Group 8 Manuscript Print (UTI)

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University of Perpetual Help System Laguna

College of Nursing

Urinary Tract Infection

Group 8

Almacen, Bryan

Cabagua, Rachelle

Carandang, Rhoxlee

Dolleton, Kristine

Fernandez, Kathie

Hermogeno, Justin

Matabang, Charles

Oñes, Jerome

Reyes, Patrixia

Turallo, Jonathan



Introduction

A urinary tract infection is an infection that affects part of the urinary tract. An infection of the

lower part of the urinary tract is referred to as cystitis, while an infection of the upper part of the urinary

tract is referred to as pyelonephritis.

Most UTIs are caused by a bacterial infection of the urinary tract, which is made up of the

kidneys, ureters, the urinary bladder, and the urethra. Each of these plays a role in removing liquid

waste from the body. The kidneys filter the blood and produces urine, the ureters carry the urine from

the kidneys to the bladder, the bladder stores the urine until it is eliminated from the body through the

urethra.

Although bacteria aren’t normally found in urine, they can easily enter the urinary tract from the

skin around the anus (the intestinal bacteria E. coli is the most frequent cause of UTIs). Many other

bacteria, and some viruses, can also cause infection. In rare cases, bacteria can reach the bladder or

kidneys through the blood. Bacterial UTIs are not contagious.

Urinary tract infections (UTIs) are common among children. By the age of five years old, about

8% of girls and 1-2% of boys have had at least one.

In older children, UTIs may have obvious symptoms, such as a burning sensation with urination.

In infants and young children, however, UTIs may be more difficult to detect because symptoms are not

as obvious. In infants, fever is often the only sign.

UTIs occur much more frequently in girls, particularly those around the age of toilet teaching,

because the female urethra is much shorter than that of the male. The proximity to the anus also

contributes to the risk of a UTI. Uncircumcised boys younger than one year of age also have a slightlyhigher risk of developing UTIs.

An abnormality in the structure or function of the urinary tract (for example, a malformed

kidney or a blockage somewhere along the tract of normal urine flow) can also contribute to the

development of a urinary tract infection.



Patient’s Profile

Name: M.M

Gender : Female

Age: 6 months

Civil Status: Child

Nationality: Filipino

Religion : Catholic

Admission Date: Jan 14, 2012

Hospital Name: JONELTA, Pediatrics Ward

Diagnosis: UTI Probable

Attending Physician: Dr. M



Growth and Development

Age Activities Observed

6 months Rolls from back to

stomach

Sits with support

Holds bottle well

Eruption of 1st

temporary teeth

Exhibits stranger

anxiety

Can be pulled from

sitting to standing

Yes

Yes

Yes

No

Yes

Yes



Patient’s History

Immunization Record

Vaccine Minimum Age at First

Dose

Interval Administered

BCG Birth or any time after

birth

None Complete (1 Dose)

DPT Six weeks Four weeks Complete (3 Doses)

OPV Six weeks Four weeks Complete (3 Doses)

Hepatitis B At birth Six weeks between

1st and 2nd dose, 8

weeks between 2nd

and 3rd dose

Complete (3 Doses)

Measles Nine months None No

Chief Complaint

Intermittent high grade fever 3 days prior to admission

Present Medical History

3 Days PTA, with fever 40°C, and rashes on perineal area Self-managed with paracetamol (Tempra) for fever;

Family History

Diabetes Mellitus on the Maternal Side (From grandmother)



Physical Assessment



Area of assessment Normal findings Actual findings Interpretation

Skin

color

texture

skin turgor

temperature

-fair; no rashes

-smooth;without lesions

-elastic;springs back

immediately whenpinched

-withing the range of

36.5-37.5

-(+) perianal macules

-smooth;with lesion

-elastic;springs back

immediately whenpinched

-warm to touch

(39.9C)

