pyielonefritis & cystitis mm

8/13/2019 Pyielonefritis & Cystitis Mm

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Management ofPatients With

Urinary Disorders

Oleh:Wardiyatmi, Skep, Ns

Perawat Muda

RSUD Dr. Moewardi


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Urinary Tract Infections (UTIs)

The second most common reason for seekinghealth care

A common site of nosocomial infection

Lower UTIs Cystitis

Prostatitis

Urethritis

Upper UTIs Pyelonephritis: acute and chronic

Interstitial nephritis

Renal abscess and perirenal abscess


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Factors Contributing to UTI

Function of glycosaminoglycan (GAG)

Urethrovesical reflux

Ureterovesical reflux

Uropathogenic bacteria

Shorter urethra in women


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Urethrovesical Reflux and

Ureterovesical Reflux


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Question

Tell whether the following statement istrue or

false.

The most common way in which bacteriaenter

the urethra is through the bloodstream.


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Answer

False.

Rationale: The most common route of

infection is transurethral, in which bacteriacolonize in the periurethral area and

subsequently enter the bladder by means

of the urethra.


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Bladder Infection With

Long-Term Catherization


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Nursing ProcessAssessment

of the Patient With a UTI

Symptoms include pain and burning uponurination; frequency; nocturia; incontinence;suprapubic, pelvic, or back pain; hematuria; orchange in urine or urinary pattern

About half of patients are asymptomatic

Assess voiding patterns, association of symptomswith sexual intercourse, contraceptive practices,and personal hygiene

Gerontologic considerations

Assess urine, urinalysis, and urine cultures

Other diagnostic tests


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Nursing ProcessDiagnosis of th

Patient With a UTI

Acute pain

Deficient knowledge


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SIGNS AND SYMPTOMS William & Hopper

Cysti t is

Symptoms include Dysuria

Frequency

Urgency Cloudyurine

Pyelonephri t is

Symptoms include urgency, frequency,dysuria, flank

pain, fever, and chills. The urine is cloudy with increased WBCs, bacteria,

casts, RBCs, and positive nitrites


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DIAGNOSTIC TESTS William &Hopper

Cyst i t is

Cystitis infection acquired outside the hospital is diagnosed with a

routine urinalysis collected as a clean-catch midstream specimen.

Changes seen in the urinalysis include cloudy urine and the presence

of WBCs, bacteria, and sometimes red blood cells (RBCs) in the

specimen. Nitrites are usually positive. Some laboratories also examine

for leukocyte esterase, which is positive if infection is present in the

urine.

Pyelonephri t is

Several tests are helpful to differentiate pyelonephritis from cystitis.

With kidney infection, the urinalysis will show casts. Casts are

microscopic particles formed in the kidney from abnormal constituents

in the urine such as WBCs, RBCs, or pus. The presence of casts

always indicates a problem in the kidneys. The complete blood cell

count (CBC) will show an elevated WBC count.


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Collaborative Problems/Potential

Complications William & Hopper

Sepsis Septicemia may occur from bacteria invading the

bloodstream.

When septicemia results from a urinary cause is

called urosepsis

Renal failureRepeated kidney infections can result in scarring and

loss of kidney function, leading to renal failure.


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Nursing ProcessPlanning the

Care of the Patient With a UTI

Major goals include relief of pain and discomfort,

increased knowledge of preventive measures and

treatment modalities, and absence of

complications

P ti t T hi t P t


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Patient Teaching to Prevent

Urinary

Tract Infection William & Hopper1. Void frequentlyat least every 3 hours while awake.2. Drink up to 3000 mL of fluid a day if there are no fluid restrictions

from the physician. Preferably drink water.

3. Drink one glass of cranberry juice (10 ounces) per day.

4. Take showers; avoid tub baths.

5. Wipe perineum from the front to the back after toileting.

6. Urinate after intercourse.

7. Avoid bubble bath and bath salts, perfumed feminine hygiene

products, synthetic underwear, and constricting clothing such astight jeans.

8. Take prescribed medication for UTIs until is it all gone.

9. If UTI is associated with another source of infection such as

vaginitis or prostatitis, ensure that both infections are treated.


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Interventions

Prevention: avoid indwelling catheters; exerciseproper care of catheters

Exercise correct personal hygiene

Take medications as prescribed: antibiotics,

analgesics, and antispasmodics Apply heat to the perineum to relieve pain and

spasm

Increase fluid intake

Avoid urinary tract irritants such as coffee, tea,citrus, spices, cola, and alcohol

Frequent voiding


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Question

Which medication classification is theideal treatment for urinary tract

infection?

a. Antifungalb. Antibacterial

c. Antihistamine

d. Antiviral


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Answer

b. AntibacterialRationale: The ideal medication for

treatment of UTI is an antibacterial

agent that eradicates bacteria from the

urinary tract with minimal effect on fecal

and vaginal flora, thereby minimizing

the incidence of vaginal yeast

infections.


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TERIMA KASIH

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