Table of Contents:

 Introduction …………………………………………………….. 2, 3

 Patient Profile ………………………………………………….. 3

 Patient History / Nursing history …………………………….. 4

 Anatomy and Physiology …………………………………….. 4

 Pathophysiology ………………………………………………. 5

 Laboratory Results …………………………………………….. 5

 Course in the Ward ……………………………………………. 5

 Nursing Care Plan ……………………………………………… 6

 Drug Study ………………………………………………………. 7,8,9

 Discharge Planning ……………………………………………. 10

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 I. INTRODUCTION

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
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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.
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.

II. PATIENT PROFILE

Patient’s Name: M.A.M

Age: 18 y.o
Gender: Male
Address: Blk 3 Lot 24 Ilang-Ilang St., Camella Town Homes, Cavite
Birth Date: Feb. 8, 1992
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: August 13, 2010 / 3PM
Attending Physician: Dr. Jumarang
Admitting Diagnosis: UTI R/O DFS

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 III. PATIENT HISTORY

 History of Present Illness:

- Admitted with the chief complaints of dysuria – difficult or painful urination.
- On & off fever
- Low back pain
 Family Health History:
M.A.M is the eldest in the family who was diagnosed of having a Urinary Tract Infection
admitted at Metro South Medical Center last August 13, 2010. 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 June 2009. He just has self medications and was able to treat himself.

IV. ANATOMY AND PHYSIOLOGY

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.
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V. PATHOPHYSIOLOGY

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

VI. DIAGNOSTIC / LABORATORY

No result yet.

VII. COURSE IN THE WARD

Standing Order:
Medication:
o Cetirizine 10mg OD in Am
o Iterax 25mg OD HS
o Omeprazole 40mg OD
o Macrodantin 100mg/tab BID x 7 days
o Solwortif 100mg TID
o Ciprofloxacin 500mg/tab BID

PRN:

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 Medication:
o Mefenamic Acid 500mg

VIII. NURSING PROCESS

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTIO RATIONALE EVALUATIO

N
N

SUBJECTIVE: Acute pain A urinary tract After 1-2 Independent: · Provides After
“Masakit ang related to infection (UTI) hours of · Assess pain, information to nursing
pagihi ko” biological may occur in nursing noting location, aid in interventions,
as verbalized by factors such the bladder, interventions, intensity (scale determining
the patient.
the
as trauma or where it is the patient’s of 0 – 10), choice or
patient
activity of called cystitis, pain will be duration. effectiveness of
Objective: disease or in the relieved or interventions.
verbalizes
· Facial grimace. process. urethra, where controlled. · Increased relieved from
· Encourage
· Restlessness. it is called increased fluid hydration pain /
· V/S taken as urethritis. Upper intake. flushes bacteria controlled
follows: tract infection and toxins. pain.
T: 37.3 results in · Urinary
· Investigate
P: 82 pyelonephritis. retention may
report
R: 19 Most UTIs develop,
of bladder
BP: 120/90 result from causing tissue
fullness.
ascending distention (
infections by bladder or
bacteria that kidney), and
have entered potentiates risk
through the for further
urinary meatus infection.
but some may · Accumulation
be caused by · Observe for of uremic waste
hematogenous changes in mental and electrolyte
spread. UTIs status, behavior or imbalances may
are much level of be toxic to the
common in consciousness. CNS.
females · Promotes
because the · Provide comfort relaxation,
shorter female measure like back refocuses
urethra makes rub, helping attention, and
them more patient assume may enhance
vulnerable to position of coping abilities.
entry of comfort. Suggest
organisms from use of relaxation
surrounding technique and
structures deep breathing
(vagina, exercises.
periurethral
· Encourage use · Promotes
glands &
Of sitz baths, muscle
rectum).
warm soaks to the relaxation.
perineum.

