Diagnosis and Management of UTI’s Essay
UTIs are among the frequently diagnosed conditions in community-dwelling and hospitalized individuals and present in different ways. While some may be uncomplicated and managed in the outpatient setting through reassurance and antibiotics, others can be complicated with wide-ranging risk factors that may result to recurrent infections, treatment failure, mortalities and morbidities with generally poor health outcomes (Grigoryan, Trautner & Gupta, 2014).This knowledge is essential for nurses to determine a client’s appropriate diagnosis based on his/her presenting complaints and institute relevant and management interventions for improved health outcomes.Diagnosis and Management of UTI’s Essay
A 30 year old female presented in the outpatient clinic with complaints of pain and burning on urination. These complaints were associated with the symptoms of discomfort and a strong urge to urinate such that, she had urinated thrice within an hour on the day of presentation. She acknowledged that her urine had a foul smell and was cloudy but denied the symptoms of myalgia, fever, irritation/itchiness of the vulva, blood in urine, vaginal discharge and nausea. The client also admitted that she was sexually active and had maintained the same partner for the last 2 years.
The client’s Obs/Gynae history was significant for a normal vaginal delivery with one child (girl) who was alive and well. Her menarche was at 13 years of age and the last date of her menses was on 01/10/2019. Her previous gynae appointment was on 10/9/2019 when she was tested for STIs and found negative for gonorrhea, chlamydia and HIV. The client had reportedly completed 3 HPV vaccine doses in 2009 and had T-dap in 2017 and flu shot early 2019. The review of systems was significant for mild pain on the suprapubic region and urgency, urinary frequency and dysuria for three days.Diagnosis and Management of UTI’s Essay
Based on the client’s objective assessment, the vital signs were within the normal range: BP-114/76mmHg, Temp-99.8, Pulse-73 and Resp-15. She however had moderate tenderness on palpation of the suprapubic region. A dipstick urinalysis test was immediately done which turned out to be positive for leukocyte esterase and nitrites.
Based on the patient’s presenting complaint, physical exam and results of the dipstick urine test, a primary diagnosis of Urinary Tract Infection was made. Alternative differential diagnoses that were initially considered were: vaginitis and pyelonephritis. In the clinical setting, the diagnosis of a UTI is predicted using clinical indicators such as the presence of urgency, tenderness on the suprapubic region, frequency and dysuria. Since the client reported no symptoms of irritation on the vulva or vaginal discharge and the dipstick urinalysis test was positive, the diagnosis of vaginitis was ruled out (Mambatta et al., 2015). Similarly, since the patient denied having myalgia, vomiting, fever or pain in the flanks, the diagnosis of pyelonephritis was entirely ruled out. It is also worth noting that, despite the fact that the client reported symptoms of urgency and frequency which is notably consistent with an overactive bladder, the positive findings of the dipstick test played an essential role in ruling out this diagnosis (Mambatta et al., 2015).
Based on the client’s diagnosis of a Uncomplicated Urinary Tract Infection, she was prescribed bactrim 12 hourly that was taken orally for 3 days. The client was also educated on the need for her to avoid products that were spermicidal since they reduce the lactobacilli of the vagina and predisposing one to UTIs. Similarly, she was educated to wipe herself from the front to the back after bowel movements. As explained by Flores-Mireles et al., (2015), this helps to prevent the transfer of intestinal bacteria to the genitourinary tract from the rectum. Apart from emphasizing on the need for her to complete the full course of the medication, she was also informed on the need to void immediately after sexual intercourse which flushes bacteria from the urethra.Diagnosis and Management of UTI’s Essay
References
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology, 13(5), 269.
Grigoryan, L., Trautner, B. W., & Gupta, K. (2014). Diagnosis and management of urinary tract infections in the outpatient setting: a review. Jama, 312(16), 1677-1684.
Mambatta, A. K., Jayalakshmi Jayarajan, V. L. R., Harini, S., Menon, S., & Kuppusamy, J. (2015). Reliability of dipstick assay in predicting urinary tract infection. Journal of family medicine and primary care, 4(2), 265.
