URINARY TRACT INFECTION (Infeksi Saluran Kemih) Rahayu Setyowati, SKp. Keperawatan Medikal Bedah III AKADEMI KEPERAWATAN YPIB MAJALENGKA

OBJEKTIF Menerangkan tentang ISK Menerangkan tentang penyebab ISK Di akhir pembelajaran mahasiswa mampu : Menerangkan tentang ISK Menerangkan tentang penyebab ISK Menjabarkan faktor risiko ISK Menjabarkan gejala ISK Menerangkan tanggungjawab perawat dalam kasus ISK

UTI Infeksi sal kemih Bag bawah Infeksi sal kemih Bag atas urethritis prostatitis cystitis Pyelonephritis Glomerulonefritis

PENDAHULUAN Asymptomatik bakteriuria (bacteria terdeteksi dalam urine teteapi tidak ada gejala) Cystitis (infeksi pada bladder) Pyelonephritis (infeksi pada ginjal) Lebih banyak terjadi pada wanita.

PENYEBAB Microorganisme: Escherichia coli Penelitian = penyebab utama Factors influencing colonization: vaginal pH, urethral length, capacity of bacteria to adhere to urothelium Osborne, 2004 Staphylococcus saprophyticus Klebsiella species (common in hospital acquired UTI) Proteus species (common in hospital acquired UTI) Pseudomonas aeruginosa (common in hospital acquired UTI) Candida Enterococci

Cont… Penyebab ISK di kalangan wanita Infection Urethra pendek Hub seksual Kekurangan Estrogen

FAKTOR RISIKO kehamilan and menopause Batu Ginjal Hubungan seksual(multiple partner) Pembesaran atau inflamasi Prostate Urethra pendek Immobility ( recovery from a hip fracture ) Tidak cukup minum Bowel incontinence Catheterization Impaired host defenses Elderly people

GEJALA Tekanan pada pelvis bag bawah Sering kencing malam hari Nyeri seperti terbakar pada saat BAK Sering kencing Ingin terburu2 untuk BAK Sering kencing malam hari Urin keruh Darah dalam urin Bau menyengat pada urin

PEMERIKSAAN DIAGNOSTIK Urinalysis Blood Culture Identify bacteremic organism in suspected urosepsis BUN, Creatinine Determine ↓ renal function for nephrotoxic medications Complete Blood Count with Differential Indicated to R/O bacterial infection supports treatment plan Careful evaluation of WBC & differential (left shift) Urine culture (clean catch) or catheterized urine specimen Bacterial identification from urine C&S

DIAGNOSIS Microscopic examination WBC, RBC Presence of bacteria Urine dipstick test: rapid screening test leukocyte esterase test Nitrate → nitrite test (+ in only 25%)

COMPLICATION Chronic or recurrent urinary tract infection – defined as at least two infections in 6 months or at least three in 1 year. Kidney infection Septic shock

PENCEGAHAN Kebersihan perineal Bersihkan area perineal dari depan ke belakang Minum yang banyak BAK setelah hub seksual Hindari minuman yang dapat mengiritasi bleder seperti alkohol, kafein feine Jangan menggunakan pembersih kewanitaan (feminine hygiene products) Gunakan pakaian dalam yang nyaman Minum minuman yang mengandung Vit C tinggi

PENDIDIKAN KESIHATAN Fluid intake of at least 2-3 liters a day Genital and urinary hygiene Urinate frequently especially after sexual intercourse (women) Avoid sex with multiple partners Avoid feminine hygiene wash Choose napkins instead of tampons. To be changed after each urination.

Cont… Use cotton based underwear and avoid tight fitting pants. Observe urine = color, amount, odor, and frequency Dry perineal area after urination or defecation from front to back. Drink two glasses of water before and after sex and void after intercourse. Take showers rather than baths and wear underwear with a cotton crotch.

TANGGUNGJAWAB PERAWAT Preparation for investigation Farmacology Pain Urinary elimination – i/o chart Knowledge deficit

PENGOBATAN Asymptomatic UTI = does not require treatment Symptomatic infection = antibiotik [oral, parenteral therapy] Cranberry juice has been tried in the treatment of UTIs. Antibiotik Nitrofurantoin Cephalosporins Sulfa drugs (sulfonamides) Amoxicillin Trimethoprim – sulfamethoxazole Doxycycline Quinolones

DAFTAR PUSTAKA My Health for Life. 2008. Urinary Tract Infection in Adult Brunner & Suddart. Medical Surgical Nursing. 2008. WB Sounders : USA