Case Study UTI
Case Study UTI
Case Study UTI
Introduction
Urinary Tract Infection (UTI) is a bacterial infection that affects any part of the urinary tract. The main causitive agent is
Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When
bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder
infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more
serious. Although they cause discomfort, urinary tract infections can usually be quickly and easily treated with a short course of
antibiotics.
The diagnosis is confirmed by examining a sample of the child's urine under a microscope for bacteria and white blood cells.
The urine may also be cultured identify the bacteria and test to see which medications will provide the most effective treatment. The
Urinary tract infections are a serious health problem affecting millions of people each year. Infections of the urinary tract are
the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each
year. About 3% of girls and 1% of boys have had a recognized urinary tract infection (UTI) by age 11. The symptoms are not always
obvious. They may range from just an unusual smell of the urine or mild burning on urination to very severe pain and high fever.
Recognizing and treating urinary tract infections is important. A urinary tract infection in a child may be a sign of an abnormality in
the urinary tract that could lead to repeated problems and serious kidney damage.
Another diagnosis to be considered in the patient is Dengue Fever. Dengue fever is a disease caused by a family of viruses that
are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever,
exhaustion, severe joint and muscle pain, swollen glands, and rash. The presence of fever, rash, and headache is particularly a
characteristic of dengue.
This case study took place at Jose P. Rizal Hospital and it will be presented by the students of Group 8 section 2BSN2 of Colegio
de San Juan de Letran-Calamba. All information about the client shall only be confined to the aforementioned witnesses of the case
Begins at the kidneys and includes the paired ureters, unpaired urinary bladder, and the urethra.
The urinary system is the principal system responsible for water and electrolyte balance. It also functions to excrete urea and
Kidneys -2 (paired) = normal condition. The left is higher than the right due to the presence of the liver.
Nephron - the functional unit of the kidney. It functions to produce urine. It is made up of many tubules and their associated blood
Glomerular (Bowman's) capsule - surrounds the glomerulus. Together they form the renal corpuscle. The epithelium of the glomerular
capillaries contains pores called fenestrae. These allow filtrate but NOT proteins to pass from the blood into the glomerular capsule.
The glomerular capsule has a parietal and a visceral layer. The parietal layer is for structure only and does not play a role in filtration.
The visceral layer is made up of highly specialized cells called podocytes. These cells have foot processes (pedicels) which line the
basement membrane of the glomerulus. Between the foot processes we see filtration slits which allow the filtrate to pass into the
capsular space.
Proximal convoluted tubule - Here we see cuboidal cells with a brush border (microvilli) These cells resorb substances from the
filtrate as well as secrete substances into the filtrate. The microvilli greatly increase the ability to resorb water.
Descending limb - (thin segment) is simple squamous epithelium and is highly permeable to water.
Ascending limb - (thick segment) the epithelium is cuboidal or even low columnar.
Distal convoluted tubule - here the cells are cuboidal and thinner than those seen in the proximal convoluted tubule. This shows that
these cells play a role in secreting substances into the filtrate rather than removing substances from it. Here we also see two cell types:
1. Intercalated cells (cuboidal with microvilli) - these function in acid/base balance of the blood.
2. Principal cells (no microvilli) - these function in body Na+ and water balance.
Collecting duct - not a part of the nephron. The distal convoluted tubules connect to collecting ducts. Passes through the renal
pyramids and ends at the renal papillae where it empties into a minor calyx.
1. Cortical nephrons: these make up 85% of our nephrons. With the exception of the tip of the loop of Henle these nephrons
are located in the renal cortex.
2. Juxtamedullary nephrons: here the renal corpuscles are located in the cortex, yet very near the cortex-medulla junction.
Blood supply
Renal arteries feed into segmental arteries, which turn into interlobar arteries (in renal columns) which feed into arcuate
arteries (branched out at the level between the cortex and medulla). Interlobular arteries branch off of the arcuate arteries and run out
into the cortex. From these branch the afferent arterioles which bring blood to the glomeruli (blood filtrate enters the urinary tubules).
