Management of Patients With Urinary Disorders

Oleh: Wardiyatmi, Skep, Ns Perawat Muda RSUD Dr. Moewardi

Urinary Tract Infections (UTIs)

The second most common reason for seeking health care A common site of nosocomial infection Lower UTIs

Cystitis Prostatitis Urethritis

Upper UTIs
Pyelonephritis: acute and chronic Interstitial nephritis Renal abscess and perirenal abscess

Factors Contributing to UTI

Function of glycosaminoglycan (GAG) Urethrovesical reflux Ureterovesical reflux Uropathogenic bacteria

Shorter urethra in women

Urethrovesical Reflux and Ureterovesical Reflux

Question
Tell whether the following statement is true or false. The most common way in which bacteria enter the urethra is through the bloodstream.

Answer
False. Rationale: The most common route of infection is transurethral, in which bacteria colonize in the periurethral area and subsequently enter the bladder by means of the urethra.

Bladder Infection With Long-Term Catherization

Nursing ProcessAssessment of the Patient With a UTI

Symptoms include pain and burning upon urination; frequency; nocturia; incontinence; suprapubic, pelvic, or back pain; hematuria; or change in urine or urinary pattern About half of patients are asymptomatic Assess voiding patterns, association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene Gerontologic considerations Assess urine, urinalysis, and urine cultures Other diagnostic tests

Nursing ProcessDiagnosis of the Patient With a UTI

Acute pain Deficient knowledge

SIGNS AND SYMPTOMS

William & Hopper

Cystitis Symptoms include Dysuria Frequency Urgency Cloudyurine Pyelonephritis Symptoms include urgency, frequency,dysuria, flank pain, fever, and chills. The urine is cloudy with increased WBCs, bacteria, casts, RBCs, and positive nitrites

DIAGNOSTIC TESTS
Hopper

William &

Cystitis
Cystitis infection acquired outside the hospital is diagnosed with a routine urinalysis collected as a clean-catch midstream specimen. Changes seen in the urinalysis include cloudy urine and the presence of WBCs, bacteria, and sometimes red blood cells (RBCs) in the specimen. Nitrites are usually positive. Some laboratories also examine for leukocyte esterase, which is positive if infection is present in the urine.

Pyelonephritis
Several tests are helpful to differentiate pyelonephritis from cystitis. With kidney infection, the urinalysis will show casts. Casts are microscopic particles formed in the kidney from abnormal constituents in the urine such as WBCs, RBCs, or pus. The presence of casts always indicates a problem in the kidneys. The complete blood cell count (CBC) will show an elevated WBC count.

Collaborative Problems/Potential Complications

William & Hopper

Sepsis
Septicemia may occur from bacteria invading the bloodstream. When septicemia results from a urinary cause is called urosepsis

Renal failure
Repeated kidney infections can result in scarring and loss of kidney function, leading to renal failure.

Nursing ProcessPlanning the Care of the Patient With a UTI

Major goals include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications

Patient Teaching to Prevent Urinary Tract Infection

William & Hopper

1. Void frequentlyat least every 3 hours while awake. 2. Drink up to 3000 mL of fluid a day if there are no fluid restrictions from the physician. Preferably drink water. 3. Drink one glass of cranberry juice (10 ounces) per day. 4. Take showers; avoid tub baths. 5. Wipe perineum from the front to the back after toileting. 6. Urinate after intercourse. 7. Avoid bubble bath and bath salts, perfumed feminine hygiene products, synthetic underwear, and constricting clothing such as tight jeans. 8. Take prescribed medication for UTIs until is it all gone. 9. If UTI is associated with another source of infection such as vaginitis or prostatitis, ensure that both infections are treated.

Interventions

Prevention: avoid indwelling catheters; exercise proper care of catheters Exercise correct personal hygiene

Take medications as prescribed: antibiotics, analgesics, and antispasmodics Apply heat to the perineum to relieve pain and spasm Increase fluid intake Avoid urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol Frequent voiding

Question
Which medication classification is the ideal treatment for urinary tract infection? a. Antifungal b. Antibacterial c. Antihistamine d. Antiviral

Answer
b.

Antibacterial Rationale: The ideal medication for treatment of UTI is an antibacterial agent that eradicates bacteria from the urinary tract with minimal effect on fecal and vaginal flora, thereby minimizing the incidence of vaginal yeast infections.

TERIMA KASIH