Question

Im doing a case study on a patient with UTI and dementia but Im having hard time to find references to support my answers. Can anyone help me to find reliable and accurate sources about the nursing intervention for UTI and Dementia??

Answer 1

Ans) Urinary tract infections and dementia. UTIs can cause sudden confusion (also known as delirium) in older people and people with dementia. If the person has a sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI.

Pathophysiology
The urine is normally sterile, but exposure to bacteria at the distal urethra (meatus) may lead to colonization of bacteria within the urinary tract. Infection may take place anywhere within the urinary tract, including the lower urinary tract (cystitis), or the upper urinary tract (pyelonephritis). Cystitis refers to inflammation and infection of the bladder, Pyelonephritis refers to inflammation and infection of the kidneys.

Etiology
The bacteria associated with 80% – 90% of urinary tract infections is Escherichia coli. Other bacteria that commonly cause infections include klebsiella, Enterococcus and Staphylococcus. Bacteria may be introduced to the urinary tract through the use of indwelling catheters. Antibiotic use disrupts the normal flora of the vagna and allows bacteria to grow and spread to the urethra, as does frequent or recent sexual intercourse. Difficulty voiding and inability to empty the bladder are also causes for the development of bacterial infections in the urinary tract.

Desired Outcome
Patient will be free from pain and symptoms of UTI and will be free of infection.

Urinary Tract Infection Nursing Care Plan
Subjective Data:
Lower back pain
Dysuria
Frequent urination
Urethral discharge (primarily in men)
Nocturia
Suprapubic pain
Nausea / vomiting
Objective Data:
Hematuria (may be microscopic)
Fever / chills
Oliguria
Foul smelling urine

Nursing Interventions and Rationales
- Monitor vital signs for infection

Symptoms that indicate worsening infection or progression of disease include :

Tachycardia
Fever / chills
Elevated blood pressure

- Assess / palpate the bladder every 4 hours

- Assess for bladder distention to determine if there is urinary retention.

- Assess hydration status and encourage increased fluids

Increasing fluid intake will help the kidneys to flush excess waste and increase blood flow. This will also prevent dehydration with can complicate UTI.

- Administer medications to treat

Infection
Pain
Fever

Infection– Most UTIs can be treated with common antibiotics such as nitrofurantoin, cephalexin and sulfamethoxazole/trimethoprim, depending on urine culture & sensitivity test results.
Pain– Analgesics for urinary pain include phenazopyridine, which is a dye that helps numb the pain within the urinary tract.
Fever– Ibuprofen or acetaminophen may be given in case of fever and chills per facility protocol

- Provide education regarding hygiene and prevention of future infections

Wipe from front to back when urinating and defecating to prevent bacteria being introduced to the vagna and urethra

- Avoid scented hygiene sprays, douches and bath products to prevent infection and irritation
Cleanse genital area before and after sex
Empty bladder frequently and completely to avoid build up of toxins in the bladder
Drink lots of water
Wear cotton underwear and avoid tight fitting clothing
Apply heating pad for comfort

Application of heat to lower back or abdomen may help relieve pain and cramping. Avoid prolonged exposure to heating pad, using only 15 minutes per session with at least 15-30 minutes in between to prevent burns.