Urinary tract infection, (UTI) is an infection of one or more of the structures in the urinary tract.

Most UTI’s happen from bowel organisms, (E-coli). Women are more prone to UTI’s because of the
shortness of their urethra.

CYSTITIS

Infections of the lower urinary tract are called cystitis. This is an inflammation of the urinary
bladder related to a superficial infection that doesn’t extend to the bladder mucosa, most often caused by
ascending infection from the urethra; it can also be caused by sexual intercourse.

• Causes

o Stagnation of urine in the bladder

o Obstruction of the urethra
o Sexual intercourse
o Incorrect aseptic technique during catheterization
o Incorrect perineal care
o Kidney infection
o Radiation
o Diabetes mellitus
o Pregnancy

• Other causes

o Cystitis is usually due to a bacterial infection of the urine. Occasionally, in children it can be
caused by a virus.
o The infection is more common in women because a woman's anatomy is designed in such a way
that it makes it easier for bacteria to enter the bladder.
o Sexual intercourse, using spermicidal creams, and using diaphragms all increase the risk of
developing Bladder Infection.
o People who have a catheter in their bladder or who have to periodically catheterize them have a
higher risk of developing bladder infection.
o People with Bladder Cancers or abnormal connections between their bladder and intestines also
have a higher risk of developing Bladder Infection.

• Pathophysiology

• Bacterial infection from a second source spreads to the bladder, causing an inflammatory
response.
• Cell destruction from trauma to the bladder wall, particularly the trigone area, initiates an acute
inflammatory response.
• Complications

• Chronic cystitis (recurrent or persistent inflammation of the bladder)

• Urethritis (inflammation of the urethra)

• Pyelenophritis (Infections of the upper urinary tract)

• Clinical manifestations
 Any changes in the clients voiding habits should be assessed as a possible UTI. The most
common clinical manifestation of cystitis is burning pain of urination (dysuria), Frequency, urgency,
voiding in small amount, inability to void, incomplete emptying of the bladder, cloudy urine and hematuria
( blood in urine). Asymptomatic bacteriuria (bacteria in urine).

• Nursing Diagnosis

Impaired Urinary Elimination. The primary diagnosis when a client is experiencing problems related to
cystitis is Impaired Urinary Elimination related to irritation of the bladder mucosa.

Acute Pain. Another common nursing diagnosis for clients with cystitis is Acute Pain related to irritation
and inflammation of bladder and urethral mucosa.

• How to diagnose

o Often times, treatment may be based on the symptoms alone, without additional tests.
o Urinalysis (in which the urine is tested for the presence of an infection) is the most common
method of diagnosis.
o Blood and Urine cultures may also be required.
o In women with frequent infections (more than three a year), a full examination of the urinary
tract (usually by a specialist) needs to be done. Also, it is sometimes recommended that all
men who develop any type of urinary infection, including Bladder Infections, need to be
seen by a specialist.
• Diagnostic test findings

 Urine culture and sensitivity: positive identification of organisms (Escherichia coli, Proteus
vulgaris, Streptococcus faecalis)

 Urine chemistry: hematuria, pyuria,; increased protein, leukocytes, specific gravity

 Cytoscopy: obstruction or deformity

• Assessment findings

 Frequency of urination  Nocturia (need to get up during the night

in order to urinate, thus interrupting
 Urgency of urination sleep)

 Burning or pain on urination  Low-grade fever

 Lower abdominal discomfort  Urge to bear down during urination

 Dark, odoriferous urine  Dysuria (refers to painful urination)

 Flank tenderness or suprapubic pain  Dribbling

• Medical management
  Diet: acid-ash diet with increased intake  Treatment: Sitz baths
of fluids and vitamin C
 Antibiotics: co- trimoxizole (Bactrim),
 Activity: as tolerated cephalexin (Keflex)

 Monitoring: vital signs and intake and  Analgesic: oxycodone (Tylox)

output
 Urinary antiseptic: Phenazopyridine
 Laboratory studies: specific gravity, (Pyridium)
urine culture and sensitivity
 Antipyretic: acetaminophen (Tylenol)

• Nursing interventions

 Maintain the patients diet

 Encourage fluids (cranberry or

orange juice) to 3qt (3L)/day

 Assess renal status

 Monitor and record vital signs, I/O,

and laboratory studies

 Administer medications, as
prescribed

 Allay patient’s anxiety

 Maintain treatments: sitz baths,

perineal care

 Encourage voiding every 2 to 3 hours

 Individualize home care instructions

o Avoid coffee, tea, alcohol and

cola

o Increase fluid intake to 3 qt (3L)/

day using orange juice and
cranberry juice

o Void every 2 to 3 hours and

after intercourse

o Perform perineal care correctly

o Avoid bubble baths, vaginal

deodorants ant tub baths
• Evaluation

The client will have return of normal voiding habits within 3 days of starting antibiotic treatment as
evidenced by an absence of fever, pain, burning, frequency, and urgency.

The client will be able to urinate with minimal or no discomfort within 24 hours after treatment begins and
will return to normal voiding habits within 3 days, as evidenced by an absence of pain and burning on
urination.