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

2. 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

3. 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: 5-6x/day and occasionally at night ♦Volume of urine produced at night is less than half that produced during the day -- ADH

4. 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

5. 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)

6. 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

7. Urinary Tract Infection UTI Diagnosis ♦History and physical exam ♦Urinalysis (UA) ♦Urine for C&S ♦Imaging studies of the urinary tract (IVP, cysto)

8. 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

9. 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 Health Promotion

10. 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

11. 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

12. 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