A Study Of Medical-Surgical Nursing

Urinary Tract Infection

In Partial Fulfilment Of The Requirements

In NCM 102

Presented To:
Level-II Clinical Instructor

By:
Casquejo, John Reconell, Rulete, Albert Jon C., Tabaranza, Leovil Joni Jun P.,
Tan, Nolvie A., Vega, Cristine Jane J.

December 14, 2012

TABLE OF CONTENTS

Chapter I - Introduction
Background of the Study...............................................................................01
Objectives.....................................................................................................02
Significance of the Study...............................................................................03

Chapter II Patients Profile (Comprehensive Assessment)

Present Medical History................................................................................04
Past Medical History.........................................................................................
Family History...................................................................................................
Nutritional History..........................................................................................05
Immunization..................................................................................................
Physical Examination..............................................................................06 - 10
1. General Appearance
Chapter III
Pathophysiology........................................................................................11 - 13

Chapter IV Results, Analysis, And Justification

Course in the Ward............................................................................................

Laboratory Findings.....................................................................................14-17
Drug Study...................................................................................................18 - 21
Nursing Care Plan.......................................................................................22 - 24

Chapter V Summary, Conclusion, And Recommendation

Bibliography

CHAPTER I
Introduction

Urinary tract infection

Urinary tract infection is an infection involving the kidneys, ureters,

bladder, or urethra. Synonyms for UTI include bacteriuritis, asymptomatic
bacteriuritis, bacteria cystitis, urethritis, pyelonephritis, and prostatitis. A UTI can
cover a wide variety of conditions, ranging from asymptomatic infections with low
bacterial counts not requiring intervention to severe infection of the kidney and
sepsis with threat to survival. Early intervention has the potential to save costs,
prevent significant incapacity, and save lives.
A UTI is labelled according to the region of infection. In general terms,
reference is made to lower urinary tract and upper urinary tract infection. In
addition, a UTI may be classified by events such as initial or recurrent, acute or
chronic. A UTI may be identified as drug-resistant. Combinations of theses labels
offer critical information to the provider for assessment, care planning, and
patient education purposes. For example, an initial, lower tract UTI most likely
prompts a lower level of concern than does a diagnosis of a chronic, recurrent,
upper tract UTI.
Further, a UTI may be classified as uncomplicated in patients without
structural abnormalities or altered urodynamics or complicated in patients with a
structural abnormality or altered urodynamics, or any urinary infection in males.
UTIs are common during pregnancy because of changes in the urinary
tract. The uterus sits directly on top of the bladder. As the uterus grows, it
increased weight can block the drainage of urine from the bladder, causing an
infection. If the UTI goes untreated, it may lead to kidney infection. Kidney
infections may cause early labor and low birth weight. If the doctor will treats a
urinary tract infection early and properly , the UTI will not cause harm to the
baby.
UTIs prompt over five million office visits annually in the united states.
Uncomplicated infections incur annual health care costs in excess of $350
01

million. UTIs are more common in females because of a shorter urethra and the
proximity of the urethra to the vagina and anus. Sexual intercourse and forward
cleansing following defecation offer primary sources of contamination. Incidence
increases in the aging female because of bladder prolapsed. Recurrent infection
is common.
In the male, the incidence of bladder infection is higher in the
uncircumcised. Incidence in all males increases with age because of problems
of prostatic hypertrophy.
Bacteria causing UTI usually originates from the bowel as normal flora
of the host. Escherichia coli are the most common infective bacterial organism in
acute cystitis and represent 80 present of all cases requiring treatment. E coli
bacteria are present in feces, adhere easily to the epithelium of the urinary tract,
and have the capability to resist destruction by the white blood cells.
Hospital acquired (nosocomial) infection adds a significant health care
dollar burden to the public and to the public and to the institution. UTIs are of
particular significance. Physical and psychological stress response to
hospitalization predisposes patients to acquired infection. Hospitalized patients
frequently require procedure associated bladder catheterization. Catheter
intrusion into the urinary system predisposes the patient to inoculation with
bacteria contaminated equipment or bacterial entry along the in place catheter.
In addition to E. Coli exposure from episodes of fecal incontinence or
compromised hygiene, the environment offers exposure to more virulent
organisms such as pseudomonas and staphylococcus. More recently,
interdisciplinary health faces the challenge of limiting the spread of drug
resistant organisms, such as vancomycin resistant enterococcus.
(Contemporay medical-surgical nursing. Thomson asian edition. Rick daniels,
laura nosek and leslie nicoll. )

02

OBJECTIVES
General Objectives:
This case study aims to conduct a thorough investigation on
urinary tract infection during pregnancy, which aim to provide information and
understanding about the underlying cause of the patients current condition by
the application of the nursing process.

