I – INTRODUCTION

A. Overview of the Case

The "urinary tract" consists of the various organs of the body that produce,

store, and get rid of urine. These include the kidneys, the ureters, the bladder,

and the urethra.

The kidneys filter this blood, and the "filtrate" is processed to separate out

waste products and excess amounts of minerals, sugar, and other chemicals.

Since it sees so much of the body's blood flow, the kidneys also contain

pressure-sensitive tissue which helps the body control blood pressure, and some

of the minerals and water are saved or discarded partly to keep your blood

pressure in the proper range.

The waste products and "extras" make up the urine, which flows through

"ureters" (one per kidney) into the bladder, where it is held until you are ready to

get rid of it. When you urinate, muscles in the bladder wall help push urine out of

the bladder, through the urethra, and out. (In men, the urethra passes through

the penis; in women, the urethra opens just in front of the vagina.) When you

aren't urinating (which is most of the time) a muscle called the "sphincter"

squeezes the urethra shut to keep urine in; the sphincter relaxes when you

urinate so that urine can flow out easily. Urine is normally sterile -- that is, it does

not normally contain bacteria. This is a good thing, since the mineral and sugar

content of urine make it a great medium for bacteria to grow in. Usually several

things keep bacteria out of the urine. These include:

The urethral sphincter: when the urethra is squeezed shut, bacteria cannot

climb up the urethra from the "meatus" (the outside opening) into the

bladder.

The length of the urethra: it's a long way up to the bladder for a bacterium.

(A woman's urethra is shorter than a man's, which is one reason why

women are much more likely than men to get UTI's.)

Frequent washing: any bacteria that make it into the urethra are flushed

out the next time you urinate, and since most people empty their bladders

almost completely when they urinate any bacteria that get to the bladder

will be flushed out too. There are also valves where the ureters enter the

bladder to prevent urine from "refluxing" from the bladder to the kidneys,

so even if the bladder and its urine is infected the bacteria shouldn't travel

up to the kidneys.

A urinary tract infection (UTI) is a bacterial infection that affects any part of

the urinary tract. Although urine contains a variety of fluids, salts, and waste

products, it usually does not have bacteria in it. When bacteria get into the

bladder or kidney and multiply in the urine, they cause a UTI. The most common

type of UTI is a bladder infection which is also often called cystitis. Another kind

of UTI is a kidney infection, known as pyelonephritis, and is much more serious.

Although they cause discomfort, urinary tract infections are usually quickly and

easily treated by seeing a doctor promptly.

B. Objective of the Study

The objective of the study is to understand what Urinary Tract Infection is.

The gathered Data Base and History, chief complaints of patient and History of

present illness, Medications given to the patient, Nursing System Review Chart,

Nursing Assessment and Health Teaching are the bases in this study.

C. Scope and Limitation of the Study

This study is to impart to the patient what to do for early recovery. The

Nursing Process was used for scope and limitation of the study. Assessment,

assessing the patient with interview while gathering the data. Diagnosis – Urinary

Tract Infection (Acute Pyelonephritis). Planning – plan what would be best for the

patient for fast recovery. Intervention – implement what would be the plans and

finally Evaluation – if the objective was met.

II – HEALTH HISTORY

A. Profile of Patient:

Name of Patient:

Address:

Civil Status:

Sex:

Age:

Religion:

Nationality:

Date of Admission:

Time:

Hospital:

Vital Signs:

Temperature: 38.1 C

Pulse Rate: 87 bpm

Respiratory Rate: 16 cpm

Blood Pressure: 110/80 mmHg

Height: 5’2 inches

Weight: 48 kg.

B. Family and Personal Health History:

Mr.X, the eldest in the family who was diagnosed of having a

Urinary Tract Infection admitted at Polymedic General Hospital lasts

January 9, 2007. According to my interview with him it was his first time to

be admitted at the hospital. The previous illness that he experienced was

only fever and cough last November 2006. He just have self medications

and was able to treat himself.

C. History of Present Illness:

A case of 17 years old, male, Roman Catholic, single, from

Poblacion, Lantapan Bukidnon. Admiited at the Polymedic General

Hospital, Cagayan de Oro City on January 9, 2007 at 9:45 p.m.

D. Chief Complaints:

The patient Kenneth Mr. X was admitted at Polymedic General

Hospital with the chief complaints of dysuria – difficult or painful urination.

This is usually associated with urgency and frequency of urination due to

cystitis or urethritis.

