Catanduanes State Colleges

COLLEGE OF HEALTH SCIENCES

Virac, Catanduanes

NAME OF STUDENT: Jefferson R. Salamena

Date of Exposure: June 22, 2011

NAME OF CI: Mrs. GoyetaPereyra

Ward: OPD

I.

PATIENTS BACKGROUND
Name: Pedregosa, Lerma
Address: Paniquihan ,Baras
Age: 27

Religion: Roman Catholic

Civil Status: Married
Nationality: Filipino

A. PAST HISTORY
Her past history in childhood illness, she experienced mumps, chicken fox and fever. She accidentally fell in the motor cycle having a wound in her left knee.
She has an allergy in sea foods like crabs and shrimps. She experienced a temperature of 40.5 and hospitalized and treated immediately in the emergency room when
she was 8 years old. Her last medication was an antibiotic for her UTI.
PHYSICAL EXAMINATION
VITAL SIGNS: Recorded in nursing notes: She had a G4, P3. She had a temperature of 37.5degrees. She hadnormal BP of 100/60. Her pulse oximetry is
normal. Herpulse rate is in the low 90s. Her respiratory rate is 16.
GENERAL APPEARANCE: Her mood and affect are normal. She was alert and oriented x 3. She was an excellent historian.
DIAGNOSTIC IMPRESSION:
1.

Urinary tract infection.

Medical Diagnosis by the Physician

A> UTI
P>Cefotaxime 500mg 1 tablet for 1 week
B. PRESENT HEALTH HISTORY
Chief Complaints
Mrs. Pedregosa complains for pain at her left quadrant within 3 days. She is experiencing dysuria and difficulty in urinating. She feels pain when she
urinates.
Family History
Mrs. Pedregosa claimed that they have heridofamilial disease, such as arthritis on mother side. No known genetic disease on paternal side.
Delivery History
She delivered her 3 child with a normal delivery. Have a complete cycle of maternity for each of them.
Psychosocial History
She is a housewife, her husband work as permanent casual in the Baras Municipal Hall. Their house is strong, cemented and has a good ventilation. No
nearby lake, river, and open drainage, they use water coming from the damp as their water supply (not for drinking).

Precipitating cause of diseases

What Causes a UTIS?

Escherichia coli (E.coli), a bacterium normally found in the digestive tract and present on the skin around and the rectal area, is the organism most often
responsible for UTIs. Other bacteria can also be involved, but E.coli is by far the most prevalent of UTIs (over 80%).
Structure of the female anatomy predisposes women to infection because the urethral opening is located much closed to the anus, which is a common source
of bacteria. Therefore, bacteria can easily migrate across the perineum (the narrowbands of flesh between the anus and the vagina) to the urethra. Bacterial invasion
can result in acute cystitis, the most common type of UTI. A more r4are condition is urethritis, a condition in which only the urethra is inflamed. When the bacteria
from the bladder ascend to the kidneys via the ureters, they can cause a more serious infection called the pyelonephritis. Although men get UTIs, the structure of
their physical anatomy makes infection less likely. The male urethra is much longer, and secretions from the prostate gland pr0ovide a better barrier against this type
of infection.
What are the symptoms of UTI?
Not everyone with a UTI has symptoms, but most people get at least some symptoms. These may include a frequent urge to urinate and a painful, burning
feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all overtired, shaky, washed outand to feel pain even when not
urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience fullness in the rectum. It is common for a person with a
urinary infection to complain that, despite the urge to urinate; only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if
blood is present. Normally, a UTI does not cause fever if it is in the bladder or urethra. A fever may mean that the infection has reached the kidneys. Other
symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.
In children, symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered when a child or infant seems
irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving. Unlike adults, children are
more likely to have fever and no other symptoms. This can happen to both boys and girls. The child should be seen by a doctor if there are any questions about these
symptoms, especially a change in the child's urinary pattern.
How is UTI treated?
UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the
offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine,
uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin
(Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent
years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro), and trovafloxin (Trovan).
Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or other disorder. Still, many doctors ask their
patients to take antibiotics for a week or two to ensure that the infection has been cured. Single-dose treatment is not recommended for some groups of patients, for
example, those who have delayed treatment or have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate

