NR 507 Week 4 Study Guide: Urinary System Pathologies & UTIs (2026), Exams of Nursing

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WEEK 4 STUDY

GUIDE

Urinary Systems Pathologies -

Understanding UTIs and Their Management

URINARY SYSTEMS

PATHOLOGIES:COMMON DISEASES

AND DISORDERS

URINARY TRACT INFECTIONS

Urinary tract infections (UTIs) can affect the kidneys, bladder, or urethra. UTIs can be managed in most instances with antibiotics. The severity of the infection often increases with kidney involvement; therefore, prompt identification and treatment of UTIs are essential.

This learning module focuses on disease processes associated with urinary tract infections and enables you to meet the following course outcomes:

● CO 1: Analyze pathophysiologic mechanisms associated with selected disease states across the lifespan. ● CO 2: Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions across the lifespan. ● CO 3: Distinguish risk factors associated with selected disease states across the lifespan. ● CO 4: Integrate advanced pathophysiological concepts in the diagnosis and treatment of health problems in selected populations. ● diagnosis and treatment of health problems in selected populations.

Severity of Urinary Tract Infection

Introduction to Urinary Tract

Infections

Severity Rationale

Responds well to oral antibiotics

Uncomplicate d

An uncomplicated, symptomatic UTI (cystitis) will typically require a 3 - 7 day course of appropriate antibiotic therapy, often oral.

Occurs in an immunocompromised individual

Complicated An immunocompromised individual’s immune system is less effective against infectious organisms.

Infection beyond the bladder

Complicated An infection of the kidney can cause acute renal failure if left untreated.

Associated with indwelling urinary catheters

Complicated The catheter may introduce bacteria that colonize and form biofilms, which promote survival and allow them to cling to surfaces.

Which of the following are upper urinary tract infections (UTIs)? Select all that apply.

Prostatitis

Cystitis

Urethritis

Upper UTIs occur in organs that are above the urinary bladder and include ureter infections and pyelonephritis (kidney infection).

Ureter infection Pyelonephritis

Upper Urinary Tract Infections

Cystitis (bladder infection), urethritis (infection of the urethra), and prostatitis (infection of the prostate) occur in the lower urinary tract.

Which of the following instructions should the nurse practitioner (NP) provide to a 20-year-old female being discharged with a urinary tract infection (UTI)? Select all that apply.

Empty the bladder every 5 hours Wipe

front to back

Wear latex, rayon underwear

Drinking plenty of water (at least eight, 8-ounce glasses or 2 liters per day), wiping from front to back, voiding after sex, wearing absorbent, breathable underwear, and emptying the bladder every 3 – 4 hours are correct discharge instructions for this client.

Underwear made with synthetic fibers promotes a warm, moist environment in which bacteria can flourish and migrate into the urethra. Waiting 5 hours between emptying the bladder allows urine to remain in the bladder, providing bacteria with a moist environment in which to multiply.

The urinary system is responsible for the removal of waste from the blood by converting it to urine. The kidneys, ureters, bladder, and urethra must all function adequately for normal urination to occur. Click each plus (+) sign in the activity below to review the normal function of the urinary system.

Normal Physiology of the Urinary

System

Drink at least 2 liters of water per day Void after sex

Client Education: Urinary Tract

Infection

● Women are more likely to experience lower UTIs due to the shortness of the urethra and the proximity of the urinary meatus to the vagina and anus.

Click each plus (+) sign in the activity below to review the typical progression of UTIs.

Click spot 1:

● Bacteria enter the lower urinary tract, colonizing in the urethra and bladder. ● An inflammatory response is triggered, bringing neutrophils to the bacteria. ● Bacteria continue to multiply and form biofilm, which allows bacteria to stick to one another and adhere to surfaces,

including urinary tract tissues, to survive and increase in number. ● The result is urethritis or cystitis, which are considered lower urinary tract infections.

Click spot 2:

● When left untreated, bacteria may enter one or both ureters and ascend to the kidneys. ● This results in a ureter infection or pyelonephritis, which are considered upper urinary tract infections. ● If left untreated, the bacteria can spread into the circulation via the renal veins, causing bacteremia that may lead to septic shock.

Place the sequence of events that lead to cystitis in the correct order from first to last.

