Notes
Definititon
Cystitis is an inflammation of the bladder wall, which may be acute or chronic. It is generally accepted to be an ascending infection, with entry of the pathogen via the urethral opening. Noninfectious cystitis is referred to as interstitial cystitis (IC), but this is a poorly understood disorder with an uncertain cause. In this condition, in spite of symptoms of cystitis, the urine is sterile.
The person develops a decreased bladder capacity, possibly because of healing of bladder ulcers (called Hunner’s ulcer) that leave behind scar tissue. If IC is associated with chemical agents that lead to bleeding, it is termed hemorrhagic cystitis; otherwise, IC may also be termed painful bladder disease (PBD).
Although cystitis occurs in both men and women, the incidence in women is significantly higher. Sexually active women have 50 times more cystitis than men in general. Females are more susceptible to cystitis because of their short urethra, which is 1 to 2 inches long, as contrasted with the male urethra, which is 7 to 8 inches in length. The placement of the female urethra, which is closer to the anus than is the male urethra, increases the risk of infection from bacteria in the stool.
Causes
The most common pathogen that leads to bladder infection is Escherichia coli, which accounts for about 80% of cases of cystitis. Predisposing factors are urethral damage from childbirth,catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and, in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides). No one is certain about the frequency of viral and herpetic cystitis because culture results are sometimes negative even when the patient has the condition. A large number of people probably have asymptomatic infections initially with herpes simplex viruses, so the incidence of herpetic cystitis may be higher than culture-positive results indicate. Hemorrhagic cystitis may also occur owing to adenoviral infections, particularly in people who are immunocompromised, such as patients with bone marrow transplantation or acquired immunodeficiency syndrome (AIDS).
The cause of IC is unknown but has been linked to chemical agents such as some medications (cyclophosphamide) and radiation therapy. Some experts suggest that PBD is an autoimmune response.
Gender, Ethnic/Racial and Life Span Considerations
Cystitis is uncommon in young children and teenagers. Pregnancy increases the risk of infection because of hormonal changes in women and because the enlarging uterus restricts the flow of urine and creates urinary stasis and bacteria proliferation. Men, on the other hand, secrete prostatic fluid that serves as an antibacterial defense. As men age past 50, however, the prostate gland enlarges, which increases the risk for urinary retention and infection. As women age, vaginal flora and lubrication change; decreased lubrication increases the risk of urethral irritation in women during intercourse. By age 70, prevalence is similar for men and women.
IC occurs primarily in women, and is more common in Jewish women. Prevalence is higher among U.S. women than those in Europe and Japan. Although at one time IC was considered a disease of menopause, experts note that it is most common in middle-aged rather than older women.
Clinical Manifestations
- Urgency, frequency, burning, and pain on urination.
- Nocturia, incontinence, and back, suprapubic, or pelvic pain.
- Hematuria.
Assessment and Diagnostic Methods
- Urine cultures, colony counts, cellular studies
- Leukocyte esterase test and nitrite testing
- Tests for sexually transmitted diseases (STDs)
- CT scans and transrectal ultrasonography; cystourethroscopy may be indicated to visualize the ureters or to detect strictures, calculi, or tumors
Diagnosis
PRIMARY NURSING DIAGNOSIS
- Altered urinary elimination related to irritation of bladder mucosa
OUTCOMES. Urinary elimination; Knowledge: Medication, Symptom control
INTERVENTIONS. Medication prescribing; Urinary elimination management
Other Nursing Diagnoses
- Acute pain related to infection within the urinary tract
- Deficient knowledge related to factors predisposing to infection and recurrence, detection and prevention of recurrence, and pharmacologic therapy
Potential Complications
- Sepsis
- Renal failure, which may occur as the long-term result of either an extensive infective or inflammatory process
Planning and Goals
- Goals of the patient may include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications.
Medical Management
- Management of UTIs typically involves pharmacologic therapy and patient education. The nurse teaches the patient about prescribed medication regimens and infection prevention measures.
Acute Pharmacologic Therapy
- Ideal treatment is an antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora.
- Medications may include Cephalexin (Keflex), Cotrimoxazole (TMPSMZ, Bactrim Septra), Nitrofurantoin (Macrodantin Furadantin), ciprofloxacin (Cipro), levofloxacin (Levaquin), and Phenazopyridine (Pyridium).
- Occasionally, ampicillin or amoxicillin (but Escherichia coli has developed resistance to these agents).
