Urinary Tract Infection Nursing Care Plan

Subjective: burning on urination for 2 days, urinary frequency and urgency, suprapubic pressure, "my urine smells strong"; in the older adult, new confusion and a fall rather than classic symptoms.

Objective: temp 38.4 °C, HR 96, suprapubic tenderness, no CVA tenderness; urinalysis with positive leukocyte esterase and nitrites, WBC 45/hpf, bacteria present; urine culture > 10⁵ CFU/mL E. coli; indwelling catheter in place day 6 with no documented indication.

1. Impaired urinary elimination related to infectious inflammation of the bladder mucosa AEB dysuria, frequency, urgency, and WBC 45/hpf.
2. Acute pain (suprapubic and dysuria) AEB self-report 6/10 and suprapubic tenderness.
3. Hyperthermia related to infectious process AEB temp 38.4 °C.
4. Risk for infection progression (pyelonephritis / urosepsis) AEB fever with a bacteriuric indwelling catheter.
5. Deficient knowledge regarding hydration, perineal hygiene, and post-coital voiding.
6. Risk for acute confusion in the older adult.

• Afebrile (< 37.5 °C) within 48 h of appropriate antibiotic therapy.
• Dysuria and urgency resolved or ≤ 2/10 by 72 h.
• Fluid intake ≥ 2,000 mL/24 h (unless restricted) with urine output ≥ 0.5 mL/kg/h.
• Unnecessary indwelling catheter removed within 24 h of identification.
• Patient states three recurrence-prevention behaviours before discharge.
• No progression to pyelonephritis or sepsis: no flank pain, no rigors, lactate within normal limits.

• Obtain the culture before the first antibiotic dose, then start empiric therapy promptly and de-escalate on sensitivities — a culture drawn after antibiotics may be falsely negative and prevents targeted therapy.
• Review catheter necessity every shift and remove as soon as the indication ends — duration of catheterization is the dominant CAUTI risk factor; daily review with nurse-driven removal is the highest-yield intervention on this plan.
• Maintain a closed drainage system, bag below bladder level and off the floor, secured tubing, no dependent loops, hand hygiene before and after any contact — prevents retrograde bacterial migration.
• Encourage 2–3 L/day fluids unless contraindicated and scheduled voiding every 2–3 h — mechanical flushing lowers bacterial load and relieves symptoms.
• Treat pain with acetaminophen ± NSAID and, if ordered, phenazopyridine; warn the patient about orange urine and staining of contact lenses.
• Monitor for progression: flank pain, rigors, vomiting, hypotension, tachycardia, altered mentation; escalate for sepsis screening — the older adult with new confusion may present without fever.
• Do not treat asymptomatic bacteriuria (except in pregnancy or before urologic instrumentation) — treating it drives resistance and C. difficile without improving outcomes.
• Teach prevention: front-to-back wiping, void after intercourse, avoid douches and spermicides, complete the full antibiotic course, and hydrate.

By hour 48: temp 37.1 °C, dysuria 1/10, intake 2,400 mL/24 h with output 1,900 mL, catheter removed at hour 14 with successful voiding trial, no flank pain or rigors, patient states three prevention behaviours. Antibiotic narrowed to cephalexin on sensitivities. All outcomes met.