infections. Longer treatment is also needed by patients with infections caused by Mycoplasma or Chlamydia, which are usually treated with tetracycline,
trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A followup urinalysis helps to confirm that the urinary tract is infection-free. It is important to take the
full course of treatment because symptoms may disappear before the infection is fully cleared.
Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally
require several weeks of antibiotic treatment. Researchers at the University of Washington found that 2-week therapy with TMP/SMZ was as effective as 6 weeks of
treatment with the same drug in women with kidney infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely
lead to kidney damage or kidney failure unless they go untreated.
Various drugs are available to relieve the pain of a UTI. A heating pad may also help. Most doctors suggest that drinking plenty of water helps cleanse the
urinary tract of bacteria. During treatment, it is best to avoid coffee, alcohol, and spicy foods. And one of the best things a smoker can do for his or her bladder is to
quit smoking. Smoking is the major known cause of bladder cancer.
Medical Diagnosis by the Physician
B> UTI
P>Cefotaxime 500mg 1 tablet for 1 week

II.

DEVELOPMENTAL TASK

Love: Intimacy vs. Isolation (Young Adults, 19 to 40 years)

The Intimacy vs. Isolation conflict is emphasized around the ages of 30. At the start of this stage, identity vs. role confusion is coming to an end, and it still lingers at
the foundation of the stage. Young adults are still eager to blend their identities with friends. They want to fit in. Erikson believes we are sometimes isolated due to
intimacy. We are afraid of rejections such as being turned down or our partners breaking up with us. We are familiar with pain, and to some of us, rejection is painful; our
egos cannot bear the pain. Erikson also argues that "Intimacy has a counterpart: Distantiation: the readiness to isolate and if necessary, to destroy those forces and people
whose essence seems dangerous to our own, and whose territory seems to encroach on the extent of one's intimate relations.
Once people have established their identities, they are ready to make long-term commitments to others. They become capable of forming intimate, reciprocal
relationships (e.g. through close friendships or marriage) and willingly make the sacrifices and compromises that such relationships require. If people cannot form these
intimate relationships perhaps because of their own needs a sense of isolation may result.
The young adult should have achieved self-efficacy during adolescence and is now ready to open up and become intimate with others. Although this stages focuses on
the desire for a special and permanent love relation. It also includes the ability to have close, caring relationships with friends of both sexes and a variety of ages. Spiritual
love also develops during this stage. Have established an identity apart from the childhood family, the young adult is now available to form adult friendships with his
parents and siblings. However, the young adult will always be a son and daughter.
If the young adult cannot express emotion and trust enough to open up to others, social and emotional isolation may occur. Loneliness may cause the young adult to turn
to addictive behaviours such as alcoholism, drug abuse, or sexual promiscuity. Some people try to cope this developmental stage by becoming very spiritual or social,
playing an acceptable role, but never fully sharing with others. When adults successfully navigate this stage, thy have stable, and satisfying relationships with important
others.

III. Anatomy and Function of the Urinary System

How does the urinary system work?

The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are
left behind in the bowel and in the blood.
The urinary system keeps the chemicals and water in balance by removing a type of waste called urea from the blood. Urea is produced when proteins, found in meat
products, are broken down in the body.
Urinary system parts and their functions:

Two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to:
o Remove liquid waste from the blood in the form of urine.
o Keep a stable balance of salts and other substances in the blood.
o Produce erythropoietin, a hormone that aids the formation of red blood cells.

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a
glomerulus and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the
renal tubules of the kidney.

Two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine
downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small
amounts of urine are emptied into the bladder from the ureters.

Bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic
bones. The bladder's walls relax and expand to store urine and contract and flatten to empty urine through the urethra.

Two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.

Nerves in the bladder - alert a person when it is time to urinate, or empty the bladder.

Urethra - the tube that allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder.
At the same time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the
correct order, normal urination occurs.

