Types & Risk Factors
Lower (cystitis), upper (pyelonephritis). Causes: E. coli (80-85%). Risk: female anatomy, sexual activity, catheters, pregnancy, diabetes, menopause, obstruction.
Assessment
Cystitis: dysuria, frequency, urgency, suprapubic pain, hematuria, cloudy urine. Pyelonephritis: fever, chills, flank pain, CVA tenderness, nausea. Elderly: confusion may be only sign. UA: leukocyte esterase, nitrites, WBCs. Culture >100,000 CFU/mL.
Nursing Management
Antibiotics: cystitis 3-day course (TMP-SMX, nitrofurantoin, fosfomycin). Pyelonephritis 7-14 days. Fluids 2-3 L/day. Urinate q2-3h, after intercourse. Wipe front to back. Catheter-associated: remove ASAP.
Important Notes
- Pregnant women with asymptomatic bacteriuria must be treated — risk of pyelonephritis and preterm delivery.
- Elderly patients with UTIs may present with confusion as the only symptom.
Clinical Tips
- Foley catheter should be removed ASAP — each day increases UTI risk by 5%.
- Nitrofurantoin ineffective for pyelonephritis — does not achieve tissue levels in kidney.
Summary
UTI management requires appropriate antibiotics, increased fluid intake, hygiene education, and prompt catheter removal.
