Transcript Lower Urinary Tract Problems

Lower Urinary Tract
Problems
♦ A & P Review
♦ Lower urinary tract infections
♦ Bladder Disease
Bladder
♦ Hollow,distensible, muscular organ
♦ 4 layers of muscle
♦ Reservoir for urine
♦ Organ of excretion
♦ Expands as it becomes filled with urine
♦ Pressure within bladder is low
♦ 600 ml capacity, normal voiding 300 ml
Bladder
♦ Trigone-base of bladder –
♦ Triangular area formed by the two ureteral openings and
the bladder neck at the base on the bladder
♦ Muscular layer-detrusor muscle
♦ Distention during filling & contraction during emptying
♦ Parasympathetic innervation stimulates detrusor during
urination (smooth muscle contraction) resulting in bladder
emptying
♦ Diurnal pattern of urination: 5-6x/day and
occasionally at night
♦ Volume of urine produced at night is less than half that
produced during the day -- ADH
Bladder
♦ External Sphincter control
♦ voluntary control
♦ Sympathetic innervation cause smooth
muscle relaxation allowing bladder to fill
♦ Internal Sphincter
♦ involuntary control by SNS
♦ causes urethrea to remain closed until person is
ready to void
♦ Control of Micturition: the result of
coordination between the opening of the
sphincters and contraction of detrusor
Alterations in Urinary
Elimination
Lower Urinary Tract
Infection
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7 million office visits a year
Most common nosocomial infection on U.S.
Most from catheterization or post-op
Bacteria in the urine may lead to the spread
of organisms into bloodstream (Urosepsis)
Urinary Tract Infection
UTI Symptoms
♦ Pain or burning on urination (dysuria)
♦ Fever, chills, malaise
♦ Hematuria - irritation of bladder & urethral mucosa
resulting in blood-tinged urine
♦ Cystitis: Frequency and urgency, suprapubic pain,
and foul smelling urine
♦ Pyelonephritis-infection spreads up to kidney from
lower UTI- flank pain, fever, nausea and vomiting
Urinary Tract Infection
UTI Diagnosis
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History and physical exam
Urinalysis (UA)
Urine for C&S
Imaging studies of the urinary tract (IVP, cysto)
Urinary Tract Infection
Common Causative
Microorganisms
♦ Escherichia coli
♦ 80% of cases without urinary tract structural abnormalities
or calculi
♦ Enterococcus
♦ Klebsiella
♦ Enterobacter
♦ Serratia
♦ Proteus
♦ Pseudomonas
♦ Staphylococcus
Urinary Tract Infection
Treatment - uncomplicated
♦ Antibiotic – Sulfa; Broad-spectrum
♦ 1-3 day regimen
♦ Adequate fluid intake
♦ Urinary analgesic (Pyridium)
♦ Pt Education: avoid recurrence
Health Promotion
Urinary Tract Infection
Recurrent - uncomplicated
♦ Repeat UA - Urine C&S
♦ Antibiotic 3-5 day course
♦ Sulfa
♦ Sensitivity-guided antibiotic – Ampicillin, cephalosporin,
fluoroquinolone
♦ Consider 3-6 month trial of suppressive antibiotics
♦ Adequate fluid intake
♦ Urinary analgesic – Pyridium
♦ or combination agent – Urised
♦ Counseling risk of recurrence / reduce risk factors
♦ Imaging study of urinary tract in select cases
Urinary Tract Infection
Nursing Management
♦ Assess: Pain; urine elimination;
♦ Nsg Action: Pain relief – urinary analgesics;
midstream specimens for C&S;
♦ Pt Education: Medications; force fluids;
hygiene; signs & symptoms of recurrent UTI;
adequate hydration during health
UTI - Nursing Management
Patient / Family Education
♦ Antibiotic therapy – adherence after symptoms
subside
♦ Hygiene
♦ Cleansing perineal area
♦ Wiping from front to back after urinating & BM
♦ Cleanse with soap & water after BM
♦ Empty bladder before and after intercourse
♦ Establish regular urination pattern – every 2-4
hours
♦ Avoid harsh soaps, bubble baths, powders, talcs,
and sprays to the perineal area
♦ Report signs & symptoms of UTI