Blood leaving the glomerulus enters an efferent arteriole which takes the blood to peritubular capillaries around the convoluted tubules
OR vasa recta surrounding the ascending and descending limbs of Henle. At this point the blood enters veins that parallel the arteries.
That is, interlobular veins to arcuate veins to interlobar veins to renal veins to the IVC.
1. Inner mucosa - continuous with the lining of the urinary bladder. It has transitional epithelium that secretes a protective
mucous (lubrication)
2. Middle layer - muscularis. It has an inner longitudinal and outer circular layer of smooth muscle.
The proximal 1/3 also has an outer longitudinal layer of smooth muscle.
3. Outer layer - fibrous coat made of loose CT. This coat covers the ureter and anchors it in place.
Urinary bladder - storage bag for urine. It is located behind the pubic symphysis yet in front of the rectum in males and in front of
1. Muscoa - innermost layer. Has transitional epithelium. Will find many folds (rugea) except in the area known as the trigone. This is
a triangular area demarcated by three points, the two openings of the ureters and the exit point for the urethra.
4. Serosa - outermost layer. It is found only on the superior surface of the bladder. It is actually a continuation of the peritoneum.
Urethral wall -The inside of the wall is lined by mucous membrane surrounded by a thick layer of smooth muscle. We also see
urethral glands which secrete mucous into the urethral canal. There is an external urethral sphincter which is composed of voluntary
skeletal muscle.
Micturition - urination, which is a reflex action. Stretch receptors activate the detrusor muscle and relax the internal urethral
sphincter. The external urethral sphincter is under voluntary control after approx. 2 years of age. This has to do with growth of the
Haematogenous seeding of the kidneys may occur when a patient is bacteraemic with organisms such as S. aureus or Candida,
Most bacteria causing UTIs originate in the bowel. They colonise the lower vagina and periurethral mucosa before colonising
the distal urethra. From there they may ascend the urethra into the bladder, and from there up the ureters into the renal
parenchyma. Establishment of a UTI by the bacteria colonising the urethra is dependent on interactions between bacterial
Bacterial factors
Most UTIs are caused by only a few serotypes of Escherichia coli: “uropathogenic clones”. These are selected
from the colonic flora by virulence factors that enhance adhesion and invasion of the urinary tract. Some of these
- Type 1 fimbriae: bind to mannosides present on urinary epithelial cells. These adhesins are imp ortant for
Host factors
- Antibacterial activity of urine: low pH, high [urea], prostatic secretions, Tamm-Horsfall protein from cells of loop of Henle
(hypothesis: mannose containing side chains of THP bind to E. coli type 1 fimbriae, preventing them from binding to mannose
- In some women, defective local perineal and vaginal defence mechanisms leading to increased colonisation
- Impairment of urinary flow (eg. congenital abnormalities of ureters or urethra, prostatic enlargement, calculi,
This case study, Urinary Tract Infection t/c Dengue Fever was chosen because it could enable us to contribute to the research
and information regarding the problem and it could help us to gain more understanding and knowledge.
It is an opportunity for us to research and get information about this case so that we can explain and make our client
understand.
Through this study, the patient can receive a quality, personalized, and holistic care coming from the student nurses. The result
of the study can provide additional insights or knowledge about Urinary Tract Infection not only to the students and the patient. This
study will also provide a chance to test the student’s skills regarding a thorough patient assessment and quality nursing care in the
clinical setting. Critical thinking will also be exercised by the students in relating the patient’s problem to the interventions to correct
This study focuses on a patient who was diagnosed with a Urinary Tract Infection t/c Dengue Fever. The study also includes
the assessment of the physiological and psychological status, adequacy of support systems, and care given by the family as well as
Data collected via assessment, observation and clinical records during duty
The client’s profile, family history, health history, medical orders and rationale, anatomy and physiology,
the pathophysiology of the condition, and nursing system review chart, drug study, and evaluation.
The development of plans of care that will reduce identified predicaments and complications.
