The patient is a 15-year-old female, with a two-year history of “recurrent urinary tract

infection” (UTI)/cystitis. She has had two positive cultures and 10 negatives. Courses of
antibiotics have provided some relief at times, but other times have had no effect.

She presents for an ongoing episode over the past two weeks in which she has been
experiencing frequency (every 30–60 minutes during the day), a constant urge, voiding five
times prior to falling asleep, and waking three times each night. She experiences significant
dysuria and suprapubic (SP) pain with bladder fullness. She has not experienced any episodes of
incontinence. Although she describes this as a “flare,” she has had similar but slightly less
intense symptoms on a daily basis for the past two years. She is accompanied at this visit by her
mother, who is demanding answers about what is wrong with her daughter.

She has been sexually active for the past two years and says that she finds sexual activity
uncomfortable. She is a smoker (approximately two packs per week) but has no other chronic
conditions or remarkable medical history.
Physical examination finds a tender SP region and anterior vaginal wall.
Urinalysis shows 1 to 3 red blood cells and 5 to 10 white blood cells per high-power field.
Culture and sensitivity are negative.

PATHOPHYSIOLOGY
Urinary Tract Infection (UTI) are frequent infections that occur when bacteria enter the urethra
and infect the urinary system, usually through the skin or rectum. Infections can affect several
areas of the urinary tract, but the most frequent is a bladder infection (cystitis). Another kind of
UTI is kidney infection (pyelonephritis).
ETIOLOGY

UTIs are caused when bacteria from outside the body enter the urinary system via the urethra
and begin to grow. The majority of cystitis cases are caused by a strain of Escherichia coli (E.
coli) bacteria. Bacterial bladder infections in women can arise as a result of sexual contact.
Even sexually inactive girls and women can get lower urinary tract infections because the
female vaginal region frequently houses germs that cause cystitis.
RISK FACTORS

Some people are more likely than others to get a UTI. Females are more prone to UTIs
because their urethras are shorter and closer to the rectum. This allows germs to enter the
urinary system more easily. Women at greatest risk of UTIs (cystitis) include those who:
Sexually Active – Sexual intercourse can result in bacteria being pushed into the urethra.
Pregnant – Hormonal changes during pregnancy may increase the risk pf a bladder infection.

Use certain types of birth control – Women who use diaphragms are at increased risk of a UTI.
Diaphragms that contain spermicidal agents further increase the risk.

Have experienced menopause – Altered hormone levels in postmenopausal women are

often associated with UTIs.

Other factors that can increase the risk of UTIs:

• A previous UTI
• Sexual activity

• Changes in the bacteria that live inside the vagina, or vaginal flora. For example,
menopause or the use of spermicides can cause these bacterial changes.
• Pregnancy
• Age (older adults and young children are more likely to get UTIs)
• Structural problems in the urinary tract, such as enlarged prostate

• Poor hygiene, for example, in children who are potty-training

SIGNS AND SYMPTOMPS

Most healthy, fully hydrated people have urine that is light yellow or transparent and almost
odorless. It also produces no pain or discomfort during passing. However, for the vast
majority of people who get a urinary tract infection, this is not the case. Instead, they will
likely encounter at least one of the following indicators:

A consistent and strong urge to urinate when the bladder and urethra are inflamed, this
mucks up the receptors that signal when it is time to pee.

Pain or burning while urinating where the bacteria irritates the lining of the urinary
tract, which then spurs inflammation that can cause unpleasant sensation.

Cloudy urine occurs when the body’s white blood cells have built up while the system tries
to eliminate the offending bacteria.

Pelvic pain or pressure is often felt in the center of the pelvis and can mimic the sensation
of bloating.
A full feeling in the rectum this symptom is only present in men.

Passing gas in your urine is called pneumaturia occasionally occurs when the UTI causes air to
be passed to the urine.
DIAGNOSTIC TESTS

Urinalysis

A urinalysis is a group of physical, chemical, and microscopic tests on a sample of urine. These
tests look for evidence of infection, such as bacteria and white blood cells.
Urine culture

This is a test that detects and identifies particular bacteria and yeast that may be causing a UTI
in a patient's urine. Urine cultures can also assist doctors in determining the most effective
medication to treat a UTI.
Susceptibility testing

Susceptibility testing measures how sensitive the bacteria is to an antibiotic or antifungal drug.
This helps doctors determine which treatment is most appropriate.
TREATMENT

The infection of the urinary tract should be addressed. Antibiotics are medications that are
used to destroy germs and fight infections. Typically, antibiotics are used to treat urinary tract
infections. The healthcare provider will pick a drug that best treats the particular bacteria that
is causing the infection. Some commonly used antibiotics can include:
• Nitrofurantoin
• Sulfonamides (sulfa drugs)
• Amoxicillin
• Cephalosporins

• Trimethoprim/sulfamethoxazole
• Doxycycline
• Quinolones

It is essential to take the medication according to the instructions provided by your healthcare
professional. The antibiotic should not be withdrawn just because the symptoms have subsided
and the condition is improving. If the infection is not treated completely with the full course of
antibiotics, it can return.
NURSING MANAGEMENT

• Assess the symptoms of UTI

• Encourage patient to drink fluids
• Administer antibiotic as ordered
• Encourage patient to void frequently
• Educate patient on proper wiping (from front to the back)
• Educate patient on drinking acidic juices which help deter growth of bacteria
• Take antibiotics as prescribed
• Void as soon as possible after sexual intercourse
DRUG STUDY

Antibiotics
Mechanism of Action

Antibiotics interfere with critical bacterial activities or structures. This either kills the organism
or limits its development. An antibiotic is classified as bactericidal or bacteriostatic based on
these properties.

Indication

Antibiotics are used to treat or prevent some types of bacterial infections. They are
not effective against viral infections, such as the common cold or flu.
Antibiotics should only be prescribed to treat health problems:

• That are not serious but are unlikely to clear up without antibiotics
• That are not serious but could spread to other people if not promptly treated
• Where evidence suggests that antibiotics could significantly speed up recovery
• That carry a risk of more serious complications

Contraindications

Hypersensitivity to penicillin, cephalosporins, or components. Cautions: Extreme caution

with history of allergies, asthma; gastrointestinal disease; renal dysfunction; bleeding
disorders; and (for some penicillins) hepatic dysfunction.

Adverse Reactions

The most common side effects of antibiotics occur in the digestive system. Side effects
of antibiotics that affect the digestive system include:
• Vomiting

• Nausea
• Diarrhea
• Bloating and indigestion
• Abdominal pain
• Loss of appetite

These side effects are usually mild and should pass once when the treatment is finish.
REFERENCES:
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%20bactericidal%20or%20bacteriostatic.

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