Module 11 Learning Guide
Nursing Care of the Patient with Urinary Problems
Answers and review of UTIs, cystitis, urethritis, interstitial cystitis,
acute pyelonephritis:
1. What is the most common organism responsible for UTIs? Escherichia coli most
common pathogen
2. What patients are at risk for UTI’s? Immunosuppressed, have diabetes,
undergone multiple antibiotic courses, traveled to certain third-world countries,
catheterized
3. What are Signs and symptoms of a lower UTI infection? Dysuria, frequent
urination, urgency, and suprapubic discomfort or pressure.
4. How are the symptoms for an older adult with a UTI different? They may have
abdominal discomfort, and present with cognitive impairment or generalized
clinical deterioration.
5. How do you prevent an UTI?
Emptying the bladder regularly and completely,
evacuating the bowel regularly, wiping front to back after urination, drinking an
adequate amount of liquid each day, pre-postcoital voiding for females.
6. How do you prepare a client for an IVP? What is the most important question to
ask? What is the purpose of an IVP? Evening before the procedure, give
cathartic, or enema to empty colon of feces and gas.
Patient is kept NPO for 8 hr before the procedure. Ask the patient about iodine
sensitivity to avoid anaphylactic reaction. The purpose is to assess for cysts,
tumors, lesions, and obstruction that may cause a distortion in the normal
appearance of these structures.
7. What is the purpose of a KUB?
It is an xray exam of abdomen and pelvis to
look at size, shape, and position of kidneys.
8. What is the purpose of a cystoscopy? To inspect the interior of the bladder. Can
be used to insert ureteral caths, remove calculi, obtain biopsy specimens, Prep
includes fluids
9. What are expected signs and symptoms after a cystoscopy? How do you manage
them? What are possible complications and how do you recognize them?
Post cystoscopy client may have urinary frequency, burning on urination, pinktinged urine. Offer warm sitz baths, heat, and mild analgesics to relieve
discomfort. A complication may be bright red bleeding so observe urine post
cystoscopy.
10. What is the purpose of a renal ultrasound? Is used to detect renal or perineal
masses, . Noninvasive procedure passing sound waves into body structures and
recording images.
11. What is the purpose of 24 hour urine? To examine or measure components ,
such as electrolytes, glucose, protein, catecholamines, creatinine, and minerals.
12. How is a 24 hour urine specimen collected? The first urine specimen is
discarded. This time is noted as the start of the test. It is critical to save ALL
urine during the 24 hours. The client is asked to urinate and this is added to the
container at the end of the 24 hours. Some specimens need to be kept on ice and
some have preservatives in the containers.
13. What is the purpose of doing a urine for culture and sensitivity? If you have a
concurrent antibiotic order, which do you do first? To confirm suspected urinary
tract infection and identify causative organisms. Collect the specimen prior to the
initiation of antibiotics.
14. What are the nursing responsibilities and teaching for, TMP-SMZ (Bactrim),
nitrofurantoin cipro, and pyridium?
 TMP-SMZ (Bactrim), used to treat uncomplicated UTI, taken BID, E coli
is resistant, counsel to have adequate fluid intake.
 Nitrofurantoin:given to clients with sulfa sensitivities for UTI also for long
term use, taken 3-4times per day, counsel to call MD for any fever, chills,
cough, chest pain, dyspnea rash, or numbness or tingling of fingers or toes.
Avoid sunlight, use sunscreen, and wear protective clothing.
 Cipro: is a fluoroquinolones for complicated UTIs
 Pyridium: urinary analgesic, counsel patient their urine will turn orange it
may permanently stain underclothing.
15. What is an infections of the upper urinary tract called? What are the signs and
symptoms? Pyelonephritis: inflammation of renal parenchyma and collecting
system. S&S: vary from mild fatigue to fever, chills, flank pain, dysuria urgency
and frequency.
16. What is an infections of the upper urinary tract called? What are the signs and
symptoms? Cystitis-inflammation of bladder wall. Usually no systemic
manifestations
17. What is different about the antibiotic therapy for pyelonephritis compared to
cystitis?
A client with pyelonephritis usually will have 14 –21 days of
antibiotics and a client with cystitis will take 1-3 days of antibiotics
18. Once antibiotics are initiated when should symptoms subside? 48-72 hours
19. Why should a client diagnosed with acute pyelonephritis not stop taking a full
course of antibiotics? What complication may they encounter? Even if they feel
better the may have bacteriuria and pyuria, untreated and recurring episodes may
lead to scarred poorly functioning kidneys
20. What is urethritis? What counseling may be considered? It is an inflammation of
the urethra. Counsel to avoid vaginal deodorant sprays, properly cleanse the
perineal area, and avoid sexual intercourse until symptoms subside.
21. What is interstitial cystitis? What are the symptoms? A chronic painful
inflammatory disease of the bladder with symptoms of urgency/frequency and
pain in the bladder and/or pelvis.
22. What counseling should a client with interstitial cystitis receive? What about
dietary considerations?
Relaxation techniques, application of heat or cold to
the area, diet to eliminate caffeine, alcohol, citrus products, aged cheeses, nuts,
foods with vinegar, hot peppers, and foods that may lower the urine ph.