Primary Nursing Diagnosis

Altered urinary elimination related to infection

OUTCOMES. Urinary elimination; Knowledge: Medication, Symptom control INTERVENTIONS. Medication prescribing; Urinary elimination management

U PLANNING AND IMPLEMENTATION Collaborative

An acid-ash diet may be encouraged. A diet of meats, eggs, cheese, prunes, cranberries, plums, and whole grains can increase the acidity of the urine. Foods not allowed on this diet include carbonated beverages, anything containing baking soda or powder, fruits other than those previously stated, all vegetables except corn and lentil, and milk and milk products. Because the action of some UTI medications is diminished by acidic urine (nitrofurantoin), review all prescriptions before instructing patients to follow this diet.

UTIs are treated with antibiotics specific to the invading organism. Usually, a 7- to 10-day course of antibiotics is prescribed, but shortened and large single-dose regimens are currently under investigation. Most elderly patients need a full 7- to 10-day treatment, although caution is used in their management because of the possibility of diminished renal capacity. Women being treated with antibiotics may contract a vaginal yeast infection during therapy; review the signs and symptoms (cheesy discharge and perineal itching and swelling), and encourage the woman to purchase an over-the-counter antifungal or to contact her primary healthcare provider if treatment is indicated.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Cephalosporins

Varies with drug

Ceftriaxone (Rocephin) Cephalexin monohydrate (Keflex)

Bacteriocidal

Ciprofloxacin (Cipro)

250-500 mg PO bid

Quinolone

Bacteriocidal

Sulfisoxazole (Gantrisin)

Initially 2-4 g PO, then 1-2 g qid for 10-14 days

Anti-infective, Sulfonamide

Bacteriocidal

Co-trimoxazole (Bactrim, Septra)

160 mg q 12 hr for 7-14 days

Anti-infective, Sulfonamide

Bacteriocidal

Nitrofurantoin (Macrodantin)

50-100 mg PO qid for 10-14 days

Urinary antiseptic

Bacteriocidal; concentrates in the urine and kidneys to kill bacteria

Phenazopyridine (Pyridium)

100-200 mg PO tid until pain subsides

Urinary analgesic

Relieves pain

Other Drugs: Tobramycin (Nebcin), Ertapenem (Invanz), amoxicill (Augmentin)

n/clavulanate

Independent

Encourage patients with infections to increase fluid intake to promote frequent urination, which minimizes stasis and mechanically flushes the lower urinary tract. Strategies to limit recurrence include increasing vitamin C intake, drinking cranberry juice, wiping from front to back after a bowel movement (women), regular emptying of the bladder, avoiding tub and bubble baths, wearing cotton underwear, and avoiding tight clothing such as jeans. These strategies have been beneficial for some patients, although there is no research that supports the efficacy of such practices.

Encourage the patient to take over-the-counter analgesics unless contraindicated for mild discomfort but to continue to take all antibiotics until the full course of treatment has been completed. If the patient experiences perineal discomfort, sitz baths or warm compresses to the perineum may increase comfort.

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