Catheter-Associated Urinary Tract Infection (CAUTI) is a significant healthcare-associated infection that occurs when bacteria enter the urinary tract through an indwelling urinary catheter. This nursing diagnosis focuses on preventing, identifying, and managing CAUTIs while promoting optimal patient outcomes.
Causes (Related to)
CAUTIs can develop due to various factors that increase infection risk:
- Prolonged catheterization (>2 days)
- Improper catheter insertion technique
- Poor catheter maintenance
- Patient-specific risk factors such as:
- Advanced age
- Compromised immune system
- Diabetes mellitus
- Female gender
- Poor nutritional status
- Environmental factors including:
- Breaks in the sterile technique
- Inadequate hand hygiene
- Improper catheter care
- Poor perineal hygiene
Signs and Symptoms (As evidenced by)
CAUTI presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Suprapubic pain or discomfort
- Burning sensation around the catheter
- General malaise
- Lower back pain
- Feeling feverish
- Confusion (especially in the elderly)
- Lethargy
Objective: (Nurse assesses)
- Fever (>38°C/100.4°F)
- Cloudy urine
- Foul-smelling urine
- Visible sediment in urine
- Blood in urine
- Increased WBC count
- Positive urine culture
- Tenderness in the suprapubic area
Expected Outcomes
The following outcomes indicate the successful management of CAUTI:
- The patient will remain free from urinary tract infection
- The patient will maintain clear, odorless urine
- The patient will demonstrate an understanding of infection prevention measures
- The patient will maintain proper hydration status
- The patient will report decreased discomfort
- The patient’s catheter will be removed as soon as clinically appropriate
- The patient will demonstrate improved knowledge of catheter care
Nursing Assessment
Monitor Catheter Care
- Assess catheter necessity daily
- Check insertion site
- Evaluate drainage system integrity
- Monitor catheter fixation
- Document catheter days
Assess Infection Signs
- Monitor vital signs
- Check urine characteristics
- Assess pain levels
- Monitor mental status
- Document symptoms
Evaluate Risk Factors
- Review medical history
- Assess immune status
- Check nutrition status
- Monitor mobility level
- Document comorbidities
Monitor Hydration Status
- Track fluid intake
- Assess urine output
- Check skin turgor
- Monitor mucous membranes
- Document fluid balance
Check Complications
- Monitor for sepsis signs
- Assess kidney function
- Check for bladder spasms
- Monitor for urinary retention
- Document systemic symptoms
Nursing Care Plans
Nursing Care Plan 1: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to presence of indwelling urinary catheter as evidenced by potential for microorganism invasion of urinary tract.
Related Factors:
- Invasive procedure (catheterization)
- Duration of catheterization
- Break in sterile technique
- Compromised host defenses
Nursing Interventions and Rationales:
- Maintain a closed drainage system
Rationale: Prevents bacterial entry into the system - Perform proper hand hygiene
Rationale: Reduces risk of contamination - Monitor catheter site and urine characteristics
Rationale: Early detection of infection signs
Desired Outcomes:
- The patient will remain free from infection
- Urine will remain clear and odorless
- The catheter site will remain clean and dry
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to bladder spasms and catheter irritation as evidenced by verbal reports of discomfort and suprapubic tenderness.
Related Factors:
- Mechanical trauma
- Chemical irritation
- Bladder spasms
- Tissue inflammation
Nursing Interventions and Rationales:
- Assess pain characteristics
Rationale: Guides pain management interventions - Ensure proper catheter positioning
Rationale: Reduces mechanical irritation - Administer prescribed medications
Rationale: Manages pain and discomfort
Desired Outcomes:
- The patient will report decreased pain
- The patient will demonstrate improved comfort
- The patient will maintain a normal activity level
Nursing Care Plan 3: Risk for Impaired Urinary Elimination
Nursing Diagnosis Statement:
Risk for Impaired Urinary Elimination related to mechanical interference by catheter as evidenced by the potential for urinary retention or overflow.
Related Factors:
- Mechanical obstruction
- Catheter blockage
- Bladder spasms
- Reduced bladder tone
Nursing Interventions and Rationales:
- Monitor urine output
Rationale: Ensures adequate drainage - Check catheter patency
Rationale: Prevents blockage complications - Maintain proper drainage bag position
Rationale: Promotes gravity drainage
Desired Outcomes:
- The patient will maintain adequate urinary elimination.
- The catheter will remain patent
- The patient will avoid retention complications
Nursing Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to lack of familiarity with catheter care as evidenced by questions about self-care and infection prevention.
Related Factors:
- Limited previous experience
- Misinterpretation of information
- Lack of exposure to education
- Anxiety about condition
Nursing Interventions and Rationales:
- Provide catheter care education
Rationale: Improves self-care ability - Demonstrate proper techniques
Rationale: Enhances learning through observation - Verify understanding
Rationale: Ensures effective education
Desired Outcomes:
- The patient will demonstrate proper catheter care
- The patient will verbalize understanding of infection prevention
- The patient will identify signs of complications
Nursing Care Plan 5: Risk for Compromised Skin Integrity
Nursing Diagnosis Statement:
Risk for Compromised Skin Integrity related to mechanical factors from catheter as evidenced by potential for tissue damage.
Related Factors:
- Mechanical friction
- Pressure from catheter
- Moisture exposure
- Chemical irritation
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Enables early detection of breakdown - Maintain proper catheter securement
Rationale: Prevents tissue trauma - Provide meticulous skincare
Rationale: Maintains skin integrity
Desired Outcomes:
- The patient will maintain intact skin
- The patient will demonstrate proper catheter positioning
- The patient will remain free from pressure injuries
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Assadi F. Strategies for Preventing Catheter-associated Urinary Tract Infections. Int J Prev Med. 2018 Jun 4;9:50. doi: 10.4103/ijpvm.IJPVM_299_17. PMID: 29963301; PMCID: PMC5998608.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 40(6), 548-553. https://doi.org/10.1016/j.ajic.2011.07.018
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Willson M, Wilde M, Webb ML, Thompson D, Parker D, Harwood J, Callan L, Gray M. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):137-54. doi: 10.1097/01.WON.0000347655.56851.04. PMID: 19287262.
