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

2. Bladder Hollow,distensible, muscular organ Reservoir for urine
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 – Muscular layer-detrusor muscle
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 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