Laura Saldivar

UTIs affect 2.6% to 3.4% of children annually, with a childhood risk of developing a UTI 2% for boys and 8% for girls (Freedman, 2007). Pre-school or school aged children present symptoms in the form of abdominal or suprapubic pain, dysuria, frequency, urgency, enuresis, urinary incontinence.  The child should be asked if they are experienced burning upon urination or if there is any blood in the urine.    The child should also be asked how long any symptoms may have been present in order to gage how long the infection has been present. 

  Lower-tract UTIs are mostly caused by gram negative bacteria (95% of UTIs), with E. coli the most prevalent organism (80% of all lower UTIs are caused by E. coli). Particularly for school aged girls, they must be educated on wiping from front to back to avoid spreading feces to their urethra. Febrile UTI is treated aggressively in infants and children because fever is often an indication of pyelonephritis (Gaylord& Starr, 2009).  Infants and children with febrile UTI should receive parenteral antibiotics for the first 24 hours or until fever subsides. Ceftriaxone 50 to 75 mg/kg divided every 12 to 24 hours IV/IM is often used in children older than 3 months because of the convenience of 24-hour dosing (Woo, T. M., & Robinson, M. V. 2020). Other appropriate parenteral antibiotic choices are cefotaxime, ceftazidime, ampicillin, or gentamicin (Woo, T. M., & Robinson, M. V. 2020).  The parents must be educated on proper hygiene techniques and more frequently drinking water rather than juices and sodas. 

Yamile

Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages.

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1.      What other assessment data would be helpful for the nurse practitioner to have?

2.      What are the organisms most likely to cause an UTI?

3.      What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

4.      What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

During the patient assessment will be very important for the Nurse Practitioner ask to the parent for chronic conditions in the child, use of medications, hygiene habits, use of Pampers, regular fluids intake, physical inspect the patient for evaluation of the signs and   general symptoms, on the abdomen inspection specifically, the Nurse Practitioner will look for distention or visible mass, on palpation, the nurse practitioner will look for tenderness, distended Bladder, painful Ballot the Kidney, auscultation for renal bruit, and edema. To confirm the infection, the nurse practitioner must collect the urine sample, can be done a urine strip test, urinalysis, and urine culture with drug selection.

The most common cause of UTI in all age groups is Escherichia coli (65% to 75%). Other agents include Klebsiella species, usually Klebsiella pneumoniae (23%), Proteus mirabilis (7%), other Enterobacteriaceae, Enterococcus species, Pseudomonas aeruginosa.

Pharmacological Treatment is based in the specific bacteria that are identified by the urine culture, but empirical we can use Amoxicillin-clavulanate , Oral Suspension ( 125 mg/31.25 mg in 5 ml ), Tablets,(200mg/28.5 mg), Chewable, ( 200 mg/28.5 mg). Trimethoprim-Sulfamethoxazole, Injected Solution, (16 mg/80 mg in 1 ml), Oral Solution, (40 mg/200 mg in 5 ml), Tablets, (80 mg/400 mg) or (160 mg/800 mg), Cephalexin, capsule ( 200 mg, 500 mg), Oral Suspension, (125 mg/5 ml, 250 mg/5 ml), Tablets, (125 mg, 250 mg) and Cefixime among other oral cephalosporin until the result of the culture.

Prior to be discharge, for the patient and her mother, is very important to receive teaching about the Urinary Tract Infection treatment to been follow up, to avoid daily activities that can contribute to the recurrence.

Ask the doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do to care for your child.

Be sure your child takes all of the drugs to treat the UTI.

Teach your child to wipe from front to back after going to the bathroom.

Teach your child to go to the bathroom every 2 to 3 hours. This will help your child learn not to hold urine for a long time.

Ask the doctor how to treat hard stools if this is a problem

Put a hot water bottle or a heating pad wrapped in a cloth or towel on your child’s belly to help with pain. Do this for 20 minutes at a time. Never let your child sleep with a heating pad as this may cause burns.

Make sure your child drinks at least 6 to 8 glasses of fluids each day.

Have your child wear cotton underwear.

Avoid giving your child bubble baths.

References

:

Woo & Robinson. Pharmacotherapeutics for Advanced Practice Nurse Prescriber. (4th Edition)

American Psychological Association. Publication Manual of the American Psychological Association. (6th Edition)

Adams, Holland & Quam. Pharmacology for Nurses: A Pathophysiologic Approach. (5th Edition)

Dailyn Gonzalez

Advanced Pharmacology

What other assessment data would be helpful for the nurse practitioner to have?

            The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%; therefore, the NP should be vigilant and pay attention to additional assessment data (Allen, Manilal & Gezmu, 2019).  For example, patient population is typically premenopausal women of any age with risk factors of diabetes, diaphragm use, especially those with spermicide, history of UTI or UTI during childhood, mother or female relatives with history of UTIs, and sexual intercourse.