Specific Objectives:
To support the foregoing objective, the following are the specific
objectives:

Find a client suited for the case presentation.

Get the patients profile (medical history, family background, present
illness, laboratory results)
Review concepts and principle related to anatomy and physiology of
affected body organ.
Gather all pertinent data from patients chart and assess patients history.
Make a course in the ward supported by the facts in the doctors order.
Assess clients physical status through elaborative physical assessment.
Collect and study drugs taken by the patient.
Come up with prioritized nursing care plans.
Teach client appropriate and relevant life skills that can help her health
status better.

03
Significance of the study

To the client and family:

The study helps to determine the clients condition during her pregnancy
and for her living. It also helps the family to understand the situation or condition
to plan for action in giving appropriate ways in dealing with the clients needs to
improve and maintain or promote a healthy living.

To the community:
This study will help the community to become aware of the clients
condition and development. Through this they can address to the clients needs
in order to solve the problem.

To the students:
Through this study, it will help the students apply their knowledge and
help the client towards a better or healthy condition.

Chapter II Patients Profile (Comprehensive Assessment)

PATIENTS PROFILE
Name:

Retes, Florescel Dioso

Age:

29

Sex:

Female

Address:

P1 B30 L18 Melon street, NHA Bangkal, Davao City

Birthday:

September 22, 1983

Birthplace:

Midsayap Cotabato

Civil status:

Married

Religion:

Protestant

Nationality:

Filipino

Admission date:

Dec. 01, 2012

Admission Time: 01:52 PM

Attending physician: Dr. Regina P. Ingente
Admitting physician: Dr. Gladies Desesto Rioferio, MD
Chief Complaint: Urinary frequency, fever
Diagnosis: Pregnancy uterine 34 4/7 weeks age of gestation, cephalic in
preterm labor, to consider urinary tract infection.

Comprehensive assessment

04
Present medical history

Patient has been complaining of pain during urination. Patient also

complaining of headache shortly and scaled as 5/10 for 3 weeks. There was no
medicine taken and no consultation done. Right prior to admission, patient
suffers from urinary frequency associated with fever and uterine contraction
were also noted.

Past medical history

The patient verbalized that they dont have any history of diabetes in
their family both on the maternal and paternal side, only hypertension is known.
Patient is not known diabetic, hypertensive and asthmatic. She was not
hospitalized before, it was her first time to be hospitalized. In her childhood days
she only experienced cough and common colds but it was just treated by over
the counter medication like paracetamol and carboceistine.

Family medical history

Mrs. R a 29 y.o. housewife and was currently staying with her husband a
government employee. She is the youngest among the two siblings. According
to the patient they have a history of hypertension in their paternal side and she
has no known allergies in any antibiotics and seafoods. In patients heredo
familial disease, she said that in their maternal side there is no familial disease.

05

Nutritional Status

The patient stated that Prior to her admission, she ate rice with chicken
adobo and a slice of mango for her lunch. Right after her admission, she almost
consume the food serving at the hospital and every serving. She love soft drinks
right after her meal especially when her pregnancy started. Her husband always
bought her burger, fries and orange juice for her snacks. The patient also likes
vegetables, fruits, and seafoods.

Immunization

The patient stated that, during her examination, the Doctor confirmed that
she is pregnant. She immediately had her prenatal visit on the month of May
2012, receiving her 1st dose of Tetanus Toxoid. Last June 2012 is her second
prenatal visit, receiving her 2nd dose of Tetanus Toxoid, and December is her last
visit receiving her 3rd dose of Tetanus Toxoid and The patient is not yet a fully
immunized.

06

Physical exam

General appearance

Our client RF, female, 29 years old was admitted to Davao Doctors
Hospital on December 01, 2012 at 01:52 pm due to urinary frequency and fever.
The assessment was done on Dec. 07, 2012 at Davao Doctors Hospital. Upon
assessment the patient was lying on the bed wearing her street clothes with an
IVF of D5LR @ 140cc/hr infusing well @ her left metacarpal vein @ 750cc level.
She is awake, coherent and responsive and not in any respiratory distress.

