CLINICAL CASE STUDY (URINARY TRACT INFECTION)

Part I: Assessment (Tracy Lauren A. Aycardo)

A. Nursing Health History
● Personal Data
Patient`s Name: A.R.A
Age: 24 years old
Occupation: Fish Vendor Sex: Female
Address: Brgy. 143, Sagpon, Daraga, Albay Date of Birth: July 5, 1998
Marital Status: Single
Religion: Roman Catholic
Nationality: Filipino
Educational Background: High School Graduate

● Chief Complaint
The 24 weeks pregnant patient describes the pain as sharp, steady, and radiating across
her lower abdomen bilaterally and also reports a frequent urge to urinate and a sensation of
incomplete bladder emptying for the past 3 days.

● History of Present Illness

➔ The patient verbalized that she has a past history of Urinary Tract Infection for 2
years.
● Family Health History
➔ The patient verbalized that she has a family health history of Hypertension in the
paternal side.
● Social History
➔ The patient was a fast food crew. Before she got pregnant, she used to drink
alcohol and smoke but did not engage in any illicit drugs.

B. Physical Examination (Head to Toe)

General Health Status
❖ Patient is a well-developed female.
❖ Patient appears tired and ill but in no apparent distress.
Vital Signs:
T: 38.8
PR: 120 bpm
RR: 20 cpm
BP: 110/60 mmHg
❖ Appropriate response to verbal communications.
❖ Low energy appearance.
Head, Ears, Eyes, Mouth, Nose & Throat
 ❖ Face is symmetrical and appears smooth and has uniform consistency with no
presence of nodules or masses.
❖ A grimace expression is present
❖ Ears are parallel and symmetrical.
❖ Eyes are symmetrical with no drooping, infections or tumors of the lids.
❖ Eyebrows are present bilaterally and are symmetrical and without lesions or
scaling.
❖ The lips are pale and downward because of pain.
❖ Normal adventitious and vocal vibrations.

Neck & Shoulders

❖ The neck muscles are equal in size. showed coordinated, smooth head movement
with no discomfort.
❖ ROM: Normal

Skin, Hair & Scalp

❖ Skin looks pale; skin`s temperature is not in normal limit.

❖ Hair distribution is normal
❖ Hair moisture is normal
❖ No palpable lesions

Thorax, Lungs, & Abdomen

❖ The chest wall is intact with no tenderness and masses.

❖ The heart experienced tachycardic. There is no presence of heaves or lifts.
❖ The abdomen has a symmetric contour.

Lower Extremities (Legs, Knee, Heels, & Toes)

❖ Cannot maintain to walk straight due to lower abdominal pain.

❖ Able to walk several steps on toes or heels.

C. Definition and Description of the Disease (Jessa Mae S. Belen)

● UTIs are common to happen when infections than bacteria, often from the skin or
rectum, enter the urethra, and infect the urinary tract.Urinary tract infections
 (UTIs) are caused by pathogenic microorganisms in the urinary tract (the normal
urinary tract is sterile above the urethra).
● UTIs are generally classiɹed as infections involving the upper or lower urinary
tract and further classiɹed as uncomplicated or complicated, depending on other
patient related conditions.
● Lower UTIs include bacterial cystitis (inɻammation of the urinary bladder),
bacterial prostatitis (inɻammation of the prostate gland), and bacterial urethritis
(inɻammation of the urethra). There can be acute or chronic nonbacterial causes of
inɻammation in any of these areas that can be misdiagnosed as bacterial
infections.
● Upper UTIs are much less common and include acute or chronic pyelonephritis
(inɻammation of the renal pelvis), interstitial nephritis (inɻammation of the
kidney), and renal abscesses. Upper and lower UTIs are further classiɹed as
uncomplicated or complicated, depending on whether the
UTI is recurrent and the duration of the infection.
● Most uncomplicated UTIs are community acquired. Complicated UTIs usually
occur in people with urologic abnormalities or recent catheterization and are often
acquired during hospitalization.
● Risk factors of UTI includes inability or failure to empty the bladder completely;
Obstructed urinary flow caused by congenital abnormalities, urethral strictures,
contracture of the bladder neck, bladder tumors, calculi (stones) in the ureters or
kidneys, and compression of the ureters; Decreased natural host defenses or
immunosuppression; Instrumentation of the urinary tract (e.g., catheterization,
cystoscopic procedures) ; Inflammation or abrasion of the urethral mucosa;
Contributing conditions such as: Female gender, Diabetes, Pregnancy, Neurologic
disorders, Gout, Altered states caused by incomplete emptying of the bladder and
urinary stasis.

