Fundamentals of Nursing Q 272
A nurse educator on a medical unit is reviewing factors that increase the risk of urinary tract infections with a group of assistive personnel. Which of the following should be included in the review? Select all that apply.
A. Having sexual intercourse on a frequent basis.
B. Lowering of testosterone levels.
C. Wiping from front to back.
D. The location of the vagina in relation to the anus.
E. Undergoing frequent catheterization.
Correct Answer: A, D, and E
Uncomplicated urinary tract infection (UTI) is a bacterial infection of the bladder and associated structures. These are patients with no structural abnormality and no comorbidities, such as diabetes, immunocompromised, or pregnancy. Uncomplicated UTI is also known as cystitis or lower UTI. E.coli causes the majority of UTI but other organisms of importance include proteus, klebsiella, and enterococcus. The diagnosis of UTI is made from the clinical history and urinalysis, but the proper collection of the urine sample is important.
Option A: Having sexual intercourse on a frequent basis is a factor that increases the risk of UTI in both males and females. Sexual intercourse and the use of spermicide and diaphragm are also risk factors for UTI. Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. People who frequently void and empty the bladder have a much lower risk of a UTI.
Option B: The decrease in estrogen levels during menopause increases a woman’s susceptibility to UTIs. An uncomplicated UTI usually only involves the bladder. When the bacteria invade the bladder mucosal wall, cystitis is produced. The majority of organisms causing a UTI are enteric coliforms that usually inhabit the periurethral vaginal introitus. These organisms ascend into the bladder and cause a UTI.
Option C: Wiping from front to back decreases a woman’s risk of UTIs. After urination, women should wipe from front to back, not from the anal area forward, which seems to drag pathogenic organisms nearer to the urethra. Bacteria that cause UTI have adhesins on their surface which allow the organism to attach to the mucosal surface. In addition, a short urethra also makes it easier for the uropathogen to invade the urinary tract. Premenopausal women have large concentrations of lactobacilli in the vagina and prevent the colonization of uropathogens. However, the use of antibiotics can erase this protective effect.
Option D: The close proximity of the female urethra to the anus is a factor that increases the risk of UTIs. Pathogenic bacteria ascend from the perineum, causing UTI. Women have shorter urethras than men and therefore are more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria. Escherichia coli is the most common organism in uncomplicated UTI by a large margin.
Option E: Undergoing frequent catheterization and the use of indwelling catheters are risk factors for UTIs. A major risk factor for UTI is the use of a catheter. In addition, manipulation of the urethra is also a risk factor. In-and-out catheterization of the bladder will cause UTI in uninfected women 1% of the time. Men should start the urine stream to clean the urethra and then obtain a midstream sample. Urine should be sent to the lab immediately or refrigerated because bacteria grow rapidly when a sample is left at room temperature, causing an overestimate of the infection’s severity.