Cystitis Nursing Care and Management: Study Guide

Cystitis is inflammation of the urinary bladder, usually from pathogenic microorganisms in the urinary tract. Acute or chronic nonbacterial causes exist and get misdiagnosed as bacterial infection. Normally several mechanisms keep the bladder sterile: the physical barrier of the urethra, urine flow, a competent ureterovesical junction, antibacterial enzymes and antibodies, and the anti-adherent effect of the bladder's mucosal cells. The job is to treat the infection and stop it from coming back.

Pathophysiology

Infection follows a sequence. Bacteria gain access to the bladder, attach to and colonize the urinary tract epithelium to avoid being washed out with voiding, evade host defenses, and then trigger inflammation.

Statistics and Incidences

UTI is the second most common infection in the body. Most cystitis occurs in women, and one in five women in the United States will develop a UTI in her lifetime. About 11.3 million women are diagnosed with UTIs annually. Cystitis is nearly 10 times more common in women than men and affects roughly 10% to 20% of all women at least once. Lower UTI is also a common bacterial disease in children, with girls most often affected.

Causes

Cystitis follows bladder incompetence (failure to empty completely), bladder tumors (obstructed flow causing stasis), and decreased host defenses (immunosuppression). Most lower UTIs come from ascending infection by a single gram-negative enteric organism such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia. The short female urethra raises the incidence in women by letting bacteria from the vagina, perineum, rectum, or a sexual partner reach the bladder.

Clinical Manifestations

Expect burning on urination, frequency (voiding more than every 3 hours), nocturia, dysuria, and possible urethral discharge, especially in males.

Prevention

Maintain hydration with plenty of fluids, mostly water. Urinate promptly with the urge rather than holding it. Wipe front to back after urinating and after bowel movements to keep anal bacteria away from the vagina and urethra. Empty the bladder as soon as possible after intercourse. Avoid deodorant sprays, douches, and powders, which irritate the urethra.

Assessment and Diagnostic Findings

Bacterial colony counts, cellular studies, and urine cultures confirm the diagnosis. Microscopic urinalysis showing red and white blood cells greater than 10 per high-power field suggests UTI. Urine culture documents cystitis and identifies the organism. Cellular studies usually show microscopic hematuria and pyuria. A multiple-test dipstick (leukocyte esterase) checks for WBCs and nitrites. CT may detect pyelonephritis or abscesses. Ultrasonography is highly sensitive for obstruction, abscesses, tumors, and cysts.

Medical Management

Treatment is appropriate antimicrobials for most initial lower UTIs, plus patient education.

Antibiotic therapy. The ideal agent eradicates bacteria with minimal effect on fecal and vaginal flora. A single dose or a 3 to 5 day regimen may be enough to sterilize the urine. Single-dose therapy with amoxicillin or trimethoprim and sulfamethoxazole can work in women with acute uncomplicated UTI. A urine culture 1 to 2 weeks later shows whether the infection cleared.

Nursing Management

Care targets the underlying infection and prevents recurrence.

Assessment. Document and report pain, frequency, urgency, hesitancy, and urine changes. Assess the usual voiding pattern for factors that predispose to UTI. Check urine volume, color, concentration, cloudiness, and odor, all altered by bacteria.

Diagnosis. Nursing diagnoses include acute pain related to urinary tract infection, and deficient knowledge about predisposing factors, recurrence, detection and prevention, and pharmacologic therapy.

Planning and goals: relief of pain and discomfort, increased knowledge of prevention and treatment, and absence of complications.

Interventions. Explain the nature and purpose of antibiotic therapy and stress completing the full course, or adhering strictly to the ordered dose with long-term prophylaxis. Urge plenty of water (at least eight glasses a day) and a consistent intake of 2 L/day. Fruit juices, especially cranberry juice, and oral vitamin C may acidify the urine and enhance the drug's action. Watch for GI upset from antimicrobials, and give nitrofurantoin crystals with milk or a meal to prevent it. Suggest a warm sitz bath for perineal discomfort, or apply heat sparingly to the perineum without burning the patient. Teach the woman to clean the perineum and keep the labia separated during voiding, since an uncontaminated midstream specimen is essential for accurate diagnosis.

Evaluation. The patient reports relief of pain and discomfort, increased knowledge of prevention and treatment, and no complications.

Discharge and Home Care Guidelines

Help the patient prevent and manage recurrent cystitis. Wipe front to back after urinating or a bowel movement and wear cotton underwear. Increase fluids to promote voiding and dilute the urine. Void regularly and empty the bladder completely. Comply strictly with the medication regimen so bacteria do not develop resistance.

Documentation Guidelines

Document the patient's description of and response to pain, the pain inventory, expectations and acceptable level of pain, prior medication use, learning style, identified needs, learning blocks, the plan of care, the teaching plan, responses to interventions and teaching, progress toward outcomes, and modifications to the plan.