Coordination and delegation of interventions within the plan of care, to team members, in order to assist the
client to reach maximum functional health. An array of factors influencing the limitations of the this study
includes:
The focus of this study will be on the problem of the patient which is Urinary Tract Infection t/c Dengue Fever. The
assessment phase includes the subjective and objective data of the patient through observation and interview. This case study
shall focus on a nursing diagnosis which is constipation related to irregular defecation habits as evidenced by absence of stool
for two days. The planning, implementation, and evaluation phases are focused on the gathered subjective and objective data
and most importantly the establishment of proper nursing care to proved wellness for the patient.
II. Clinical Summary
A. General Data
Name: Patient X
Sex: Female
Religion: Catholic
The patient has been confined at San Pablo City last August 2008.
E. Family History
There is no family history of any illnesses or any family member has been deceased.
III. PHYSICAL ASSESSMENT
Parts, senses and systems to Techniques Normal findings Findings from the Clinical Analysis
be assessed patient
Hair >Inspect the evenness >Evenly distributed hair >The hair of the >The hair growth is normal.
of growth of the scalp. patient is evenly
distributed.
Nails >Inspect fingernail >Convex curvature;angle >The patient has this >There are no abnormalities
plate shape to of nail plate about 160˚ findings has seen in the nails.
detremine its curvature
and angle
Skull and face >Inspect the skull for >Rounded >Has normal > No abnormalities seen, the
size shape and (normocephalic and findings for the patient complied for the ff.
symmetry. symmetric, with frontal, following with 52cm procedures to check for the
parietal and occipital of circumference facial movements
prominences) smooth
skull contour.
>Note symmetry of
facial movements. Ask >Symmetric facial
the client to move movements >She has symmetric
eyebrows, close ey3e movements and does
tightly, puff cheeks and follow the following
smile show teeth steps we have.
Eye structures >Inspect eye brow for >Hair evenly distributed; >The skin is intact >The eye structures and visual
and visual acuity hair distribution skin intact and the hair of eye acuity are normal. No lesions
brow is evenly and edema
distributed
>Inspect eyelashes for >Equally distributed
evenness and hair
>Normal and equally
growth .
distributed.
Ears and hearing >Inspect the auricles >Color same as facial >Normal findings, >There are no abnormalities
for the color, texture, skin symmetrical, and the while assessing the ff.
size and position auricle is aligned w/ procedures. The client has
>Symmetrical
outer canthus of eye. normal findings.
>auricle aligned w/ outer
canthus of eye, about 10
from the vertical
Nose and sinuses >Inspect external nose >Symmetry and straight; >Normal findings is >The client has normal
for size, shape or color no discharge or flaring; met. findings of the nose and
and flaring or discharge uniform in color sinuses, there are no lesions or
from the nares. any abnormalities.
>Observe presence of
>Mucosa pink; clear,
redness, swelling, >Mucosa is pink,
watery discharge ;no
growths and discharges with clear and
lesions
watery discharge and
(-)lesions
>Inspect nasal septum
>Nasal septum intact and >The septum is
between the nasal
in midline intact and in midline
chamber
Mouth and Oropharynx >Lips and buccal >Uniform in color; soft, >The client is met >Some of the findings are not
moist, smooth texture;
mucosa symmetry of contour and the normal findings normal
ability to purse
--Inspect outer lips for
symmetry of contour,
color, and texture. Ask
the client to purse lips
as if to whistle
Neck >Assess for muscle >Equal strength >The client has the >The client has normal
strength by turning the equal strength findings in neck, (-)lymph
head of the patient in nodes, (-) thyroid gland
one side and to the visiblity
other side
Thorax and lungs >Assess posterior and >No abnormalities, >No abnormalities is >The client’s thorax is normal
anterior thorax for scoliosis, and any seen both posterior and anterior.
symmetry and shape, distention
assess for deformities,
abnormalities
>Auscultate by using
stethoscope >Vesicular and broncho
>With vesicular and
vesicular sounds
bronchovesicular
sounds
Abdomen >Assess for skin >Unblemished skin >The client has >The client has distention and
integrity distention and with with bowel sounds
>Assess for any >No distention bowel sounds
distention
Muscoloskeletal system >Inspect the muscles >Equal size on both sides >The client’s muscle >The client’s muscluloskeletal
for size. Compare the of body has equal size. system is normal. The muscles
muscles on one side of are firm and of equal size.
the body to the same
muscle on the other
side. For any
discrepancies, measure
the muscles with a
tape.