-abnormal

-abnormal

-normal

-abnormal

Abdomen

Contour

bowel sounds

Umbilicus

-symmetrical

-audible bowel sounds

-Midline at lateral area

-abdomen is flat

-audible bowel sounds

-umbilicus is midline atlateral are

-normal

-normal

-normal

Female Genital area

Labia majora

and perianal area

Labia minora

Urethral meatusand vaginal

opening

-equal in size;free of

lesions

-smooth

-

symmetric;darkpink;moist

-small and slitlike

-no

lesions;noswelling;no

bulging in the vaginal

opening;no discharge

-equal in size;presence

macules from the labia

majora to the perianal

area

-symmetric;darkpink;moi

st

-small and slitlike

-no

lesions;noswelling;no

bulging in the vaginal

opening;no discharge

-abnormal

-normal

-normal



Anatomy and Physiology



The Urinary System

The Parts and Function of the Urinary System

Our body is like a machine. Machine needs oil or gasoline to work. Our body needs food in order to carry

out its activities. Once the food has reached the body systems, they are quickly used for energy. In theprocess, wastes materials are produced which need to be removed from the body. The solid waste

material comes out through the anus, while the fluid material is eliminated through the urinary system.

The Urinary System and Its Major Parts

1. Kidneys- the kidneys are two brownish, bean shaped organs about the size of a fist. They weigh

about 5 ounces. They are located in the upper right and left back part of the abdominal cavity.

Each kidney contains about 1,200,000 microscopic filters called nephrons. Nephrons are smaller

than the smaller dots.

The main function of the kidneys is to maintain the water balance and to eliminate waste materials from

the blood.

2. Ureters – the left and the right ureters are long muscular tubes. They are about 12 inches long

with a diameter of 2 to 3 millimetres.

The ureters connect pelvis of each kidney to urinary bladder. They carry urine from each kidney to the

urinary bladder.

3. Urinary Bladder – the urinary bladder is a muscular sac that holds urine. It is located in front of

the pelvis and behind the pubis. As the bladder fills, walls stretch signalling the desire to urinate.

4. The Urethra- the urethra is a muscular tube which carries urine from the bladder to the outside

part of the body. In the female, it is a one inch long from the bladder to the cleft of the labia. In

the male, it is several inches long from the prostate gland to the penis. When one is about to

urinate, a valve in the urethra relaxes to allow the urine to flow out.



The Urinary System Cleans the Blood

Waste Products

During normal activity of the body, waste products are formed. The chief waste products of the body are

carbon dioxide, water, urea, and salts. Carbon dioxide is eliminated through the lungs, while water, ureaand salts are eliminated through the urine. Urea is a product resulting from the breakdown of protein

foods and of protoplasm. It is excreted mainly by the kidneys.

Urinary Systems Mechanism

1. Glomerulus – each nephron is composed of a glomerulus. The glomerulus is surrounded by

hollow capsule known as Bowman’s capsule. The capillaries in the glomerulus filter the waste

materials of the blood except protein and the cells.

2. Filtered Fluid – the filtered fluid enters the Bowman’s capsule, where it flows down through its

twisted tubes. The walls of the tubes absorb back in to the blood the needed water and bloodchemicals.

3. Pathway of Unwanted Chemicals – Unwanted chemicals are discharged. The unwanted

chemicals are the waste products. They come out in the form of urine. The urine passes into the

ureter and on to the urinary bladder, then to the urethra which releases it to the outside of the

body. Urine gives valuable clues to the body. Sugar in the urine is an indication of diabetes.

Albumin may signify that the kidneys are not functioning properly.



Pathophysiology

Schematic Diagram

Non-Modifiable Factors

Age – UTI has the highest

frequency in infancy

Gender – UTI has a higher

incidence rate among females

Modifiable Factors

Inadequate frequency of diaper change

Poor hygienic practices

Bacterial Invasion

Multiplication of bacteria, causing infection in the lower urinary tract

Interruption in the

normal homeostatic

environment of the

urinary tract

Immune response by the

body (defense

mechanism of the body

against foreign bodies)

Increased

WBC

Cytokine and

prostaglandin release

Body induces the action of the

cytokines and prostaglandins,

which are aimed at elevating

body temperature

Fever

Urinary Tract

Infection



Medical Management

Diagnostic Test Nursing Responsibility

CBC

Inform the patient this test can assist in

evaluating the amount of hemoglobin in

the blood to assist in diagnosis andmonitor therapy.

Obtain a history of the patient's

cardiovascular, gastrointestinal,

hematopoietic, hepatobiliary, immune,

and respiratory systems; symptoms; and

results of previously performed

laboratory tests and diagnostic and

surgical procedures.

