Urinary Tract Infection (UTI)

A.      Definition

Urinary Tract Infection (UTI) or urinary tract Infection (UTI) is a condition infasi presence of microorganisms in the urinary tract. (Agus Tessy, 2001)

Urinary Tract Infection (UTI) is a bacterial infection on the state of the urinary tract. (Enggram, Barbara, 1998)

B.       Classification

Urinary Tract Infection types, among others:

1.         Bladder (cystitis)

2.         urethra (urethritis)

3.         prostate (prostatitis)

4.         kidneys (pyelonephritis)

Urinary Tract Infection (UTI) in the elderly, can be divided into:

1.         UTI uncomplicated (simple)

       Simple UTI that occurs in patients with urinary tract is not good, normal anatomic and functional. UTI is the usi further, especially regarding women and people with infections only about superficial bladder mucosa.

2.         Complicated UTI

       Often cause a lot of problems because they are often difficult to eradicate germs, germs are often resistant to multiple kinds of antibiotics, frequent bacteremia, sepsis and shock. The UTI occurs when the circumstances are as follows:

a.         Abnormal urinary tract abnormalities, such as stones, urethral obstruction vesico reflex, bladder atony, paraplegia, permanent bladder catheter and prostatitis.

b.        Abnormalities of renal physiology: ARF and CRF.

c.         Impaired immune system

d.        Infections caused by virulent organisms just as urease-producing prosteus spp.

C.      Etiology

1.         The types of microorganisms that cause UTI, among others:

b.        Escherichia Coli: 90% of the causes of UTI uncomplicated (simple)

c.         Pseudomonas, Proteus, Klebsiella: cause complicated UTIs

d.        Enterobacter, epidemidis staphylococci, enterococci, and-others.

2.         The prevalence of UTI in the elderly, among others:

a.         Residual urine in the bladder is increased due to the emptying of the bladder is less effective

b.        Decreased mobility

c.         Nutrients are often less well

d.        Decreased immune system, both cellular and humoral

e.         The existence of barriers to the flow of urine

f.         The loss of bactericidal effect of prostate secretions

D.      Pathophysiology

Urinary Tract Infection caused by the presence of pathogenic microorganisms in the urinary tract. These microorganisms enter through: direct contact from kat terde infection, hematogenous, limfogen. There are two main lines of UTI, asending and hematogenous. In asending namely:

-     mikroorgani influx sme preformance bladder, among others: the factor anatomy where the women have a shorter urethra than men so the higher incidence of UTI, urinary stress factor during micturition, fecal contamination, installation of equipment into the urinary tract (sistoskopik examination, catheter), the presence of infected pressure sores.

-    Rising bacteria from the bladder to the kidney

Hematogenous namely: common in immunocompromised patients, thus simplifying system deployment hematogenous infections There are several things that affect the structure and function of the kidney that facilitate hematogenous spread, namely: the presence of the dam resulted in total urinary bladder distension, due to dam intrarenal scarring, and others.

At the advanced age of UTI is often caused due to:

-    Residual urine in the bladder is increased due to the emptying of the bladder which is incomplete or ineffective.

-     Decreased mobility

-    Nutrients are often less well

-    System imunnitas yng decreased

-     Obstruction of the urinary tract

-     The loss of bactericidal effect of prostate secretions.

Residual urine in the bladder increased the lead to excessive distensii causing pain, this situation resulted in a decrease resistance to bacterial invasion and urinary residue into bacterial growth media which in turn will lead to impaired kidney function itself, then this state of hematogenous spread to the urinary tract suluruh . Additionally, some of the things that predispose to UTI, among others: obstruction of urine flow proximal result pressurized fluid accumulation in the renal pelvis and ureter are referred to as hidronefroses. Common causes of obstruction are: renal scarring, stones, neoplasms and prostate hypertrophy is often found in men over the age of 60 years.

E.       Signs and Symptoms

Signs and symptoms of UTI at the bottom (cystitis):

-        Pain is often a burning sensation when urinating and

-        Spasame the bladder and suprapubic area

-        Hematuria

-        Back pain dap a t happen

Signs and symptoms of upper UTI (pyelonephritis)

-        Fever

-        Shiver

-        Pelvic pain and waist

-        Pain when urinating

-        Malaise

-        Dizziness

-        Nausea and vomiting

F.        Examination Support

1.        Urinalysis

-        Leukosuria or pyuria: is one of the important clues presence of UTI. Leukosuria positive if there are more than 5 leukocytes / high power field (LPB) urine sediment

-        Hematuria: hematuria positive if there is a 5-10 erythrocytes / LPB urine sediment. Hematuria is caused by a variety of pathological conditions in the form of glomerular injury or urolithiasis.