Long Term Pharmacologic Therapy
- About 20% of women treated for uncomplicated UTIs experience a recurrence.
- Recurrence in men is usually due to persistence of the same organism; further evaluation and treatment are indicated.
- Reinfection of women with new bacteria is more common than persistence of the initial bacteria.
- If diagnostic evaluation reveals no structural abnormalities, patient may be instructed to begin treatment on own, testing urine with a dipstick whenever symptoms occur, and to contact health care provider only with persistence of symptoms, at the occurrence of fever, or if the number of treatment episodes exceeds four in a 6month period.
- Long term use of antimicrobial agents decreases risk of reinfection.
Nursing Interventions
Assessment
- Take careful history of urinary signs and symptoms.
- Assess for pain and urinary frequency, urgency, and hesitancy and changes in urine.
- Determine usual pattern of voiding to detect factors that may predispose patient to infection.
- Assess for infrequent emptying of the bladder, association of symptoms of UTIs with sexual intercourse, contraceptive practices, and personal hygiene.
- Check urine for volume, color, concentration, cloudiness, and odor.
Relieving Pain
- Use antispasmodic drugs to relieve bladder irritability and pain.
- Relieve pain and spasm with analgesic agents and heat to the perineum.
- Encourage patient to drink liberal amounts of fluid (water is best).
- Instruct patient to avoid urinary tract irritants like coffee, tea, spices, colas, alcohol
- Encourage frequent voiding (every 2 to 3 hours).
Monitoring and Managing Complications
- Recognize and teach patient to recognize the signs and symptoms of UTIs early; initiate prompt treatment.
- Manage UTIs with appropriate antimicrobial therapy, liberal fluids, frequent voiding, and hygiene measures.
- Instruct patient to notify physician if fatigue, nausea, vomiting, or pruritus occurs.
- Provide for periodic monitoring of renal function and evaluation for strictures, obstructions, or stones.
- Avoid indwelling catheters if possible; remove at earliest opportunity. Use strict aseptic technique if an indwelling catheter is necessary.
- Check vital signs and level of consciousness for impending sepsis.
- Report positive blood cultures and elevated WBC counts.
Teaching Self-care
- Teach patient health-related behaviors that help prevent recurrent UTIs, including practicing careful personal hygiene, increasing fluid intake to promote voiding and dilution of urine, urinating regularly and more frequently, and adhering to the therapeutic regimen.
- Teaching should meet the patient’s individual needs.
Evaluation
Expected Patient Outcomes
- Experiences relief of pain
- Explains UTIs and their treatment
- Experiences no complications
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Exam
Nursing Care Plan
Nursing Diagnosis
- Acute pain related to bladder infections
Goal : There is no pain and burning sensation during urination
Expected outcomes
- The client says the pain is reduced
Nursing Interventions
- Monitor: The bow of the urine to change color, odor and urine patterns, input and output every 8 hours and the results of urinalysis.
- Rationale: To identify the indications, the progress or the storage of the expected results.
- Give analgesics as needed and evaluate its success
- Rationale: Analgesics block the path of pain, thereby reducing the pain
- Consul doctor if:
- Previous amber-yellow urine, dark orange, hazy or cloudy
- Micturition pattern changes, as an example of heat such as burning during urination, a sense of urgency when urinating
- Persistent pain or increasing pain
- Rationale: These findings may indicate further tissue damage and need more extensive checks, such as radiology examination if not previously done
- If the frequency becomes a problem, assure access to the bathroom, bedpan under the bed. Instruct the patient to urinate whenever there is a desire.
- Rationale: frequent urination, reduce static urine in the bladder and prevent bacterial growth.
Nursing Diagnosis
- Risk for infection related to the risk factors of nosocomial
Goal : There is no infection in the bladder
Expected outcomes
- Clients can urinate without the inconvenience of clear urine, urinalysis within normal limits, urine culture showed no bacteria.
Nursing Interventions
- Provide perineal care with soapy water every shift. If the patient’s incontinence, perineal wash as soon as possible
- Rationale: To prevent contamination of the urethra
- If placed indwelling catheter, catheter care given 2 times per day (part of the shower in the morning and at bedtime) and after defecation
- Rationale: Catheter give way on the bacteria to enter the bladder and up into the urinary tract
- Reposition the patient every 2 hours and encourage fluid intake of at least 2400 ml / day (unless contraindicated). Help make ambulation as needed
- Rationale: To prevent static urine
- Take action to maintain the acid urina
- Rationale: urina acid prevents the growth of germs.
