CHAPTER I INTRODUCTION 1.1 Background Urinary Tract Infection is an infection involve the kidneys, ureters, bladder, or urethra.

The bacteria that cause the majority of UTIs is E.Colli, but many other bacteria, fungi, and parasites may also cause UTIs. Females have a higher risk for UTIs than most males, probably because of women urethra anatomy is short than men. Other risk factors for UTIs include any condition that may impede urine flow (e.g., enlarged prostate, congenital urinary tract abnormalities, and inflammation). Patients with catheters or those who undergo urinary surgery and men with enlarged prostates are at higher risk for UTIs. UTIs are diagnosed usually by isolating and identifying the urinary pathogen from the patient. There are many risk factors which can causes UTI there are anatomy of urethra (women have big risk), sexuallity activity, personal higyne etc. We must be prevention our self from UTI expecially a girl, you must keep your personal hygine. As nurse many intervention must use to the UTIs patients, first a nurse must assesst the data of patient and look for risk factor which cause the UTI. Second, a nurse colaboration with others health worker as a laboratory assistent to check the sample of patients urine and colaboration with the doctor to give some antibiotic to patient. The last as nurse you must give health education to the patient about UTI from risk factor which can causes until a treatman and prevention of UTI.

1.2 This Paper Will Discuss About 1. Hows the anatomy and physiology of urinary system ? 2. What is the definition of Urinary Tract Infection (UTI) ? 3. What is the pathophysiology of Urinary Tract Infection (UTI)? 4. What is the Signs, Symptoms, And Causes Urinary Tract Infection (UTI) ? 5. What is the nursing care plans for Urinary Tract Infection (UTI)?

Nursing Care Plans of Urinary Tract Infection

1.3 Goal 1. To describe the anatomy and physiology of urinary system 2. To describe the definition of Urinary Tract Infection (UTI) 3. To describe the pathophysiology Urinary Tract Infection (UTI) 4. To describe the Signs, Symptoms, And Causes Urinary Tract Infection (UTI) 5. To describe the nursing care plans for Urinary Tract Infection (UTI)

1.3 Benefits 1. Students are able to and understanding of Urinary Tract Infection (UTI) 2. Students are able to apply the nursing care plans to clients with Urinary Tract Infection (UTI)

Nursing Care Plans of Urinary Tract Infection

CHAPTER II REVIEW OF THE LITERATURE

2.1.Anatomy And Physiology Of Urinary System Urology system is a system that process testing of blood, so the blood free from substain which waste from our body (Nursallam, 2010). According to National Institute of Health (2007) Urinary system is the organs, tubes, muscles, and nerves that work together to create, store, and carry urine. The urinary system includes two kidneys, two ureters, the bladder, two sphincter muscles, and the urethra.

Urinary System ihuman body Human urology system consist of: 1) Kidneys 2) Ureters 3) Bladder 4) Urethra The urology system work together with the lungs, skin and intestines-all of our body which excrete wastes to keep the chemicals and water in our body are balanced.

Nursing Care Plans of Urinary Tract Infection

Human urology system consist of: 1) Kidney Most people are born with two kidneys that are located in the back of the abdominal cavity above the waist, along the spinal column. In adults, each kidney is fist-sized and shaped like a bean. By arteries and veins, the kidneys are connected to the body's vascular system. Every minutes, the kidneys receive about 20% of the hearts output of blood and filter it. This job is done by a huge network of structures known as nephrons, which act as filters, regulating the balance of water, salts and electrolytes. All things that unused are filtered through and eliminated as urine (Newman, 2009).

Kidney Structure According to Nursallam (2010) the kidney in our body have many funtions, such as: 1. Expendituring of body toxin. 2. Keep balance of liquid, acid and basa in the body 3. Release the finish result of metabolism protein ureum, ammonia, and creatinin.

2) Ureters

Nursing Care Plans of Urinary Tract Infection

The ureters are pair of muscular tubes which delivered the urine from kidneys to the urinary bladder. The lenght about 25-35 cm and the diameter is about 3 mm (Srestha, 2011). The location of the ureters in retroperitoneal structure in the posterior abdominal wall (upper part) and lateral pelvic wall (lower part).

