Lower Urinary Tract Problems A & P Review Lower urinary tract infections Bladder Disease

Bladder Hollow,distensible, muscular organ Reservoir for urine 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 – Muscular layer-detrusor muscle 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: 5-6x/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