Nursing Care Plan for Urinary Tract Infection (UTI)

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Pathophysiology

The urine is normally sterile, but exposure to bacteria at the distal urethra (meatus) may lead to colonization of bacteria within the urinary tract. Infection may take place anywhere within the urinary tract, including the lower urinary tract (cystitis), or the upper urinary tract (pyelonephritis).  Cystitis refers to inflammation and infection of the bladder, Pyelonephritis refers to inflammation and infection of the kidneys.

Etiology

The bacteria associated with 80% – 90% of urinary tract infections is Escherichia coli. Other bacteria that commonly cause infections include klebsiella, Enterococcus and Staphylococcus. Bacteria may be introduced to the urinary tract through the use of indwelling catheters. Antibiotic use disrupts the normal flora of the vagina and allows bacteria to grow and spread to the urethra, as does  frequent or recent sexual intercourse. Difficulty voiding and inability to empty the bladder are also causes for the development of bacterial infections in the urinary tract.

Desired Outcome

Patient will be free from pain and symptoms of UTI and will be free of infection.

Urinary Tract Infection Nursing Care Plan

Subjective Data:

  • Lower back pain
  • Dysuria
  • Frequent urination
  • Urethral discharge (primarily in men)
  • Nocturia
  • Suprapubic pain
  • Nausea / vomiting

Objective Data:

  • Hematuria (may be microscopic)
  • Fever / chills
  • Oliguria
  • Foul smelling urine

Nursing Interventions and Rationales

  • Monitor vital signs for infection

 

Symptoms that indicate worsening infection or progression of disease include :

  • Tachycardia
  • Fever / chills
  • Elevated blood pressure

 

  • Assess / palpate the bladder every 4 hours

 

Assess for bladder distention to determine if there is urinary retention.

 

  • Assess hydration status and encourage increased fluids

 

Increasing fluid intake will help the kidneys to flush excess waste and increase blood flow. This will also prevent dehydration with can complicate UTI.

 

  • Administer medications to treat
    • Infection
    • Pain
    • Fever

 

  • Infection– Most UTIs can be treated with common antibiotics such as nitrofurantoin, cephalexin and sulfamethoxazole/trimethoprim, depending on urine culture & sensitivity test results.
  • Pain– Analgesics for urinary pain include phenazopyridine, which is a dye that helps numb the pain within the urinary tract.
  • Fever– Ibuprofen or acetaminophen may be given in case of fever and chills per facility protocol

 

  • Provide education regarding hygiene and prevention of future infections

 

  • Wipe from front to back when urinating and defecating to prevent bacteria being introduced to the vagina and urethra
  • Avoid scented hygiene sprays, douches and bath products to prevent infection and irritation
  • Cleanse genital area before and after sex
  • Empty bladder frequently and completely  to avoid build up of toxins in the bladder
  • Drink lots of water
  • Wear cotton underwear and avoid tight fitting clothing

 

  • Apply heating pad for comfort

 

Application of heat to lower back or abdomen may help relieve pain and cramping. Avoid prolonged exposure to heating pad, using only 15 minutes per session with at least 15-30 minutes in between to prevent burns.

 


References

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Video Transcript

Okay guys, let’s work through an example Nursing Care Plan for your patient with urinary tract infection. So step one of our five step process is always to gather all of your data, all of your information. What do you know about this patient? And we’re going to use a patient with an isolated problem. We’re going to say urinary tract infection is the only thing going on with them. So what kinds of things might we see? Well, we’re definitely going to see pain right? This patient is not going to be comfortable. So they’re probably gonna report maybe some back or flank pain. They might report suprapubic pain, so just depends on where they’re actually hurting. They’re actually gonna report pain with urination as well, which we’ll call dysuria. That’s definitely not comfortable. They might actually report frequent urination. So maybe Polyuria, but really just frequent, right? It’s not necessarily more just more often. And we might be able to just observe that with objective data as well. 