Structure of Ureter Tract Muscle The ureters have walls with three layers. When we use the virtual microscopic to identify the ureters the components are: 1. The inner mucosa, including a surface of transitional epithelium and underlying areolar connective tissue. 2. Muscularis, containing smooth muscle, with inner layers arranged more longitudinally and outer layers more circularly. 3. The outer adventitia, which is formed from areolar connective tissue (Srestha, 2011).

3) Bladder Bladder also we called as vesica urinaria, it has shape like a pear fruit. The located of bladder is behind the shmphysis pubica in flank cavity. The bladder wall has several tissue layers, internal lining of the vesica is transitional ephitelium with mucos setcreting glands. After that thera are three ill defined muscle layers. The inner and outer layers tend have fibers line

Nursing Care Plans of Urinary Tract Infection

longitudinally, while those of the middle layers are sirkular (Nursallam, 2010). According to Farr (2012) The superior top of the bladder is triangular and covered with peritoneum. The bladder is supported on the levator ani muscles, which constitute the upper part of the floor of the pelvic cavity. The bladder is covered, and to a certain extent supported, by the visceral layer of the pelvic fascia. This fascia layer is a leaf of connective tissue that sheaths the organs, blood vessels, and nerves of the pelvic cavity.

Structer of Bladder The anatomy of the bladder forms an extraperitoneal muscular urine reservoir that lies behind the pubic symphysis in the pelvis. A normal bladder functions through a complex coordination of musculoskeletal, neurologic, and psychological functions that allow filling and emptying of the bladder contents. The prime effector of continence is the synergic relaxation of detrusor muscles and contraction of the bladder neck and pelvic floor muscles. (Rackley, 2011).

Nursing Care Plans of Urinary Tract Infection

4) Urethra The urethra lining consist of stratified epithelium that varies from transitional at the neck of the urinary bladder, to stratified columnar at the mid point, to stratified squamous near the external urethal orifice (Marthini & Nath, 2009) a. Male Nursallam (2010) the urethra tube that starts at the base of base of the bladder and extends to the surface of the body. Lenght at men about 13.716.2 cm consist of: 1. Prostatica urethra 2. Membranosa urethra 3. Spongiosa urethra b. Female Lenght of womanss urethra is about 3.7-6.2 cm or 3-5 cm. Spinchter urethra located in upside vagina, among vagina and clitoris and urethra here only as chanel of excretion (Nursallam, 2011). According to wikipedia (2012) The urethra placed behind the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downward and forward; it is slightly curved with the concavity directed forward. Its lining is composed of stratified squamous epithelium, which becomes transitional near the bladder. The urethra consists of three coats: muscular, erectile, and mucous, the muscular layer being a continuation of that of the bladder. Between the superior and inferior fascia of the urogenital diaphragm, the female urethra is surrounded by the Sphincter urethrae (urethral sphincter).

Nursing Care Plans of Urinary Tract Infection

2.2. The Definition Of Urinary Tract Infection (UTI) Urinary Tract Infection is an infection involve the kidneys, ureters, bladder, or urethra. UTI is called to include bacteriuritis, asympthomatic bacteriuritis, bacterias cystitis, urethritis, pyelenophritis, and prostatitis. UTI is able covered a wide variety of conditions, start from asymptomatic infections with low bacterial count not requiring intervention to severe infection of the kidney and sepsis with threat to survival. Early interventions have the potential to save costs, prevent significant inability, and save patient lives (Daniel, 2007). A UTI labeled according to region of infection. In general terms, reference is made to lower urinary tract ( e.g,.urethra, bladder, or prostate) and upper urinary tract infections ( e.g,. ureters of kidneys). In addition, UTI may be classified by events such as initial or reccurent, acute or chronic. A UTI perhaps identified as drug-resistant. Combinations of these labels offer educations purposes, assesement, care plan, and patient education. For example, lower UTI most likely suggest lower level of concern, a diagnosis of chronic, recurent, upper tract UTI. Furthermore, a UTI may be classified as uncomplicated in patient without structural abnormalities or altered urodynamics or complicated in patient with a structural abnormality or altered urodynamics, or any urinary infections in males. Cystitis ( Urinary Tract Infection) is an inflammation of urinary baldder with both infectious and noninfectious causes. Infectious are caused by bacteria, virues, fungi, and parasites. Non infectious are caused by chemical expisure and radion therapy (Winkelman, 2010). Urinary Tract Infection ( UTI ) is an invasion of all or apart of urinary ract (kidneys, bladder, urethra) by pathogens. UTIs are usually caused by bacteria, as like Escherichia coli, although viral and fungal organism are able cause UTI. UTI may begin as pathogens form the perineum and ascend through the urethra to the urinary bladder. UTIs are common nosocomial infections and also result following instrumentation (e.g.,catheterization or diagnostic prosedures of the genitourinary tract). The Centers for Disease Control and Prevention ( CDC ) has prepared guidelines for prevention of catheter-associated urinary tract infections ( CAUTI).

