UTI Symptoms
Also Consider: Fever, Hematuria, Lactic Acid, Nausea, Urinalysis, Urine Culture, WBC Count
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Symptoms or Signs of Urinary Tract Infection
Pain with urination (dysuria)
Tenderness or pain in the lower abdomen / suprapubic / pelvic region, or the back / flank region
Visible blood in urine (hematuria)
Pain in testes or purulent drainage (pus) from urethra
New or worsening urinary urgency, frequency, incontinence
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change (lethargy, unresponsiveness, increased confusion)
Not eating or drinking as much as usual
Acute decline in ADL abilities
Chills, rigors, or diaphoresis (sweats)
GI: Nausea, vomiting, constipation, abdominal distention or tenderness
GU: New or worsened incontinence, pain with urination, blood in urine, Pain/tenderness in testes, bladder scan
Fingerstick glucose (patients with diabetes)
Presence and function of urinary catheter
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
New onset T>100° F or 2°F over baseline, with any of the above symptoms or signs of UTI.
Notify medical staff & resident representative within the next 16 hours.
Any of the above symptoms or signs of UTI.
Notify medical staff on the next business day
Abnormal urine lab test without any symptoms.
SBAR Report
Situation: "UTI symptoms of” (acute symptoms) “associated with:" (fever of ___) (patient with urinary catheter)
Background:
Reason the patient is in the nursing home (rehab for__, long term care for __).
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal Vital Signs
MOLST / Advance Directives
Recent illness, antibiotics
General observation of patient condition
Ability to take oral medications or presence of feeding tube
Prior urinary problems, last urine culture result
Diuretic Use & recent dose changes
Fluid restriction, thickened liquids
Presence of urinary catheter
Tube feeding rate and water flush orders
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with manual diff, CMP/Chem14, Lactic Acid, Blood cultures
INR if patient is on warfarin
Antibiotic if infection is diagnosed.
Straight catheterization for urine sample for urinalysis and culture (unless patient is able to collect clean-catch, midstream urine). Obtain prior to starting antibiotic. For residents with indwelling catheter: change the catheter first and then obtain sample from the new catheter
Increase tube feed water flushes
Change fluid restriction orders
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Offer fluids frequently
Place on Intake & Output monitoring
Oral, IV, or subcutaneous fluids if needed for hydration
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Urinalysis with >9 WBCs/HPF
Urine culture and sensitivity (only if urinalysis with >9 WBCs/HPF AND culture with >100,000 CFU/ML)
Abnormal values in blood count or metabolic panel
WBC > 12,000 or neutrophils > 90%
INR if antibiotic therapy ordered and the patient is on warfarin (Coumadin).
Only give acetaminophen, if ordered, for discomfort, fever > 103°F, or if chronic cardiopulmonary problems are present
Implement infection control measures if indicated
If an antibiotic is started, perform an “Antibiotic Time Out” after 2-3 days of antibiotic treatment
Is the antibiotic the most appropriate choice given the culture results
If needed, revise the duration given the response to treatment.
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative daily.
2025-04-27
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