D. Anatomy and Physiology (Julienne Amaranto)

 The urinary system consists of two kidneys, two ureters, a urinary bladder, and a urethra.
The kidneys alone perform the functions and manufacture urine in the process, while the other
organs of the urinary system provide temporary storage reservoirs for urine or serve as
transportation channels to carry it from one body region to another.

The kidneys. Kidneys are two bean-shaped organs. The functional units of the kidney are the
nephrons, numbering in the millions, that filter the blood in the kidneys and remove waste
products and excess water from the body. The kidney is a retroperitoneal organ located on either
side of the spine in the lower back. Urine passes from the kidneys through the ureters to the
bladder, which stores urine until it is ready to be excreted.

Kidneys’ Internal Structure

Renal fascia. The renal fascia, the outermost capsule, anchors the kidney and helps hold it in
place against the muscles of the trunk wall.
Renal cortex. The outer region, which is light in color, is the renal cortex.
Renal medulla. Deep to the cortex is a darker, reddish-brown area, the renal medulla.
Renal pyramids. The medulla has many basically triangular regions with a striped appearance,
the renal, or medullary pyramids; the broader base of each pyramid faces toward the cortex while
its tip, the apex, points toward the inner region of the kidney.
Renal columns. The pyramids are separated by extensions of cortex-like tissue, the renal
columns.
Renal pelvis. Medial to the hilum is a flat, basinlike cavity, the renal pelvis, which is continuous
with the ureter leaving the hilum.
Calyces. Extensions of the pelvis, calyces, form cup-shaped areas that enclose the tips of the
pyramid and collect urine, which continuously drains from the tips of the pyramids into the renal
pelvis.
Renal artery. The arterial supply of each kidney is the renal artery, which divides into segmental
arteries as it approaches the hilum, and each segmental artery gives off several branches called
interlobar arteries.

Nephrons and Vessels

Nephrons. Each kidney contains over a million tiny structures called nephrons, and they are
responsible for forming urine.
Glomerulus. One of the main structures of a nephron, a glomerulus is a knot of capillaries.
Renal tubule. Another one of the main structures in a nephron is the renal tubule.
Bowman’s capsule. The closed end of the renal tubule is enlarged and cup-shaped and
completely surrounds the glomerulus, and it is called the glomerular or Bowman’s capsule.
Collecting ducts. As the tubule extends from the glomerular capsule, it coils and twists before
forming a hairpin loop and then again becomes coiled and twisted before entering a collecting
tubule called the collecting duct, which receives urine from many nephrons.
Proximal convoluted tubule. This is the part of the tubule that is near to the glomerular capsule.
Loop of Henle. The loop of Henle is the hairpin loop following the proximal convoluted tubule.
Distal convoluted tubule. After the loop of Henle, the tubule continues to coil and twist before
the collecting duct, and this part is called the distal convoluted tubule.
Juxtamedullary nephrons. In a few cases, the nephrons are called juxtamedullary nephrons
because they are situated next to the cortex-medullary junction, and their loops of Henle dip deep
into the medulla.
Afferent arteriole. The afferent arteriole, which arises from a cortical radiate artery, is the
“feeder vessel”.
Efferent arteriole. The efferent arteriole receives blood that has passed through the glomerulus.
Peritubular capillaries. They arise from the efferent arteriole that drains the glomerulus.

The Ureters. The ureters carry urine from the kidneys to the bladder. The ureters are two in
number which is a tube-like structure about 25 cm long and are located posterior to the
abdominal aorta and anterior to the psoas major muscle.

The urinary bladder. The urinary bladder is a hollow temporary store of urine until it is ready to
be excreted. that is made up of smooth muscle fiber arranged in different directions called the
detrusor muscle. Its urine storage capacity is 400 to 600 ml in normal conditions.

The urethra. The urethra is also a part of the urinary system which is a tube that carries urine
from the bladder to the outside of the body. Its length varies between males and females, it is
about 17 to 20 cm (7–8 inches) in males and 3 to 4 cm (about 1.5 inches) in females.