What are the organisms most likely to cause an UTI?

            Urinary tract infections are primarily caused by gram-negative bacteria, but gram-positive pathogens may also be involved. More  than  95%  of  uncomplicated  UTIs  are  monobacterial.  The most common pathogen for uncomplicated UTIs is E.coli (75%–95%), followed by Klebsiella pneumoniae, Staphylococcus saprophyticus,  Enterococcus  faecalis,  group  B  streptococci,  and Proteus  mirabilis (Bollestad, Vik, Grude& Lindbæk, 2018).

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

            The first step in treating Shelly is to classify the type of infection, such as acute uncomplicated cystitis or pyelonephritis, acute complicated cystitis or pyelonephritis, CA-UTI, asymptomatic  bacteriuria  (ASB),  or  prostatitis  (Allen, Manilal & Gezmu, 2019).  The Infectious Diseases Society of America (IDSA) recommends that  empiric  regimens  for  uncomplicated  UTIs  be  guided  by  the  local  susceptibility,  particularly  to  E.  coli.  They  recommend   considering   trimethoprim/sulfamethoxazole if the local resistance rate is less than 20% and fluoroquinolones if the resistance rate is less than 10% (Bollestad, Vik, Grude& Lindbæk, 2018). The empiric regimen for complicated UTIs should also be guided by local susceptibility trends of uropathogens,  and  definitive  regimens  should  be  tailored  according  to  susceptibility  results,  when available.

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

            The teaching priority for Shelly is hydration.  During  UTI  management,  hydration  dilutes  the  uropathogen  and  removes  infected  urine  by  frequent  bladder  emptying.  However, the bacterial count returns to the prehydration  level  after  hydration  is  discontinued.  Potential problems with forcing fluids include urinary retention in a  patient  with  a  partially  obstructed  bladder  and  decreased  urinary antibiotic concentration.

References

Allen, M., Manilal, A., Gezmu, T., (2019). Prevalence and associated factors of urinary tract infections among women. Journal of Urology, 45(1), 56–62. https://doi.org/10.5152/tud.2018.32855

Bollestad, M., Vik, I., Grude, N., & Lindbæk, M. (2018). Predictors of Symptom Duration and Bacteriuria in Urinary Tract Infection. Scandinavian Journal of Primary Health Care, 36(4), 446–454. https://doi.org/10.1080/02813432.2018.1499602

Eduardo Soto Quinones

Urinary Tract Infections

Helpful assessment data

To be sure that indeed Sheila, a four-year-old girl, has a Urinary tract infection, the nurse practitioner should carry out a comprehensive data assessment. Other than interviewing the patient, the nurse practitioner will need to carry out an additional assessment, which will involve collecting data from the daycare that Sheila goes to. Talking the brother and the parents will also go a long way in helping the nurse practitioner come up with a report on the significant alterations in Sheila’s health conditions and to know what caused Sheila’s UTI. Also, the NP should have assessment data containing other nurse diagnoses of similar conditions. This will, in turn, increase accuracy during diagnosis (Practicalnursing.org Staff Writers, 2020).

Most likely causes of UTI and pharmacological treatment

The most causative agent of UTI is bacteria.to be specific its caused by a bacterium known as Escherichia coli, which can be abbreviated to E. coli. This bacterium is mainly found in the digestive tract and enters the urinary tract through the urethra. This bacterium led to Sheila’s symptoms, which included running a fever, frequent urination as well as pain when urinating. What to know about urinary tract infections. To treat it, antibiotics will help in the treatment of this infection. Oral antibiotics will be a good starting point, the drug of choice being TMP/SMX or cephalosporins e.g., cefixime, which is to be taken 8 milligrams once per day. Sheila should take the medications for 7-14 days .by By doing this, Sheila is assured of recovery (Mersch, 2020).

Teaching priorities to be adhered to after Sheila’s discharge from the clinic.

Sheila and her mother must follow the stipulated teaching guidelines after Sheila is discharged regarding how to prevent any reoccurrence of the UTI. Sheila should be encouraged to take a lot of fluids and regularly empty the bladder during urinating. It’s also essential for Sheila’s mom to train her how to wipe from the front to the back after using the toilet. Sheila should not be constipated at all, and hence the mother should include roughage in the diet. Sheila should avoid using a bubble bath at all costs. Also, Sheila needs to finish taking all her dosage even if she starts feeling better (Mount Nittany health, 2020).

