Cystitis

Cystitis

CYSTITIS

Cystitis is a lower lower urinary infection involving inflammation of the urinary bladder.

Acute bacterial cystitis is common in women as the short urethra predisposes them to infection of the bladder.

Causes of Cystitis

  • Cystitis also arises when there is an obstruction to urine flow, disease inside the urinary bladder duct such as stones and tumor. 
  • Bladder incompetence. The inability to empty the bladder completely could lead to infection.
  • Bladder tumors. Urine flow is obstructed by the tumor, causing urinary stasis.
  • Prostrate enlargement, paraplegic patients with loss of bladder control suffer from cystitis due to prolonged and repeated catheterization.
    Other diseases like gonorrhea, tuberculosis may cause cystitis.
  • Ascending infections. More lower UTIs result from ascending infection by a single, gram-negative, enteric bacterium such as Escherichia coliKlebsiella, Proteus, Enterobacter, Pseudomonas, and Serratia.
  • Decreased natural host defenses. Immunosuppression and a weak immune system could predispose the patient to infection
  • > Klebsiella aerogenosa
    > Proteus mirabilis
    > E-coli and E. faecalis contributes to 80% of all cases
    > Streptococcus faecalis
    > Chlamydia
    > Neisseria gonorrhoea
    > Mycobacterium

Common Clinical Presentation of cystitis

  • Dysuria (painful urination)
  • Nocturia. The patient experiences awakening at night to urinate.
  • Urethral discharge. The presence of discharge is also possible, especially in males.
  • Frequency and urgency of urination
  • Pyuria (making urine cloudy)/WBCs
  • Fever
  • Haematuria
  • Tenderness on the suprapubic region (lower abdominal pain burning in nature)
  • Foul smelling urine
  • Nausea and vomiting
  • Fatigue and anorexia
  • Bacteriuria

Investigation of cystitis

  • Urinalysis of the midstream urine to rule out proteins, pus, infecting organism (microscopy  confirms the organisms)
  • Blood for urea and creatine
  • Cystoscopy/ intravenous pyelography
  • A CT scan may detect pyelonephritis or abscesses.
  •  Ultrasonography is extremely sensitive for detecting an obstruction, abscesses, tumors, and cysts.
  • Cellular studies. A patient with cystitis usually has microscopic hematuria and pyuria.
  • Leukocyte esterase test. A multiple-test dipstick often includes testing for WBCs.

Management of Cystitis

  1.  Appropriate antibiotics after urine culture and sensitivity for 7 days to 10 days
  2. Ciprofloxacin 250mg to 500mg bd
  3. Nitrofurantoin 100mg 8 hourly for 5 days or
  4. Cotrimoxazole 960 to 480mg 12 hourly
  5. Ampicillin or gentamycin
  6. Relieve pain with analgesics
  7. Give plenty of fluids to flush the bladder and reduce irritation of the bladder
  8. Examine urine periodically
  9. Avoid bladder irritants like coffee, alcohol, citrus juice, chocolate, beverages and highly spiced foods
  10.  Health educate the patient on preventive interventions of UTIs and treatment adherence
  11. Adequate rest promotes healing
  12. Use condom/abstain from sex during treatment
  13.  Improve perianal hygiene and avoid sharing bathing basins and towels

Prevention or Patient advice

  • Maintain hydration. Suggest drinking plenty of fluids, i.e. water(8litres a day)
  • Urinate promptly. Tell the patient to urinate promptly whenever the urge arises.
  • Maintain hygiene. Wiping from front to back after urinating and after bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Sexual hygiene. After intercourse, the bladder should be emptied as soon as possible.
  • Avoid irritation. Use of deodorant sprays and other feminine products, such as douches and powders, should be avoided because that may irritate the urethra.
  • Compliance. Strict compliance with the medication regimen ensures non resistance of bacteria from the drug

Nursing Care Management

Nursing DiagnosisPlanningGoal/OutcomeInterventionEvaluation
Acute pain related to infection within the urinary tract.Relieve pain and discomfort within 2 hoursRelief of pain and discomfort.- Suggest a warm sit bath for relief of perineal discomfort -Administer prescribed analgesics Patient was relieved of pain and was comfortable within 2 hours.
Deficient knowledge related factors predisposing the patient to infection and recurrence, characterized by patient asking a lot of questions.Increase knowledge of the patient about preventive measures and the treatment modalities. Increased knowledge of preventive measures and treatment modalities. -Education about nature & purpose of the treatment and emphasize the importance of drug compliance. Patient understood uses of drug compliance and preventive measures.

URETHRITIS

Urethritis is the inflammation of the urethra.

It co-exists with cystitis, which makes it harder to diagnose. 

Causes of Urethritis

  • Trichomonas and monilial infection are causes of urethritis in women.
  • In men urethritis is commonly caused by Chlamydia and gonorrhea
  • Other bacterial infection like in cystitis
  • Viral organisms like herpes.
  • Non infective urethritis is due to chemicals like deodorants spray and drugs.

Signs and symptoms of Urethritis

(a) Urethral discharge is cardinal in the diagnosis
(b) Pain in urination and urethral itching.
(c) Other signs as in cystitis

Investigations

  1. Urine culture to isolate organisms
  2. As in cystitis

Management of Urethritis

  1.  Give doxycycline 100mg 12 hourly to treat chlamydia infection
  2. Trichomonas is treated with metronidazole 200 – 400mg 8 hourly for 7 days
  3.  Moniliasis infection is treated with nystatin or fluconazole
  4.  Treat pain with analgesics
  5.  Ciprofloxacin 250mg to 500mg
  6. Nitrofurantoin 100mg 8 hourly for 5 days or
  7. Cotrimoxazole 960 to 480mg 12 hourly
  8. Hot sit bath gives relief to women
  9. Improve perianal hygiene
  10. Stop using deodorants and chemicals causing urethritis
  11. Stop intercourse during treatment
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