Functions of The Urinary System

The function of the kidneys are as follows:

Filter. Every day, the kidneys filter gallons of fluid from the bloodstream.
Waste processing. The kidneys then process this filtrate, allowing wastes and excess ions to
leave the body in urine while returning needed substances to the blood in just the right
proportions.
Elimination. Although the lungs and the skin also play roles in excretion, the kidneys bear the
major responsibility for eliminating nitrogenous wastes, toxins, and drugs from the body.
Regulation. The kidneys also regulate the blood’s volume and chemical makeup so that the
proper balance between water and salts and between acids and bases is maintained.
Other regulatory functions. By producing the enzyme renin, they help regulate blood pressure,
and their hormone erythropoietin stimulates red blood cell production in the bone marrow.
Conversion. Kidney cells also convert vitamin D to its active form.

E. Pathophysiology
 Diagram by: Chloelyn Francisco

During pregnancy, a woman’s kidney increases in size, alongside with this her GFR will also
increase between 30%-50%. As progesterone levels increase, the smooth muscles relax which
leads to less urethral peristalsis and increased urinary stasis. Also, mechanical obstruction
secondary to uterine compression occurs. These factors all contribute to the dilation of the renal
pelvis and ureters that results in the genitourinary tract primed for an ascending infection. Thus,
conditions that are often benign in non-pregnant women or before pregnancy, such as
asymptomatic bacteria or urinary tract infections are much more dangerous during pregnancy
and are managed aggressively.

According to the given case, the predisposing and precipitating factors contribute to the
differential diagnosis of PYELONEPHRITIS.

To understand and see a clear view of the disease process, the pathophysiology of the disease
follows;

The most common causative organism for pyelonephritis is the usual urinary tract pathogens E.
coli (Escherichia coli), which is 60-80% in occurrence. However, gram positive
bacteria/organisms also account for a decent percentage, approximately 10% and about 5% of
this infection are due gram negative bacteria.

When pathogen/s colonizes the periurethral area and ascends through the urethra upwards
towards the bladder, the fimbria allows the bladder epithelial cell to attach and penetrate.
Following penetration, bacteria continue to replicate and may form biofilms. Once sufficient
bacterial colonization occurs, bacteria may ascend on the ureter towards the kidney. After which,
adherence of bacteria to renal parenchyma causes bacterial proliferation leading to an upper
urinary tract infection, PYELONEPHRITIS.

The bacterial colony can now irritate the urinary epithelium causing dysuria and a stimulation of
urinary reflex. This stimulation generates the urgency and frequent urination, with this comes
along severe dehydration because of fluids lost that also lowers the blood pressure and produce
an amber colored urine. Furthermore, the infection present triggers the inflammatory response of
the body. WBC will be releasing enzymes that can show urine findings of; (+) Bacterial culture,
(+) Foul, turbid urine. (Chloelyn Francisco)

The inflammatory response initiates systematically release of cytokines. Infection triggers the
cytokine release which causes fever, chills, nausea, vomiting, and increased pulse rate. A
bacterial illness called acute pyelonephritis causes kidney inflammation. A urinary tract infection
that ascends from the bladder to the kidneys might lead to pyelonephritis as a side effect. Renal
parenchymal Capsule usually is associated with urinary tract infection. Inflammation of the
Renal Parenchymal Capsule causes Flank pain, Costovertebral Angle Tenderness (CAT),
 progresses to Abdominal Pain are among the symptoms. These are interrelated with one another
as it contribute to the differential diagnosis of pyelonephritis. (Camille R. Manzanades)

Part II: Drug Study (Alyssa Marie Briones)

Brand Name Generic Frequency/ Mechanism of Adverse Nursing

Name Mode/Route of Action Effect Responsibility
Administration

Rocephin Ceftriaxone 1 gram IV once a Is used to treat a ● Black, ● Watch

day until 48 hrs. wide variety of tarry for
bacterial stools. seizures
infections. ● chest ; notify
pain. physici
● shortnes an
s of immedi
breath. ately if
● sore patient
throat. develop
● sores, s or
ulcers, increase
or white s
spots on seizure
the lips activity.
or in the ● Monitor
mouth. signs of
● swollen pseudo
glands. membra
● unusual nous
tirednes colitis,
s or includin
weaknes g
s. diarrhea
,
abdomi
nal
pain,
fever,
pus or
mucus
in
stools,
and
 other
severe
or
prolong
ed GI
proble
ms.

● Abdomi
Keflex Cefalexin 500 mg QID for Used to treat nal or ● Arrange
14 days certain stomach for
infections pain. culture
caused by ● blisterin and
bacteria such as g, sensitiv
pneumonia and peeling, ity tests
other respiratory or of
tract infections; loosenin infectio
and infections g of the n
of the bone, skin. before
skin, ears, , ● clay- and
genital, and colored during
urinary tract. stools. therapy
● general if
tirednes infectio
s and n does
weaknes not
s. resolve.
● itching ● Give
or rash. drug
● light- with
colored meals;
stools. arrange
● nausea for
and small,
vomitin frequen
g. t meals
● red skin if GI
lesions, complic
often ations
with a occur.
purple ● Refrige
center. rate
suspens
ion,
discard
after 14
 days.

