Question

1. A female patient has developed her third urinary tract infection (UTI) in the past 4 months. Which common organisms cause UTIs? What assessments should be made? Discuss appropriate nursing actions during the treatment of the current UTI and measures to be instituted to prevent another episode.

2. Identify premedication assessments and actions associated with antimicrobial agents used to treat disorders of the urinary system and drugs used in the treatment of overactive bladder syndrome.

3. A patient undergoing fluoroquinolone therapy is complains of mild headaches and dizziness and wishes to stop therapy. How do you respond?

4. Describe the patient education that you would use to help prevent incontinence.

5. What are the nutritional history questions that you should ask a patient with a urinary system disease?

Answer 1

Urinary tract infection ( UTI)

Urinary tract infection is an infection that affects the part of urinary tract from lower urinary tract to upper urinary tract.

1. Organisms that cause UTI

The main causative agent of UTI is the bacterium Escherichia coli. Some time other bacterias and rarely virus or fungi cause it.

A previous episode, sexual intercourse, female, Diabetes and obesity are the risk factors for UTI.

Assessment

* Assess the urinary elimination pattern of the patient

* Assess for signs and symptoms of urinary tract infection( fever, chills, burning on urination)

* Assess for risk factors like history of previous UTI or STD( sexually transmitted diseases) , surgery on urinary tract or catheterization.

* Assess the nature of pain

Nursing Actions

* Encourage fluid intake( 2-3 litres/ day), if not contraindicated.

* Instruct to avoid alcohol and sodas and other caffeinated beverages.

* Encourage the client to complete the course of antibiotic therapy, if the symptoms reduce also .

* Instruct the importance of Personal hygiene including perineal hygiene( clean from front to back) and the frequent emptying of bladder.

2. Premedication assessments

* Assess for the pattern of urinary elimination

* Obtain urine sample. assess for colour and odour

* Laboratory testing of urine sample for the presence of blood, epithelial cells, pus cells, microbes

Drugs for UTI: Antibiotics such as

Cephalexin

Ceftriaxone

Trimethoprim

Sulfamethaxazole

Drugs used in bladder overactive syndrome

Overactive bladder syndrome is a group of urinary symptoms such as incontinence, nocturia and urinary urgency and frequency. Drugs that used for this syndrome are;

Anticholinergic medications ( acetylcholine is the neurotransmitter that stimulate the contraction of bladder, Anticholinergic drugs will inhibit acetylcholine) such as

Tolterodine( Detrol)

Solifenacin

Oxybutynin( Ditropan)

Mirabergon ( beta 3 adrenergic agonist)

Flavoxate( antispasmodics)

Desipramine ( one of the antidepressants to relax bladder)

3. Fluoroquinolone

Floroquinolone is an antibiotic with mild sideeffects.

A nurse can respond that Floroquinolone is a safe antibiotic with mild side effects such as headaches, nausea and dizziness. But the symptoms are persisting it can be reported to Physician and also inform about patient's unwillingness to continue it. Physician can change the antibiotic according to the condition of patient.

4. Preventing incontinence: educate and encourage patient to:

* Go for the urination only when bladder is full

* completely void the urine. take the time

* Healthy eating( avoid alcohol,sodas and other caffeinated beverages), drinking adequate fluids can help to prevent bladder irritation

* Maintain a healthy body weight and be physically active

* avoid smoking