A nurse is planning care for a female client who has a T4 spinal cord injury and is at risk for acquiring urinary tract infections. Which of the following actions should the nurse include in the client's plan of care?

Choice A rationale Increasing fluid intake is a primary nursing intervention to prevent urinary tract infections in clients with spinal cord injuries. Adequate hydration promotes frequent voiding, which helps flush bacteria out of the urinary tract and reduces the concentration of pathogens in the bladder. For a client with a T4 injury, maintaining a high urine output helps prevent stasis. Normal fluid intake for adults is typically 2,000 to 3,000 mL per day to maintain healthy renal and bladder function. Choice B rationale Cleansing the perineum from back to front is an incorrect practice that significantly increases the risk of urinary tract infections. This action introduces enteric bacteria, such as Escherichia coli from the anal region, directly toward the urethral opening. Proper perineal hygiene for a female client must always involve wiping from front to back to move contaminants away from the urethra. Education on this technique is vital for clients with spinal cord injuries who may have impaired sensation. Choice C rationale Indwelling urinary catheters are associated with a very high risk of catheter-associated urinary tract infections and should be avoided whenever possible. For a client with a T4 injury, intermittent catheterization is generally preferred over a chronic indwelling catheter to maintain bladder health and reduce infection rates. Long-term use of an indwelling catheter can lead to bladder stones, urethral trauma, and chronic colonization by resistant bacteria. The goal is to maximize independence while minimizing invasive device usage. Choice D rationale Offering a bedpan every 2 hours may be insufficient for a client with a T4 spinal cord injury who likely has a neurogenic bladder. Depending on whether the bladder is spastic or flaccid, the client may require a specific bladder training program or intermittent catheterization to ensure complete emptying. Simply using a bedpan does not address the underlying physiological inability to voluntarily coordinate voiding. Regular assessment of bladder distention is necessary to prevent reflux and secondary renal damage.