PATHOPHYSILOGY OF THE DISEASE

For infection to occur, bacteria must gain access to the bladder, attach to and colonize the epithelium of the urinary tract to avoid being washed with voiding, evade
host defense mechanisms, and initiate inflammation. Most UTIs result from fecal organisms that ascend from the perineum to the urethra and the bladder and then adhere to
the mucosal surfaces.
BACTERIAL INVASION OF THE URINARY TRACT
By increasing the normal slow, shedding of the bladder epithelial cells, the bladder can clear itself of even large numbers of bacteria. Glycosaminoglycan a
hydrophilic protein normally exerts a non-adherent protective effect against various bacteria. The GAG molecule attracts water molecules, forming water barrier that serves
as defensive layer between the bladder and the urine. GAG may be impaired by certain agents. The normal bacteria flora of the vagina and urethra area also interferes with
adherence of Escherichia coli (the most common microorganisms causing UTI). Urinary immunoglobulin A (IgA) in the urethra may also provide a barrier to bacteria.

Reflux
An obstruction of free-flowing urine is a problem known as urethrovesical reflux, which is the reflux (backward flow) of urine from the urethra into the bladder.
With coughing, sneezing, or straining, the bladder pressures rises, which may force urine from the bladder into the urethra. When the pressures returns to normal, the urine
flows back into the bladder then it brings into the bladder bacteria from the anterior portions of the urethra. Urethravesical reflux is also caused by dysfunction of the
bladder neck or urethra. The urethravesical angle and urethra closure pressure may be altered with menopause, increasing the incidence of infection in postmenopausal
women. Reflux is most often noted, however, in young children. Treatment is based on its severity.

Ureterovesical or vesicouteral reflux refers to the backflow of urine from the bladder into one or both ureters. Normally, the ureterovesical junction prevents urine
from travelling back into the urether. The ureters tunnel into the bladder wall so that the bladder musculature compresses a small portion of the ureter during normal
voiding. When the uretevesical valve is impaired by congenital causes or ureteral abnormalities, the bacteria may reach and eventually destroy the kidney.
Schematic Diagram:

Loss of integrity of the mucosal (caused by in indwelling catheter, tumor, parasites, or calculus)

Decreased resistance to invading organisms

Inflammatory changes occur in the affected portion of the Urinary Tract.

Clumps of bacteria may be present.

Inflammatory changes in the renal pelvis and throughout the kidney.

Scarring of the kidney parenchyma (occurs in chronic infection), which interferes kidney function.

Etiology:
Causative organism:
-

Escherichia Coli 90% in women.

Enterocobacter
Pseudomonas
Staphylococcus saprophyticus
Candida

Route of entry:
-

Obstruction usually congenital

vesicoureteral reflux

Infections elsewhere in the body

1. Upper respiratory
2. Gastrointestinal diarrhea

Poor perineal hygiene

Short female urethra

Catherization

Inherent defect in the ability of the bladder mucosa to protect it from microbial infection.

IV. DIAGNOSTIC TESTS

Laboratory Examination
Name:

LermaPedregosa

Age:

27

Sex:

Female

Civil Status:

Married

Address:

Paniquihan, Baras

Physician:

Dr. Rendon

Urine Microscopic
Color:

dark yellow, transparency

Ph:

Specific Gravity:

1.020

Reaction:

acidic

Microscopic
Red Cells:

o L/mg

Pus Cells:

TNTC (tronumerous to count)

Epithelial Cells:

#
Delia T. Abada
RMT, Medical Technologist

V. DRUG STUDY
Cefotaxime is in a group of drugs called cephalosporin antibiotics. Cefotaxime injection is used to treat many kinds of bacterial infections, including severe or lifethreatening forms. Cefotaxime is also used to prevent infections in people having surgery.
Indications: Cefotaxime is indicated for the treatment of patients with serious infections caused by susceptible strains of the designated microorganisms in the diseases
listed below:
Lower respiratory tract infections: including pneumonia, caused by Streptococcus pneumoniae, Streptococcuspyogenes and other streptococci, Staphylococcus
aureus , Escherichia coli, Klebsiella species, Haemophilusinfluenzae, Haemophilusparainfluenzae, Proteus mirabilis, Serratiamarcescens,, Enterobacter species, indole
positive Proteus and Pseudomonas species.
Genitourinary infection: Urinary tract infections caused by Enterococcusspecies, Staphylococcus epidermidis, Staphylococcus aureus, Citrobacterspecies,
Enterobacter species, Escherichia coli, Klebsiella species, Proteus mirabilis, Proteus vulgaris, Providenciastuartii, Morganellamorganii, Providenciarettgeri,
Serratiamarcescens and Pseudomonasspecies. Also, uncomplicated gonorrhea caused by Neisseriagonorrhoeae, including penicillinase producing strains.
Gynecologic infections, including pelvic inflammatory disease, endometritis and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species,
Enterococcus species, Enterobacter species, Klebsiella species, Escherichia coli, Proteus mirabilis, Bacteroides species, Clostridium species, and anaerobic cocci and
Fusobacteriumspecies. Cefotaxime, like other cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when cephalosporins are used in the treatment of
patients with pelvic inflammatory disease and C. trachomatisis one of the suspected pathogens, appropriateantichlamydial coverage should be added.
Bacteremia/Septicemia caused by Escherichia coli, Klebsiella species, and Serratiamarcescens, Staphylococcus aureusand Streptococcus species (including S.
pneumonia).
Skin and skin structure infections caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes and other
Streptococci, Enterococcus species, Acinetobacter species, Escherichia coli, Citrobacter species, Enterobacter species, Klebsiella species,
Proteus mirabilis, Proteus vulgaris, Morganellamorganii, Providenciarettgeri, Pseudomonas species, Serratiamarcescens, Bacteroides
Species,and anaerobic cocci.
Intra-abdominal infections including peritonitis caused by Streptococcusspecies, Escherichia coli, Klebsiella species, Bacteroides species, and anaerobic cocci
Proteus mirabilis, and Clostridium species.
Bone and/or joint infections caused by Staphylococcusaureus (penicillinase and non-penicillinase producing strains), Streptococcus
Species (including S. pyogenes), Pseudomonas species (including P. aeruginosa), and Proteus mirabilis.

 Central nervous system infections, e.g., meningitis and ventriculitis, caused by Neisseria meningitidis, Haemophilusinfluenzae, Streptococcus pneumoniae,
Klebsiellapneumoniae and Escherichia coli.

Name of Medications

Dosage/Route
of Action
Administration
CLASSIFICATION:
500 mg 1 tablet per day or Inhibits bacterial cell wall
Cephalosporins antibiotic through IM insertion.
synthesis by binding to one
ALTERED
NAMES:
or more of the penicillinCLAROFAN(Cefotaxime)
binding proteins (PBPs)
which in turn inhibits the
final transpeptidation step
of peptidoglycan synthesis
in bacterial cell walls, thus
Inhibiting
cell
wall
biosynthesis.
Bacteria
eventually lyse due to
ongoing activity of cell
wall autolytic enzymes
(autolysins and murein
hydrolases) while cell wall
Assembly is arrested.

Side Effects
diarrhea that is watery or
bloody;
severe pain, irritation, or
skin changes where the
needle was placed;
skin rash, bruising, severe
tingling, numbness, pain,
muscle weakness;
uneven heartbeats;
fever, chills, body aches,
flu symptoms;
easy bruising or bleeding,
unusual weakness;
fever, sore throat, and
headache with a severe
blistering, peeling, and red
skin rash;
seizure (black-out or
convulsions); or
jaundice (yellowing of the
eyes or skin).
pain, irritation, or
hardening
where
the
injection was given;
stomach pain, nausea,
vomiting;
headache; or

Nursing Implications

Contradicted
in
patients with known
hypersensitivity to
cephalosporins
Use with caution in
patients
with
hypersensitivity to
penecilins
1g
cefotaxime
contains 2.2 mmol
(50.5 mg) of sodium

 Vaginal
discharge.

itching

or

VI. NURSING CARE PLAN

Assessment

Diagnosis

Inference

Planning

SUBJECTIVE:
Masakitangpag-ihiko
(I feel pain whenever I
urinate) as verbalized
by the patient

Acute
pain
related
to
infection with in
urinary tract

A urinary tract
infection (UTI)
may occur in the
bladder, where
it
is
called
cystitis or in the
urethra, where
it
is
called
urethritis. Upper
tract
infection
results
in
pyelonephritis.
Most UTIs result
from ascending
infection
by
bacteria
that
have
entered
through
the
urinary meatus
but some may be
caused
by
hematogenous
spread. UTIs are
much common
in
female

After
the
planning stage,
the patients pain
will be relieved
or controlled and
increased
knowledge
of
preventive
measures
and
treatment
modalities and
absence
of
complications

OBJECTIVE:
Facial grimace
Restlessness.
V/S taken as
follows:
T: 37.3
P: 85
R: 20
BP: 100/60

Intervention

Rationale

Independent:
Assess
pain,
noting location,
intensity (scale
of 0-10), and
duration.

