Urinary Tract Infection in Postpartum Women
Description
- A UTI is indicated by more than 105 bacterial colonies/mL of urine in two consecutive clan, voided, mistream specimens.
- Two common types of UTIs are cystitis, inflammation of the urinary bladder, and pyelonephritis, inflammation of the renal pelvis.
- UTIs occur in about 5% of postpartum women; they occur in 15% of women who have undergone postpartum catheterization.
Etiology
- Ascending bacterial infections account for most UTIs.
- Another cause of UTIs is retention and residual urine due to overdistention and incomplete emptying of the bladder.
- Temporary urine retention may be due to decreased perception of the urge to void, resulting from perineal trauma and the effects of analgesia, or anesthesia.
- Urinary stasis and residual urine provide a medium for bacterial growth, predisposing the client to cystitis and pyelonephritis.
Pathophysiology
- Causative organisms in cystitis and pyelonephritis include E. coli (most common), Proteus, Pseudomonas, S. aureus, and Streptococcocus faecalis.
- Consequences of not recognizing early symptoms of UTI include the extension of the infection upward with subsequent permanent loss of kidney function.
Assessment Findings
Clinical manifestations depend on the type of infection.
- Clinical manifestations include frequency, urgency, dysuria, hematuria, nocturia, temperature elevation, and suprapubic pain.
- Pyelonephritis manifestations include high fever, chills, flank pain, nausea, and vomiting.
Nursing Management
Recognize signs of infection and prevent the development of further complications.
- Determine if symptoms are present and if the woman had difficulty urinating after delivery.
- Obtain specimens, report findings, and administer antibiotics and medications as prescribed.
- Describe self-care related to regular emptying of bladder, proper perineal cleansing, and the need for increased fluids.
- Insert intermittent or indwelling catheter as needed.
- Observe and record the response to treatment.
