Cystitis Nursing Care Plan & Management

 Definititon

Cystitis is an inflammation of the bladder wall, which may be acute or chronic. It is generally accepted to be an ascending infection, with entry of the pathogen via the urethral opening. Noninfectious cystitis is referred to as interstitial cystitis (IC), but this is a poorly understood disorder with an uncertain cause. In this condition, in spite of symptoms of cystitis, the urine is sterile.

The person develops a decreased bladder capacity, possibly because of healing of bladder ulcers (called Hunner’s ulcer) that leave behind scar tissue. If IC is associated with chemical agents that lead to bleeding, it is termed hemorrhagic cystitis; otherwise, IC may also be termed painful bladder disease (PBD).

Although cystitis occurs in both men and women, the incidence in women is significantly higher. Sexually active women have 50 times more cystitis than men in general. Females are more susceptible to cystitis because of their short urethra, which is 1 to 2 inches long, as contrasted with the male urethra, which is 7 to 8 inches in length. The placement of the female urethra, which is closer to the anus than is the male urethra, increases the risk of infection from bacteria in the stool.

Causes

The most common pathogen that leads to bladder infection is Escherichia coli, which accounts for about 80% of cases of cystitis. Predisposing factors are urethral damage from childbirth,catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and, in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides). No one is certain about the frequency of viral and herpetic cystitis because culture results are sometimes negative even when the patient has the condition. A large number of people probably have asymptomatic infections initially with herpes simplex viruses, so the incidence of herpetic cystitis may be higher than culture-positive results indicate. Hemorrhagic cystitis may also occur owing to adenoviral infections, particularly in people who are immunocompromised, such as patients with bone marrow transplantation or acquired immunodeficiency syndrome (AIDS).

The cause of IC is unknown but has been linked to chemical agents such as some medications (cyclophosphamide) and radiation therapy. Some experts suggest that PBD is an autoimmune response.

Gender, Ethnic/Racial and Life Span Considerations

Cystitis is uncommon in young children and teenagers. Pregnancy increases the risk of infection because of hormonal changes in women and because the enlarging uterus restricts the flow of urine and creates urinary stasis and bacteria proliferation. Men, on the other hand, secrete prostatic fluid that serves as an antibacterial defense. As men age past 50, however, the prostate gland enlarges, which increases the risk for urinary retention and infection. As women age, vaginal flora and lubrication change; decreased lubrication increases the risk of urethral irritation in women during intercourse. By age 70, prevalence is similar for men and women.

IC occurs primarily in women, and is more common in Jewish women. Prevalence is higher among U.S. women than those in Europe and Japan. Although at one time IC was considered a disease of menopause, experts note that it is most common in middle-aged rather than older women.

Clinical Manifestations
  • Urgency, frequency, burning, and pain on urination.
  • Nocturia, incontinence, and back, suprapubic, or pelvic pain.
  • Hematuria.
Assessment and Diagnostic Methods
  • Urine cultures, colony counts, cellular studies
  • Leukocyte esterase test and nitrite testing
  • Tests for sexually transmitted diseases (STDs)
  • CT scans and transrectal ultrasonography; cystourethroscopy may be indicated to visualize the ureters or to detect strictures, calculi, or tumors
Diagnosis
PRIMARY NURSING DIAGNOSIS
  • Altered urinary elimination related to irritation of bladder mucosa

OUTCOMES. Urinary elimination; Knowledge: Medication, Symptom control
INTERVENTIONS. Medication prescribing; Urinary elimination management

Other Nursing Diagnoses
  • Acute pain related to infection within the urinary tract
  • Deficient knowledge related to factors predisposing to infection and recurrence, detection and prevention of recurrence, and pharmacologic therapy
Potential Complications
  • Sepsis
  • Renal failure, which may occur as the long-term result of either an extensive infective or inflammatory process
Planning and Goals
  • Goals of the patient may include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications.
Medical Management
  • Management of UTIs typically involves pharmacologic therapy and patient education. The nurse teaches the patient about prescribed medication regimens and infection prevention measures.
Acute Pharmacologic Therapy
  • Ideal treatment is an antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora.
  • Medications may include Cephalexin (Keflex), Cotrimoxazole (TMPSMZ, Bactrim Septra), Nitrofurantoin (Macrodantin Furadantin), ciprofloxacin (Cipro), levofloxacin (Levaquin), and Phenazopyridine (Pyridium).
  • Occasionally, ampicillin or amoxicillin (but Escherichia coli has developed resistance to these agents).
Long Term Pharmacologic Therapy
  • About 20% of women treated for uncomplicated UTIs experience a recurrence.
  • Recurrence in men is usually due to persistence of the same organism; further evaluation and treatment are indicated.
  • Reinfection of women with new bacteria is more common than persistence of the initial bacteria.
  • If diagnostic evaluation reveals no structural abnormalities, patient may be instructed to begin treatment on own, testing urine with a dipstick whenever symptoms occur, and to contact health care provider only with persistence of symptoms, at the occurrence of fever, or if the number of treatment episodes exceeds four in a 6month period.
  • Long term use of antimicrobial agents decreases risk of reinfection.