● Bacteria enter the lower urinary tract ● An inflammatory response is triggered ● Neutrophils arrive ● Bacteria continue to multiply ● Biofilm forms ● Bacteria adhere to the bladder wall ● Client experiences pain with urination

The sequence of events starts with the bacteria entering the urethra and end with the client having symptoms of infection. The correct order is:

1. Bacteria enter the lower urinary tract
2. An inflammatory response is triggered
3. Neutrophils arrive
4. Bacteria continue to multiply
5. Biofilm forms
6. Bacteria adhere to the bladder wall
7. Client experiences pain with urination

Pathology of Urinary Tract

Infection

● Insufficient fluid intake can reduce urine production and concentration, making it easier for bacteria to multiply in the urinary tract.

Obesity

● Excess weight can contribute to the development of UTIs, possibly due to factors like compromised immune function and hormonal changes.

Poor Personal Hygiene

● Improper wiping or inadequate cleansing after bowel movements can contribute to the spread of bacteria to the urethra.

Previous UTIs

● Individuals who have had UTIs in the past may be more prone to recurring infections.

Family History

● A family history of UTIs may indicate a genetic predisposition to these infections.

● Upper UTI Risk Factors

Risk factors for infections that originate in the upper urinary tract are more complex since the infectious organism enters the ureters or kidneys from within the body and include the following:

Suppressed Immune System

● Individuals living with diabetes, human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS), or immunosuppressive drugs are at increased risk.

Urinary Tract Abnormalities

● Structural issues in the urinary tract, such as kidney stones or abnormalities from birth, can increase susceptibility to infections.

Urinary Tract Obstructions

● Anything that blocks the normal flow of urine, like an enlarged prostate or urinary stones, can contribute to upper UTIs.

3. Urgency: A sudden and intense need to urinate is associated with inflammation of the bladder and urethra (lower UTI).
4. Lower Abdominal Discomfort: Pain or pressure in the lower abdomen can be caused by an infection anywhere in the urinary tract.
5. Pelvic Pain: Pain in the pelvic area is associated with a bladder infection, especially in women with a bladder infection.
6. Cloudy or Strong-Smelling Urine: Changes in the appearance or odor of urine can be caused by an infection anywhere in the urinary tract.
7. Blood in Urine (Hematuria): The presence of blood, giving the urine a pink or reddish color can be caused by an infection anywhere in the urinary tract.
8. Fever: In some cases, a UTI can be accompanied by a systemic fever.
9. Back Pain: Pain in the lower back is associated with an infection in the kidneys. Assessment for pain or tenderness at the costovertebral angle (CVA) can increase both pain and inflammation and should be part of a routine assessment.
10. Fatigue: Feeling tired or generally unwell can be caused by an infection anywhere in the urinary tract.
11. Discomfort or Pain During Sex: Women with bladder or urethra infections may experience pain or discomfort during sexual activity.

Basia Rhoden (pronouns she/her/hers) presents with complaints of urinary frequency and urgency. For each finding from the nurse practitioner’s (NP) assessment, specify if it supports a diagnosis of lower urinary tract infection (UTI), upper UTI, or sexually transmitted infection (STI). Each finding may be associated with more than one type of infection.

Symptoms of infection, including fatigue, bacteria in the urine, and an elevated temperature, may be present for any infection, including lower UTI and upper UTI.

Note: Foul smelling urine and painful urination can be present with both lower and upper UTI.

Pelvic pain is more likely to be present in a female with a lower UTI. An

urgency to void is associated with lower UTI.

Location of Infection

A urinary tract infection (UTI) is diagnosed through a comprehensive health history, clinical assessment, and diagnostic tests. Due to normal changes of aging, older adults with a UTI may have non- specific changes, such as malaise, low-grade fever, and confusion.

Click each plus (+) sign in the activity below to learn more about the diagnosis of urinary tract infections.

Client History

The nurse practitioner (NP) will conduct a focused health history, inquiring about previous UTIs, chronic conditions, medications, and relevant lifestyle factors.

Symptom Assessment

The NP will inquire about the specific symptoms the client is experiencing, such as frequency and urgency of urination, pain or discomfort during urination, and any associated symptoms like fever or back pain.