III – DEVELOPMENTAL DATA

Erikson believed that childhood is very important in personality

development. All of the stages in Erikson's theory are implicitly present at birth (at

least in latent form), but unfold according to both an innate scheme and one's up-

bringing in a family that expresses the values of a culture. Each stage is

characterized by a psychosocial crisis, which is based on physiological

development, but also on demands put on the individual by parents and/or

society. Ideally, the crisis in each stage should be resolved by the ego in that

stage, in order for development to proceed correctly. The outcome of one stage

is not permanent, but can be altered by later experiences. Everyone has a

mixture of the traits attained at each stage, but personality development is

considered successful if the individual has more of the "good" traits than the

"bad" traits.

Kenneth Jay Isip belongs to the Identity vs. Role Confusion (or

Diffusion).

The adolescent is newly concerned with how they appear to others.

Ego identity is the accrued confidence that the inner sameness and

continuity prepared in the past are matched by the sameness and

continuity of one's meaning for others, as evidenced in the promise of a

career.

The inability to settle on a school or occupational identity is disturbing.

IV – MEDICAL MANAGEMENT

The first step in treating a UTI is to make sure there really is one. The only

certain way to know if there is a UTI is to take a sample of urine and test for

urinalysis. If there are bacteria, we can then test several antibiotics to see which

ones kill the bacteria most efficiently.

The problem here is in getting a good sample of urine for culture. Simply

urinating into a sterile cup may not stop contamination by bacteria on the skin,

especially with girls. If you can control your urine, it is possible to use a "clean-

catch" sample. You get this by cleaning the meatus and the surrounding area

thoroughly with antiseptics (such as iodine solution), then urinating a little into the

toilet before filling the sample cup, and finishing your urination in the toilet. This

flushes out bacteria that may be in the urethra or meatus.

Once we have diagnosed a UTI we treat the patient with antibiotics.

Typical antibiotics used for UTIs include trimethoprim-sulfamethoxamole,

nitrofurantoin, and certain penicillins such as amoxicillin. In some cases, when

we are pretty sure from the symptoms that you actually have a UTI, we will start

antibiotics right after we get the urine culture; if the culture result shows that we

need a different antibiotic, we can always change. We repeat the culture 3-5

days after starting antibiotics to make sure that we are actually killing all the

bacteria, and again soon after the antibiotics are finished to make sure we killed

everything that needed killing.

B. Actual Nursing Management

ACTUAL NURSING INTERVENTIONS

S SUBJECTIVE: “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the patient.

O - Facial grimace - Guarding - Restlessness

A Alteration in comfort pain related to urinary infection evidenced by reports of pain and dysuria.

P At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize relief/ control of pain.

I Assess pain noting location, characteristics and intensity. (0-10 scale).- Helps evaluate degree of discomfort.

Note urine flow and characteristics.- Decrease flow may reflect urinary retention. Cloudy urine may be normal (presence of mucous).

Apply hot or cold compress when indicated.- Reduces pain

Provide comfort measures e.g. back rub, repositioning the patient.- Promotes relaxation and may enhance coping abilities.

DEPENDENT:

Administer medications as indicated e.g. narcotics, analgesics.- Relieves pain enhances comfort and promotes rest.

E At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized relief/ control of pain.

ACTUAL NURSING INTERVENTIONS

S SUBJECTIVE: “Basta mangihi ko kay haplos lahi dayon sakit” as verbalized by the patient.

O OBJECTIVE:

- facial grimace- guarding

A Urinary Elimination impaired related to bladder atony evidenced by urinary tract infection.

P At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize behaviors and techniques to prevent urinary infection.

I Assess voiding pattern: frequency, amount. And compare urine output with fluid intake.- Identifies characteristics of bladder function.

Palpate for bladder distention.- Bladder distention can precipitate autonomic dysreflexia.

Have patient obtain urine sample for Urinalysis.- To know any abnormalities in the urine, e.g. presence of bacteria, protein and glucose.

Encourage patient to increase fluid intake 2-4 L/ day.- Prevents infection and urinary stone.

DEPENDENT

Administer medications as indicated. e.g. Vit. C and urinary antiseptics.- Maintains acidic environment and discouraged bacterial growth.

E At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized behaviors and techniques to prevent urinary infection.

ACTUAL NURSING INTERVENTIONS

S SUBJECTIVE: “gi- hilanat ko, labad lagi akong ulo” as verbalized by the patient.

O OBJECTIVE:

- weak- skin hot to touched- restlessness

A Hyperthermia related to increased metabolic rate evidenced by increased in body temperature.

