CYSTITIS (LOWER URINARY TRACT INFECTION)
Cystitis is an inflammation of the urinary bladder.
Causes
1. Ascending infection from the urethra.
2. Urine flowing back from the urethra into bladder (urethrovesical reflux)
3. Faecal contamination [Organism from rectal / vaginal discharge after readily] Instrumentation e.g. Catheter or cystoscope.
Predisposing factors - Use of indwelling catheters, trauma of the tissues, stagnation of the urine and distortion or compression of the bladder by an enlarged neighbouring organ [Pregnant Woman in the last trimester; the enlarging uterus compresses the bladder] (sexual intercourse and the type of contraception particularly diaphragm use)
Incidence: More common in women.
Clinical manifestation
Frequency urgency dysuria and abnormal urine constituents, nocturia and a bearing - down sensation in the region of the bladder and suprapubic area.
Pathophysiology
Inflammation is generally confined to the mucosa and submucosa which are hyperaemic and edematous. Scattered hemorrhagic areas are present, a small ulcerative lesions may develop as a result of sloughing of the living tissue of the bladder.
If there is chronic UTI
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Inflammation extends into the detrusor muscle.
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Persisting inflammation
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fibrosis of the tissues
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reduces the bladder capacity and increases the frequency.
Medical Management
1. Administration of antibiotics or urinary antiseptic e.g. Co-trimoxazole or amoxycillin.
2. Administration of sodium bicarbonate/sodium citrate for the purpose of making the urine alkaline to decrease bladder irritation and dysuria.
3. Warm baths reduce bladder spasm and provide considerable relief.
4. Encourage to drink liberal amounts of fluids which should include citrus fruit juices. if
5. If UTI persists, investigate for a 1ª condition pyelonephritis a bladder calculus, urethral stricture and in case of males an enlarged prostate.
6. Good personal hygiene of efficient cleansing of the perineum especially after defecation.
Diagnostic Evaluation
Urine specimen is usually obtained for smears and culture [so that the appropriate drug may be selected].
Nursing Management
1. Administer antimicrobial agents as prescribed.
2. Administer antispasmodic drugs as prescribed. (Antispasmodics relieve bladder irritability and pain].
3. Provide hot tub baths to relieve urgency, discomfort and spasm.
4. Encourage the patient to drink liberal amounts of fluid to promote renal blood flow and to flush the bacteria from the urinary tract.
5. Avoid fluids that irritate the bladder. E.g. Coffee, tea, colas.
6. Encourage frequent voiding (every 2-3 hrs) to empty the bladder completely since this can lower urine bacterial counts, reduce urinary stasis and prevent reinfection.
Patient Education
1. Advise women to shower rather than bathe in tub, since bacteria in the bath water may enter the urethra.
2. To clean around the perineum and urethral meatus (cleansing from front to the back) after each bowel movement.
3. To drink liberal amounts of fluids during the day.
4. To void every 2-3 hrs during the day and completely empty the bladder, [This prevents over distention of the bladder and compromised blood supply to the bladder wall which predisposes the patient to to UTI.]
5. If sexual intercourse is the initiating event
a. Void immediately after sexual intercourse.
b. Take the prescribed single dose of an oral antimicrobial agent following sexual intercourse.
6. If bacteria continue to appear in the urine, long term antimicrobial therapy may be required to prevent colonization of the periurethral area and recurrence of infection. The drug should be taken after emptying the bladder just before going to bed to ensure adequate concentration of the drug during the over night period.
7. If prescribed, monitor and test the urine for bacteria with dip slides (microstix) as follows:
a. Wash around the urethral meatus several times, using different wash cloths.
b. Collect a midstream specimen.
c. Remove a slide from its container, dip it into the urine sample, and return it to the container.
d. Incubate the slide at room temperature according to product directions.
e. Read the results by comparing the slide with the colony density chart that comes with the product.
8. See health care provider regularly for follow up recurrence of symptoms, infections non-responsive to treatment, or further involvement of the urinary tract.]
