NURSING ASSESMENT IN URINARY SYSTEM

PATIENT WITH
URINARY TRACT INFECTION

BY:
Maura Angelina O
Carolina Laro
Viendya Firstiyanti
Julia Isabella Dija
Nicholaus Rocetyo M.

Nursing Faculty of Widya Mandala Catholic University Surabaya

Surabaya
2014

CHAPTER I
INTRODUCTION
1.1

Background
UTI is a common term which used to state that theres invasion of microorganism inside
the urinary tract. The prevalence of UTI in the people is increasing along with the aging
factor. In age of 40 60 years old have the number 3.2%. Meanwhile in age more than 65
years old, the number of UTI is about 20%. UTI can occur whether on male or female
from every age, start from the children, youngsters, adult, even the elderly. But between
male and female, the numbers of UTI mostly occur in female than the male with the rate
about 5 -15%.
To state that theres UTI, its a must thing to find the bacteria inside the urine. Bacteriuria
which come along with the symptoms of urinary tract is called as bakteriuria
symptomatic. Meanwhile the one without any symptoms showing is called as bakteriuria
asymptomatic. We could call it as positive bacteriuria in an asymptomatic patient if
theres more than 105 colony of bacteria in the sample of the midstream urine, while in
symptomatic patient can be found lower number of colony in the sample of the
midstream

urine.

The high prevalence of UTI in elderly which are caused by the leftover of the urine inside
the bladder is increasing because of the ineffectiveness process of emptying the bladder,
decreasing mobility, and the bad nutrition, decreasing immune system.

CHAPTER II
REFERENCE

2.1 Definition
UTI is an acute inflammation on the mucosa of the bladder because of bacterial infection
which caused by the spreading of infection by the bacteria (M. Clevo Rendy, Margareth
TH, 2012 page 217).
UTI is an inflammation reaction of urotelium cells that covering the urinary tract (Sibuea,
W. Heidin, 2005 page 16).
UTI is a condition where theres an invasion of microorganism into the urinary tract
(Agus Tessy, 2001 page 112).

2.2 Classification
M. Clevo Rendy and Margareth TH (2012, page 220) stated that types of UTI can be
devided by the area of the inflammation, such as:
1. Bladder (Cystitis)
2. Urethra (Urethritis)
3. Prostate (Prostatitis)
4. Renal (Pyelonephritis)

2.3 Etiology
UTI is caused by the microorganism which consists of:
1. Negative gram bacteria: E. Coli, Entherobacter, Pseudomonas, Serrativa
2. Positive gram bacteria: Staphylococcus Saprophyt, streptococcus.
3. Virus: rare to be found
4. Fungi: rare to be found
Those microorganisms can be found inside the vesica urinaria which caused by some
factors, which are:

1. Less fluid intake per day

2. Less personal hygiene
Rarely change the underwear
Female underwear which made from synthetic material, not katun
Wearing jeans which is too tight
3. Wrong personal hygiene
The right personal is by cleaning the perineum after urinated and defecated using the
right movement from the front side to the back side.
4. Doing too much sexual activities.
5. Urine reflux
6. Trauma of the urethra
7. Using the non-sterile instrument (eg: Catheter insertion)
8. Using the unbalance pH soap; but mostly caused the increasing level of pH
9. Age more than 65 years old
10. Renal stone which can caused the urine obstruction

2.4 Patophysiology
Lower UTI mostly caused by the microorganism, moreover by the negative bacteria gram
which is the E. Coli that can be found in 90% cases, and followed by the pseudomonas,
enterobacter, positive bacteria gram: streptococcus, S. Saprofit. Normally, those
microorganisms can be found in the intestinal tract, but if theres infection in the
intestinal tract, there will be response from our body to the infection then the fever,
anorexia, vomit, nausea, diarrhea might occur. The invasion of those microorganisms can
be caused by doing too many sexual activities, and mostly happen to the young women,
where the intersection between the vagina and vesica urinaria is pretty close so that this
can make the pH increased and the ability to kill the bacteria which entered inside the
vesica urinaria will be decreased.
The insertion of an equipment for urinarius tractor, eg: the usage of catheter and
cystocopy are the main factors to get UTI for a person, because when we spread out the
urethra the bacteria can enter altogether with the equipment which will be inserted inside
the body and in the end, the bacteria will spreading to the urinary tract. Low fluid intake,

