Urinary Tract Infections (UTI)

Lower UTI:
Urethritis, Cystitis

Pathophysiology
Ascending pathogens such as E. coli cause inflammation of the urethra (urethritis) and inflammation of the bladder (cystitis)

Risk Factors
Catheterization, female gender, incontinence, ↑age, DM

Signs and Symptoms
Frequency, urgency, burning
Bacteria, RBC, and WBC in urine, ↑serum WBC

Upper UTI:
Pyelonephritis

Pathophysiology
Urine reflux from bladder into ureters (ureterovesical reflux) or obstruction causes inflammation of the renal pelvis

Risk Factors
Calculi, stricture, enlarged prostate, incompetent ureterovesical valve

Signs and Symptoms
■ ↑T, chills, N&V
■ Tender costovertebral angle (flank pain)

Glomerulonephritis

Pathophysiology
Infections elsewhere in the body precipitate inflammation of glomerular capillaries

Risk Factors
■ Beta hemolytic streptococcal throat infections
■ Bacterial, viral, or parasitic infection elsewhere in the body
■ Exogenous antigens (e.g., medication)

Signs and Symptoms
■ Hematuria, proteinuria, ↓urination

Treatment
■ Urine and blood cultures prn
■ Antibiotics, antispasmodics, urinary tract antiseptics, sulfonamides, urinary tract analgesic—phenazopyridine (Pyridium)
■ Sepsis requires IV fluid volume replacement, antibiotics, and nutritional support Nursing
■ Monitor S&S, C&S to determine appropriateness of antibiotic, ↑fluids to 3-4L daily, empty bladder q3-4hr, perineal care
■ Indwelling catheter: Surgical asepsis during insertion, closed system, secure to leg to prevent movement in and out of urethra, keep collection bag lower than bladder

Cystitis, Glomerulonephritis, Pathophysiology
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