Lower Urinary Tract Problems A P Review Lower
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 -6 x/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 ♦ 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 ♦ 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
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