Physical Examination

A physical examination may be conducted to assess for signs of infection. This may include checking for tenderness or pain in the lower abdomen or back. Note: The NP should assess for

Urinary Tract Infection Diagnosis

The signs and symptoms of pyelonephritis are often acute and include all the symptoms associated with cystitis plus fever, flank pain, costovertebral angle (CVA) tenderness, nausea, and vomiting. Malaise is also a common complaint for the client with pyelonephritis. Signs of shock may occur if the infection has entered the circulation from the kidney via the renal vein. Think of the symptoms of pyelonephritis in a classic triad: vomiting, flank pain, and fever.

Low levels of protein in urine are not pathologic and may increase after exercise or during illness. Higher levels of protein suggest a complicated UTI that may involve the kidneys.

This is a non-specific indicator of UTI; therefore, other data is required for diagnosis.

The presence of nitrites is the most specific finding and has the highest positive predictive value. Nitrites detect the presence of the Enterobacteriaceae (gram-negative) bacteria, which converts nitrates into nitrites. Because not all bacteria produce nitrites (e.g., Enterococcus ) the client may have a UTI when the urine is nitrate free.

Hematuria, or RBCs in the urine, is often present with a UTI. Greater than 3 red blood cells per high power field (RBC/hpf) is considered abnormal. Abnormal morphology of the RBC strongly suggests glomerular disease.

Greater than 5 WBC/hpf is considered abnormal and supports a diagnosis of UTI.

Casts, the most abundant protein excreted in urine, are long cylindrical structures formed in the renal tubules in concentrated or acidic urine. The presence of casts is non-specific to UTIs and may be seen with dehydration. The appearance of casts can provide information on the underlying pathology as follows:

WBC Casts

White Blood Cells

Red Blood Cells

Nitrites

Leukocyte Esterase

Protein

● WBC casts suggest interstitial inflammation. ● Muddy brown casts suggest acute tubular necrosis. ● Waxy casts suggest acute and chronic renal failure. ● Fatty casts suggest nephrotic syndrome. ● RBC casts suggest glomerulonephritis.

Bacterial presence occurs with both complicated and uncomplicated UTIs.

Crystals are microscopic solids composed of a small number of ions and molecules commonly found in urine. The presence of a small number of crystals is not pathologic.

Uncomplicated UTI

Complicated UTI

Protein + or – + or –

Leukocyte Esterase + +

Nitrates + or – + or –

Red Blood Cells (RBC) + or – +

White Blood Cells (WBC)

5 WBC/hpf > WBC/hpf

WBC Casts – +

Bacteria + +

Crystals + or – + or –

Crystals

Bacteria

Status Rationale

the NP may need to include a genital exam to rule out or diagnose a sexually transmitted infection (STI).

Order blood culture and sensitivity testing

Inappropriat e

Blood culture and sensitivity testing are not indicated with a simple presentation of a lower urinary tract infection. Should the infection not respond to treatment or migrate to the upper urinary tract, blood cultures may be warranted.

Obtain a clean-catch urine sample

Appropriate If the initial tests suggest a UTI, a urine culture may be ordered to identify the specific bacteria causing the infection and determine its susceptibility to antibiotics.

Complete a point of care urine dipstick

Appropriate A urine dipstick test can quickly identify the presence of blood, protein, leukocytes, and nitrites at the point of care.

Refer the client to a urologist

Inappropriat e

Evidence-based practice guidelines inform the diagnosis and treatment of UTIs. If there are complications or if the infection is recurrent, the client may be referred to a specialist for further

Severity of Urinary Tract

Infections

Determining if a urinary tract infection (UTI) involves the lower or upper urinary tract is crucial in treating the infection and preserving renal health. An untreated lower UTI can progress to an upper UTI, leading to permanent kidney damage or sepsis.

Uncomplicated Urinary Tract Infection Characteristics

● Normal urinary tract function ● Normal renal function ● Lower risk for permanent renal damage or sepsis ● Absence of white blood cell (WBC) casts absent ● Presence of local symptoms (e.g., pain or burning with urination; foul-smelling, cloudy urine) ● Requires no treatment if asymptomatic ● Requires oral antibiotics if symptomatic or a client is pregnant

Complicated Urinary Tract Infection Characteristics

● Altered urinary tract function ● Decreased renal function ● Increased risk for permanent renal damage or sepsis ● Presence of white blood cell (WBC) casts

Evidence-based practice guidelines inform the diagnosis and treatment of UTIs. If there are complications or if the infection is recurrent, the client may be referred to a specialist for further evaluation.