Nursing Assessment for Urinary Tract Infection
Only foul smelling or Plus other symptoms Frequency
concentrated urinewithout Burning
other symptoms Supra pubic tenderness
Newor Increased countenance
New or increased frequency Fever100 or greater
Significant change in mentation
(See nursing documentation sheet)
Gross hematuria not related to trauma
______Try IfUrine Chemstripare used
Results
Increase fluids and monitorfor
24 hours and monitor Positive Negative
Nitrates Nitrates
Leukocytes Leukocytes
Leukocyte esterase Leukocyte
esterase
Send Urine C&S Watch, no Rx
Symptoms and Chemstrip results must be present before aurine for C&Sis collected.
Anyurine sent for culture and sensitivity must be either a clean-catch midstream or a sterile, catheterized specimen.
______
Results Actions
Symptoms+ a positive culture
Improved smell, color, etc. with one or two organisms*
Watch, no treatment Treat per sensitivity test results
Return to routine fluid intake and physician orders
* Three or more organisms indicate a contaminated specimen – repeat, don’t treat!
______
Revised McGeer - Stone Criteria of 2012
National criteria for documentation of infection
Nursing documentation of UTI symptoms or lack of them is required.
Constitutional Criteria
A. Fever
1. Single oral temperature >100, or
2. Repeated oral temperature of > 99, or rectal temperature of > 99.5 or
3. Single temperature of 2 degrees F over baseline.
B. Leukocytosis
1. Neutrophilia (>14,000), or
2. Left shift (>6% bands or >/= 1,500 bands)
C. Acute change in mental status from baseline (all criteria must be present)
1. Acute onset
2. Fluctuating course
3. Inattention, and
4. Either disorganized thinking or altered level of consciousness.
D. Acute functional decline
1. A new 3 point increase in total ADL scores (range 0-28) from baseline, based
on the following ADL items, each scored from 0 (independent) to 4 (total
dependence)
a. Bed mobility
b. Transfer
c. Locomotion within the facility
d. Dressing
e. Toileting
f. Personal hygiene
e. Eating
Presentations of infection in LTC residents may be atypical so failure to meet surveillance definitions may not fully exclude the presence of infection.
Infections should be attributed to the facility if:
1. There is no evidence of an incubating infection at the time of admission to the facility (on the
basis of clinical documentation of appropriate signs and symptoms and not solely on screening
microbiologic data).
2. Onset of clinical manifestation occurs > 2 calendar days after admission.
Three important conditions should be met.
1. Symptoms must be new or acutely worse.
2. Alternative noninfectious causes of signs and symptoms should be generally be considered and
evaluated before an event is deemed an infection.
3. Identification of infection should not be based on a single piece of evidence but should always
consider the clinical presentation and any microbiologic or radiologic information that is
available.
a. Microbiological and radiological findings should not be the sole criteria for defining an
infection.
b. Physician diagnosis alone is not sufficient for a definition of infection and must be
accompanied by documentation of compatible signs and symptoms.
c. Communicate to the Physician all clinical informationabout the resident, not simply
that the“Culture is Positive and what do you want to order.”
Resident Name______Date______
Check all new symptoms
____ Fever
____ Suprapubic tenderness
____ Change in mental status as outlined
____ New or increased incontinence
____ Burning on urination
____ Increased frequency
____ Gross hematuria, not related to trauma
Do Urine Chemstrip only if:
3 symptomsare present and the resident does not havean indwelling catheter
2 symptomsare present and the resident hasan indwelling catheter
Urine Chemstrip Results
Leukocytes ___ (must be positive)
Nitrates ___ (must be positive)
Leukocyte esterase ___ (must be positive)
pH ___
Protein ___
Glucose ___
Ketones ___
Urobilinogen ___
Bilirubin ___
Blood ___
January 2017
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