2.        Bacteriological

-        Microscopic

-        Bacterial culture

3.        Urine culture to identify any specific organism

4.        Count the colonies: colony count of about 100,000 colonies per milliliter of urine or midstream urine capacity of the catheter specimen is considered as the main criterion of infection.

5.        Method of test

-        Multistrip dipstick test for WBC (leukocyte esterase test) and nitrite (Griess test for nitrate reduction). Positive leukocyte esterase test: the psien experience pyuria. Nitrate reduction test, if there is a positive Griess bacteria reduce nitrate to nitrite normal urine.

-        Test Sexually Transmitted Diseases (STDs):

Uretritia acute due to sexually transmitted organisms (eg, Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex).

-        Additional tests:

Intravenous urogram (IVU). Pyelography (IVP), msistografi, and ultrasound may also be performed to determine whether the infection is a result of abnormalities of the urinary tract, stones, renal mass or abscess, or hiperplasie hodronerosis prostate. IV urogram or ultrasound evaluation, cystoscopy and urodynamic procedures can be performed to identify the cause of the recurrence of infections that are resistant.

G.      Management

Handling of Urinary Tract Infection (UTI) is an ideal antibacterial agent that effectively removes bacteria from the urinary tract with minimal effect terhaap faecal and vaginal flora.

Therapy Urinary Tract Infection (UTI) in the elderly can be divided into:

-        Single-dose antibiotic therapy

-        Conventional antibiotic therapy: 5-14 days

-        Long-term antibiotic therapy: 4-6 weeks

-        Low-dose therapy for suppression

Long-term use of antimicrobial decrease the risk of recurrence of infection. If recurrence is caused by a persistent bacterial infection in early, causative factors (eg, stone, abscess), if one arises, must be addressed. After handling and sterilization of urine, low-dose preventive therapy.

The use of common medications include: sulfisoxazole (gastrisin), trimethoprim / sulfamethoxazole (TMP / SMZ, Bactrim, Septra), ampicillin or amoxicillin sometimes used, but E. coli was resistant to these bacteria. Pyridium, a urinary analgesic indigenous jug used to reduce the discomfort caused by infection.

The use of drugs in the elderly should be considered likelihood is:

-        Impaired absorption in the digestive tract

-        Interansi drug

-        Side effects of drugs

-        Impaired accumulation of drugs, especially drugs that excretion via the kidneys

Risk of drug administration in the elderly in relation to renal function:

1.         Effects of drugs nefrotosik

2.         Effects of drug toxicity

The use of drugs in the elderly should setiasp when evaluated its effectiveness and should always answer the question as follows:

-        Is medications given really useful / necessary /

-        Is a given drug causes things better or malh membahnayakan /

-        Is a given drug would still be appropriate?

-        Can some dikuranngi drug dosage or discontinued?

H.      Assessment

1.         Physical examination: do head to toe and body systems

2.         History or presence of fac-tors risk factors:

-        Is there any history of previous infections?

-        Is there any obstruction in the urinary tract?

3.         The presence of factors that predispose patients to nosocomial infections.

-        What about foley catheter?

-        Immobilization in a long time.

-        Is urinary incontinence occurs?

4.         Assessment of clinical manifestations of urinary tract infections

-        How patient voiding pattern? For detecting factors predisposing to UTI patients (impulse, frequency, and amount)

-        Is there dysuria?

-        Is there urgency?

-        Is there hesitancy?

-        Is there a pungent smell of urine?

-        How orine volume output, color (grayish) and the concentration of urine?

-        Is there a suprapubic pain-usually on lower urinary tract infections

-        Is there nye the pangggul or waist-usually on the upper urinary tract infections

-        Increased body temperature is usually in the upper urinary tract infections.

5.         Psychological assessment of patients:

-        How do you feel toward patients and treatment outcome measures that have been done? Adakakan feelings of shame or fear of recurrence of the disease.

