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1 Chapter 48
Urinary Disorders
2 Urinary Tract Infections
Cystitis
Lower urinary tract infection
Frequently in females → shorter urethra
E. coli, Staphylococcus, Klebsiella, Proteus, Pseudomonas
Symptoms
• Pain and burning on urination, frequency, urgency
3 Urinary Tract Infections (Cont.)
Pyelonephritis
Upper urinary tract infection
Usually female patients
Most common organism involved, E. Coli
Symptoms
• Chills, high fever, flank pain
• Painful urination, frequency, urgency, pyuria
4 Urinary Antiseptics/Antiinfectives
and Antibiotics

minds (
Nitrofurantoin
Methenamine
Trimethoprim-sulfamethoxazole
Fluoroquinolones

5 Urinary Antiseptics/Antiinfectives and Antibiotics (Cont.)

Nitrofurantoin
Bacteriostatic or bactericidal
Depending on the drug dosage
Effective against many gram-positive and gram-negative organisms, especially E. coli.
Side effects/adverse reactions
Anorexia, nausea, vomiting, abdominal pain, diarrhea
Clostridium difficile–associated diarrhea
Peripheral neuropathy, brown urine discoloration → wear panty liner
6 Nursing Process: Nitrofurantoin
Assessment
Assess the patient for evidence of UTI.
Monitor urine culture and sensitivity results. → Before starting meat
Nursing diagnoses
Pain, acute related to inflammation in the urinary tract
Infection, risk for
Planning

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The patient will be free of signs and symptoms of UTI within 10 days.

7 Nursing Process: Nitrofurantoin (Cont.)

Nursing interventions
Monitor urinary output and urine specific gravity.
Obtain urine culture to identify infecting organism before initiation of drug therapy to
treat UTI.
Advise patient to avoid antacids as they interfere with absorption.
Inform patient to increase fluids and take the drug with food to minimize GI upset.
Evaluation
8 Urinary Antiseptics/Antiinfectives and Antibiotics
Methenamine
Bactericidal when urine is acidic
• Urine pH less than 5.5
Use
• Chronic UTIs
• Effective for E. coli and P. aeruginosa
Side effects/adverse reactions
• Nausea, vomiting, crystalluria, elevated hepatic enzymes
Considerations
• Avoid taking with sulfonamides
& • Consume acidic foods and fluidsp
-

9 Urinary Antiseptics/Antiinfectives and Antibiotics (Cont.)

Trimethoprim and trimethoprim sulfamethoxazole
Use
• Acute and chronic UTIs
Side effects/adverse reactions
• Headache, dizziness, nervousness, insomnia
• Photosensitivity, GI distress, crystalluria
• Clostridium difficile–associated diarrhea
• Elevated hepatic enzymes, seizures
• Hyperkalemia, torsades de pointes

10 Urinary Antiseptics/Antiinfectives and Antibiotics (Cont.)

Fluoroquinolones
Use
• Treats lower UTIs
Side effects/adverse reactions
• Headache, dizziness
• Photosensitivity, visual impairment
• Peripheral neuropathy, GI distress
• Tendinitis, tendon rupture, seizures
• Clostridium difficile–associated diarrhea

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due to
as last meal option
Muse side Effects
Caution
• Use in uncomplicated UTI only if no other treatment options are available
11 Urinary Analgesics
Phenazopyridine
Peridium IANS
Action
• Relieve pain, burning sensation, frequency, urgency
only use for 2

Side effects/adverse reactions

• GI distress
days
• Red-orange urine
• Hemolytic anemia
• Nephrotoxicity, hepatotoxicity
12 Urinary Stimulants
Bethanechol
Action
• Increase bladder tone of detrusor muscle
Use also use in parafoil sin
Neurogenic bladder, urinary retention
Side effects/adverse reactions
• GI distress, headache, dizziness
• Nephrotoxicity, hepatotoxicity
Contraindication
of stomach
• Peptic ulcer - irritates lining
13 Urinary Antispasmodics
Oxybutynin
Action
• Direct action on smooth muscles to relieve spasms
Long
-

term
Side effects/adverse reactions
• Drowsiness, dizziness
• Blurred vision, tachycardia
• Dry mouth, GI distress, constipation
Contraindication
• Avoid in glaucoma, GI, or urinary obstruction
14 Urinary Antispasmodics/Antimuscarinics
Tolterodine tartrate
Use
• Control an overactive bladder
• Decrease urge and urinary incontinence
Side effects/adverse reactions
• Headache, dizziness, confusion
• Blurred vision, dysphonia
• Peripheral edema, elevated hepatic enzymes

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• Dry mouth, diarrhea, constipation, abdominal pain

Contraindications
• Narrow-angle glaucoma
• Hepatic impairment

15 Practice Question #1
A patient entering the medical clinic has been diagnosed with an overactive bladder. Which
medication would the nurse expect to be ordered?

A. Ciprofloxacin
B. Oxybutynin
C. Bethanechol
D. Tolterodine tartrate
16 Practice Question #2
Patients taking methenamine for urinary tract infections are counseled to drink cranberry juice
in order to

A. ensure a brisk urine flow.

B. increase the alkalinity of the urine.
C. decrease urinary retention.
D. lower the pH of the urine.
17 Practice Question #3
A patient with an urinary tract infection is complaining of pain with urination. The nurse would
anticipate the patient’s receiving
•
A. norfloxacin.
B. ciprofloxacin.
C. methenamine mandelate.
D. phenazopyridine.
18 Practice Question #4
Which medication is indicated in the treatment of hypotonic or atonic bladder?
•
A. Bethanechol
B. Oxybutynin
C. Tolterodine
D. Solifenacin
19 Practice Question #5
A female patient has been diagnosed with a lower urinary tract infection caused by E. coli. The
patient has been prescribed nitrofurantoin. Which information will the nurse include when
teaching the patient about nitrofurantoin therapy?

A. Take the medication with an antacid.

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B. Tell the patient to inform the health care provider immediately if her urine turns brown.
C. Warn patient not to drive a motor vehicle.
D. Teach patient to crush tablets and open capsules to facilitate absorption of the drug.