Part III: Nursing Care Plan (Ofie Ribas & Angeline Repolona)

Assessment Nursing Dx Planning Intervention Rationale Evaluation

Subjective: Acute Pain r/t Short term Independent: Independent: Short term
“Tatlong araw ng infection of goal: ● Assess ● To goal:
masakit ang pag- the urinary After 8 hours the identify After 8 hours
ihi ko” as tract as of nursing client’s baseline of nursing
verbalized by the manifested by intervention: descripti data and intervention:
patient sharp, steady, on of plan
and radiating The patient pain, further The patient
Objective: pain across will be able such as interventi verbalized
- Facial her abdomen to verbalize quality, on pain
grimace bilaterally pain nature, reduction and
- Vital signs reduction and and maintained an
taken as maintain an severity effective pain
follows: effective pain of pain. management
BP: 110/60 management
PR: 120 ● Provide ● To The patient
The patient comforta provide demonstrated
will be able ble comfort relaxation
to supine techniques to
demonstrate position mitigate pain
relaxation with
techniques to pillows
mitigate pain supporte Long Term
d to the Goals:
flanks After 3 days
Long Term of nursing
Goals: ● Apply a ● The intervention:
After 3 days heating applicatio
of nursing pad to n of heat The patient
intervention: the to the reported
suprapu perineum relief of pain
The patient bic area. helps or discomfort
will be able relieve aeb a pain
to report pain and scale rating of
relief of pain spasm. 1/10 or less
or discomfort
aeb a pain ● Advise ● To The patient
scale rating the relieve demonstrated
of 1/10 or patient pain and effective
less to take a morning technique to
warm micturitio prevent
The patient water n urinary
will be able when infection.
to there is
demonstrate irritation
effective
technique to ● Encoura ● Sitz baths
prevent ge the may
urinary patient reduce
infection. to do pain and
sitz bath bladder
spasms
caused by
a UTI.

● Encoura ● Increasin
ge the g fluid
patient intake
to helps
increase facilitate
d oral urine
fluid productio
intake n, dilutes
unless urine,
contrain reduces
dicated irritation
and
flushes
bacteria
from the
urinary
tract.

● Instruct ● These
to avoid foods are
coffee, considere
tea, d urinary
spices, tract
alcohol, irritants
and and may
sodas irritate
the
 urinary
system

● Encoura ● Helps
ged the prevent
client to bladder
void distention
frequentl , lower
y bacterial
urine
counts,
reduce
stasis of
the urine,
and
prevent
reinfectio
n.

Dependent: Dependent:
● Adminis ● analgesic
ter agents are
analgesi useful in
c relieving
(ceftriax bladder
one) as irritabilit
ordered y, spasm,
and pain.