VITAL SIGNS AND CLINICAL MEASUREMENT

Temperature
Cardiac rate
Pulse rate
Respiratory rate
Blood pressure

RESULT
36.2
89 bpm
87 bpm
22 cpm
110/90 mmHg

NORMAL RANGE
36.5C- 37.5C
80-90 beats/min
80-90 beats/min
16-20 cycles per min.
110/70-130/90 mmHg

07

SKIN

The patient has generally uniform brown complexion. Her skin is

smooth, moist and has good skin turgor. The skin of the patient is warm to touch.

Hair and Nails

The patient has smooth, fine shoulder level hair. Her hair is thin and
evenly distributed on the scalp. There were no infestation or infections noted.
She has clean and trimmed nails. The nail beds are pinkish in color with capillary
refill time of 2 seconds.

Skull and Face

The patients head is normocephalic and symmetrical in shape. Her

facial features and facial movements are symmetrical. There were no lesions
noted.

Eyes

The patients eyebrows are black in color and are evenly distributed.
They are symmetrically aligned and have coordinated movements. Her lashes
are curled outward. The sclera appears white and her irises are black in color.
Her pupils are equally round and briskly reactive to light stimulation and
accommodation with pupil size of 2 mm. Both eyes move in a coordinated
movement.
08

Ears

Patients ears are symmetrical and of the same color as her face.
The auricles are aligned with the outer canthus of the patients eyes. No
cerumen was noted upon inspection of the external ear canal and responds to
normal voice tones without difficulty. There is no tenderness noted upon
palpation.

Nose and Sinuses

The patients nose is of the same color as the rest of her face. The
nose is symmetric and straight. Upon inspection, the nares were dry and no
crusting noted and nasal septum is in midline. There was no tenderness,
masses or lesions noted. The maxillary and frontal sinuses are non tender.
Signs of inflammation were not noted. No discharges and lesions were noted.
The nostrils are patent.

Mouth

The patients outer lips are symmetric, moist, pinkish in color and
smooth in texture. She is able to move her lips with coordination. Her inner lips
and buccal mucosa are pinkish, moist and smooth without lesions. . Her gums
are pink in color and moist. There are no retractions noted. The uvula is located
at the midline and the tonsils are not inflamed in appearance.

09
Neck

The head is positioned at the center. The neck muscle

(sternocleidomastoid and trapezius) appears equal in size and muscle strength
is also equal on both sides. The patient displays coordinated and smooth
movements with no discomfort. No swelling or masses are noted on the patients
neck.
The patients lymph nodes are non palpable and non-tender. The
trachea is at midline. There are no enlargement and masses of the thyroid gland
noted.

Chest and Lungs

The skin on the area is clear and same as that of the neck. The
clavicles are slightly visible. No masses of sort were noted. The chest wall
expands symmetrically and bilaterally.

Breast and Axillae

Rounded shape slightly unequal in size, generally symmetrical.

Abdomen

The abdominal skin is intact and is lighter in color than the

extremities. There are no rashes and lesions noted. Her bowel sounds are
present. There is no tenderness and enlargement of the liver noted.

10
Genitourinary

The patient refused to do the assessment

Elimination

The patient was not able to defecate during our shift. The patient
can void freely. The patient urinated 8x during our shift.
Musculoskeletal

There is an equal size of muscles on both sides of the body with no

contractures and tremors. The muscles are firm and moves smoothly and
coordinated. There are no deformities of the bones noted.

Chapter III
ANATOMY AND PHYSIOLOGY

The renal system is vital to the functioning of the human body. It is

responsible for a wide variety of activities within the body and is integrated with
the function of the other body systems. The renal system controls the fluid
balance of the body, controls many of the metabolic processes within the body,
and provides stabilization for the human body circulation. At the macrovascular
level, the renal system consists of two kidneys, ureters, bladder, and urethra.

KIDNEYS
The kidneys are bean-shaped organs, each about the size of a tightly
clenched fist. They lie on the posterior abdominal wall, behind the peritoneum,
with one kidney on either side of the vertebral column. A connective tissue renal
capsule surrounds each kidney. Around the renal capsule is a thick layer of fat,
which protects the kidney from mechanical shock. On the medial side of each
kidney is the hilum, where the renal artery and nerves enter and where the renal
vein and ureter exit the kidney. The hilum opens into a cavity called the renal
sinus, which contains blood vessels, part of the system for collecting urine and
fat.

Functions of the kidney:

the primary functions of the kidney are:
1. Maintain fluid and electrolyte balance through excretion and reabsorption.
2. Assist in blood pressure regulation through the rennin-angiotensin
system.
3. Maintain chemical balance.
4. Maintain mineral balance.
5. Produce erythropoietin in response to low oxygen states.
6. Convert vitamin D to its active enzyme from and thus influence calcium
metabolism
7. Excrete waste products of protein metabolism.
8. Contribute to acid base balance.

