Acute nursing - Evidence Review - Task Critique

Acute nursing - Evidence Review - Task Critique
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Abstract
The disturbances related to the elimination of urine are of two categories that are those that involve urinary incontinence (frequency) and those that relate to urinary obstruction (retention). Just like problems in gastrointestinal elimination, individuals that suffer from problems of urinary elimination experience discomfort and embarrassment due the disease’s nature. Nurses often provide the initial assessment, diagnosis, and the management of altered elimination of urine and the related nursing diagnoses. Impaired urinary elimination is a nursing diagnosis and treatment function for conditions involving the urethra, bladder, and ureters and the diagnosis and treatment involves the urethra, bladder, and ureters. Specifically this diagnosis and treatment involves stress, urinary incontinence, and urinary retention. This paper is going to look at urinary tract infection as a predisposing factor to urinary dysfunction by providing a brief definition and aetiology of urinary tract infection. The paper will also look into the therapeutic strategies for managing urinary tract infection that is based on evidence, the impact of these strategies on patient treatment outcomes and provide areas that require future research.
Introduction
UTI is a common infection that accounts for approximately 1-3% of all the consultations made in general practice (O'shea, 2010). UTIs are common among men and women; however, the incidence of occurrence is high among women due to the physiological nature of women. This simply means that it can be referred to a condition that women are certainly going to encounter during their lifespan with the prevalence being higher during pregnancy. As suggested by the name, the infection affects the urinary tract that comprises of the upper and lowers urinary (Vasudevan, 2014). This is a common problem that is diagnosed and treated in medical practice. About, 3.1% of the cases that are reported in urgent care visits with approximately eight million UTI episodes occurring yearly (Gibson & Toscano, 2012).
Definition & Aetiology
Different types of infections can occur in the urinary tract and they are collectively referred to as Urinary Tract Infections (UTIs). The bladder, the kidneys, ureters, and the urethra are the parts that makeup the UTI. Therefore, any infection in this pathway is referred to as a urinary tract infection with the alternative names for the infection being bladder infection, cystitis, or UTI (A.D.A.M Inc., 1997-2008). The common cause of UTIs is the bacterium Escherichia Coli (75% - 95%) and is the bacteria that lives normally (normal flora) within the bowel. Bacteriuria develops when this bacteria enters the urinary tract, and this is commonly through the urethra and also, but less commonly through the bloodstream (O'shea, 2010).
The infection may be asymptomatic where there is asymptomatic bacterium that is when there is a significant amount of bacterium in test samples, but the patient has symptoms of infection. The UTIs may be complicated that is caused by a myriad of factors such as anatomical or functional disorders, renal insufficiency, transplantation, or comorbid illness just to mention a few. There are also uncomplicated UTIs, and these are those that occur in premenopausal women that have normal kidney and urinary tract function, and these are cystitis and pyelonephritis (Mazulli, 2012).
UTIs range from bladder infections to infections of the kidney. When the infection occurs in the urethra it is referred to as urethritis, in the vagina is vaginitis, upper urinary tract is pyelonephritis and this is a serious condition that may extend into the kidneys, and when it occurs in the urinary bladder, it is cystitis. This is a common as a lower urinary tract infection and results into the inflammation of the bladder lining (Mazulli, 2012). However, other pathogenic microorganisms such as Mycoplasma and Chlamydia are also responsible for causing urethritis in both men and women and are passed during sexual intercourse (A.D.A.M Inc., 1997-2008). Other such staphylococcus bacteria (Staphylococcus saprophyticus), Klebsiella species, Proteus species, enterococci, pseudomonas aeruginosa, and even yeast can cause UTIs (Mazulli, 2012).
Apart from the microorganisms, catheters often act as aetiological agents in UTIs that is Indwelling Urinary Catheters (IUC) and referred to as Catheter Associated – UTIs (CA-UTI) and is associated with significant levels or morbidity and mortality among both men and women. The main causes here include the colonization of the urinary tract by fungi and bacteria introduced by the catheter during treatment (Diane, 2010).
Current Therapeutic Strategies for Managing UTIs
There are different therapeutic management approaches that can be applied in UTIs. The management approach depends on the aetiological agent responsible for infection, the site of infection, the gender of the infected individual, antimicrobial susceptibility, or the age among other factors (Barber, Norton, Spivak, & Mulvey, 2013). Different strategies exist that can be used in the management of bacteriuria, and these include biotic, non-biotic, natural and alternative and contemporary strategies for the management of the different types of and stages of UTIs including their prevention. The strategies are applicable to different types of individuals depending on the demographic characteristics relevant to UTIs.
Antibiotic Strategies for Managing UTIs
Effective treatment of UTIs can be achieved using antibiotics, but the choice of the antibiotic depends on the aetiological agent of the UTI. The results from the urinalysis determine the type of antibiotics to be administered. Antimicrobial therapy begins during the first visit to the hospital without waiting for the test results that usually takes 2-3 days and involves the use of broad spectrum antibiotics. Most of the UTIs as highlighted earlier are caused by E.coli and most of the antibiotics are usually efficacious against the bacteria. Therefore, majority of the individuals often begin experiencing health improvements with the initial pre-test prescriptions, but resistance develops after a certain period hence discourages its use (University Health Service, 2011).
For example, Etienne and his colleagues conducted as study on treatment of Acute Uncomplicated Cystitis (AUC). In Specific, the study looked at antibiotics and their efficacy in treatment of the condition. Two approaches were used as the basis for research that is rapid urine test and a primary care series’ local epidemiology (Etienne et al., 2014). The study comprised of women aged between 18-65 years and presented with symptoms of AUC and a Rapid Urine Test (RUT) and sent urine samples at a central laboratory for testing. Based on RUT and results obtained from resistance testing, different antibiotic treatment strategies were employed. Seventy eight percent of the enrolled participants had a positive urine test with E.coli being the dominant bacteria (71%). It has high susceptibility rates to the antibiotics nitrofurantoin (100%) pivmecillin, (87%), ofloxacin (97%) and trimethoprim-sulfamethoxazole (Etienne et al., 2014).
Modelizing the findings highlighted that using RUT systematically results into a reduction of the number of treated patients by ten percent. Fosfomycin could treat 90% of the total bacterial coverage, nitrofurantoin 98%, ofloxacin 95%, trimethoprim-sulfamethoxazole 86%, and pivmecillin 78%. This local surveillance data on UTI epidemiology indicated antibiotics are efficacious in the treatment of acute cystitis hence efficacious in the treatment of UTIs (Etienne et al., 2014). However, they linked with drug resistance development hence making alternative methods better compared to the conventional antibiotics.
Non-antibiotic Strategies for Managing UTIs
The changes in the epidemiological patterns of resistance that is increasingly being observed today is making the effective treatment of bacterial infections increasingly difficult (Deasy, 2009). Multiple resistance organisms are on the rise and have become a serious threat in regards to the increased incidence of UTIs. This has, however, not yet prompted a radical revision of the use antibiotics, but it has instead increased the development of even more antibiotics and does not relieve the underlying pressure in the selection that drives the development of resistance (Carson & Riley, 2003).
Therefore, antimicrobial therapy res...