Assessment Nursing Dx Planning Intervention Rationale Evaluation

Subjective: Impaired Short Term Independent: Independent: Short Term

“Itong nakaraang Urinary Goals: ● Assess ● To Goals:
tatlong araw po Elimination After 8 hours client’s establish After 8 hours
parang lagi po r/t urinary of nursing usual a of nursing
akong naiihi, incontinence intervention: bladder baseline intervention:
tapos paka ihi ko as manifested eliminati for
po nararamdaman by nausea and The patient on comparis The patient
ko na parang vomiting will be able on adhered to the
kulang po yung to adhere to ● Perform ● Health therapeutic
inihi ko, the health history regimen and
nakakaramdam therapeutic history provides participated
din po ako ng regimen and to the clues to in the
pagsusuka at participate in client the assessment as
pagkahilo” the includin causes, indicated.
assessment as g the
Objective: indicated. duration, severity
- Weak in frequenc of the The patient
appearanc The patient y, and condition decreased
e will be able severity , and its urinary
to decrease of manage complaints.
Vital Signs: urinary leakage ment.
BP: 110/60 complaints. episodes
mmHg ● Monitor ● To
T: 38.8 C Long Term vital and establish Long Term
PR: 120 bpm Goals: cognitive baseline Goals:
After 3 days signs, data and After 3 days
of nursing includin check for of nursing
intervention: g, the intervention:
watching improve
The patient for ment of The patient
will be able change the reported a
to report a in BP patient's decreased
decreased and RR. condition number of
number of . times she uses
times she ● Monitor ● To help the bathroom
uses the the determin and feels that
bathroom and patient’s e her bladder is
feels that her daily hydratio empty after
bladder is fluid n. voiding.
empty after intake
voiding. and
output The patient
The patient ● Emphasi ● To achieved
will be able ze the reduce normal
to achieve importan the risk urinary
normal ce of of elimination
urinary having infection patterns
elimination good including the
patterns perineal absence of
including the hygiene. urinary
absence of ● Instruct ● To urgency.
urinary client’s increase
urgency. in Kegel perineal
Exercise muscle The patient
The patient s. tone and demonstrated
will be able control effective
to over methods to
demonstrate leakage. prevent
effective urinary
methods to Dependent: Dependent: infection
prevent Collaborative: Collaborative:
urinary ● Limit ● Alcohol,
infection. ingestion coffee,
of and tea
bladder have a
irritants natural
such as diuretic
coffee, effect
tea, and a
alcohol, bladder
and irritant.
chocolat
e.
● Encoura ● To
ge the regulate
patient bowel
to eat moveme
food that nts and
is high in overflow
fiber incontine
such as nce.
beans,
broccoli,
and
whole
grains.
● Advise ● Cranberr
the y Juice is
patient helpful
to drink in
cranberr preventin
y juice g and
as controlli
recomme ng
nded pyelonep
● Collabor hritis
ate with symptom
dietician s.
s for
nutrition
al
consult
 or
dietary
plans.

Assessment Nursing Dx Planning Intervention Rationale Evaluation

Subjective: Hyperthermi Short Term Independent: Independent: Short Term

“Mainit ang a r/t infection Goals: ● Assess ● Room Goals:
pakiramdam ko” process as After 8 hours environ temperat After 8 hours
as verbalized by manifested of nursing mental ure and of nursing
the patient by an intervention: factors. bed intervention:
increase in linens
Objective: body The patient can The patient
- Febrile temperature, will maintain contribut maintained a
- Warm to shivering, a core e to an core
touch feeling warm temperature increased temperature
- Weak in and increased and heart rate body and heart rate
appearance heart rate within normal temperat within normal
- vital signs range ure. range
taken as
follows: ● Monitor ● Continuo
BP: 110/60 Long Term the us Long Term
RR: 20 Goals: patient’s monitori Goals:
PR: 120 After 3 days core ng After 3 days
Temp: 38.8 of nursing temperat allows of nursing
intervention: ure at for quick intervention:
least recogniti
The patient every on of The patient
will be able hour. changes showed no
to show no and signs of fever
signs of fever whether and reported
and will treatment no associated
report no is complications
associated effective.
complications The patient
● Monitor ● Measurin demonstrated
The patient fluid g correct effective
will be able status intake methods to
to and prevent
demonstrate output is urinary
effective crucial infection.
methods to so fluid
prevent status
urinary can be
infection. corrected

● Hyperthe
● Assess rmia can
neurolog cause
ical confusio
status n and
frequentl delirium.
y
● Many
● Identify different
the factors
underlyi can
ng cause cause
of hyperthe
hyperthe rmia.
rmia Being
consideri aware of
ng the the cause
patient’s helps
age, treat
history, hyperthe
current rmia and
conditio prevent
ns, and the
recent illness
procedur from
es. happenin
g again.

● Sodium
● Monitor may be
electroly lost
te during
imbalanc excessiv
e e
sweating
. Low
sodium
levels
can
cause
 complica
tions
such as
brain
swelling
and
altered
mental
status.

● This may
● Provide provide
a tepid comfort
sponge and a
bath further
decrease
in body
temperat
ure.

● Continuo
● Use a us way
cooling to reduce
blanket an
increased
body
temperat
ure.

● Prolonge
● Monitor d
the exposure
patient’s to
skin cooling
during blankets
cooling may
measures cause
damage
to the
skin.

● Educate ● Recogniz
about the ing signs
signs early
and helps
symptom accelerat
 s of e
hyperthe treatment
rmia and
ensure
the best
outcome.

Dependent:
Dependent: ● Antipyre
● Administ tics work
er on the
antipyret hypothal
ic amus to
medicati reduce
ons the
body’s
temperat
ure.

● Fluid
● Promote helps in
sufficien body
t fluid temperat
intake ure
regulatio
n.

● This
● Infuse helps
cooled with
IV line hydratio
as n and
ordered further
decrease
s body
temperat
ure.