Obtain a list of the patient's current

medications, including herbs, nutritional

supplements, and nutraceuticals Review the procedure with the patient.

Inform the patient that specimen

collection takes approximately 5 to 10

min. Address concerns about pain and

explain that there may be some

discomfort during the venipuncture.

Promptly transport the specimen to the

laboratory for processing and analysis.

Urinalysis

Collect specimens form infants and young

children into a disposable collection

apparatus consisting of a plastic bag with

an adhesive backing around the opening

that can be fastened to the perineal area

or around the penis to permit voiding

directly to the bag. Depending on hospital

policy, the collected urine can be

transferred to an appropriate specimen

container.

Cover all specimens tightly, label properly

and send immediately to the laboratory.

If the specimen cannot be delivered to the

laboratory or tested within an hour, it

should be refrigerated or have an

appropriate preservative added.



Fecalysis

If he is taking any medications, thesemust be screened as some can affect

test results. A patient is usually

discouraged as well from takingaspirin, alcohol, vitamin C, ibuprofen

and certain types of food if his fecal

sample will be checked for any sign of blood. Recent travel and X-Ray testscan also affect the results of fecalysis

If the patient is suffering from

diarrhea, placing a plastic wrap andsecuring it under the toilet seat couldfacilitate the collection process

Collected samples must be brought tothe doctor's office or laboratory assoon as possible. Delays could

compromise the quality of thesample. Volume or amount is alsoimportant so the patient must be sure

he has collected an adequate amount

of stool



Medications

Medications Rationale

Cefuroxime (Ceftin) To treat bacterial infection of theurinary tract

Paracetamol To treat hyperthermia

IV Fluids

IV Fluid Rationale

D5 IMB 500cc, 30 cc/hr To prevent dehydration or electrolyte

imbalance

Diet

Diet Rationale

NPO temporarily x4h then start milk

feeding with strict aspiration

prevention

The patient had an episode of vomiting

(only once)



Laboratory Results

Latest CBC, 1/16/2012

Test Name Result Normal Value Units Interpretation Indication

Hemoglobin 105 110 – 140 gm/L Decreased

Due to iron

deficiency

anemia

Hematocrit 0.30 0.37 – 0.47 Decreased

Due to iron

deficiency

anemia

RBC Count 3.85 4 – 5.5 x 10^12/L Decreased

Due to iron

deficiency

anemia

WBC Count 22.9 5.0 – 10.0 x 10^9/L Increased

Indicates

presence of

infection

Segmenters 0.72 0.50 – 0.70 Increased

Indicates

presence of

infection

Lymphocytes 0.16 0.20 – 0.40 Decreased

Indicates

presence of

infection

Monocytes 0.12 0 – 0.05 IncreasedIndicates

presence of

infection

MCV 76.5 80 – 98 fl Decreased

Indication of

iron deficiency

anemia

MCH 27.4 26 – 32 pg Normal

MCHC 358 320 – 360 g/L Normal

Platelet Count 233 150-400 x 10/L Normal



Urinalysis, 1/15/2012

Test Name Actual Findings Normal Findings Interpretation

Color Light Yellow Light yellow to

amber

Normal

Transparency Slightly Hazy Clear to slightly hazy Normal

Reaction (pH) Acidic, 6.0 4.5 – 8.0 Normal

Protein Negative Negative Normal

Glucose Negative Negative Normal

Specific Gravity 1.005 1.003-1.030 Normal in infants

Pus Cells 10-15/HPF 0-5/HPF Indicates presence of

bacteriaRBC 1-2/HPF 2-3/HPF Normal

Epithelial Cells Occasional Occasional Normal

Mucus Threads Few Few Normal

Fecalysis, 1/15/2012

Test Name Actual Findings Normal Findings Interpretation

Color Yellow Green Brown Result of bottle feeding

Consistency Soft Soft and bulky,

depending on the diet

Normal

Blood (gross) N/A 0-3 HPF Normal

Occult Blood N/A None N/A

Bacteria N/A Abundant N/A

Mucus N/A None N/A

Bile N/A None N/A

OVA/Parasite None Found None Normal

Pus Cells N/A 0-3 HPF N/A

RBC N/A 0-3 HPF N/A

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