultation with the use of materials and investments such as the penlight, thermometer,
sphygmomanometer, tape measure and stethoscope and also the senses. During the procedure,
the group made every effort to recognize and respect the patients feelings as well as to provide
comfort measures following appropriate safety precautions and patients privacy.
A. General Physical Assessment
Mrs. UTI stands 54, with a pulse rate of 91 beats per minute, respiratory rate of 20 cycles per
minute, a blood pressure of 110/60mmHg and a temperature of 36.7 C. She is conscious and
coherent upon interaction. She is in a complete bed rest without bathroom privilages, in a
trendelenburg position with pillows under buttocks and lower legs with stable condition but in
tolerable pain.
B. Assessment of the Head
Head is round in shape (normocephalic). Hair is long in length, thick and coarse, straight and
evenly distributed over scalp. There is no presence of abrasions, lice or any infiltrations.
C. Assessment of the Eyes
Her eyes are proportioned, brown in color, round shape. Pupils constricts when diverted to light
(PERRLA) and dilates when he gazes afar, conjunctivas are pink. Eyelashes are equally
distributed and skin around the eyes is intact. The eyes involuntarily blinks.
D. Assessment of the Ears
Ears are clean, no ear wax was noted and approximately of the same size and shape. Patient can
hear normally when spoken softly.
E. Assessment of the Nose
With narrow nose bridge. No swelling of the mucous membrane and presence of nasal hairs were
seen.
F. Assessment of the Mouth
She has a complete set of teeth with minimal dental caries noted. Oral mucosa and gingival are
pink in color, moist and there were no lesions nor inflammation noted. Tongue is pinkish and is
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free of swelling and lesions. Lips are symmetrical, appears pale without bits noted upon
observation.
G. Assessment of the Neck
Neck has strength that allows movement back and forth, left and right. Patient is able to freely
move his neck. Darker in color compared to other area of the skin maybe related to her
pregnancy.
H. Assessment of the Lungs and Thoracic Region
No reports of pain during the inhalation and exhalation. There is an absence of adventitious
sounds upon auscultation. Respiratory rate 18 breathes per minute from the normal range of 16-
20 breaths per minute.
I. Assessment of the Heart
There is a visible distribution of hair from the chest wall.Patient has an audible heart sound upon
auscultation of the S1 and S2 caused by the closure of the valves. Heart is pumping well with a
pulse rate of 91 bpm from the normal rate of 60-100 beats per minute.
J. Assessment of the Abdomen
Upon inspection on the skin of the abdomen is uniform in color and slightly lighter than exposed
areas and globular in shape with a fundic height of 32 centimeters. There are striae gravidarum
and linea nigra along the abdomen. There is a active bowel sound upon auscultation. Abdominal
movement as with respiration. With presence of fetal heart tone in Right lower quadrant (FHT:
158 BPM)
K. Assessment of the Upper Extremities
Skin: White in color. Skin is smooth, moist and soft to touch with good skin turgor.
Theres a presence of edema along the lower legs . Skin is warm to touch.
Hands: Medium in size with 5 fingernails in each side. Nails are light pink in color,
smooth and firm to touch short with brisk capillary refill of 1-3 seconds.
Arms: Able to move through active ROM. Able to extend arms in front or push them out
to the side.
L. Assessment to the Lower Extremities
Size of the feet is undefined with lines on the sole, without presence of scars and lesions. Ten
fingers are present. Patient was unable to move one of his legs due to presence of pain below the
hypogastric area maybe possibly in her pelvic brim leading to inability to walk comfortably.
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M. Assessment of the Genitourinary
She urinates infrequently (difficulty on urination). She has a bright scanty amount of yellow
urine. There is the urgency of urination but unable to pass through urine (urinary incontinence).
O. Neurological Assessment
BehaviorPatient is having a facial grimace due to pain but is conscious and coherent
upon interaction.
Motor FunctioningThe patient is unable to move her legs comfortably due to presence
of pain. But she was able to extend arms in front and resist active as pushed down/up on
her hands.
ReflexesSome of the reflexes were noted such as blinking, coughing or gag reflexes
are present.
Sensory Functioning Patients sensory system is intact, she was able to distinguish
touch, pain, hot and cold.
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ANATOMY ANDD PHYSIOLOGY
Kidneys
The role of the kidneys is to cleanse the blood and balance its fluids:
They manufacture urine to filter out substances that the body does not need. They also take nutrients and other substances from the urine and return them to the blood.
Urine is manufactured in the kidney's renal tubules. There are approximately one million of these
in each kidney. The raw material the body uses to manufacture urine is filtered blood serum,which is the plasma portion of the blood (minus proteins and blood cells).