Nursing Care Plans of Urinary Tract Infection

These guidelines include recommendations for suitable use of urinary catheters in hospital and long-term care setting, and alternatives to indewelling urinary catheters for manageement of patient problem with urination. UTIs are more common in the women than men. UTIs, which can be chronic and reccuring, can lead to systemic infection such as urosepsis, which can be life threatening (Meg Gulanick, 2011).

2.3.The Pathophysiology Urinary Tract Infection (UTI)

The urinary tract above urethra is normally sterile, and organisms that cause UTIs are usually introduced by way of the ascending route from the urethra. Other less common routes are through the blood stream or lymphatic system. Most infections are caused by gram negative aerobic bacilli normally which found in the gastrointestinal (GI) tract.

Predisposing Factors to Urinary Tract Infections Factor Factors Increasing Urinary Stasis Explanations a. Intrinsic obstruction (stone, tumor of urinary tract, urethral stricture, benign prostatic hyperthrophy) b. Extrinsic obstruction (tumor, fibrosis compressing urinary tract) c. Urinary retention (including

neurogenic bladder and low bladder wall compliance) d. Renal impairment Foreign Bodies a. Urinary tract calculi b. Catheters (indwelling, urethral external stand,

condom

catheter, tube,

nephrostomy catheterization) c. Urinary

intermittent

tract

instrumentation

Nursing Care Plans of Urinary Tract Infection

(cystoscopy, urodynamics) Anatomic Factors a. Congenital defect leading to

obstruction or urinary stasis b. Fistula (abnormal opening) exposing urinary stream to skin, vagina, or fecal stream c. Shorter female urethra and

colonization from normal vaginal flora d. Obesity Factors Response Compromising Immune a. Aging b. Human immunodeficiency virus

infection c. diabetes mellitus Functional Disorders a. Constipation b. Voiding dysfunction with detrusor sphincter dyssynergia Other Factors a. Pregnancy b. Hypoestrogenic state c. Multiple sex partner (women) d. Use of spermicidal agents or

contraceptive diaphragm (women) e. Poor personal hygiene

An important source of UTIs is health care-associated infection (HAI) previously called nosocomial infections. The cause is often E. coli and, less frequently, Pseudomonas organism. Catheter acquired UTIs are the most common HAI infections and are caused by cultivation of bacterial biofilms that are found on the inner surface of the catheter. (Lewis and Bucher, 2007) The epithelium of the kidneys, ureter, and bladder is sterile in the healthy individual. An infection occurs when bacteria enter the urine and start to grow. The infection usually begin at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.

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Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, this will not stop them. The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection. The infection can spread further as the bacteria move up from the bladder via the ureters. If they reach the kidney, they can cause the kidney infection (pyelonephritis), which can become a serious condition if not treated immedietlly. Complications of a simple lower tract infection are rare and typically involve resistance microorganisms or indicated undiagnosed structural

abnormalities or abnormal urodynamics. Primary complications of complicated and resistance UTI are ascending infection and spread to the blood stream. Nephritis and sepsis make the patient at high risk have potential for chronic illness or death. (Rick et al, 2007).