Evaluation

Provides
After the nursing
information to interventions, the
aid
in patients
pain
determining
will be relieved
choice
or controlled and
effectiveness of will
have
a
interventions
normal
renal
function,
negative
urine
Increased
Encourage
and
blood
hydration
increased fluid
cultures.
flushes bacteria
intake
and toxins
Urinary
Investigate
retention
may
report of bladder develop, causing
fullness.
tissue distension
(bladder
or
kidney),
and
potentiates risk
for
further
infection.

because
the
shorter female
urethra
makes
them
more
vulnerable
to
entry
of
organisms from
surrounding
structures
(vagina
periurethral
glands,
and
rectum).

Promotes muscle
Encourage use relaxation.
of sitz baths,
warm soaks to
the perineum.
Reduces bacteria
present
in
urinary tract and
Collaborative:
those introduced
Administer
by
drainage
antibacterial as
system
prescribed

VII. NURSING MANAGEMENT

HEALTH EDUCATION
Because UTIs can be result of more serious medical conditions, it is important to seek prompt medical advice for proper diagnosis and treatment. Most UTIs are
painful and bothersome, but usually they can be successfully treated with antibiotics. A list of antibiotics that are specific for treating UTIs would be lengthy. Just a few
of commonly used drugs are Bactrim, Ceclor, Ceftin, Kefex, Macrodantin, and Septra. All drugs for UTIs require a prescription from a physician. Besides the use of
prescription drugs, there are certain steps that persons with chronic UTIs can take to lower the likelihood of recurrence:

Avoid caffeine, alcohol, and spicy foods that can further irritate the bladder.
Use several capsules of a probiotic (Lactobacillus acidophilus) regularly.
Drink 8-10 glasses of water or other fluids each day to dilute bacteria in the urine.
Eat plain yogurt to help control development of a yeast infection after taking antibiotics for UTIs.
Cleanse well with soap and water before and after sexual activity. Your partner should do the same.
Take showers instead of baths.
Wear cotton underwear and loose-fitting clothes.
For women: if using a diaphragm, clean thoroughly, rinse, and carefully dry the diaphragm after each use. After using toilet, always wipe from front to back.
Avoid eating junk foods.

HEALTH PRACTICE
During a physical examination of a person whose symptoms may indicate a kidney disorder, a doctor may attempt to feel the kidneys. Normal kidneys
cannot usually be felt in children or adults (though they may be felt in newborn infants). Enlarged kidneys or a kidney tumor may be detectable. Often, a distended
bladder can be detected. The doctor may perform a rectal examination in a man to determine whether the prostate is abnormal or enlarged, although the size of the
prostate does not always correlate with the degree of urethral obstruction. The doctor may perform a pelvic examination in a woman to determine whether vaginitis
or the genital organs are contributing to urinary tract symptoms.
Additional procedures may need to be performed to diagnose a kidney or urinary tract disorder.
URINALYSIS
Urinalysis is testing of the urine. A urine sample is usually collected using the clean-catch method or another sterile method. For example, a method to obtain
an uncontaminated urine sample involves passing a catheter through the urethra into the bladder.
Urinalysis can be used to detect and measure the level of various substances in the urine, including protein, glucose (sugar), ketones, blood, and other
substances. These tests use a thin strip of plastic (dipstick) impregnated with chemicals that react with substances in the urine and quickly change color. Sometimes,
the test results are confirmed with more sophisticated and accurate laboratory analysis of the urine. The urine may be examined under a microscope to check for the
presence of red and white blood cells, crystals, and casts (impressions of the kidney tubules created when urinary cells, protein, or both precipitate out in the tubules
and are passed in the urine).
URINE CULTURE
Urine cultures, in which bacteria from a urine sample are grown in a laboratory, are performed to diagnose a urinary tract infection. Cultures are not part of
routine urinalysis. The sample of urine must be obtained by the clean-catch method or by briefly inserting a sterile catheter through the urethra into the bladder.
KIDNEY FUNCTION TESTS
Doctors can assess kidney function by performing tests on blood and urine samples. Creatinine, a waste product, is increased in the blood when the kidney
filtration rate is decreased by a large amount. Creatinine clearancea more accurate testcan be approximated from a blood sample using a formula that relates the
creatinine level in the blood to a person's age, weight, and sex. Determining creatinine clearance more precisely requires an accurately timed urine collection in
conjunction with the blood creatinine determination. The level of blood urea nitrogen (BUN) can also indicate how well the kidneys are functioning, although many
other factors can alter the BUN level.
IMAGING TESTS
Plain X-rays: X-rays are usually not helpful in evaluating urinary tract disorders.