The renal tubules process the filtered blood serum and remove the substances that willbecome urine These tubules lead into collecting ducts. These ducts empty the urine into small chambers referred to as renalcalyces he calyces funnel the urine into the renal pelvis, a basin-shaped cavity at the base of each
kidney.
Ureters
The ureters are tubular organs that lead from the renal pelvis of the kidney to the bladder. The
ureters transport small quantities of urine when their muscular walls contract rhythmically. This
pushes the urine in a wave-like fashion through the ureters from the kidneys to bladder.
Bladder
The bladder is a storage organ for urine. The bladder wall has the capacity to stretch like aballoon, enabling the bladder to expand as the volume of urine increases.
When enough urine is in the bladder, receptors that respond to the stretch in the bladder wall will
send electrical signals to the brain. This creates the need to urinate.
Urethra
The urethra is a tubular organ that transports urine from the bladder to the outside of the body.
In men, the urethra runs through the penis. In women, the urethra has its own opening within the vagina
Inside the body, the urethra is surrounded by a muscle that a person can control. This musclemust relax in order for urination to occur.
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PATHOPHYSIOLOGY
Physiologic changes during pregnancy
predispose such women to bacteriuria
Urinary retention caused by the weight of
the enlarging uterus. The uterus sits directly
on top of the bladder. As the uterus grows,
its increased weight can block the drainage
of urine from the bladder
Invasion of bacteria such asEscherichia coli (most
common, in as many as 70% of cases) which was
originated from fecal floras that colonize the
periurethral area (ascending infection)
Predisposing factors:
Poor hygiene
Poor intake of water
Inadequatenutritions
Sexual Intercourse
Physiologic changes
in pregnancy
Leading to different signs and symptoms of infection:
Feeling an urgent need to urinate or frequenturination.
Having difficulty urinating.
Having a burning sensation or cramps in the lower
back or lower abdomen.
Having a burning sensation during urination.
Urine that looks cloudy or has an odor.
Chills, fever, sweats
IF TREATED:
Medical management
Nursing management
Good prognosis
Recovery
IF NOT TREATED:
It may lead to different complications such
as:
Kidney infections which may
interfere with pregnancy, causing
early labor and/orlow birth weight
(pyelonephritis)
Causing a permanent scar or
damaged to kidney which can bedetrimental for both mother and child
inside the womb.
Sepsis
DEATH
http://www.amazingpregnancy.com/pregnancy-articles/115.htmlhttp://www.amazingpregnancy.com/pregnancy-articles/115.html7/27/2019 Urinary Tract Infection Case Study
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MEDICAL MANAGEMENT
Suggested for some routine diagnostics examinations such as urine analysis and cultureand sensitivity tests which is safer tests for pregnancy to determine if pus, red blood
cells or bacteria are present and to analyze the causative agent present and antibiotics
which can be suggested to certain strains of MCO.
Requested for some other examinations such as Complete blood count, platelet count,sodium-potassium, and pelvic ultrasound.
Taking 3-7 day full course of antibiotics that is safe for the mother as well as to thebaby.
Ampicillin 1gm IV q6 (-) ANST Increased oral fluid intake/hydration Monitoring of vital signs q4 Fetal heart tone monitoring q1 Ordered on Diet as Tolerated
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NURSING MANAGEMENT
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LABORATORY
Laboratory #1: Urinalysis
Result Normal Values Indication Nursing Management
PhysicalColor Yellow Straw- Dark
yellow
Normal
Reaction pH 6.0 4.6-6.5 Normal
Transparency Sl. Hazy Sl. Hazy Normal
Specific Gravity 1.020 1.016-1.022 Normal
Chemical
Albumin Trace (-) negative Albuminuria Monitor for signs andsymptoms of infection
Monitor V/S Increase fluid intake Salt restriction
Sugar (-) (-) negative Normal
Ketones (-) (-) negative Normal
Microscopic
RBC 2-4/ HPF 0-2/HPF Hematuria Monitor intake andoutput.
Monitor for signs andsymptoms of infection
Monitor V/S Increase fluid intake Instruct don't resist the
urge to urinate.
Encourage Properhygiene
Pus Cells 15-20/ HPF 0-2/HPF Bacterial
infection
Squamous Many (-) negative infection
Bacteria Many (-) negative Bacterial
infection
Laboratory #2: SodiumPotassium
Result Normal Values Indication Nursing Management
Sodium 137.9 135-148 mmo/L Normal
Potassium 3.27 3.5-5.3 mmo/L Normal
Laboratory #3: Complete Blood Count
Result Normal Values Indication Nursing Management
WBC 9.6 4.0-10 Normal
Segmenters 0.81 0.45-0.65 Increased,
Infection
Monitor intake and output. Monitor for signs and
symptoms of infection
Monitor V/S Increase fluid intake Instruct don't resist the urge
to urinate.