2.4.Signs, Symptoms, And Causes of Urinary Tract Infection There is some signs and symptoms which is will come out if a person get urinary tract infection. This signs and symptoms will come out because of urinary tract infection made a person body became abnormal. This is some of its signs, symptoms and its causes : 1. Disuria or pain when urinating this is because of Bladder irritation Disuria is because of the infection of the bacteria makes the bladder iritation and scratch. During urinating process the bladder is full of urine and then there is a feeling to do urinating. When the urine move to out from bladder it is pass through the irritated bladder and create pain. 2. The increase of urinatingThe rise of urine volume which is rise frequently. The normal urinating is is 1500 ml per-day and change by the volume of drink. This is because of urinary tract inflammation. 3. The rise of urinating feeling even if the outcome is very little 4. There is leukocyte in urine 5. Pain in lower back/ Suprapubis 6. In worst infection it has fever and there is blood in its urine 7. Bad smell of urine

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8. Urgensi ( do not urinating) 9. Enuresis nocturnal sekunder ( urinating in pants on adult ) 10. Prostatismus ( hard to start urinating, has a slow urine current, stop urinating for a while ).

2.5. The Nursing Care Plans For Urinary Tract Infection (UTI) A. Assessment Deniels, et all (2007) Focus assessment for patients with UTI (Unrinary Tract Infection) are: 1. Systemic The patient get fever, chills, nausea, diarrhea or not, and assesst the patients skin turgor. 2. Urinary Assesst cloudy of urine, hematuria, foul smelling urine, distension, or suprapubic or costovertebral tenderness. 3. Focus past health history Previous UTIs and how treated, urinary calculi, ureteral or urethral strictures, bladder cancer or prostate problems, recent hospitalization or surgery, sexually transmitted disease, vaginal infection, diabetes or pregnancy. 4. Current history Burning on urination, urinecolor and odor, fever, chills, nausea or vomiting, voiding pattern and any changes. Pain character and location. Querry especially for flank or low back pain, suprapubic discomfortor feeling unrellieved with voiding, bladder spasm or burning on urination, vaginal or penile discharge and menses. 5. Personal data Fluid and nutrition intake, hygiene habits, obidience to prescribe medications. 6. Laboratory Findings Elevated white blood cell count. Urine positive for nitrites, leukocytes, red blood cells or bacteria. 7. Medications

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History of taking anticholinergic or antispasmodic medications. Complete listing of current medications including over the counter and herbal preparations. In others book there are some differences for assest the patient who get UTI (Winkelmen at all, 2010): 1. Record patient information a. History of UTI b. History of renal or urologic problem c. History of health problem 2. Assess for a. Increased frecuency in voiding b. Urgency to void c. Pain or discomford on urination d. Changes in urine color e. Bladder distantion f. Feeling incomplete bladder emptying. g. Urinary meatus inflamation Beside all of the assessment above we must use general assessment to complete it. Complete data with patient identity, patient environtment and physical assessment.

B. Data Analysis Data Subjective data: Flank pain Fever Burning on urination Etiology Bacteria (ex: gram negative aerobic bacilli, E. Coli) or urologic intrumentation (ex: chateterization) Problems Infection

Objective data: Elevated white blood cells T= >380C Enter in the urinary tract and begin to grow

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Foul-smelling urine Hematuria Bacteriuria Infection

Subjective data: Pain during urination

Infection

Impaired urinary elimination

Objective data: Anuria

Inflammation of urinary mucosa

Pain with bladder filling

Impaired urinary elimination Subjective data: Patients say that she/he unfamiliarity with nature and treatment of UTI Deficit knowledge

Objective data: -

C. Nursing Diagnosis 1. Infection common related to Improper toileting 2. Impaired urinary elimination related to UTI (excessive urgency and pain with bladder filling) 3. Acute pain related to impaired urinary elimination secondary with infection 4. Deficit knowladge releted to unfamiliarity with nature and treatment of UTI.

