Nursing Guide to Urinary Tract Infection: Nursing Diagnosis, Interventions, & Care Plans

Urinary Tract Infection (UTI) Etiology and Epidemiology 

A urinary tract infection, or UTI, is an infection of any part of the urinary system including the: 

• Bladder known as cystitis 
• Kidneys known as pyelonephritis 
• Urethra known as urethritis 

Most UTIs involve the lower urinary tract that is composed of the urethra and bladder. Upper UTIs are rarer than lower UTIs but are often more severe. They include an infection of the ureters or kidneys. 

When excess water and waste products are removed from an individual’s blood by the kidneys, urine is created. Urine normally does not contain bacteria. If bacteria enters the urinary system, inflammation and infection can occur. Most UTIs are caused by bacteria, but they may also be caused by fungi and occasionally viruses (Lights, 2020). 

 Anyone can suffer from a UTI, but they are more common in women and older adults. Other risk factors for a UTI include: 

• Being sexually active 
• Having diabetes 
• Structural issues in the urinary system 
• Kidney stones 
• Quadriplegia or paraplegia 
• Enlarged prostate 
• Vesicoureteral reflux 
• Postmenopausal 
• History of kidney transplant 
• Pregnancy 
• Sickle cell disease 
• Disease or disorders the make it difficult to drain the bladder 
• Weakened immune system 
• Catheter use 
• Diaphragm use 
• Prior surgery on the urinary tract 

The urethra in women is shorter and closer to the anus than in men. This makes it easier for bacteria to enter the urinary tract. The most common cause of UTIs in women is bacteria from the bowel that enters the urinary tract. The most common cause of UTIs in men is an enlarged prostate that can cause the restriction of urine flow. The most common organism that causes a UTI is Escherichia coli or E.coli. Other organisms that frequently cause UTIs include: 

• Proteus 
• Klebsiella 
• Enterococcus 
• Pseudomonas 

ICD-10 Code for UTI: 

• N39.0 - Urinary tract infection, site not specified

UTI Diagnosis 

Common symptoms of a UTI include: 

• Pain or burning on urination 
• Pressure or cramping in the lower abdomen or groin 
• Lower back pain 
• Nausea and vomiting 
• Frequent urination 
• Urgency 
• Cloudy urine 
• Hematuria or blood in the urine 
• Fever 
• Chills 
• Rectal pain in men 

The gold standard for a diagnosis of UTI is the detection of pathogens in the urine with the presence of symptoms (Bono & Reygaert, 2021). The detection of pathogens is achieved by a urinalysis and urine culture. 

An accurate urine specimen is vital to the appropriate diagnosis of a UTI. A clean catch specimen is preferred when the individual can provide it. An indication that a urine sample is not a clean catch is when the urinalysis shows many epithelial cells. 

An in-and-out catheterization may be required even though it can cause a UTI in uninfected women about 1% of the time (Bono & Reygaert, 2021). Urine should be refrigerated or sent to the lab immediately after being obtained because bacteria grows rapidly when left at room temperature. 

Dipstick testing of urine can occur at the bedside. A negative dipstick does not rule out a symptomatic UTI, but positive findings can help make a diagnosis. Values that can assist in a diagnosis include: 

• Nitrites 
• pH 
• Blood 
• Leukocyte esterase 

The most common and accurate dipstick test detects nitrites. Bacteria must be present in the urine to have nitrites, but not all bacteria result in nitrites (Bono & Reygaert, 2021). Normal urine is slightly acidic. A urine pH above the normal range or below can indicate an infection. Bacterial infections in the lining of the bladder may cause bleeding which may result in hematuria. White blood cells present in the urine release leukocyte esterase in response to bacteria. 

Urine cultures are recommended to help differentiate between recurrent infections and relapsing infections. Cultures are also recommended due to antibiotic resistance. 

If an individual has a history of UTIs, a cystogram or cystoscopic exam may be performed. 

UTI Management 

Asymptomatic bacteriuria is common and usually requires no treatment. The exception to no treatment includes pregnant women, immunosuppressed individuals, and individuals who have had recent surgical procedures. 

 Symptomatic UTIs are treated with antibiotics. The antibiotic used depends on the culture and sensitivity results. Severe UTIs may require IV antibiotics. Analgesics may be given for pain. 

Individuals with recurrent UTIs may be given a low dose antibiotic over a long period of time, a single antibiotic dose after sex, or an antibiotic to begin at the first sign of symptoms. 

UTI Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for UTI are listed below. 

UTI Assessment 

Nursing assessment should include assessment of the urine for: 

• Clarity and color 
• Foul smell 
• Blood 

Evaluation of an individual’s symptoms should monitor for: 

• Fever 
• Suprapubic pain 
• Low back or abdominal pain 
• Urgency and frequency of urination 
• Nausea and vomiting 

Laboratory tests should include a complete blood count, urinalysis, and urine culture. 

Nursing Diagnosis/Risk For 

Nursing diagnoses used for acute UTI include: 

• Pain related to inflammation of the urinary tract 
• Infection related to urinary retention as evidenced by positive urine culture result 
• Impaired urinary elimination related to UTI as evidence by patient reports of dysuria, frequency, and urgency 

Interventions 

Medication should be given as ordered and observed for effectiveness and adverse reaction or complications. Adequate fluid intake should be encouraged including IV fluids as ordered. Some other nursing interventions provided may be: 

• Administer pain medication and/or antispasmodic agents
• Encourage frequent voiding 
• Avoid irritants such as caffeine 
• Perform labs as ordered 
• Vital signs 
• Monitor Intake and output

Expected Outcomes 

• Verbalizes decrease or absence of urinary symptoms 
• Returns to prior level of functioning 
• Verbalizes a decrease in pain 

Individual/Caregiver Education 

• Condition, treatment, and expected outcomes 
• Drink at least 64 ounces of fluids daily 
• Empty bladder frequently 
• Empty bladder as soon as possible after intercourse 
• Wipe front to back 
• Avoid tight-fitting clothes 
• Avoid the use of a diaphragm, unlubricated condoms, or spermicidal jelly 
• Cleanse the genital area before sex 
• Keep genital area dry by wearing cotton underwear 
• Avoid irritating feminine products 
• Choose showers over baths 
• Medication regimen 
• Recommended follow-up with healthcare provider 
• Notify healthcare provider or seek immediate medical care for: 
  • Continued symptoms after antibiotic use

Content Release Date

4/1/2022

Content Expiration

12/31/2028

Course Contributor 

The content for this course was created/revised by Kim Matthews, RN. 

Ms. Matthews obtained a nursing degree from Western Kentucky University in 1998. Ms. Matthews possesses over 20 years of nursing experience with over 17 of those in the Skilled Nursing industry. Ms. Matthews has extensive experience in MDS, restorative nursing programs, and nursing management. Ms. Matthews is currently a Post-Acute Care Content writer and subject matter expert for MDS. 

References 

• Bono, M., & Reygaert, W. (2021). Urinary tract infection. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470195/ 
•  Light, V. (2020). Everything you need to know about urinary tract infection. Healthline. https://www.healthline.com/health/urinary-tract-infection-adults