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

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 InfectionNursing 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 ManagementPatient / 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