Clinical Findings

Lower UTI (cystitis)

• Dysuria, frequency, urgency, hesitancy.
• Cloudy, foul-smelling, or bloody urine.
• Suprapubic pain.
• Fever >101°F, chills, and malaise.

Upper UTI (pyelonephritis)

• Fever >101°F, shaking chills.
• Nausea, vomiting, flank pain.
• Older adults: AMS, delirium, anorexia, abdominal pain, incontinence, or asymptomatic.

Labs: Urine analysis: leukocytes, nitrites, hemoglobin, and bacteria; urine culture: >100,000 bacteria. Escherichia coli (responsible for 80% of all uncomplicated UTIs), Enterobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae are common offenders).

Possible Causes: Bacteria (usually E coli); factors that increase risk: incomplete emptying of bladder, neurogenic bladder; lack of adequate fluids; bowel incontinence; immobility or decreased mobility; indwelling urinary catheters.

Collaborative Management

• First-line treatment is antibiotic therapy and is dependent on urine culture sensitivities. An uncomplicated UTI (nonpregnant women, nondiabetic, or afebrile) can be treated with a 3-day course of antibiotics. A complicated UTI (diabetic, febrile, male) is typically treated with a 7- to 10-day course.
• Monitor urine characteristics (odor, volume, color, cloudiness).
• Obtain clean catheter urine specimen.
• Change or discontinue indwelling urinary catheter.
• Encourage Pt to drink fluids to flush urinary system.
• Assess for flank pain and monitor temperature.
• Offer acetaminophen if ordered and heat therapy to relieve suprapubic pain.
• Assess history of UTI and usual voiding patterns.
• Establish IV access and administer IVF as ordered.
• Administer prescribed antibiotics (trimethoprim/sulfamethoxazole and ciprofloxacin are common) promptly and on schedule.
• Administer phenazopyridine (if ordered) prn for dysuria, frequency, and urgency.
• Monitor for complications (urosepsis, onset of upper UTI).