Encourage Proper hygieneLymphocytes 0.15 0.20-0.35 Decreased,
Infection
Monitor intake and output. Monitor for signs and
symptoms of infection
Monitor V/S Increase fluid intake Instruct don't resist the urge
to urinate.
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Laboratory #4: Pelvic Ultrasound
Impressions:
Single line intrauterine pregnancy, 35 weeks by fetal biometry.
Cephalic presentation, with good cardiac and somantic activities.
Somantic activities
Anterior placenta grade II
Normohydramnios
Sonographic estimated fetal
Weight is appropriate for gestational age.
Encourage Proper hygiene
Monocytes 0.04 0.02-0.06
Eosinophils 0.00 0.02-0.04 Decreased,
Infection
Monitor intake and output. Monitor for signs and
symptoms of infection Monitor V/S Increase fluid intake Instruct don't resist the urge
to urinate.
Encourage Proper hygieneBasophils 0.00 0.00-0.005
RBC 3.22 3.9-5.6
Hemoglobin 105 115165 Decreased Monitor intake and output. Monitor for signs and
symptoms of infection
Monitor V/S Increase fluid intake
Instruct don't resist the urgeto urinate. Encourage Proper hygiene
Hematocrit 0.31 0.36-0.47 Decreased Monitor intake and output. Monitor for signs and
symptoms of infection
Monitor V/S Increase fluid intake Instruct don't resist the urge
to urinate. Encourage proper hygiene
Platelet 221 150-350 Normal
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DISCHARGE PLANNING
Medications
Instructed to follow prescribed medications and advised to avoid taking over the counter
medicines without doctors prescription thus it will affect her child inside the womb.
Exercise/Activities
Participation in exercise, including kegel exercise and deep breathing exercise , can enhance
circulation and aid in the elimination of blood congestion in the pelvic area.
Treatments
The first step in treating urinary tract infections is prevention. Prevention measuresinclude drinking plenty of fluids, urinating as soon as possible when the urge is felt, and
drinking cranberry juice, which may have infection-fighting qualities.
For women, prevention measures include urinating promptly after having sexualintercourse, wiping the genital area from front to back after urinating or defecating, and
not using douches or deodorant feminine products. These can be irritating to the genitals.
Other treatments:o Treating Urinary Tract Infection by drinking water or fluids
It is very important for your system to have a good flow of urine. This canbe done by consuming plenty of water. It cleanses your body by diluting
and flushing out the unwanted substance.
o Treating Urinary Tract Infection by Cranberry Juice Cranberry juice disallows bacteria to cling to the cell, which line the
urinary tract. It is a great remedy to fight this infection. If you cannot have
the cranberry juice directly you can mix it with apple juice to add some
taste.
Health teachings
For women with recurrent UTIs, give the following instructions:a. Reduce vaginal introital concentration of pathogens by hygienic measures.
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b. Wash genitalia in shower or while standing in bath-tub bacteria in bath watermay gain entrance into urethra.
c. Cleanse around the perineum and urethral meatus after each bowel movement,with front-to-back cleansing to minimize fecal contamination of periurethral area.
Drink liberal amounts of water to lower bacterial concentrations in the urine. Avoid bladder irritantscoffee, tea, alcohol, cold drinks, and aspartame.
Out-patient/ Follow up
Advise women with simple, uncomplicated cystitis that they do not require follow-up aslong as symptoms are completely resolved with antibiotic therapy. But still follows the
doctors order in case of there is a follow up check up to ensure that are no presence of
infection especially if the case is pregnancy.
Diet
Since bacteria that cause infections in your urinary tract cannot live in very acidicconditions, one of the suggestions you should heed if you are prone to urinary tract
infections is to increase your intake of vitamin-C-rich foods and to drink citrus juices that
have a lot of vitamin C. Not only will this increase the acidity of your urine, it will also
make you more resistant to infection.
Some foods may have to be avoided when you have UTI, and these include processed
foods, cheeses, and other dairy products. You may also need to avoid chocolates, coffee,
and tea that have high caffeine content.
Other things you may need to avoid when you have urinary tract infections include spicyfood, fizzy drinks or soda pop, beer, and other alcoholic beverages.
Try to increase your intake of healthy substances like vegetables and fruits. You can alsohave these in fresh juice form by juicing them or pureeing them. You can also mix fruit
and vegetables in one healthy juice that you can drink every day for your health.
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