Collaborative:
· Administer · Reduces
antibacterial as bacteria present

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 prescribed. in urinary tract
and those
introduced by
drainage
system

IX. DRUG STUDY

NAME OF DRUG MECHANISM INDICATION CONTRAINDI- SIDE / NURSING

/ DOSAGE / OF ACTION CATION ADVERSE RESPONSIBILITIES
ROUTE EFFECT
/FREQUENCY
Cetirizine A long acting Used for the Contraindicated -D rowsiness - Use cautiously in
non-sedating symptomatic in patients -H ead ach e patient s with renal or
Classification: antihistamine that relief of allergic hypersensitive -I m paired hepatic disorder
Antihistamine selectively symptoms such to drug or to muscular -Warm patient not to
(piperazine inhibits as hay fever hydroxyzine coordination perform hazardous
derivative) peripheral H1 and urticaria and in breast -Pharyngitis activities until CNS
receptors feeding women -Dry mouth effects of drug are
Dosage: Vomiting known
10 mg -Abdom inal -Advise patient not to
distress use alcohol or other
Route: CNS depressants while
PO taking drug
-Stop drug 4dys before
Frequency: diagnostic skin test
OD because
antihistamines can
prevent, reduce, or
mask positive skin test
response

Iterax Competes with Treatment of Hypersensitivity, CNS: -Assess client for

histamine for h1- anxiety, Pregnancy Drowsiness, dizziness and
Classification: receptor sites on preoperative Agitation, drowsiness
Antianxiety effector cells in sedation, Ataxia, -Assess client with
agents, the git, blood antiemetic, Dizziness, kidney disease
Antihistamines, vessels, and antipuritic, may Headache, -Assess clients for
Sedative respiratory tract. be combined Weakness allergic reactions
with opioid Resp:
Dosage: anagesics Wheezing
25 mg GI:
Dry Mouth,
Frequency: Bitter Taste,
OD Constipation,
Nausea
Derm:
Flushing
Others : Pain
And Abscesses
At IM Site,
Chest
Tightness,
Urinary
Retention

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NAME OF DRUG MECHANISM INDICATION CONTRAINDI- SIDE / NURSING
/ DOSAGE / OF ACTION CATION ADVERSE RESPONSIBILITIES
ROUTE EFFECT
/FREQUENCY
Omeprazole Gastric acid- Short-term Contraindicated CNS: - Take the drug
pump inhibitor: treatment of with Headache, beforemeals.
Classification: Suppresses active duodenal hypersensitivity Dizziness, -Report severe
Antisecretory drug gastric acid ulcer; to omeprazole or Asthenia, headache, worsening of
Proton pump secretion by First-Line its components; Vertigo, symptoms, fever, chills.
inhibitor specific inhibition therapy in Use cautiously Insomnia, - Swallow the capsules
of the hydrogen- treatment of with Apathy, whole; do not chew,
Dosage: potassium heartburn or Pregnancy, Anxiety, open, or crush them.
40 mg ATPase enzyme symptoms of Lactation. Paresthesias,
system at the gastro Dream
Route: secretory surface esophageal Abnormalities
IV of the gastric reflux disease Dermatologic:
parietal cells; (GERD); Rash,
Frequency: blocks the Short-term Inflammation,
OD final step of acid treatment of Urticaria,
production. active benign Pruritus,
gastric ulcer; Alopecia, Dry
severe erosive Skin
Esophagitis, GI: Diarrhea,
poorly Abdominal
responsive Pain, Nausea,
symptomatic Vomiting,
Constipation,
Long-term Dry Mouth,
therapy: Tongue
Treatment of Atrophy
pathologic Respiratory:
hypersecretory URI
conditions Symptoms,
(Zollinger- Cough,
Ellison Epistaxis
syndrome, Other:
multiple Back Pain,
adenomas, Fever
systemic
mastocytosis);

