Urinary Tract Infections (UTI) Prevention and Types

Lower Urinary Tract Infections (UTIs)

• Cystitis: inflammation of the urinary bladder, causes include urologic invasive procedures, fecal contamination, prostatitis or BPH, pregnancy, and sexual intercourse
• Urethritis: inflammation of the urethra, causes include sexual transmission, Trichomonas, and Gonococcal infection

Assessment Findings

• Cystitis: urgency, frequency, low back pain, discomfort during urination, hematuria, and fever
• Urethritis: fever, chills, and discomfort during urination

Medical Management

• Cystitis: antimicrobial therapy, cranberry juice, and vitamin C to prevent bacteria from adhering to the bladder wall
• Urethritis: antibiotic therapy, increased fluid intake, and analgesics

Nursing Management

• Cystitis: instruct client on preventive measures, void at regular intervals, and practice good hygiene
• Urethritis: preventive measures, sterile/gentle technique with catheterization, and frequent perineal care

Upper UTIs - Pyelonephritis

• Acute: kidneys inflamed and enlarged, flank pain, colicky abdominal discomfort, N/V, chills, and fever
• Chronic: asymptomatic or low-grade fever, vague GI complaints, increased BP, and fatigue

Medical-Surgical Management: Pyelonephritis

• Acute: adequate fluid intake, antibiotics, antispasmodics, and anticholinergics
• Chronic: aim to prevent further kidney damage, surgery (nephrectomy) if severe hypertension develops

Interstitial Cystitis

• Chronic, painful inflammatory disease of the bladder wall, causing disintegration of the lining and loss of bladder elasticity
• Believed to be associated with an autoimmune or allergic response
• Clinical manifestations: pain, UTIs, and pain relief with urination

Urinary Incontinence

• Uncontrolled loss of urine, sufficient to be a problem
• Causes: delirium, infection, pharmacologic, psychological, excessive urine production, restricted activity, and stool impaction
• Affects 15-50% of the elderly

Types of Urinary Incontinence

• Stress incontinence: loss of urine when the force of pressure exceeds the support provided by the ligament and pelvic floor
• Urge incontinence: loss of urine resulting from an uninhibited detrusor contraction
• Overflow incontinence: loss of urine resulting from the lack of sensation
• Reflex incontinence: loss of urine resulting from the lack of sensation
• Reduced urethral function: loss of urine when the intravesicular pressure exceeds the maximal urethral pressure
• Functional incontinence: loss of urine when the lower urinary tract is intact but other factors cause the loss
• Iatrogenic incontinence: loss of urine related to medical factors

Management of Urinary Incontinence

• Medical: behavioral therapy, fluid management, standardized voiding frequency, pelvic muscle exercise, and surgery
• Nursing: support and encouragement, medication education, and pre- and post-op care

Urinary Retention

• Inability to urinate or effectively empty the bladder
• Acute: usually cannot void at all, seen with complete urethral obstruction, post-general anesthetic, epidural anesthetic, post-gyne/bladder surgery, childbirth, or certain medications
• Chronic: cannot completely empty the bladder, seen with enlarged prostate or neurologic disorders

Assessment Findings

• Acute: sudden inability to void, distended bladder, lower abdominal pain, and discomfort
• Chronic: may go unnoticed, void frequently in small amounts, or experience dribbling

Medical-Surgical Management: Urinary Retention

• Acute: immediate catheterization, intermittent or indwelling catheter
• Chronic: permanent drainage with a urethral catheter or suprapubic cystostomy, clean intermittent catheterization (CIC), or Crede voiding

Nursing Care: Urinary Retention

• Acute: conscious client will verbalize discomfort, monitor voiding pattern, and collaborate with physician regarding catheterization
• Chronic: assessment, intermittent catheterization, encourage fluid intake, and emotional support/teaching

Acute Renal Failure

• Complex disorder with many etiological factors and variant clinical manifestations
• Develops as a consequence of prerenal, intrarenal, or postrenal disorders
• Rapid accumulation of toxic wastes occurs, leading to azotemia and increased serum urea (BUN) and creatinine (CR) levels

Progression of Acute Renal Failure

• Initiation: S&S appear within hours or days
• Maintenance: oliguric-anuric phase, accompanied by a reduced blood flow to the kidney
• Recovery: return of normal renal function, increased glomerular filtration rate, and stabilizing or decreasing of BUN and CR levels