>Palpate muscles at
rest to determine
muscle tonicity >Normally firm >The client’s muscle
is firm
Bones:
A. Hypothesis
A urinary tract infection is an infection involving the organs that produce urine and carry it out of the body. These structures
include the kidneys, ureters bladder and urethra. Upper urinary tract infections usually occur because bacteria travel up from
the bladder into the kidney. Sometimes, they occur when bacteria travel from other areas of the body through the bloodstream
B. Pre-disposing Factors
Host
Female
5 yrs. old
Agent
Environment
Living conditions
Lifestyle
Diet
C. Analysis
The agent-host-environment model is primarily use in predicting illness rather than promoting wellness, although identification
of risk factors that result from the interactions of agent, host, and environment are helpful in promoting and maintaining health.
Because each of the agent-host-environment factors constantly interacts with others, health is an ever changing state. Health is seen
when all three elements are in balance while illness is seen when one, two, or all three elements are not in balance.
(Fundamentals of Nursing by Kozier 2004)
Urinary Tract infection is mostly caused by bacteria and it infects the urinary tract. Factors that can contribute to the condition
are age, lifestyle, habit, and environment. Urinary tract infection in children (symptomatic or asymptomatic) is associated with a high
incidence of urinary tract abnormalities (vesico-ureteric reflux, ureteral duplication, trabeculated bladder, hydroureter, ureteropelvic
D. Conclusion
The patient is suffering from Urinary Tract infection probably due to her lifestyle and habit. Other risk factors may also
Before the patient’s hospitalization, she perceives health in a way that she is not suffering from any disease or illness. Her
mother always reminded her to take vitamins for her to improve her health and to protect him from acquiring any disease or
Nutritional-Metabolic Pattern
Before her hospitalization, the patient takes her meal three times a day without any restrictions. According to her mother, she
has food preferences on meats. She has no difficulty in swallowing and she usually eat junk foods when its snack time. She
During her hospitalization, her appetite moderately decreased. Her fluid intake increased for about 5-7 glasses of water a day.
Elimination Pattern
Before her hospitalization, the patient used to eliminate at least once a day. She usually urinates 2 times a day with the normal
light yellow color and aromatic odor. She also perspires every time she plays.
During her hospitalization, the patient’s elimination became ineffective. She also perspires but it’s due to the hot environment
Activity-Exercise Pattern
Before her hospitalization, she used to play outside with his cousins or friends. They usually play dolls and the usual games of
During her hospitalization, she used her time reading and coloring books together with her mother. Most of her time was spent
Sleep-Rest Pattern
Cognitive-Perception Pattern
Before her hospitalization, the patient is normal in terms of her cognitive abilities. She has no problems with her senses.
During her hospitalization, she relates to us actively. She responded to our questions enthusiastically. She also related to us
According to the patient’s mother, she is a good daughter though sometimes she tends to disobey her parents. She said this is
Role-Relationship Pattern
Sexual-Reproductive Pattern
Prior to her age, the patient is not yet oriented with any sexual matters.
According to her mother, when she has problems she always approach her parents.
During her hospitalization, she feels unsafe with people when her mother is not with her.
Value-Belief Pattern
She is a Roman Catholic. They attend mass regularly. She is afraid to do something bad because she believes that God will
punish her.