REFERENCES

Mersch, J. (2020). Urinary Tract Infections in Children Symptoms, Cause & Remedies. MedicineNet. 

https://www.medicinenet.com/urinary_tract_infections_in_children/article.htm

Mount Nittany health. (2020). When Your Child Has a Urinary Tract Infection UTI. Mount Nittany Health System. 

https://www.mountnittany.org/articles/healthsheets/7299

Practicalnursing.org Staff Writers. (2020, February 5). Focused vs. Comprehensive Assessment. LPN Programs | Licensed Practical Nurse | PracticalNursing.org. 

https://www.practicalnursing.org/focused-vs-comprehensive-assessment

Yindra Isaac

Advanced Pharmacology
What other assessment data would be helpful for the nurse practitioner to have?

            Assessment data for the NP to consider are combinations of findings, including a prior history of UTI, and, in older children, typical symptoms such as frequency, abdominal or suprapubic discomfort, and dysuria, should be taken into account when making a decision to evaluate for UTI.  Guidelines from the American Academy of Pediatrics recommend considering the diagnosis of UTI in patients aged 2 months to 2 years with unexplained fever.

What are the organisms most likely to cause an UTI?

            The organism most likely to cause a UTI are infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.  Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

            Patients with a nontoxic appearance may be treated with oral fluids and antibiotics. Toxic-appearing patients must be aggressively treated with intravenous (IV) fluids and parenteral antibiotics. Most cases of uncomplicated UTI respond readily to outpatient antibiotic treatments without further sequelae. Antibiotic resistance among uropathogens is increasing dramatically, however. Previous antibiotic exposure (ie, for otitis media) has been found to be associated with drug-resistant UTIs and should be kept in mind when choosing empiric therapy.

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

            Arrange for a follow-up to monitor the patient’s response to treatment and at 48 hours to modify treatment if the results of antibacterial sensitivity studies indicate a need to change. Arrange for a follow-up visit after 7-10 days to check the patient’s clinical course.  Appropriate treatment, imaging to identify correctable anatomic abnormalities, and follow-up can help prevent long-term sequelae in patients with more severe cases or chronic, recurrent infections. All patients should have close follow-up to evaluate response to antibiotics. Repeat urinalysis and/or urine cultures are not needed if the patient’s condition responds to therapy as expected.

References

Henderson D. (2015). Abnormal Scan After UTI Raises Kids’ Risk for Renal Scarring. Medscape Medical News. [Full Text].

Shaikh N, Craig JC, Rovers MM, et al. (2016). Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection: A Meta-analysis With Individual Patient Data. JAMA Pediatr. Aug 4.

Top of Form

Ariel Lopez

March 25, 2020

        Question 1

Laboratory tests are carried out to diagnose UTIs and determine the bacteria that cause the infection and the treatment to cure the infection. The assessments that can be helpful to the nurse practitioner include culture for definitive diagnosis as well as a urinalysis. The urinalysis test shows the PH changes and the bacteria present. In addition, it shows the white blood cells present in the sample urine, (Tavana, 2017). It also shows the presence of discharge which shows the evidence of infection. Blood count can also be carried out to show where there is an infection. The white blood cells will be higher. 

Question 2

There are a variety of bacteria that can cause UTIs. However, most of them are caused by Escherichia Coli. These bacteria are mostly found in the digestive system. It can also be found around the anus or in the stool, (Rao, et al., 2018). Other bacteria’s that cause UTIs include Staphylococcus, Proteus, Enterococcus, and Klebsiella. 

Question 3

Febrile UTI in kids should be treated aggressively. They should receive antibiotics therapy for the first twenty-four hours or until afebrile. One of the drugs that should be given to the patient is Ceftriaxone (IV or IM) 50 to 75mg/kg divided every 12 to 24 hours, (Wollin, et al., 2017). The drug should be administered to children between two months to twelve years. Cephalexin25mg/kg/dose can also be given to children by mouth three times every day for ten days. 

Question 4

Educate the parents on the preventive measures, risk of UTI for both boys and girl and proper hygiene. Parents should also be educated on the importance of increasing fluids. Shelly should be encouraged to wear cotton underwear. 

Reference

Rao, R., Ponnusamy, K., Bala, S., Ramanaiah, C. J., Verma, M. K., Fateh, A., & Nayakanti, A. (2018). Urinary Tract Infection (UTI) still a Force to be Reckoned with. Journal of Biomedical Engineering and Medical Imaging, 5(4), 23-23.

Tavana, A. (2017). May P. corporis and P. copri be related to UTI disease? Yes or no?. Annals of Tropical Medicine and Public Health, 10(4).

Wollin, D. A., Joyce, A. D., Gupta, M., Wong, M. Y., Laguna, P., Gravas, S., … & Preminger, G. M. (2017). Antibiotic use and the prevention and management of infectious complications in stone disease. World journal of urology, 35(9), 1369-1379.