Urinary tract infection is a common contagion among men and women but the incidence is quite high among women due to their physiology. In simple terms, it can be referred as a condition which women will certainly encounter during the span of their life time and the prevalence is higher among women during pregnancy. As the name indicates, the infected parts involve the urinary tract comprising of the upper and lower urinary tract. The infection is named after the part that gets infected and is referred to as cystitis (bladder infection) and phylonephritis (kidney infection). The symptoms associated with the bladder and kidney infections are contrasting which includes painful and frequent urination in case of cystitis as a result of bladder infection whereas conditions like high fever and flank pain are commonly experienced in case of kidney contagion which is referred to as phylonephritis.Diagnosis and Management of UTI’s Essay This prevalence of the infection among children and elderly people is not clearly understood and is currently under study. Bacteria are the prime perpetrator responsible for conferring the infection among humans but the role of certain fungi and viruses cannot be over looked. However, the incidence of UTI as a result of viral or fungal infection is considered to be rare phenomena. Though the infection seems to be harmless in the initial stages, the patient shows a variety of symptoms as the stage progresses and can lead to death in severe circumstances. Research studies have defined urinary tract infection as the most common form of bacterial infection.1,2 Urinary tract infection can be a consequence of poor diagnosis and is regarded as the common hospital acquired infection.3,4 The infection encompasses a diverse group of clinical syndromes and diseases that differ in epidemiology, etiology, location severity of the condition.5 In addition to the above factors, it also vary in expressed local symptoms, frequency of recurrence, extent of damage caused, presence of complicating factors and the risk from their reiterate incidence.6 The occurrence of bladder infection is usually followed by kidney infection and results in blood borne infection and in severe circumstances can lead to dire consequences including death. Therefore, UTI is capable of claiming lives under severe circumstances and proper treatment results in quick recovery from the contagion. The onset of the infection is in the 6th week of pregnancy through 24th week.7 Although the prevalence of bacteriuria during pregnancy is similar to that in non pregnant women, pregnancy enhances the possibility of infection among women.8,9 The occurrence of the infection is at its peak during pregnancy which in turn relies on several other factors. Though the higher incidence of UTI during pregnancy cannot be accepted as a universal fact as the concept is under the verge of research and several researchers are attempting to figure out the significance of pregnancy in relation to urinary tract infection. The concept of the predominance of UTI among women during pregnancy is a complex aspect and is yet to be understood and validated. Diagnosis and Management of UTI’s Essay Many researchers have made several attempts in the past and the quest is still going on to derive suitable facts to correlate the prevalence of UTI during pregnancy but nevertheless, pregnancy is considered to be a crucial time and requires various precautionary measures to safeguard the women and unborn child.10 In addition to pregnancy; sexual intercourse and family history also has a central role in conferring UTI.11 The invasion of lower urinary tract by the bacteria which usually comprises the bladder causes cystitis which is trailed by the upper urinary tract infection referred to as phylonephritis. This could be a consequence of blood borne infection. Despite the fact, that 80% of the infection is caused by Escherichia coli, the involvement of other pathogens cannot be denied and one of the perpetrators responsible for conferring UTI are Gram positive cocci. Gram positive cocci are gaining worldwide importance and Staphylococcus species are one of the major pathogens belonging to the cocci group. Pathogens associated with UTI are known to exhibit a property called as bio film formation which is responsible for causing the infection.
Researchers all around the globe are making efforts to elucidate the significance of bio film as a prime source of infection. It is a widely accepted fact that pregnancy is one of the crucial periods and lack of essential care can lead to adverse outcomes. There are several infections that can lead to pregnancy related complications and one of those is the urinary tract infection which invades the lower and the upper urinary tracts. Despite the fact that E. coli is responsible for causing the urinary tract infection, a new perpetrator is gaining significance due to its complex genetic makeup responsible for its pathogenecity and toxicity. The pathogen is none other than S. aureus and sufficient research evidences are available to substantiate their role in causing the infection.Diagnosis and Management of UTI’s Essay