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Cystitis

Stacy works in a shopping mall as a sale’s associate. She rarely has time to void because their breaks are limited. After six months on the job, she started feeling a burning sensation when she voids. She also voids more frequently than before, especially at night. Stacy also began experiencing difficulty in voiding which prompted her to consult a physician, and she was diagnosed with cystitis.

Description

Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract.
  • Cystitis is the inflammation of the urinary bladder.
  • There can be acute or chronic nonbacterial causes of inflammation that can be misdiagnosed as bacterial infections.
  • Several mechanisms maintain the sterility of the bladder: the physical barrier of the urethra, urine flow, ureterovesical junction competence, various antibacterial enzymes and antibodies, and anti-adherent effects mediated by the mucosal cells of the bladder.

Pathophysiology

The process of infection occurs as such:
  • Entry. For infection to occur, bacteria must gain access to the bladder.
  • Attachment. The bacteria then must attach to and colonize the epithelium of the urinary tract to avoid being washed out with voiding.
  • Evasion. The bacteria evade host defense mechanisms.
  • Inflammation. After the bacteria has evaded the defense mechanism of the body, inflammation now starts to set in.

Statistics and Incidences

A urinary tract infection is the second most common infection in the body.
  • Most cases of cystitis occur in women; one out of every five women in the United States will develop a UTI during her lifetime.
  • Approximately 11.3 million women are diagnosed with UTIs in the United States annually.
  • Cystitis is nearly ten times more common in women than in men and affects about ten percent to twenty percent of all women at least once.
  • Lower UTI is also a prevalent bacterial disease in children, with girls again most commonly affected.

Causes

Cystitis usually occurs due to:
  • Bladder incompetence. The inability to empty the bladder completely could lead to infection.
  • Bladder tumors. Urine flow is obstructed by the tumor, causing urinary stasis.
  • Decreased natural host defenses. Immunosuppression and a weak immune system could predispose the patient to infection.
  • Ascending infection. More lower UTIs result from ascending infection by a single, gram-negative, enteric bacterium such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia.
  • Shortness of the female urethra. The high incidence of lower UTI among women may result from the shortness of the female urethra, which predisposes women to infection caused by bacteria from the vagina, perineum, rectum, or a sexual partner.

Clinical Manifestations

A variety of signs and symptoms are associated with cystitis.
  • Burning. A sensation of burning upon urination is felt.
  • Frequency. The patient experiences voiding more than every three (3) hours.
  • Nocturia. The patient experiences awakening at night to urinate.
  • Dysuria. There is difficulty in urinating.
  • Urethral discharge. The presence of discharge is also possible, especially in males.

Prevention

Following a few, simple steps can help reduce the risk of acquiring urinary tract infection.
  • Maintain hydration. Suggest drinking plenty of fluids, especially water.
  • Urinate promptly. Tell the patient to urinate promptly whenever the urge arises; urination shouldn’t be restricted for a long time after the urge to void is felt.
  • Maintain hygiene. Wiping from front to back after urinating and after bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Sexual hygiene. After intercourse, the bladder should be emptied as soon as possible.
  • Avoid irritation. Use of deodorant sprays and other feminine products, such as douches and powders, should be avoided because that may irritate the urethra.

Assessment and Diagnostic Findings

Results of various tests, such as bacterial colony counts, cellular studies, and urine cultures, help confirm the diagnosis of cystitis.
  • Microscopic urinalysis. Microscopic urinalysis shows red blood cells and white blood cells greater than ten/high-power field suggesting UTI.
  • Urine culture. Urine cultures are useful for documenting cystitis and identifying the specific organism present.
  • Cellular studies. A patient with cystitis usually has microscopic hematuria and pyuria.
  • Leukocyte esterase test. A multiple-test dipstick often includes testing for WBCs and nitrite testing.
  • CT scan. A CT scan may detect pyelonephritis or abscesses.
  • Ultrasonography. Ultrasonography is extremely sensitive for detecting an obstruction, abscesses, tumors, and cysts.

Medical Management

Management of cystitis typical involves pharmacologic therapy and patient education.

Pharmacologic Therapy

Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. Antibiotic Therapy
  • Few side effects. The ideal medication for treatment is an antibacterial agent that eradicates bacteria with minimal effects on fecal and vaginal flora.
  • The length of treatment. Recent studies suggest that a single dose of antibiotic or an antibiotic regimen of 3 to 5 days length may be sufficient to render the urine sterile.
  • Drug of choice. Single-dose antibiotic therapy with amoxicillin or trimethoprim and sulfamethoxazole may be effective in females with acute noncomplicated UTI.
  • Urine culture. A urine culture taken 1 to 2 weeks later indicates whether or not the infection has been eradicated.

Nursing Management

Nursing care of patient with cystitis focuses on treating the underlying infection and preventing its recurrence.

Nursing Assessment

The following are assessed in a patient with cystitis:
  • Manifestations. The presence of pain, frequency, urgency, hesitancy, and changes in the urine are assessed, documented, and reported.
  • Pattern of voiding. The patient’s usual pattern of voiding is assessed to detect factors that may predispose him or her to UTI.
  • Characteristics of urine. The urine is assessed for volume, color, concentration, cloudiness, and odor, all of which are altered by bacteria in the urinary tract.

