Chapter 45. Management of Patients with Urinary Disorders. Lower Urinary Tract Infections. Cystitis (inflammation of the urinary bladder), Prostatitis (inflammation of the prostate gland), and Urethritis (inflammation of the urethra).
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Prostatitis (inflammation of the prostate gland), and
Urethritis (inflammation of the urethra).
Upper UTI; Pylonephritis (inflammation of the renal pelvis), interstitial nephritis (inflammation of the kidney), and renal abscesses
Lower Urinary Tract Infections
mechanisms maintain the sterility of the bladder:
the physical barrier of the urethra,
ureterovesical junction competence,
various antibacterial enzymes and antibodies, and antiadherent effects mediated by the mucosal cells of the bladder.
Risk Factors for UTI
Inability or failure to empty the bladder completely
Obstructed urinary flow
Decreased natural host defenses or immunosuppression
Instrumentation of the urinary tract (eg, catheterization, cystoscopic procedures)
Inflammation or abrasion of the urethral mucosa
Contributing conditions: DM, Pregnancy, neurogenic disorders, Gout, and altered states caused by incomplete emptying of the bladder and urinary stasis
Bacteria gain access to the bladder, attach to and colonize the epithelium of the urinary tract to avoid being washed out with voiding, evade host defense mechanisms, and initiate inflammation.
Many UTIs result from fecal organisms that ascend from the perineum to the urethra and the bladder and then adhere to the mucosal surfaces.
Escherichia coli is the most common agent
Urethrovesical reflux: With coughing and straining, bladder pressure rises, which may force urine from the bladder into the urethra. (A) When bladder pressure returns to normal, the urine flows back to the bladder (B), which introduces bacteria from the urethra to the bladder. Ureterovesical reflux: With failure of the ureterovesical valve, urine moves up the ureters during voiding (C) and flows into the bladder when voiding stops (D). This prevents complete emptying of the bladder. It also leads to urinary stasis and contamination of the ureters with bacteria-laden urine.
Routes of Infection
transurethral route (ascending infection),
through the bloodstream (hematogenous spread), or
by means of a fistula from the intestine (direct extension)
About half of all patients with bacteriuria have no symptoms.
dysuria (painful or difficult urination), burning on urination, frequency (voiding more than every 3 hours), urgency, nocturia, incontinence, and suprapubic or pelvic pain. Hematuria and back pain may also be present
High incidence of chronic illness
Frequent use of antimicrobial agents
Presence of infected pressure ulcers
Immobility and incomplete emptying of bladder
Use of a bedpan rather than a commode or toilet
UA: puss cells > 4, ? hematouria
Pharmacological agents according to C&S
Patient should be instructed to complete the antibiotic course
UTIs – Nursing Care
Impaired Urinary Elimination
Readiness for Enhanced Self Health Management
Chills, fever, leukocytosis, bacteriuria and pyuria.
Low back pain, flank pain, nausea and vomiting, headache, malaise, and painful urination are common findings.
Pain and tenderness in the area of the costovertebral angle
Symptoms of lower UTI
On out patient basis: AB for 2 weeks
Good oral hydration
If there is a relapse, AB for 6 weeks
If there is N&V > admission, IV Fluids and IV AB
Usually asymptomatic unless an acute exacerbation occurs.
Noticeable S&S may include fatigue, headache, poor appetite, polyuria, excessive thirst, and weight loss.
Persistent and recurring infection may produce progressive scarring of the kidney resulting in renal failure