Conditions › Renal & urinary
Urinary Tract Infection Nursing Care Plan and Interventions
UTI nursing care: collect the urine culture before the first antibiotic dose, push fluids unless restricted and watch older adults for new confusion, which can be the only sign. Teach the client to finish the antibiotic, expect orange urine with phenazopyridine and prevent the next infection.
Urinary tract infection nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Infection | Symptoms resolve; culture-guided antibiotic finished. | |
| Acute pain (dysuria) | Reports less burning and urgency. | |
| Acute confusion risk (older adults) | Mental status back to baseline. | |
| Health maintenance: needs teaching | States prevention steps; catheter care follows CAUTI rules. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
UTI (cystitis): what it is
Bacteria, usually E. coli, climb the urethra into the bladder. A shorter urethra is why females get UTIs more often. 1,2
Cystitis is the bladder. If the bacteria keep climbing to the kidney, it becomes pyelonephritis.
Who gets UTIs
Females, older adults, diabetes, urinary catheters, recent sexual intercourse, and a bladder that doesn't fully empty. 3,1,4
Urine that sits in the bladder (retention) gives bacteria time to grow.
Assessment: what you will see
Classic cues of cystitis
Burning on urination (dysuria), frequency, urgency and suprapubic pain. Urine may be cloudy, foul-smelling or bloody. 1,2
Onset is usually sudden, with small, painful voids.
Older adults: confusion may be the cue
Burning and pain may be missing. New confusion, new incontinence, sleepiness, poor appetite or falls may be the only signs. 5,6,7
Acute confusion in an older adult: get a urine sample and screen for sepsis.
Urinalysis in UTI
Nitrites, leukocyte esterase, white blood cells and bacteria. Normal urine has no nitrites or leukocyte esterase and few WBCs. 1,4
No white cells and no nitrites makes a UTI unlikely.
Priority: what the nurse does first
Culture before the first dose
When a culture is ordered, collect a clean-catch or catheter urine sample before the first antibiotic dose. 8,1
The culture names the organism and the drugs that kill it, so treatment can be narrowed.
Nursing interventions and treatment
Antibiotics for cystitis
Common choices: nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX) or fosfomycin. Take every dose, even after symptoms ease. 1,3
Feeling better on day 2 is not a reason to stop. Report symptoms that last or get worse.
Nitrofurantoin: what to know
Brown urine is an expected, harmless effect. It is avoided when kidney function is poor. 8
Teach: report cough, chest pain or shortness of breath. It can cause a lung reaction.
Phenazopyridine: orange urine
A urinary analgesic that eases burning and urgency. It does not treat the infection. Use no more than 2 days. 9
Turns urine, tears and saliva reddish-orange and can stain contact lenses.
Client teaching
Preventing CAUTI
Use an indwelling catheter only when indicated, check every day whether it is still needed, and get it removed as soon as possible. 5
Catheterized client with fever, chills, new confusion, foul urine, or suprapubic or flank pain: report it.
Teach: preventing the next one
Drink plenty of fluids, void before and after sex, wipe front to back, and finish every antibiotic dose. 1,3
Infections that keep coming back need a urine culture and imaging to look for a cause.
NCLEX traps
Cystitis vs pyelonephritis
Cystitis: burning, frequency, urgency, suprapubic pain, little or no fever. Pyelonephritis adds high fever, chills, flank pain, vomiting. 2
Older adults with either one may show only new confusion. Check the flank for CVA tenderness.
Asymptomatic bacteriuria
Bacteria in the urine with no symptoms. Usually not treated, even in older adults or with a catheter. Pregnancy is the main exception. 1,2
Treating it anyway breeds resistant bacteria without helping the client.
Try 3 urinary tract infection questions
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Pharmacological and Parenteral Therapies
A client is prescribed ciprofloxacin for a urinary tract infection. Which teaching point should the nurse include?
Show answer and rationale
Answer: B. Fluoroquinolones such as ciprofloxacin (-floxacin) carry a risk of tendon rupture, so clients should be instructed to report tendon pain or swelling immediately and to avoid strenuous activity. Milk and dairy products should be avoided because they bind to the drug and reduce absorption, not taken to reduce stomach upset. Sedation is not a typical side effect of fluoroquinolones. Photosensitivity precautions apply throughout the course of therapy, not just the first dose, and are more classically associated with tetracyclines (-cycline).
Checked against: OpenStax Pharmacology for Nurses, 7.1; OpenStax Pharmacology for Nurses, 7.4
Question 2 · Physiological Adaptation
A client taking ciprofloxacin for a urinary tract infection calls the clinic reporting sudden pain and swelling in the back of the ankle after starting a new exercise routine. What is the nurse's priority action?
Show answer and rationale
Answer: A. Ciprofloxacin is a fluoroquinolone (-floxacin), a class carrying a boxed warning for tendon rupture, especially of the Achilles tendon. Sudden ankle pain and swelling in a client on this drug requires stopping the medication and seeking prompt medical evaluation to prevent complete rupture. Continuing the drug, applying ice while continuing therapy, or dismissing the symptom as normal all risk allowing tendon damage to progress, and taking the dose with food addresses GI upset, not this serious musculoskeletal warning sign.
Checked against: OpenStax Pharmacology for Nurses, 38.2
Question 3 · Pharmacological and Parenteral Therapies
A nurse is teaching a client who was prescribed ciprofloxacin for a urinary tract infection. Which instructions should the nurse include? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, C, E. Fluoroquinolone antibiotics (-floxacin) carry a black box warning for tendon rupture, so clients should avoid strenuous activity that stresses tendons and report sudden tendon pain or swelling right away; they also cause photosensitivity, so sun protection teaching is essential. Fluoroquinolones and penicillins are different antibiotic classes without a class-wide cross-reactivity concern, but a penicillin allergy does not guarantee safety with any antibiotic, so this statement is misleading and incorrect. There is no specific requirement that ciprofloxacin be taken in the evening for effectiveness. A dry cough is associated with ACE inhibitors, not fluoroquinolone antibiotics.
Checked against: dailymed.nlm.nih.gov; accessdata.fda.gov
Keep studying urinary tract infection in NurseLingo Pro
Pro has 29 urinary tract infection questions like these, with a rationale for every answer. Everything for urinary tract infection in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free fluid and electrolyte practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for urinary tract infection?
Common nursing problems for urinary tract infection include infection; acute pain (dysuria); acute confusion risk (older adults); health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for urinary tract infection?
When a culture is ordered, collect a clean-catch or catheter urine sample before the first antibiotic dose.
What nursing interventions can be used to prevent urinary tract infections?
Encourage fluids unless restricted, teach wiping front to back and voiding after intercourse, and avoid urinary catheters unless truly needed. For catheterized clients, keep the system closed, the bag below the bladder and remove the catheter as soon as possible.
More renal & urinary
Related cheat sheets
Sources
- OpenStax Maternal-Newborn Nursing, 7.3
- merckmanuals.com
- OpenStax Pharmacology for Nurses, 33.3
- OpenStax Fundamentals of Nursing, 26.4
- OpenStax Clinical Nursing Skills, 19.4
- OpenStax Psychiatric-Mental Health Nursing, 14.2
- OpenStax Medical-Surgical Nursing, 23.3
- OpenStax Pharmacology for Nurses, 35.1
- OpenStax Pharmacology for Nurses, 35.3
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.