P At the end of 30 minutes of rendering nursing intervention the patient will be able lower down body temperature back to normal range.

I Monitor patient’s temperature; noting shaking chills.- To obtain baseline and to see changes in patient’s temperature.

Check environmental temperature; limit or add bed linen as indicated.- Room temperature and number of blankets should be altered to maintain near normal body temperature.

Perform Tepid Sponge Bath and avoid the use of alcohol.- May help reduced fever, alcohol may cause chills.

Provide cooling blankets.- Used to reduced fever.

DEPENDENT

Administer antipyretics e.g. biogesic 500 mg every four hours.- help to reduced fever.

E At the end of 30 minutes of rendering nursing intervention the patient was able to lower down body temperature back to normal range.

V – PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

Bacteria enters the Bladder

Adhere to the mucosal – surface (colonize epithelium of the urinary tract to avoid being washed out during voiding).

Inflammation of the bladder and urethra

Signs and Symptoms: dysuria, difficult, painful urination

Urinary Tract Infection

The "urinary tract" consists of the various organs of the body that produce,

store, and get rid of urine. These include the kidneys, the ureters, the bladder,

and the urethra.

The kidneys filter this blood, and the "filtrate" is processed to separate out

waste products and excess amounts of minerals, sugar, and other chemicals.

Urinary Bladder is hollow, smooth collapsible, muscular sac that stores

urine temporarily. It is located in the hypogastric region.

The urethra is a tube that connects the urinary bladder to the outside of

the body. The urethra has an excretory function in both sexes to pass urine to the

outside, and also a reproductive function in the male, as a passage for sperm. In

human male, the urethra is about 8 inches (20cm) long and opens at the end of

the penis.

The ureters are the ducts that carry urine from the kidney to the urinary

bladder, passing anterior to the Psoas major. The ureters are muscular tubes

that can propel urine along by the motions of peristalsis. In the adult, the ureters

are usually 50 to 70cm long.

VII – REFERRALS AND FOLLOW-UP

Instruct the patient to follow the home medications prescribed by the

attending physician. Advised the patient to perform exercises such as jogging or

walking exercises in order to promote muscle tone and to regain patient’s

strength and condition. Encourage him to increase fluid intake, urinate when

there is an urge to urinate in order to prevent infection, proper positioning during

sleep and urinating frequently to avoid Urinary Tract Infection.

Instruct the patient for follow-up check-up on his condition after he was

discharge, one week after the discharge will do. Encouraged the patient to drink

plenty of fluids. Eat nutritious foods like fruits and vegetables. Avoid eating salty

foods, junk foods and acidic softdrinks.

IX – EVALUATION AND IMPLICATION

Common organisms that can cause UTI’s include: Escherichia coli and

Staphylococcus saprophyticus. Less common organisms include Proteus

mirabilis, Klebsiella pneumoniae and Enterobacter.

The urinary tract can be infected from above (by bacteria entering the

kidneys from the bloodstream and travelling downward) or from below (by

bacteria entering the urethra and travelling upward).

Infection from above is most often seen in newborns with generalized infection or

"sepsis". If there are many bacteria in the bloodstream, some are likely to get

through the filters of the kidney to the urine. This is especially likely if the filters

are immature, or if there are a lot of bacteria.

In older children and adults infection most often starts from below. In small

children still using diapers, stool (which is largely bacteria) can sit for some time

right at the meatus; the longer it sits there, the more likely it is that bacteria may

enter the urethra. Baby boys are less likely to have this happen than baby girls,

because girls' urethrae are much shorter and the head of the penis isn't as likely

to sit in stool. (Note, though, that bacteria can hang out in any moist, warm area,

and that UTI's in boys under 1 year old seem to happens more often in

uncircumcised boys than in circumcised boys since bacteria can accumulate

beneath the foreskin.) Older girls may become prone to UTI's through wiping

back-to-front when they are first toilet-trained, which pulls stool into the

vaginal/meatal area. Sexually active teenage and adult women are more prone to

UTI's because of friction at the meatus, which tends to push bacteria into the

urethra (urinating after intercourse helps avoid UTI's); the same mechanism may

cause UTI's in teenage boys and adult men, although they are again less prone

to UTI's than women of the same age.

B. Bibliography

Anatomy and Physiology Compilation Book

http://www.haverford.edu/psych/ddavis/p109g/erikson.stages.html

http://www.drreddy.com/uti.html