URETERS,URINARY BLADDER, and URETHRA

The ureters are small tubes that carry urine from the renal pelvis of the
kidney to the posterior inferior portion of the urinary bladder. The urinary bladder
is a hollow muscular container that lies in the pelvic cavity just posterior to the
pubic symphysis. It functions to store urine, and its size depends on the quantity
of urine present. The urinary bladder can hold from a few millilitres to a
maximum of about 1000 mL of urine. The urethra is a tube that exits the urinary
bladder inferiorly and anteriorly. The triangle shaped portion of the urinary
bladder located between the opening of the ureters and the opening of the
urethra is called the trigone. The urethra carries urine from the urinary bladder to
the outer side of the body.

11
14

Urinalysis
Name of pt. : Retes, Florecel Dioso
Physician: Ingente, Regina P
Test name
Result
Normal
Value
Color

Straw

Straw(light
yellow)

Character

Clear

Reaction

60

Specific
Gravity

1.010

Albumin

Negative

Negative

Sugar

Negative

Negative

Date: 12/01/12
Indication

Significance

A red or redbrown (abnormal)

color could be
from a food dye,
eating
fresh
beets, a drug, or
the presence of
either hemoglobin
or myoglobin. If
the
sample
contained many
red blood cells, it
would be cloudy
as well as red.

The urinalysis is
a routine
screening test
which is usually
done as a part
of a physical
examination,
during
preoperative
testing, and
upon hospital
admission.

The results of
UA are used to
diagnose, treat,
and provide
follow-up for a
variety of
conditions, such
as infections of
the kidneys and
urinary tract and
also in the
diagnosis of
diseases
unrelated to the
Presence
of urinary system.
Excess sugar in
urine
means,

Glycosuria,
generally means
diabetes mellitus

WBC

7ul

0-17ul

Pyuria occurs if
the presence of
leukocytes
are
abnormal
or
increased which
may appear with
infection in either
the upper or lower
urinary tract or
with
acute
glomerulonephritis

RBC

9ul

0-11ul

high RBC number

in urine may point
to acute tubular
necrosis, benign
familial hematuria,
calculi,
hemophilia,
hemorrhagic
cystitis,
pyelonephritis,
renal
trauma,
renal tuberculosis,
renal tumor, or
UTI.

Epithelial
cells

6ul

0-17ul

Cast

0ul

0-1ul

Bacteria

698ul

0-278ul

Bacteria are
common in urine
specimens
because of the
abundant normal
microbial flora of
the vagina or
external urethral
meatus and
because of their
ability to rapidly
multiply in urine
standing at room
temperature.
Therefore,
microbial
organisms found
in all but the most
scrupulously
collected urines
should be
interpreted in view
of clinical
symptoms.

15
Complete blood count
Name of pt.: Retes, Florecel Dioso
Physician: Ingente, Regina P
Test name
Result
Units
Hemoglobin

128

Hematocrit

0.38

g/L

Date: 12/01/12 03:04pm

Normal
values
120-140

Indicatio
n
Increase
d:
polycythe
mia

Significance

A complete blood
count (CBC)
gives important
information about
the kinds and
Decrease numbers of cells
d:
in the blood,
Blood
especially red
loss
blood cells, white
Hemolyti blood cells,
c anemia and platelets. A
Sickle
CBC helps your
cell
health
anemia
professional
Bone
check any
marrow
symptoms, such
supressio as
n
weakness, fatigu
e, or bruising, a
0.37-0.45 Increase patient may
d:
have.
Polycythe
A CBC may be
mia

Dehydrati
on
Burns

Erythrocytes

4.20

Leucocytes

5.80

10^12
/L

155.0

10^9/
L

Segmenters

0.783

10^9/
L

Lymphocytes

0.099

Thrombocyte
s

done to:
- Find the cause
of symptoms
such as fatigue,
weakness,
Decrease
Fever,
bruising,
d:
overweight loss.
Blood
- Find anemia
loss
- See amount of
Overhydr
blood loss if there
ation
is bleeding.
Dietary
- Diagnose
defecienc
polycythemia
y
- Find an
Anemia
infection
- Diagnose
4.5-5.0
disease of blood
such as leukemia
- Check how
5.0-10.0
body is dealing
with some type of
140-440
drugs
- Check if
abnormal affects
0.55-0.65
the cells inside
Screen high or
0.35-0.45 Increase
low values before
d:
surgery
Viral
- See if there is
infection
an excess or
Mononucl
deficit number of
eosis
cells that can
Tubercul
indicate
osis
conditions
Chronic
bacterial
infections
Decrease
d:

Adrenal
corticoste
roids and
other
immunos
uppressiv
e drugs
Sever
malnutriti
on
Eosinophils

0.001

0.02-0.04 Increase
d: allergic
reactions
Leukemia
Parasitic
infestatio
ns
Decrease
d:
Corticost
eroid
theraphy

Monocytes

0.114

0.06-0.12 Increase
d:
Tubercul
osis
Chronic
ulcerative
colitis
Protozoa
n
infections
Decrease
d:

Durg
therapy
predniso
ne
Basophils

0.003

0-0.2

Increase
d:
Leukemia
Decrease
d:
Acute
allergic
reaction
Cortecost
eroids
Acute
infections

MCV

90.10

MCH

30.50

80.97
fL

MCHC
338
pg
Name of pt.: Retes, Florecel Dioso
Physician: Ingente, Regina P
Examinatio
Result
n
Blood type

RH type

POS(+)

27.0-31.2
318-354
Date: 12/01/12
Significance

To prevent RH incompatibility

16

OB-GYN ULTRASOUND SECTION

Name of pt.: Retes, Florecel Dioso
12/03/2012

Date:

Physician: Ingente, Regina P

OBSTETRICS
SECOND & THIRD TRIMESTER
LMP: 03/27/2012

AOG: 35W 6D

EDC: 01/01/2013

General Survey
Anterior

Placenta location

No. Of Fetuses: 1

Grade: 2.00

Presentation: Cephalic
Os: 0.00

Distance to int.

FHB: 130 bmp

Fetal anatomic survey

Amniotic fluid index: 1.0 0.0

Last ventricles: Y

1.6 2.8

Trans Cereb. Diam

Total AFI: 5.40

Cistema Magna

Biometry

Post Nuchal fold

BPD 8.22cm AOG 33w D

4-C Heart

HC 30.03cm AOG 33W2 D

Stomach

AC 29.39cm AOG 33W3 D

Kidneys

Spine

FL

6.54cm AOG 33W5 D

17
Ave. Ultrasonic age 33W3 D
Ultrasonic EDC

01/18/2013

Estim. Fetal Weight 2194-4LB13 OZ

Gender

3 Vessel Cord Y
Bladder

Distal Fem. Ep.

female

Diagnosis: Pregnancy uterine 33W 3D fetal biometry, Cephalic, Live, Singleton

Borderline oligohydramnios AFI= 5.4cm, Anterior placenta grade 2, Female
BPS=8/8

Chapter V
Summary, Conclusion and Recommendation

Our pregnant patient is suffering from urinary tract infection, which leads
her to different problems, in which somehow it may affect the fetus inside her
womb. It affects her daily activities, lifestyle and even her emotional status. Its
not that easy for her to adjust with the environment, because of her situation
especially towards her pregnancy. She really wants to have a safe condition in
which, she really do her best to have a better outcome or condition. Especially in

following the instructions like in taking her prescribed medicines and advises
given to her.
We, as a student nurse, weve done our part in rendering comfort,
management and health teaching, because its our responsibility to take good
care for our patient. We encourage her to increase her proper hygiene, healthy
diet, proper exercise, and emotional management towards a healthy lifestyle not
just for her but also for her baby. Increasing proper hygiene is very important to
her because of her condition and also on the kind of food that she needs to take
for the better. She needs to be conscious on her diet and especially on her
wants regarding the food and soft drinks that she always ask for.

Bibliography
Sunner & Suddarth (2007). Medical-Surgical Nursing 7 th ed., Lippincott Williams
&
Wilkins. C & E Publishing., Quezon City Philippines
S.C. Smeltzer et. al., Medical Surgical Nsg. 11th edition
Rick Daniels, Laura Nosek, Leslie Nicoll. Contemporary Medical Surgical Nsg.
Thompson Asian edition
http://www.web-books.com/eLibrary/Medicine/Phisiology/Urinary.htm

http://www.scribd.com
kozier and erbs fundamentals of nursing. 8 th edition. Volume one. Berman,
synder, kozier erbs.
Daviss drug guide for nurses. 11th edition. Judith hopper deglin, pharmD, April
hazard vallerand, phd, Rn, FAAN.