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Urinary Symptoms Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Possible sexual assault

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Child ≤ 12 years

  • Macroscopic haematuria

  • Symptoms for > 7 days

  • Pregnancy with gestation ≥ 19 weeks

  • Loin pain

  • Abdominal distention / tenderness / pain

  • Existing urological abnormality including urological devices (IDC / SPC)

  • Recent urology surgery

  • New onset confusion / altered mentation

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts

Additional Observations

  • Obtain MSU and complete urinalysis. If positive for leukocytes and / or nitrites retain / send sample for formal pathology analysis as per local protocols.

  • Add urine ßHCG for females of potential child bearing age e.g. 10 – 50 years

  • Blood glucose level - consult a doctor if result is outside the range 4 to 15 mmol/L

Additional History

For females establish menses cycle

Management Principles

  1. Encourage increased oral fluids

  2. For adult patients only, administer Ural® as per Standing Orders

  3. Provide analgesia as required according to pain scale. See Pain (any cause) NMG.

  4. If urinalysis positive for leukocytes and / or nitrites commence cephalexin as per Standing Orders and local facility guidelines

  5. Document assessment findings, interventions, investigations and outcomes

References / Further Resources

  1. ECI Patient Factsheet - UTI

  2. Agency for Clinical Innovation (2012) ACI Urology Network Nursing Collection of Urine Midstream Guidelines, NSW Agency for Clinical Innovation, Chatswood

  3. Bhat, R.G., Katy, T.A., Place, F.C. (2011) Pediatric Urinary Tract Infections Emergency Medicine Clinics of North America 29 (2011) 637-653

  4. Norris, D.L., Young, J.D. (2008) Urinary Tract Infections: Diagnosis and Management in the Emergency Department Emergency Medicine Clinics of North America 26 (2008) 413-430

  5. Best et al (2014) Diagnosis and management of urinary tract infections in the emergency department; Emerg Med Prac 2014 Jul; 16(7): 1-23

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