Collaborative:
Collaborative: ● Due to
● Collabor increased
ate with metaboli
dietician c rate,
s to the
support patient’s
nutrition caloric
 al intake. and
nutrition
al needs
may
need to
be
adjusted.

Part IV: Discharge Planning (Yael Ezra)

Medication

Instruct mother to take discharge medications as directed. Take all of her medications on
schedule. Don’t stop it early, even if her symptoms fade.
Administer 1gm IV Ceftriaxone once a day for 48 hrs, according to doctor’s order. Ceftriaxone
is used to treat bacterial infections in many different parts of the body. It works by killing
bacteria or preventing their growth.
Take Cefalexin orally 500 mg four times a day for 14 days as ordered. Cefalexin is an antibiotic.
It's used to treat bacterial infections, such as pneumonia and other chest infections, skin
infections and urinary tract infections (UTIs).

Exercise
Exercising does not exacerbate this process; in fact, in the early stages, activity may aid to divert
the patient from the discomfort. Instruct the patient to avoid activities that place additional strain
on the pelvic area.

Treatment
1.Discuss behavioral methods that may be used to ensure good hygiene and reduce bacterial
contamination. Behavioral methods include:
Baths should be avoided.
After urinating or defecating, wipe from front to back.
Before using the restroom, wash your hands.
To clean the perineum, use washcloths.
To avoid colonization from bar soap, use liquid soap.

2.Rest as directed. Refrain from doing strenuous activities.

3.Drinking plenty of water: Water dilutes urine and helps flush bacteria out of the urinary tract.
4.Urinating when the urge arises: This helps bacteria pass out of the urinary tract more quickly.
5.Taking certain supplements: combination of vitamin C, cranberries, and probiotics may help to
treat recurrent UTIs in women. Take Vitamin C (250 to 500 mg), Beta-carotene (25,000 to
50,000 IU per day) and Zinc (30-50 mg per day) to help fight infection.
6. Take medications on time.
7.Make recovery as top priority. Focus on regaining strength and reduce doing unimportant tasks
for good recovery.

Health Teaching
>Drink extra water and other fluids for the next day or two. This will aid in the
elimination of the bacteria that is causing the infection.
> Advice to develop a habit of urinating as soon as the need is felt and empty bladder
completely when urinating.
>Instruct the patient that after urinating, blot dry (do not rub), and keep genital area clean.
Make sure to wipe from the front toward the back.
> Advice to avoid using strong soaps, douches, antiseptic creams, feminine hygiene
sprays, and powders.
> Instruct to change her underwear everyday.
> Advice to avoid using tight fitting pants.
> Advice to wear all-cotton or cotton-crotch underwear
> Inform the patient not to soak in the bathtub longer than 30 minutes or more than twice
a day.
> Eat a balanced diet. Probiotic foods and high fiber foods are encouraged/
>Educate the importance of bed rest. Her need to urinate will be increased if she is lying
on her left side.
>Educate the patient the importance of strict compliance to medications.
> Limit physical activity and do mild exercise. Instruct the patient to avoid activities that
place additional strain on the pelvic area.

Outpatient Department
Instruct the woman to visit her obstetrician or the hospital after a month to obtain urine
culture. With or without UTI or pyelonephritis, urine should be cultured monthly. If there has
been no improvement in the patient’s symptoms beyond this time, after taking antibiotics, factors
should be assessed promptly by a physician to exclude urinary obstruction, abscess or other
abnormalities that may require source control. The patient should consider a follow-up imaging
of the urinary tract to identify abnormalities that predispose to further infections.

Diet
Drink a lot of water, even if you’re not thirsty. This will help flush out the bacteria.
Don’t drink coffee, alcohol or caffeine until the infection is gone. These drinks can irritate your
bladder.
Do eat probiotics. They contain “good” bacteria that can help keep the bad bacteria at bay.
During the illness, limit your intake of acidic fruits such as oranges, lemons, and limes. They
have the potential to irritate your bladder. However, once you've recovered from your infection,
consuming acidic fruits high in vitamin C can help prevent future infections.
Consume high-fiber meals. Fiber-rich foods, such as bananas, beans, lentils, almonds, oats, and
other whole grains, can aid in the removal of unwanted bacteria from your body. They also
promote regular bowel motions, which can alleviate bladder strain.

Spiritual Counseling
Encourage the patient to maintain a strong faith while undergoing treatment and to participate in
religious and spiritual activities such as praying and/or attending mass. Giving spiritual therapy
to patients may help them cope with their circumstances, recover faster, and have better health
results.