Cefuroxime Anti-infective Binds Treatment for Contraindicated in Hyper- Assess for infection at
bacterial cell urinary tract hypersensitivity sensitivity beginning and during
wall infection, skin cephalosphorins reactions therapy
membrane, and skin Elevations in
causing cell structures, bone Serious hypersensitivity to serum creatinine,
death and joint penicillin nausea, vomiting
infection, and
gynecologic
infections
Ascorbic Vitamin Water- Recommend Prolonged use of excessive Dizziness, Too-rapid intravenous
acid soluble dietary allowance doses contraindicated in temporary injection is to be avoided.
vitamin with diabetes mellitus, sodium- faintness
antioxidant restricted diet, concurrent
properties, anticoagulation use, and
stimulates history of recurrent renal
collagen calculi
formation
and enhances Use cautiously in
tissue repair hypersensitivity to
tartranize or sulfites, before
tests for occult blood in
stool and breastfeeding
patients.
Ranitidine Antiulcer drug Reduces Active duodenal Headache, agitation, Cardiac Tell patient he may take
gastric acid ulcer anxiety arrhythmias, oral drug with or without
secretion and Bradycardia, food. Advice him to take
increased To maintain Nausea, vomiting, diarrhea, headache, once daily prescription
gastric mucus healing of constipation, abdominal fatigue, drug at bedtime
and duodenal ulcer discomfort or pain. dizziness,
bicarbonate depression, Caution patient to avoid
production Hepatitis, rash, Pain at IM Nausea, driving and other
creating a injection site, burning or vomiting, hyper- hazardous activities
protective itching at IV site, sensitivity
coating on hypersensitivity reaction reactions.
gastric
mucosa
IX. IV FLUIDS
Infusion Indication Classification Contraindication Nursing Responsibilities
D5 0.3 NaCl Dextrose and Sodium Isotonic crystalloid Reactions which may Check the label, expiration date, and
Chloride Injection, solution occur because of the indication.
USP is indicated as a solution or the
source of water, technique of Dextrose injections with low
electrolytes, and administration include electrolyte concentrations should not
calories. febrile response, be administered simultaneously with
Replenish fluid, infection at the site of blood through the same
nutrient and injection, venous administration set because of the
electrolyte thrombosis or possibility of hemolysis. The
phlebitis extending container label for these injections
from the site of bears the statement: Do not
injection, administer simultaneously with
extravasation and blood.
hypervolemia.
D5LR Lactated Ringer's and Hypertonic crystalloid Solutions containing Check the label, expiration date, and
5% Dextrose dextrose may be indication.
Injection is indicated contraindicated in
Lactated Ringer's and 5% Dextrose
as a source of water, patients with known
Injection should be used with great
electrolytes and allergy to corn or corn
care, if at all, in patients with
calories or as an products.
congestive heart failure, severe renal
alkalinizing agent.
insufficiency, and in clinical states in
which there exists edema with
sodium retention.
X. NURSING CARE PLAN
Subjective: Constipation related At the end of the >Instruct client and >To improve The goal is partially
to irregular nursing intervention the patient’s mother consistency of stool met after the end of
“Hindi siya defecation habits as the client will be to have a diet of and facilitate the nursing
makadumi simula evidenced by able to regain balanced fiber and passage through intervention. The
kahapon.” as absence of stool for normal pattern of bulk, and fiber colon client was able to
verbalized by the two days. bowel functioning. supplements regain a normal
patient’s mother pattern of bowel
functioning.
>Promote adequate
Objective: fluid intake, >To promote
including high fiber passage of soft stool
>No stool for 2 days
fruit juices, suggest
>Straining with drinking warm,
defecation stimulating fluids
>Distended
abdomen
>Percussed
abdominal dullness >Encourage patient >To stimulate
to exercise within contractions of the
limits of individual intestine and
ability encourage
elimination
>Identify elements >To eliminate the
that usually interfering factors
stimulate bowel which hinders
activity and any elimination
interfering factors.
>Administer stool
softeners, mild >Stool softeners
stimulants, or bulk- help in establishing
forming agents, as proper elimination
ordered or routinely,
when appropriate
XI. Discharge Planning
Exercise/Economic Factor The client should maintain regular exercise by doing simple activities suited for
her age.
Treatment The client should maintain the required treatment or therapy for her.
Health teaching The client should know things that will aggravate her condition, and be able to
avoid things that may worsen or bring forth again a complication.
Diet The client should eat 3 times a day with balanced diet.