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D. Planning Problem Infection NIC Urinary elimination management, teaching:prescribed medication, fluid management Pain Heat/fluid cold application, pain Pain control management. Empaired urinary elimination 1. Urinary elimination management 2. Consuled with diatery to include additional liquid 3. Monitor urinary elimination 1. Urinary elimination 2. achives estabilished fluid intake 3. Urine regains clarity and dysurea is reliaved Deficite knowledge Teaching: disease process Teaching: prescribe medication Increased the knowledge NOC Infection status medication respon urinary elimination

E. Implementation Problem Infection Intervention Rational of UTIs, sexual

1. Asses for any history that 1. History would predispose

instrumentation,

theperson to UTI

activity, history of sexually transmitted infections, surgeries of the

2. Asses

for

sign of UTI

and :

previous

symptoms

genitourinary tract that may have resulted in scarring,

frequency, urgency, and burning urination, or pain cloudy on or

and/or recent antibiotic therapy may all place that individual at increased risk for developing UTI.

bloody urine, complaints of lower abdominal pain or suprapubic pain. Asses

for signs that kidneys are 2. Frequency

of

urination,

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involved : flank or back pain

sensation

of

urgency,

and

burning or pain on urination are classic sign of UTI. It is

3. Encourage the patient to drink extra fluid

important to note the patients with UTI maybe

asymptomatic, especially those 4. Instruct the patient to void often (every 2 to 3 hours during the day) and to empty the bladder with recurrent infection, in older patient who may not cognitively describing capable symptoms, of a

completely

general change and behavior or decline in overall functional

5. Encourage the patient to finish all prescribed

ability often heralds a UTI.

antibiotics, effectiveness

note 3. Fluid

promotes and

urine flushes

production,

bacteria from the urinary tract, 6. Limit bladder use indwelling to minimum fluid intake is 2 to 3 L/day.

catheters

manage incontinence 4. A reguler pattern of urination enhances bacterial clearence, reduces urine stasis, and

prevents reinfection, invoiding in an upright position can facilitate bladder emptying.

5. Drugs

maybe to of

used

in

combination development

reduce bacterial

resistence. The usual length of

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antibiotic therapy is 5 to 10 days.

6. Catheters increase the risk for infection. Other measures such as regular toileting can prevent infection. Impaired urinary elimination related to UTI 1. Urinary elimination management (0590). 2. Teach the patient to drink the additional eight ounces of liquid with meals, between meals, and in early evening. 3. Monitor urinary elemination including frequency, consistency, odor, volume, and color 1. Regular urine elimination would make an effective bladder emptying so as to reduce the pain when the bladder is full 2. hemostasis can both affect tranporatasi fluids in the body, especially the kidneys, with a lot of drinking can reduce the barriers to the urinary tract 3. determine whether changes in urinary elimination is improved as a reference in the subsequent intervention Acute pain related to impaired urinary elimination secondary infection 2. Apply a heating pad to 2. This measure relieves pain. 1. Asses the of patients pain. 1. Typically, pain asssociated eith UTI is described as burning on urination. Patients may also experience lower abdominal or suprapubis pain.

description

Inquire as to the quality, nature, and severity of pain.

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the suprapubic area or lower back

3. Sitz

baths

may

reduce

perineal discomfort and pain. 4. Complementary and

3. Instruct the patient in use of a sitz bath

alternative therapies provide nonpharmacological approaches to pain

4. Use distraction and relaxation techiques whenever appropriate Deficit knowladge

management.

1. Asses knowledge of UTI 1. Frequent recurrences of UTI risk factors, prevention, and treatment may indicate that the patient does factors 2. Provide health teaching. Teach the patient : not understand or risk

medical

menagement of UTI. 2. The goal of patient teaching is to resolve the current infection and prevent recurrence a. Periodic urine cultures

a. Need for follow-up urine cultures b. Need for frequent bladder emptying c. Hygienic measures,

determine effectiveness of the antimicrobial theraphy b. Voiding at first urge

showering is perferable to tub bathing d. Wiping from front to back.

prevents stasis of urine in the bladder and minimize the oppurtunity for bacterial growth. c. Good higiene decreases

3. Teach

the

patient

to

concentration of phatogens. d. This technique prevents the introduction of enteric

complete full course of antibiotic (ex: penicillin) medication, even if

phatogens into the uretra. 3. Urinary symptoms of burning,

symptoms resolve.