Nursing Diagnosis

Based on the assessment data, the nursing diagnoses may include the following:
  • Acute pain related to infection within the urinary tract.
  • Deficient knowledge about factors predisposing the patient to infection and recurrence, detection and prevention of recurrence, and pharmacologic therapy.

Nursing Care Planning & Goals

Major goals for the patient may include:
  • Relief of pain and discomfort.
  • Increased knowledge of preventive measures and treatment modalities.
  • Absence of complications.

Nursing Interventions

The care plan should include religious patient teaching, supportive measures, and proper specimen collection.
  • Education. Explain the nature and purpose of the antibiotic therapy and emphasize the importance of completing the prescribed course of therapy or, with long-term prophylaxis adhering strictly ti the ordered dosage.
  • Increase fluid intake. Urge the patient to drink plenty of water (at least eight glasses a day) and stress the need to maintain a consistent fluid intake of 2L/day.
  • Prescribed juices. Fruit juices, especially cranberry juice, and oral doses of vitamin C may help acidify the urine and enhance the action of the medication.
  • GI disturbance. Watch for GI disturbances from antimicrobial therapy, and administer nitrofurantoin crystals with milk or a meal to prevent such distress.
  • Relieve pain. Suggest a warm sitz bath for relief of perineal discomfort, or apply heat sparingly to the perineum but be careful not to burn the patient.
  • A collection of specimen. Teach the woman to clean the perineum properly and keep the labia separated during voiding because a non contaminated midstream specimen is essential for accurate diagnosis.

Evaluation

Expected patient outcomes include:
  • Relief of pain and discomfort.
  • Increased knowledge of preventive measures and treatment modalities.
  • Complications are absent.

Discharge and Home Care Guidelines

The nurse should help the patient learn about and prevent or manage recurrent cystitis.
  • Personal hygiene. The patient should be informed to wipe from front to back after urination or bowel movement, and also to wear cotton underwear.
  • Increase fluids. The patient should increase fluid intake to promote voiding and dilution of the urine.
  • Patterns of voiding. Voiding regularly and emptying the bladder completely would avoid recurrent infection.
  • Compliance. Strict compliance with the medication regimen ensures non resistance of bacteria from the drug.

Documentation Guidelines

The focus of documentation in a patient with cystitis include:
  • Client’s description of the response to pain.
  • Specifics of pain inventory.
  • Expectations of pain management.
  • Acceptable level of pain.
  • Prior medication use.
  • Learning style.
  • Identified needs.
  • Presence of learning blocks.
  • Plan of care
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.

Practice Quiz: Cystitis

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Practice Quiz: Cystitis

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1. A sign of possible UTI is: A. A negative urine culture. B. An output of 200 to 900 ml with each voiding. C. Cloudy urine. D. Urine with specific gravity of 1.005 to 1.022. 2. You are tasked to provide health information for a female patient diagnosed with cystitis. You know that this includes all of the following except:  A. Cleanse around the perineum and urethral meatus (from front to back) after each bowel movement. B. Drink liberal amounts of fluid. C. Shower rather than bathe in a tub. D. Void no more frequently than every 6 hours to allow urine to dilute the bacteria in the bladder. 3. You have a patient that might have cystitis. Which statement by the patient suggests that a cystitis is likely? A. “I pee a lot.” B. “It burns when I pee.” C. “I go hours without the urge to pee.” D. “My pee smells sweet.” 4. Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium)? A. If the urine turns orange-red, call the doctor. B. Take phenazopyridine just before urination to relieve pain. C. Once painful urination is relieved, discontinue prescribed antibiotics. D. After painful urination is relieved, stop taking phenazopyridine. 5. You are planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? A. “Your urine might turn bright orange.” B. “You need to take this antibiotic for seven days.” C. “Take this drug between meals and at bedtime.” D. “Don’t take this drug if you are allergic to penicillin.” Answers and Rationale
1. Answer: C. Cloudy urine.
  • C: A cloudy urine is indicative of infection.
  • A: A negative urine culture means no bacteria are found in the specimen.
  • B & D: An output of 200 to 900 ml with each voiding and a urine specific gravity of 1.005 to 1.022 are normal values of the characteristics of urine.
2. Answer: D. Void no more frequently than every 6 hours to allow urine to dilute the bacteria in the bladder.
  • D: The patient should be instructed to void no more frequently than every 3 hours to avoid stasis of urine and accumulation of bacteria.
  • A, B, C: These interventions prevent the recurrence of cystitis.
3. Answer: B. “It burns when I pee.”
  • B: Burning upon urination is a sign of cystitis.
  • A: Voiding frequently could help flush out the bacteria.
  • C: Not being able to void for hours could predispose the patient to cystitis.
  • D: Sweet-smelling urine could be attributed to diabetes.
4. Answer: B. Take phenazopyridine just before urination to relieve pain.
  • B: Phenazopyridine is taken before urination to relieve the pain.
  • A: A red-orange colored urine is normal in a patient with taking phenazopyridine.
  • C: Discontinuing antibiotics without medical supervision could cause antimicrobial resistance.
  • D: Discontinuing phenazopyridine without proper medical supervision could result in complications and side effects.
5. Answer: A. “Your urine might turn bright orange.”
  • A: The drug turns the urine orange. It may be prescribed for longer than seven days and is usually ordered three times a day after meals.
  • B: Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.
  • C: Phenazopyridine is taken before urination to relieve burning sensation.
  • D: Phenazopyridine is not an antibiotic like penicillin.

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