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
Encourage increased oral fluids
For adult patients only, administer Ural® as per Standing Orders
Provide analgesia as required according to pain scale. See Pain (any cause) NMG.
If urinalysis positive for leukocytes and / or nitrites commence cephalexin as per Standing Orders and local facility guidelines
Document assessment findings, interventions, investigations and outcomes
References / Further Resources
ECI Patient Factsheet - UTI
Agency for Clinical Innovation (2012) ACI Urology Network Nursing Collection of Urine Midstream Guidelines, NSW Agency for Clinical Innovation, Chatswood
Bhat, R.G., Katy, T.A., Place, F.C. (2011) Pediatric Urinary Tract Infections Emergency Medicine Clinics of North America 29 (2011) 637-653
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
Best et al (2014) Diagnosis and management of urinary tract infections in the emergency department; Emerg Med Prac 2014 Jul; 16(7): 1-23