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frequency, and urgency often 4. Encourage reporting of sign and symptoms of recurrence resolve in the first few days antibiotic therapy. 4. One to 2 weeks after completion of a course of antimicrobial therapy is a common time frame for sign and symptoms to recur.

F. Evaluation Steps that need to be evaluated in patients with UTI was referring to the objective to be achieved are: 1. Patient feel the pain persists or decreases. 2. Discoloration of urine. 3. Changing patterns of urination, frequent urination and a little, feeling the urgen to urinate, dripping after urination. 4. Patient report satisfactory pain controlat a level less than 3 to 4 on a 0 to 10 rating scale. 5. Patient use pharmachological and non pharmacological pain relief strategies. 6. Patient habits increased comford such as baseline levels for pulse, blood pressure, respirations, relaxed muscle tone or body postures 7. Patient is free of UTI as evidenced by clear, non foul smell urine, pain free urination, normal WBC count and absence of fever, chills, flank pain and/or suprapubic pain.

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CHAPTER III CLOSING 3.1 Conclusion Urinary Tract Infection is an infection involve the kidneys, ureters, bladder, or urethra. UTIs are usually caused by bacteria, as like Escherichia coli, although viral and fungal organism are able cause UTI. UTI may begin as pathogens form the perineum and ascend through the urethra to the urinary bladder. There is some signs and symptoms which is will come out if a person get urinary tract infection,that are : disuria or pain when urinating , the increase of urinating, the rise of urinating feeling even if the outcome is very little, pain in lower back/ Suprapubis.the nursing care plans for patient among : a. Encourage the patient to finish all prescribed antibiotics, note effectiveness or Teach the patient to complete full course of antibiotic (ex: penicillin) medication, even if symptoms resolve b. Hygienic measures, showering is perferable to tub bathing c. Instruct the patient in use of a sitz bath,etc So in the end, Patient use pharmachological and non pharmacological pain relief strategies. Patient habits increased comford such as baseline levels for pulse, blood pressure, respirations, relaxed muscle tone or body postures. Patient is free of UTI as evidenced by clear, non foul smell urine, pain free urination, normal WBC count and absence of fever, chills, flank pain and/or suprapubic pain.

3.2 Suggestion As nurses, we should know the nursing care plans of urinary tract infection (UTI) with clearly in order to support nurses in providing nursing care to clients in a timely, so that services are provided in accordance and may reduce or even cure the client.

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REFERENCES

Daniels, Rick et all. 2007. Contemporary Medical Surgical Nursing. USA: Thomson Delmar Learning. Dirksen et all. 2011. Medical Surgical Nursing: Assessment and Managemen of Clinical Problems.USA: Elsevier Mosby. Farr, Gary. Oct, 19th 2011 Marthini & Nath. 2009. Fundamentals of Anatomy and Physiology. San Fransisco: pearson Benjamin Cummings. Newmen, Laura. 2009. Female Urology Anatomy and External Sexual Anatomy. http://urology.about.com/od/forwomen/ss/Femaleurologysexualanatomy_ 3.htm. acsess in Oct, 16th 2012. Rackely, 16th 2012. Shresta, Sulav. 2011. Clinical Anatomy of Ureter. http://medchrome.com/basicscience/anatomy/clinical-anatomy-ureter/. access in Oct, 16th 2012. Wikipedia. 2012. Ureter. http://en.wikipedia.org/wiki/Ureter. access in Oct, 16th 2012 Wikipedia. 2012. Urinary Bladder. http://en.wikipedia.org/wiki/urinary_bladder. access in Oct, 16th 2012 Winkelmen et all. 2010. Medical Surgical Nursing Patient Centered Collaborative Care. Canada: Saunders elvesier Raymon. 2011. Bladder Anatomy. 2011. The Genitourinary System. access in

http://www.becomehealthynow.com/article/bodygenito/779.

http://emedicine.medscape.com/article/1949017-overview. access in Oct,

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