6 Urinary Tract Infection Nursing Care Plans

Urinary tract infections (UTI) are caused by pathogenic microorganisms in the urinary tract (kidney, bladder, urethra). The majority of UTIs are caused by the bacterium Escherichia coli (E. coli), normally found in the digestive system. Usually, bacteria that enter the urinary tract system are removed by the body before they can cause symptoms. But, in some cases, bacteria overcomes the natural defenses of the body, therefore causes infection.

An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may ascend up to the ureters to multiply and cause the infection of the kidneys (pyelonephritis).

Signs and symptoms of urinary tract infections include; fever, chills, a strong, persistent urge to urinate, burning sensation when urinating, cloudy, foul-smelling urine, and pelvic pain in women.

Nursing Care Plans

The focus of this care plan for Urinary Tract Infections (UTI) include relief of pain and discomfort, increased knowledge of preventive measures and treatment regimen, and absence of complications.

Here are six (6) nursing care plans (NCP) for urinary tract infections (UTI):

1. Impaired Urinary Elimination

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Impaired Urinary Elimination: Dysfunction in urinary elimination.

May be related to

• - Frequent urination, urgency, and hesitancy.

Possibly evidenced by

• - Dysuria.
• - Urinary frequency; urge.
• - Urinary hesitancy.

Desired Outcomes

• - Client will achieve normal urinary elimination pattern, as evidenced by absence sign of urinary disorders (urgency, oliguria, dysuria).
• - Client will demonstrate behavioral techniques to prevent urinary infection.

Nursing Interventions	Rationale
Assess the patient’s pattern of elimination.	Serve as a basis for determining appropriate interventions.
Note client’s age and gender.	UTIs are more prevalent in women and older men.
Palpate the client’s bladder every 4 hours.	To determine the presence of urinary retention.
Encourage increased fluid intake (3-4 liters a day if tolerated).	To help improve renal blood flow.
Encourage the client to void every 2-3 hours.	To prevent the accumulation of urine thus limiting the number of bacteria.
Instruct the female client to wipe the area from front to back and the avoidance of bath tubs.	Proper perineal care helps in minimizing the risk of contamination and re-infection.
Maintain an acidic environment of the bladder by the use of agents such as Vit.C, Mandelamine (a urinary antiseptic) when appropriate.	To prevent the occurrence of bacterial growth.

2. Infection

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May be related to

• - Chronically alkaline urine.
• - Improper toileting.
• - Indwelling catheter.
• - Instrumentation or catheterization.
• - Pregnancy.
• - Urinary retention.

Possibly evidenced by

• - Anorexia.
• - Bacteriuria.
• - Burning sensation with urination.
• - Cognitive changes among older adults.
• - Fatigue.
• - Fever and chills.
• - Flank pain.
• - Frequency of urination.
• - Foul-smelling urine.
• - Hematuria.
• - Increased white blood cell count (WBC).
• - Suprapubic tenderness.

Desired Outcomes

• - Client will be free of urinary tract infection as evidenced by the absence of fever, chills, flank pain, and suprapubic tenderness; clear non-foul smelling urine and a normal WBC count.

Nursing Interventions	Rationale
Assess for signs and symptoms of urinary tract infection.	Common symptoms includes fever, chills, cloudy urine, reports of frequency, urgency, or burning on urination;
Assess for risk factors for UTI.	A history of sexually transmitted infections, catheter use, and previous surgeries of the genitourinary tract are at risk of developing UTI; Blockages of the urinary tract, such as those caused by a kidney stone or an enlarged prostate, can block the flow of urine also increases the risk of UTI.
Monitor laboratory as indicated:
- WBC count.	Increased WBC count is a systemic response to infection.
- Urinalysis.	The presence of RBCs and WBCs in the urine is associated with the inflammation process during an infection.
- Bacteria in the urine.	Bacterial counts of 105are usually considered diagnostic for UTI, although lower counts may also indicate UTI.
- Urine culture and sensitivity.	This will determine which antibiotics are most suitable to treat the infection
Encouraged the client to void often every 2 to 3 hours a day and completely empty the bladder.	This will prevent bladder distention, facilitate flushing of the bacteria and avoid reinfection.
Encouraged increased oral fluid intake (2 to 3 liters a day if no contraindication).	Fluid intake facilitates urine production and flushes bacteria from the urinary tract.
Suggest drinking of cranberry juice (four to six 8 ounce glasses per day).	Cranberry juice has been shown to reduce adherence of bacteria to the uroepithelial cells in the urinary tract.
Suggest the use of vitamin C. (500 to 100 mg/day).	Bacteria grow properly in an acidic environment. The use of vitamin C will help in the acidification of the urine.
Limit the use of indwelling bladder catheters to manage incontinence.	Catheter use increases the risk for UTI. Alternative measures such as regular toileting can prevent infection.
Encouraged the client to complete the whole duration of the antibiotic (The usual length of antibiotic therapy is 7 to 10 days).	Client’s should finish the prescribed duration of the antibiotics, even if the symptoms disappear, because not finishing a course of antibiotics may result to reinfection.

3. Acute Pain

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Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

• - Inflammation and infection of the urethra, bladder, and other urinary tract structures.

Possibly evidenced by

• - Burning on urination.
• - Facial grimace.
• - Guarding behavior.
• - Protective decreased physical activity.
• - Spasm in the lower back and bladder area.