Now some patients, if they’re progressed farther, they may actually see oliguria. So we may able to measure their urine output over a period of time and recognize that it’s actually pretty low. So just depending on the patient, you could have frequent urination or you could have not much, a low urine output. Let’s see, they’ve got a urinary tract infection, so you might actually see some discharge from the urinary meatus. Their urine might smell foul, it might get foul smelling urine, they might have a fever. Subjectively, they might say they have chills, right? So this is a patient with an infection. And then obviously signs of infection, increased white blood cell count. You’re urinalysis might show signs of infection as well, right?

So all of this is signs that you might see in a patient with a urinary tract infection. And so what we’re going to do in our next step, if we had a bunch of other data for our patient, again, you know, you’ve got a blood pressure, you’ve got bowel sounds, you’ve got all this other information. So in the analyze section, then step two, it’s usually when we would say, hey, this information is not really relevant or maybe it’s totally normal. So there’s no issues there. So for right now we’re going to focus on this relevant information. So what is the major, major problem? Well, this patient has an infection in their urine, right? So this is our major problem. We’ve got a urinary tract infection. So what happens when someone has a significant infection? Anytime you have an infection, you’re also at risk for severe infection or sepsis. For it to get worse, for it to get systemic.

What other problems do we have? Well the patient’s in pain? They’re pretty uncomfortable. They’re having dysuria or difficulty urinating. That’s definitely a problem, right? And then the other thing to remember is anytime you have a prolonged infection infection in the urinary tract, that includes the kidneys. And so now you have a patient who’s actually at risk for an acute kidney injury because of this urinary tract infection. If we let it get worse, it’s going to continue to be more and more of a problem. So what needs to be improved? Well, I definitely could improve their pain. I could improve their infection. I could improve their discomfort and I can of course protect them from these problems, right? So what’s my biggest priority? Well, at this point, we know the number one problem is there’s an infection. So my biggest priority is going to be taking care of that infection, right?

So I’ve analyzed my information and now I can ask my how questions. So how did I know it was a problem? This is where we just start linking all of our data together. We link our data to the things that we determined was a problem, and then we’re going to figure out how we address it. So here’s our patient. They have a urinary tract infection. They have a fever, they have all these things, they’re in pain. So how are we going to address it? Well, I’m obviously gonna monitor things like vital signs. I’m gonna monitor their urine output. I know that they probably have an infection. So I’m gonna make sure that I get a urine culture. And then I’m going to probably give them antibiotics, right? So urine culture first than antibiotics. 

I want to encourage them to increase their fluid intake. So not only is that just to kind of help dilute out the urine and make it a little bit less painful, but also helps to protect their kidneys, right? I want to protect their kidneys from that acute kidney injury risk. Let’s see, what other meds could I give them? I could give them pain meds, right? Depending on how much pain they’re in, especially when that kidney infection pain goes to your back, that’s really painful. There’s always some education I can do, right? I can educate the patient on hygiene and that’s going to help keep them from getting future urinary tract infections. And then I might have some other things I can do for pain, like a heating pad. So some nonpharmacological things that I can do for pain. So there’s lots of things I can do for this patient.

And again, we always go back when we say, how do I know if it gets better? We always kind of go back to our data. How did I know it was a problem? Well I had dysuria and I had pain, so decreased pain. Maybe I did a urine culture and I got some bacteria. So I’m going to say, you know, decreased bacteria in the urine or maybe just overall decreased signs and symptoms of infection, maybe a decreased fever, that the oliguria or the frequent urination is going to go away, right? So all those things are going to tell us that this problem has gotten better. We know we’re increasing their fluid intake too. So maybe we could say that they have signs and symptoms of adequate hydration, right? That they don’t show any signs of problems, that they have no signs and symptoms of acute kidney injury. So all of these things that we said were a problem. We know it gets better if they don’t exist anymore, right? 