Ultrasonography: Ultrasonography is often the initial imaging technique because it can be performed safely even when kidney function is impaired. It is
noninvasive and painless and requires no radiopaque contrast agent. Ultrasound scans provide some indirect information about kidney function, are an excellent way
to estimate kidney size and position, readily detect obstruction, and help diagnose structural abnormalities. Ultrasonography is not as accurate as computed
tomography (CT) in the diagnosis of kidney tumors. Doctors also use ultrasonography to locate the best place for a kidney biopsy.
Urinary tract stones may be detected by ultrasonography, although stones smaller than about inch (5 millimeters) may be missed. When doctors suspect
that the flow of urine from the bladder is obstructed, they sometimes use ultrasonography to measure the amount of urine that remains in the bladder after a person
makes every effort possible to urinate. Ultrasonography is not as accurate as CT in the diagnosis of bladder tumors.
CYSTOSCOPY
cystoscope, which has a diameter about the size of a pencil, may be between 1 and 5 feet (30 to 150 centimeters) in length, but only 6 to 12 inches (about 15
to 30 centimeters) of the scope are inserted into the urethra and bladder. Most contain a light source and a small camera, which allows the doctor to view the inside
of the bladder and urethra. Many cystoscopes also contain a small clipping device on the tip, allowing the doctor to obtain a sample (biopsy) of the bladder lining.
Cystoscopy can be done while a person is awake and causes only minor discomfort. The doctor usually inserts an anesthetic gel into the urethra before the
procedure. Possible complications include bleeding in the urine and, rarely, perforation of the bladder.
HEALTH RESEARCH
Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells
lining the urinary tract. A recent NIH-funded study found that bacteria formed a protective film on the inner lining of the bladder in mice. If a similar process can be
demonstrated in humans, the discovery may lead to new treatments to prevent recurrent UTIs. Another line of research has indicated that women who are "nonsecretors" of certain blood group antigens may be more prone to recurrent UTIs because the cells lining the vagina and urethra may allow bacteria to attach more
easily. Further research will show whether this association is sound and proves useful in identifying women at high risk for UTIs.
Infections in Pregnancy
Pregnant women seem no more prone to UTIs than other women. However, when a UTI does occur in a pregnant woman, it is more likely to travel to the
kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the
position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic
testing of urine during pregnancy.
Complicated Infections

Curing infections that stem from a urinary obstruction or other systemic disorders depends on finding and correcting the underlying problem, sometimes
with surgery. If the root cause goes untreated, this group of patients is at risk of kidney damage. Also, such infections tend to arise from a wider range of bacteria,
and sometimes from more than one type of bacteria at a time.

Infections in Men
UTIs in men are often a result of an obstructionfor example, a urinary stone or enlarged prostateor from a medical procedure involving a catheter. The
first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommend lengthier therapy in men than in women, in part to
prevent infections of the prostate gland.
Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this
reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic. UTIs in older men are frequently associated with acute bacterial
prostatitis, which can have serious consequences if not treated urgently.

Catanduanes State Colleges

College of Health Sciences
Department of Nursing
Virac, Catanduanes

Case Study about Urinary Tract Infection

By:
Jefferson R.Salamena
Bsn2A

To:
Mrs. GoyetaPereyra
Clinical Instructor