caused the urinated will be less too which it supposed to be normal to bring the metabolit
is about 1400-1900 ml. Low fluid intake also can caused the bacteria in the vesica
urinaria couldnt be move out from the body.
In diabetic mellitus, high amount of insulin caused the urine contains glucose and there
will be disorder in the urination, eg: Nephropaty and Angiopathy in the renal, so that the
urine will contain more glucose than the normal one and this made the bacteria will be
easily to grow up.
Those previous things can make the spreading of organisms to all of the urinary tract so
that this can caused the urine static make infection and there will be complain about
dysuria, urinate more often, discomfort in suprapubic, urgency, hyperthermia. Static urine
can cause the reflux to urether which the urine contaminated already to the pelvic renalis.
Normally, microorganism which entered can be defeated by the bladder because of the
layer of the bladder that product the mucosa cell where can maintain the integrity of
vesica urinary layer, so the sterility of the urine can return fastly, because the defeating
mechanism of vesica urinary can along the inflammation phase will inserting
microorganism into the fagocytosis process to the mucosa (epitel) of vesica urinary and
urine, where in normal state, the defeating mechanism have anti-bacteria work (the
mucosa of the urethra).
After the obstruction occurred, the urinary tract will make it easier for the bacteria to
grow up become an alkali media and this can be happened if theres damage in the
urinary tract. The obstruction can caused the urine will be out in small amount, the
unfinished emptying the bladder, spasm of the bladder, thick color of the urine, low back
pain, and hematuria, especially to the urethra trauma condition ( M. Clevo Rendy,
Margareth TH, 2012 page 218)..

2.5 Clinical Manifestation

In general, 10% of the patients of UTI which caused by the bacteria wont show any
symptoms, so the patient didnt realize that she/he already infected with the bacteria. In
some conditions, the signs and symptoms are:
1. Dysuria (burning feeling when urinated)
2. Frequency when urinated is in small amount but often

3. The disability to emptying the bladder

4. Suprapubic pain and spread out become waist pain and can caused the low back pain
5. Spasm of bladder
6. Thick color of the urine
7. Hematuria in long time condition
8. Intestinal tract disorder: anorexia, vomit, nausea

2.6 Treatment
M. Clevo Rendy dan Margareth TH (2012 : page. 221) stated, the medication of UTI is to
remove the symptoms fastly, will clear the urinary tract from the microorganism and
avoid the reappearance of the infection, so this can decrease the number of death. Those
goals can be achieved by:
1. Caring system by:
a. Increase the fluid intake 2 3 liters/day if theres no contra-indication
b. The change of life style, such as:
-

Cleaning the perineum from the front side to the back side

Underwear which made of katun

Avoid consuming coffee, alcohol

2. Medicines
a. Antibiotic: To kill the bacteria
b. Short term antibiotics for 1 2 weeks
c. Long term antibiotics (with the same medicine or substitute with the other
medicine) for 3 4 weeks
d. Prophylactic medication with low dose 1 time per day before sleep for 3 6
months or more is the next step medication if theres more complication.
3. Analgesic and anti-spasmodic
Those are to decrease the pain level of the patient.
4. Medication in Venozopyridine group: Pyridium
The medication is to decrease the symptoms of the irritation in the urinary tract.

2.7 Supporting Examination

The supporting examinations which can be done to diagnose the disease or for the
medication are:
1. Laboratorium

Urine analyze: Theres leukocyte, erythrocyte, crystal, pus, bacteria, and the
increasing pH

Urine culture
-

To determine the bacteria or the cause of the UTI, eg: streptococcus, E.Coli,
etc

To determine the antibiotic for the medication

Blood: the increasing number of leukocyte, ureum and creatinin

2. Blass Nier Ophage Intra Venous Pyelogram ( BNO IVP )

Showing the right confirmation about the cause of abdominal pain

Showing the abnormalities of urinary tract

3. Cystocophy: To find out the damage of the fiber of the muscle in the bladder.

CHAPTER IV
CLOSING

4.1 Conclusion
UTI is an acute inflammation on the mucosa of the bladder because of bacterial infection
which caused by the spreading of infection by the bacteria. UTI is caused by the
microorganism which consists of negative gram bacteria: E. Coli, Entherobacter,
Pseudomonas,

Serrativa,

Positive

gram

bacteria:

Staphylococcus

Saprophyt,

streptococcus, Virus: rare to be found and Fungi: rare to be found. The symptoms of this
disease are dysuria (burning feeling when urinated), frequency when urinated is in small
amount but often, the disability to emptying the bladder, suprapubic pain and spread out
become waist pain and can caused the flank pain, spasm of bladder, thick color of the
urine, hematuria in long time condition, and intestinal tract disorder: anorexia, vomit,
nausea. The medical examinations for this disease are using Blass Nier Ophage Intra
Venous Pyelogram ( BNO IVP ), laboratory test, and cystocophy.

REFERENCE LIST

M. Clevo Rendy, Margareth TH. 2012. Asuhan Keperawatan Medikal Bedah Penyakit Dalam.
Jakarta. Nuha Medika.
Sibuea, W. Heidin. 2005. Ilmu Penyakit Dalam. Rineka Cipta: Jakarta