So next step is always to translate, be concise, get your high level concepts or your nursing diagnoses in order. So again, we said our number one priority for this patient was going to be infection control, right? We’ve got to get that infection under control. Keep them from getting, um, sepsis, keep them from getting worse and progressing. Then let’s see what else we talked about them being in a lot of pain. So let’s say pain or comfort, right? We want to make sure that we get their pain under control. And then all of this talk about oliguria, dysuria, they could even have nocturia, or frequent urination. All of that has to do with urination issues. And so I think it’s fair to say that we want to pay close attention to their elimination needs, right?

Even the hygiene, right? There’s something that’s going to come into play when it comes to elimination. Okay? So there’s our priorities. Let’s get this on paper. Infection control, comfort and pain control and elimination. We’ve got to take care of these problems. So let’s connect the dots. Let’s get this on paper. Use whatever form you need to use. But let’s say infection control’s my priority. How do I know that that was a problem? Well, they had a fever and chills. They may have had some discharge from their urinary meatus. Their urine might have smelled foul and maybe they had some increased white blood cells. So what am I going to do about it? I’m going to monitor my vital signs. I’m going to get a urine culture, and I’m probably going to give antibiotics as well. And I’m going to educate this patient on urinary hygiene.

Why are we doing these things? So we know they’re at risk for sepsis. So we need to be able to monitor for that. We need to know what organism it was so that we can treat the infection. And then this urinary hygiene is actually gonna help decrease the risk of future UTIs. Not everybody gets it because of hygiene, but if you get a urinary tract infection frequently, sometimes just improving urinary hygiene can really help. So overall, our expected outcomes, decreased signs and symptoms of infection, right? All these things that we saw that told us this was a problem, we’d like to see those go away. Right? And of course we don’t want them to get worse. So no signs and symptoms of Sepsis. All right, let’s look at our pain control. How do we know? Well, they reported back pain or maybe suprapubic pain or they reported pain with urination.

So all of these things are reported subjective data from the patient. So what are we going to do? We’re going to encourage fluid intake. We’re going to give those pain meds. Might even apply a heating pad before we give pain meds. We always want to try nonpharm first. So why are we doing this? Sometimes that fluid intake diluting out the urine can help decrease some of that dysuria. Um, we’re obviously wanting to help control their pain, decrease their discomfort, and just kind of make it a little bit of a better experience for them. So overall, my expected outcome decreased dysuria and patient reports decreased pain level. Again, all these things that told us it was a problem. I’d like to see them go away or I’d like to see them get better. So let’s look at elimination again. Remember we saw the possibility of frequent urination or even oliguria, which is not enough, and especially this oliguria is going to tell us they might be running that risk for acute kidney injury.

And then some patients might even see nocturia where they’re having issues having to pee in the middle of the night because of this infection. So what are we going to do? Monitor that urine output? We’re going to encourage that fluid intake because all of these things are going to help not only to evaluate the progress, how are we doing? Is it getting better? Again, this all is going to possibly tell us there’s AKI happening. So we definitely want to be monitoring. And then of course increasing fluids is going to decrease that risk of AKI. This is our way of protecting the kidneys. So expected outcomes, signs and symptoms of adequate hydration and no signs and symptoms of an acute kidney injury. So really we want to see this urine output go up, back to normal, and possibly less frequent but a good volume.

All right, so let’s just review our five steps. We collected all of her information, we analyzed it, we chose the relevant information and figured out what our priority problems were. We asked our how questions, so how are we going to manage it? What are we going to do? What are we gonna expect to see? And then we translated it. We’ve got our concise terms, we’ve got our high level concepts so that we knew exactly what we needed to focus on for that patient. And then we got it on paper, we transcribed it, use whatever form or template you need to use, but just get everything on paper and make sure you’re connecting the dots. So I hope that was helpful. Again, this is just a hypothetical patient with UTI as the only problem. Remember, make sure you’re always looking at the big picture for your patient. Look at all of their data and all of their possible problems before you start to prioritize. All right guys, make sure you check out the rest of the examples in this course as well as our nursing care plan library. Now go out and be your best self today. And as always, happy nursing.

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