I.         Nursing Diagnosis Arising

1.         Pain and discomfort associated with inflammation and infection of the urethra, bladder and other urinary tract sruktur.

2.         Elimination pattern changes associated with mechanical obstruction of the bladder or other urinary tract structures.

3.         Lack of knowledge about the condition, prognosis, and treatment needs related to lack of resources.

J.        Nursing Interventions

1.         Dx 1:

Pain and discomfort associated with inflammation and infection of the urethra, bladder and urinary tract s t ruktur another.

Criteria for evaluation:

No pain when urinating, no pain in the pelvic percussion

Intervention:

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2.         Dx 2:

Elimination pattern changes associated with mechanical obstruction of the bladder or other urinary tract structures.

Ria Krite Evaluation:

Elimination pattern improve, not the signs urinary disorders (urgency, oliguric, dysuria)

Intervention:

a.         Keep an eye on income and expenditure karakteristi urine

       Rationale: provide information about kidney function and complications

b.         Determine the pattern of urination patients

c.         Encourage increased fluid intake

       Rationale: increased hydration washes the bacteria.

d.        Assess full bladder complaints

       Rationale: urinary retention may occur causing tissue distension (bladder / kidney)

e.         Observations of changes in mental status:, behavior or level of consciousness

       Rationale: accumulation of uremic and electrolyte imbalance can be toxic to the central nervous system

f.          Unless contraindicated: reposition the patient every two hours

       Rational: to prevent static urine

g.         Ko laborasi:

-     Watch the laboratory examination; electrolytes, BUN, creatinine

       Rationale: surveillance of renal dysfunction

-     Take action to maintain acidic urine: input increase berry juice and give medications to improve the aam urine.

Rationale: aam urine blocking the growth of germs. Increased input juice affect preformance DAPT treatment of urinary tract infections.              

3.         Dx 3:

Lack of knowledge about the condition, prognosis, and treatment needs related to lack of resources.

Evaluation Criteria: menyatakna understand the condition, diagnostic examination, treatment plan, self-care and preventive measures.

Intervention:

a.         Review the pemyakit prose and expectations will datanng

Rationale: provide a basic knowledge of where patients can make choices beradasarkan information.

b.        Provide information about: source of infection, measures to prevent the spread, jelaskna antibiotics, diagnostic examination: objectives, brief description, ynag preparation needed before the examination, the examination after treatment.

Rational: the knowledge of what to expect can lessen anxiety and m, embantu elicits a therapeutic plan of compliance to the client.

c.          Make sure the patient or significant others have written agreements for further treatment and written instructions to treatment after examination

Rationale: verbal instructions can easily be overlooked

d.        Instruct the patient to m a n a drug enggunak given, inum by about eight glasses per day, especially berry juice.

Rationale: Patients often discontinue their medication, if the signs of abating disease. Fluids help flush the kidneys. Pyruvic acid of berry juice helps maintain the state of the urine acid and prevent the growth of bacteria

e.         Provide the opportunity for patients to express their feelings and concerns about the treatment plan.

Rationale: To detect cues indicative of the possibility of non-compliance and help develop a therapeutic plan acceptance.

REFERENCES

Doenges, Marilyn E. (1999). Nursing care plan: guidelines for planning and documenting patient care. Miscellaneous: I Made Kariasa, Ni made ​​Sumarwati. Edition: 3. Jakrta: EGC.

Enggram, Barbara. (1998). Plans Nursing

Nugroho, Wahyudi. (2000). Keperawa ta n Gerontik. Edition: 2. Jakarta: EGC.

Parsudi, Imam A. (1999). Geriatrics (Elderly Health Sciences). Jakarta: Faculty of medicine

Price, Sylvia Andrson. (1995). Pathophysiology: clinical concepts of disease processes: Pathophysiology clinical concept of disease processes. Miscellaneous: Peter Grace. Edition: 4. Jakarta: EGC

Smeltzer, Suzanne C. (2001). Textbook of Medical-Surgical Nursing Brunner & Suddart. Rather Bhasa: Supreme Waluyo. Edition: 8. Jakarta: EGC.

Tessy Agus, Ardaya, Suwanto. (2001). Textbook of Medicine: Urinary Tract Infections. Edition: 3. Jakarta: Faculty of medicine.