Chapter 37
Nursing Care of Patients With Disorders of the Urinary System
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a urinary analgesic, treats dysuria. Explain to the patient that urine turns orange while taking phenazopyridine.
Nursing Diagnoses, Planning, and Implementation
Acute Pain related to inflammation and infection of urinary structures EXPECTED OUTCOME: The patient will report relief from pain and discomfort. • Administer phenazopyridine (Pyridium) as ordered to relieve pain . • Apply heat to suprapubic area to relieve discomfort . Ineffective Health Maintenance Behaviors related to lack of knowledge on preventing and resolving UTIs EXPECTED OUTCOME: The patient will state understanding of prevention of UTIs and be free from UTIs. • Suggest eating foods that may prevent UTIs, including polyphenols (cranberry or blueberry products, coffee, black tea, and dark chocolate) for potential preventive action against UTIs . • Reinforce teaching to drink fluids, including water to produce clear light-yellow urine, to prevent dehydration and flush bacteria from urinary tract . • Reinforce teaching to void as soon as the urge occurs or every 3 hours while awake to empty the bladder and lower bacterial counts, reduce stasis, and prevent infection . • Reinforce teaching females to wipe from front to back to prevent spreading bacteria from anal area to urinary meatus . • Reinforce teaching females to wear cotton crotch underwear and avoid constricting clothing such as tight jeans to allow air circulation to reduce moisture . • Reinforce teaching to avoid perfumed feminine hygiene products, bubble bath and bath salts, scented toilet paper, and tub baths, which can irritate the urethra or introduce bacteria into the urinary meatus . • Reinforce teaching to void after sexual intercourse to flush bacteria from the urinary tract that entered the urinary meatus . • Reinforce teaching signs and symptoms of UTI to report to detect UTI . • Reinforce teaching to finish all prescribed antibiotic medications as directed to prevent recurrent infection or resistance to antibiotics . Evaluation The outcomes have been met if the patient verbalizes relief of pain and burning, and describes ways to prevent UTI.
Cystitis Cystitis is inflammation of the bladder wall, usually caused by a bacterial infection. E. coli causes most UTIs. Cystitis can also result from catheter use, chemical irritants, medications, or radiation therapy. Chronic interstitial cystitis, or painful bladder syndrome, has no known cause. Signs and symp- toms are listed in Table 37.1. Urinalysis or sometimes cys- toscopy is used for diagnosis. Urinalysis findings for cystitis include cloudy urine, WBCs, bacteria, sometimes red blood cells (RBCs), positive nitrites, and positive leukocyte ester- ase (pyuria). Urine culture and sensitivity are done if indi- cated. Bacterial cystitis is often treated with nitrofurantoin (Macrobid, Macrodantin), sulfamethoxazole and trimetho- prim (Bactrim, Septra), or fosfomycin (Monurol). Instruct patient to finish all prescribed medications to prevent bac- terial resistance and have a follow-up urinalysis or culture. Encourage fluids to flush the bladder. Pyelonephritis Pyelonephritis is infection of one or both kidneys, which can be serious. Bacteria can travel from the ureters to the bladder and then up to the kidneys. Young women and older adults experience this infection most. Risk factors for uncom- plicated pyelonephritis include a history of UTIs within the past year, sexual intercourse, or spermicide use. Complicated pyelonephritis risk factors are diabetes, weak immune sys- tem, or structural or obstruction problems. In addition to shared UTI signs and symptoms, high fever, chills, nausea/ vomiting, flank pain, and costovertebral tenderness (tender- ness at the angle where rib and vertebrae join with palpation) indicate pyelonephritis. Urinalysis shows cloudy urine, bacte- ria, WBCs, pyuria, positive nitrites, and casts. The urine cul- ture will have 100,000 or more colony-forming units (CFU) per milliliter. In acutely ill patients, blood cultures may be obtained. Antibiotics are given orally or, if the patient is hos- pitalized, intravenously (Table 37.2). After treatment, there is usually no lasting kidney damage. However, frequent kidney infections can result in scarring and loss of kidney function. Urosepsis Urosepsis is sepsis caused by a UTI. Septic shock and death can result so prompt treatment is essential. Older adults are at greater risk for urosepsis. Nursing Process for the Patient With a Urinary Tract Infection Data Collection Ask what the patient’s usual pattern of voiding is and if changes have occurred. Document the presence of a cathe- ter, recent urinary instrumentation, or surgery. Note the pres- ence of signs or symptoms (see Table 37.1). Inspect the urine for volume, color, concentration, cloudiness, blood, or foul odor. Review urinalysis and culture results.
• WORD • BUILDING • cystitis: cyst—closed sac containing fluid + itis—inflammation pyelonephritis: pyelo—pelvis + nephr—kidney + itis—inflammation urosepsis: uro—urine + sepsis—infection in the blood
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