One fairly common patient that you'll care for in the hospital is someone with a urinary tract infection. I had no idea how deadly these can actually be! If the UTI develops into sepsis, especially in the older population, it can cause a patient to deteriorate quickly. What signs should you be looking for with your patients? Jessica from Vive Health put together this great post about UTIs and what you should be watching for.
Urinary Tract Infections
As a nurse, one common infection you will encounter with patients is bound to be urinary tract infection (UTI). Studies suggest that upwards of 40% to 50% of all women will contract UTI at some point in their lives and that over 8 million people visit a healthcare provider each year for UTI. Understanding its causes, risk factors, diagnosis, and treatment can help you provide even better care to your patients who may develop one.
Where Do UTIs Develop?
The term UTI can be used to describe an infection anywhere in the urinary tract from the urethra to the bladder to the ureters and kidneys. The body’s defense systems, which are great at eliminating infectious pathogens, include the kidneys that continuously filter excess fluid, urea, and other waste from the blood and send it to the bladder - this becomes urine.
Bacteria thrive in the urinary tract, however, in part because it fosters a moist and warm environment for rapidly growing. Bacteria most often start out in the urethra (because of its proximity to the outside world) and then make their way up to the bladder and sometimes beyond.
The most common forms of bacteria that cause UTI include E. Choli and Klebsiella pneumoniae though additional organisms like Streptococcus, Staphylococcus, Enterococcus, epidermidis, and Pseudomonas aeruginosa can too.
What Factors Put Patients at Risk?
A primary risk factor that explains in part why women develop UTI much more frequently than men is simply sexual anatomy. Women have shorter urethras through which bacteria can travel up as well as smaller distances in bacteria-prone places like the perineal area. Additional risk factors include:
- Sexual activity
- Use of certain birth control agents like diaphragms or those with spermicide
- Blockages like an enlarged prostate or kidney stones
- Urinary abnormalities
- Genetic predisposition
- Diabetes and other conditions which suppress the immune system
- Urological procedures
- Use of catheters
How Are UTIs Diagnosed?
Nurses are oftentimes the frontline help for patients struggling with UTI. If a patient complains of symptoms including a burning sensation when peeing, abdominal pain and pressure, pink, bloody, or cloudy urine, and a frequent urgency to urinate, their doctor may order a urinalysis. You may check for symptoms that indicate an infection in general as well, i.e. use a thermometer to gauge whether a fever is present and a sphygmomanometer to check for changes in baseline blood pressure levels.
Elderly patients may not communicate those more typical symptoms but could experience side effects from UTI that mimic dementia, i.e. disorientation, confusion, and mental fog. As a nurse, you will help collect a urine sample from your patient that can be analyzed and cultured. It may be a “clean catch” specimen that is taken in a cup directly from the flow of urine when a patient goes in a bedpan or toilet. In other instances, however, you may need to use an in-and-out catheter, i.e. wit an immobile senior, or a bag, i.e. with an infant.
A lab can quickly tell from a urine sample whether the presence of white blood cells indicate an infection is present as well as hemoglobin, nitrites, cellular debris, bacteria, and more. A culture of the urine sample is then administered (takes roughly 3 days to get results) to narrow down the specific type of bacteria that is causing the infection. Sometimes doctors will also administer imaging scans of the urinary tract or a cystoscopy.
How Are UTIs Treated?
Once the patient’s doctor knows the results of the urinalysis and culture, they can prescribe antibiotics that specially target the bacteria causing the infection. A simple round of oral antibiotics typically does the trick for wiping out a UTI, however, in severe cases where the infection has spread past the bladder and into the kidneys, more aggressive treatment with intravenous antibiotics may be needed in the hospital.
Complications from untreated UTIs include kidney infection and even kidney damage or failure, increased risk to a fetus in pregnant women, urethral stricture in men, chronic recurring infections, as well as life-threatening sepsis.
Researchers have made some recent discoveries in how chronic UTIs develop, finding that a specific protein called FmlH is likely responsible for helping E. coli bacteria stick to the lining of the bladder wall. Preventative treatments like vaccines for chronic UTI may be available in the future.
The good news for patients is that preventing UTIs is possible to some extent. Preventative measures include:
- Drinking lots of water to boost the body’s ability to flush out bacteria
- Taking cranberry (via juice, extract, or supplement) and d-mannose
- Urinating right after sexual intercourse to empty the bladder
- Practicing good hygiene (wiping front to back, properly managing incontinence)
- Changing birth control methods
- Avoiding feminine products that irritate the area
- Taking low-dose antibiotics for chronic UTI
Jessica Hegg is the content manager at ViveHealth.com. Avid gym-rat and nutrition enthusiast, she’s interested in all things related to staying active and living healthy lifestyle. Through her writing she works to share valuable information aimed at overcoming obstacles and improving the quality of life for others.