Macrodantin Bacteriostatic in Treatment of Contraindicated CNS: -Arrange for culture &

low UTIs caused by with allergy to Peripheral sensitivity tests before and
Classification: concentrations, susceptible nitrofurantoin, Neuropathy, during therapy.
possibly by -Give with food or milk to
Urinary Tract strains of Renal Headache,
prevent GI upset.
Anti-Infective interfering with Escherichia Dysfunction; Dizziness, -Continue drug for at least
Antibacterial bacterial coli, Pregnancy, Drowsiness, 3 days after a sterile urine
carbohydrate Staphylococcus Lactation. Vertigo specimen is obtained.
Dosage: metabolism; aureus, Dermatologic: -Monitor clinical
100 mg/tab bactericidal in Klebsiella, Exfoliative response; if no
high Enterobacter, Dermatitis, improvement is seen or a
Route: concentrations, Proteus Pruritus, relapse occurs, send urine
PO possibly by Prophylaxis or Urticartia, for repeat culture and
disrupting sensitivity.
long-term Angioedema
-Monitor pulmonary
Frequency: bacterial cell wall suppression of GI: Nausea, function carefully;
TID formation, UTIs Abdominal reactions can occur within

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 causing cell Cramps, hours or weeks of
death. Vomiting, nitrofurantoin therapy.
Diarrhea,
NAME OF DRUG MECHANISM INDICATION CONTRAINDI- SIDE / NURSING
/ DOSAGE / OF ACTION CATION ADVERSE RESPONSIBILITIES
ROUTE EFFECT
/FREQUENCY
Ciprofloxacin Inhibition of used to treat Persons with a ♣ Nausea -Twice a day exactly at
topoisomerase infections of the history of ♣ Vomiting 6 am & 12 noon; Make
Classification: (DNA gyrase) skin, lungs, hypersensitivity ♣ Stomach sure to drink plenty of
Antibacterial enzymes, airways, bones, to pain water or other fluids
which inhibits and ciprofloxacin, ♣ Heartburn everyday while taking
Dosage: relaxation of joints caused by any ♣ Diarrhea Ciprofloxacin; Do not
500 mg supercoiled susceptible member of the ♣ Feeling an take or eat a lot of
DNA and bacteria. quinolone class urgent need caffeine products such
Route: promotes Ciprofloxacin is of to urinate as coffee, tea, energy
PO breakage of also frequently antimicrobial ♣ Headache drinks, cola or
double used agents, ♣ Hives chocolate within 6
Frequency: stranded to treat urinary or any of the ♣ Difficulty hours before or 2 hours
BID DNA. infections product breathing or after you take
caused components. swallowing ciprofloxacin.
by bacteria such ♣ Hoarseness - Instruct client to
as E. coli. or throat report any adverse
Ciprofloxacin is tightness reaction to the
effective in ♣ Rapid, physician or nurse. Tell
treating irregular, or patient that antacids
infectious pounding and mineral
diarrheas heartbeat supplements may
caused by E. ♣ Fainting decrease the absorption
coli, ♣ Fever of Ciprofloxacin
Campylobacter ♣ Joint or which makes it less
jejuni, and muscle pain effective when taken at
Shigella the same time.
bacteria. - Do not take the
medication in larger
amounts, or take it for
longer than
recommended by your
doctor.

Mefenamic Acid Inhibits the To decrease Patient who are Hemolytic -Instruct patient to
biosynthesis of pain; relief of hypersensitive to Anemia, avoid alcohol (includes
Classification: prostaglandin pain; or prevent the drug. Use Neutropenia, wine, beer, and liquor)
Urinary Tract affecting the limit cautiously in Leukopenia, when taking this
Anti-Infective inflammatory inflammation. patient with long Pancytopenia medicine since it can
Antibacterial process.‡ Also term alcohol use Hepatic: cause increases in
has an analgesic, because Jaundice stomach irritation.
Dosage: antipyretic and therapeutic Metabolic: - Use caution if the
500 mg/tab anticoagulant doses cause Hypoglycemia patient has a weakened
effect. hepatotoxicity in Diarrhea heart. It may cause
Route: this patients. Skin: increased shortness of
PO Rash, breath or weight gain.
Urticaria - Take it with meals to
Frequency: avoid GI irritation
OD

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 X. DISCHARGE PLANNING

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 one week after he was discharge
and to repeat urinalysis after 7 days of antibiotic. Eat nutritious foods like fruits and vegetables. Avoid
eating salty foods, junk foods and acidic softdrinks.

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