Desired Outcomes

• - Client will use pharmacological and nonpharmacological pain relief strategies.
• - Client will report satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.

Nursing Interventions	Rationale
Assess client’s description of pain such as quality, nature and severity of pain.	Pain associated with UTI is described as burning on urination,flank pain, lower abdominal or suprapubic pain. While some clients with recurrent infection are asymptomatic. This information will help in determining the choice of intervention.
Suggest use of non-pharmacological techniques as appropriate.	Alternative therapies such as relaxation, massage, guided imagery, or distraction may decrease pain and provide comfort.
Encourage increased oral fluid intake (2-3 liters if no contraindications).	Increased hydration helps in flushing the bacteria and toxins.
Encouraged the use of a sitz bath.	Sitz baths may reduce perineal pain and promotes muscle relaxation.
Instruct to avoid coffee, tea, alcohol, and sodas.	These food items cause irritation to the urinary system and should be avoided.
Apply a heating pad to the suprapubic area or lower back.	This measure alleviates the pain.
Encouraged the use of analgesic (e.g., acetaminophen) or antispasmodics (e.g., phenazopyridine).	Antispasmodic and analgesic agents are useful in relieving bladder irritability, spasm, and pain.

4. Deficient Knowledge

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Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

• - Unfamiliarity with nature and treatment of UTI.

Possibly evidenced by

• - Lack of questions.
• - Multiple questions.
• - Recurrent UTI.
• - Verbalizing inaccurate information.

Desired Outcomes

• - Client will verbalizes knowledge of causes and treatment of UTI, controls risk factors, and completes medical treatment of UTI.

Nursing Interventions	Rationale
Explain to the client about UTI risk factors, prevention, and treatment.	Frequent recurrences of UTI may indicate that the client has no understanding of the disease and its management.
Encouraged the client to finish all prescribed antibiotics, even if symptoms resolve.	In the first few days of antibiotic therapy, urinary symptoms of burning, frequency, and urgency usually resolve. However, Not finishing the antibiotic on the prescribed time will make the bacteria grow and multiply again.
Encouraging the reporting of signs and symptoms of recurrence.	1 to 2 weeks after completing the antibiotic therapy is a common time frame for the signs and symptoms to recur.
Teach the client about the importance of preventing urinary tract infection.	The goal of client teaching is to resolve the current infection and prevent recurrence.
- Hygienic measures (showering rather than bathe in a tub).	Bacteria in the bath water may enter the urethra.
- Perineal hygiene after a bowel movement.	This will help in preventing the migration of the pathogen in the urethral opening and, in women, the vaginal opening.
- The importance of frequent bladder emptying.	Completely emptying the bladder prevents bladder distention and compromised blood supply to the bladder wall. These predispose the client to UTI.
- Use tampons for periods.	Tampons are advised during the menstruation rather than sanitary napkins because they keep the bladder opening area drier, hence limiting the growth of bacteria.
- Avoid wearing tight-fitting or constricting undergarments made of non-breathing materials.	Such fabrics can accumulate moisture and can provide an environment for bacterial growth. Cotton fabric and loose fitting clotting are more encouraged.
- Need for follow-up urine cultures.	Periodic urine cultures identify the effectiveness of the antimicrobial therapy.

5. Disturbed Sleep Pattern

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Disturbed Sleep Pattern: Time-limited disruption of sleep (natural periodic suspension of consciousness)

May be related to

• - Nocturia.
• - Pain.

Possibly evidenced by

• - Sleep onset greater than 30 minutes.
• - Sleep maintenance insomnia.
• - Restlessness; irritability.

Desired Outcomes

• - Client will report improvement in sleep/rest pattern.
• - Client will report sense of well-being and feeling rested.

Nursing Interventions	Rationale
Identify the client’s sleeping habits/routine and changes.	To determine usual sleep pattern and appropriate interventions.
Provide comfort measures such as warm bath, back rub.	To increase relaxation and improve the sleeping pattern.
Encourage the client to drink milk.	L-tryptophan in milk helps induce and maintain sleep.
Reduce environmental distraction such as noise and light.	Provide a situation conducive to sleep.
Limit fluid intake during night time.	To minimize the need to urinate in the evening.
Encourage to limit intake of chocolate and caffeinated beverages prior to bedtime.	Caffeine increases alertness by blocking sleep-inducing chemicals in the brain and increasing adrenaline production.

6. Hyperthermia

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Hyperthermia: Body temperature elevated above normal range.

May be related to

• - Inflammation.

Possibly evidenced by

• - Increase body temperature above normal range.
• - Flushed skin; warm to touch.

Desired Outcomes

• - Client will maintain core temperature within normal range.

Nursing Interventions	Rationale
Assess for signs of increased body temperature.	Increased body temperature will show a variety of symptoms such as sweating, shivering, headache, warm skin, and body malaise.
Monitor vital signs, especially temperature, as indicated.	To determine appropriate interventions.
Provide tepid sponge bath.	A tepid sponge bath is done to reduce fever.
Encourage adequate fluid intake.	To prevent the occurrence of dehydration.
Encourage the use of hypothermia blanket and wrap extremities with bath towels.	This will help to reduce shivering.
Maintain bed rest.	To reduce metabolic demands/oxygen consumption.
Administer antipyretic drugs as indicated.	To reduce body temperature.

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References and Sources : nurseslabs.com