drug therapy for Urinary tract antiseptics and Urinary incontinence retention

Question 1

Indications: Antibiotic used to treat urinary tract infections.
Precautions: Notify physician if taking antacids, antibiotics, benztropine (Cogentin), diphenhydramine (Benadryl), probenecid (Benemid), and trihexyphenidyl (Artane).

Answer 1

indications/precautions for nitrofurantoin

Question 2

Use caution in patients with anemia, kidney disease, lung disease, nerve damage, or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Pregnancy
Older adults
Patient education: can cause drowsiness (do not drive heavy machinery); alcohol can increase side effects; plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Nitrofurantoin may make your skin sensitive to sunlight.

Answer 2

nitrofurantoin caution and education

Question 3

Side Effects:
dark yellow or brown urine
nausea
vomiting
loss of appetite
difficulty breathing
excessive tiredness
fever or chills
chest pain
persistent cough
numbness, tingling, or pinprick sensation in the fingers and toes
muscle weakness
swelling of the lips or tongue
skin rash

Answer 3

side effects of nitrofurantoin

Question 4

Indications: Treatment of UTI caused by gram negative bacteria; only used to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria
DO NOT give within two hours after antacids, iron or zinc

Answer 4

nalidixic acid indications

Question 5

Side effects: vertigo, decrease in visual acuity, abdominal pain, N/V, and diarrhea
Interactions:
Interferes with metabolism of caffeine
Enhances effects of warfarin
Action is inhibited in presence of another antibacterial medication (probenecid reduces effectiveness)
Precautions: liver disease, epilepsy, severe cerebral arteriosclerosis (can increase risk for seizures), severe renal failure, sunlight (can cause phototoxicity)

Answer 5

nalidixic acid

Question 6

Indications: Antibiotic to prevent recurrent bladder infections for adults and children (older than 6 years old)
Usually given after antibiotics have been given for initial treatment
Contraindications: kidney disease, severe liver damage, with sulfa drug, if dehydrated

Answer 6

methenamine indications, contraindications

Question 7

Precautions:
Ever had: liver disease, asthma, allergy to aspirin, allergy to yellow food dye
Pregnancy
Take as directed. Taking extra does NOT increase effectiveness but does increase risk for side effects.
Side effects: painful or difficult urination, upset stomach, nausea, rash, bladder irritation, increased urination, blood in urine, new or worsening symptoms

Answer 7

methenamine

Question 8

Side effects: painful or difficult urination, upset stomach, nausea, rash, bladder irritation, increased urination, blood in urine, new or worsening symptoms
Patient Education:
Drink plenty of fluids
Increase the acidity of urine by drinking cranberry juice
Increase protein
Avoid milk and dairy products
Need frequent urine screens to see if infection is clear
Monitor liver function
Medication needs to be stored at room temperature, away from moisture, heat, and light
There are 47 drug interactions so need medication reconciliation

Answer 8

methenamine

Question 9

Oppose the action of neurotransmitter acetylcholine. It inhibits the transmission of parasympathetic nerve impulses. Resulting in reduction of muscle spasms.
______ will decrease secretions in the body – saliva, sweat, gastric, etc.

Answer 9

Anticholinergics

Question 10

Primary drug used in the treatment of urinary incontinence and over-active bladder

Answer 10

anticholinergics

Question 11

Therapeutic Use:
1. Treat urinary incontinence due to over active bladder
2. Treat neurogenic bladder (dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition. Neurogenic bladder usually causes difficulty or full inability to pass urine without use of a catheter or other method)

Answer 11

anticholinergics

Question 12

Pharmacologic Action:
1. Blocks muscarinic receptors in the detrusor muscle which lines the bladder causing the bladder to relax
2. At same time anticholinergic causes contraction of the internal sphincter of the bladder
3. Relaxation of the bladder while internal sphincter of the bladder is in contraction allows urine to stay in bladder preventing release of urine at undesired times

Answer 12

anticholinergic urinary incontinence drugs

Question 13

block muscarinic receptors of the heart, smooth muscles throughout the body and exocrine glands so you get:
Dry Mouth, Constipation, Mydriasis (pupil dilation), Dry eyes, Blurred vision, Fever, Flushing (due to decrease in sweat production), Heat exhaustion (decrease in sweat production leads to hyperthermia), Urinary retention, Headache, Dizziness, Drowsiness (avoid use of heavy machinery)

Answer 13

anticholinergic effects for urinary incontinence drugs

Question 14

Interventions: Monitor for _____ effects
Patient education: Be cautious in hot weather or during physical activity, avoid use of heavy machinery due to drowsiness
Contraindications:
Narrow angle glaucoma.
Ileus, GI stenosis, severe inflammatory bowel disease, toxic megacolon.
Myasthenia gravis.
Tachyarrhythmias.
Urinary retention.

Answer 14

anticholinergic

Question 15

______drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter acetylcholine, the primary transmitter of nerve impulses within the parasympathetic nervous system—i.e., that part of the autonomic nervous system that contracts smooth muscles, dilates blood vessels, increases bodily secretions, and slows the heart rate.
For ______, many of the undesirable adverse effects are due to nicotinic receptor stimulation. The desired effects come from muscarinic receptor stimulation.

Answer 15

Cholinergic

Question 16

Treatment of urinary retention; Helps to cause urination and emptying of the bladder

Answer 16

cholinergics

Question 17

What are the cholinergics?

Answer 17

bethanechol

Question 18

Certain stomach problems
Gastroesophageal reflux (caused by acid in the stomach washing back up into the esophagus)
Megacolon (an abnormally large or dilated colon)
Treatment of urinary retention; Helps to cause urination and emptying of the bladder

Answer 18

indications for cholinergics

Question 19

______ acts principally by producing the effects of stimulation of the parasympathetic nervous system. It increases the tone of the detrusor urinae muscle, usually producing a contraction sufficiently strong to initiate micturition and empty the bladder. It stimulates gastric motility, increases gastric tone and often restores impaired rhythmic peristalsis.

Answer 19

Bethanechol

Question 20

dizziness or drowsiness;
headache;
nausea, vomiting, diarrhea, or abdominal discomfort;
slow heartbeats followed by fast heartbeats;
flushing or warmth about the face;
sweating; or
tearing eyes.

Answer 20

side effects of bethanechol (a cholinergics)

Question 21

Eye effects: blurred vision, brow pain, headache, eye irritation
Systemic effects: stomach pain, dizziness, salivation, diarrhea, runny nose, heart burn, flushing, chills, nausea/vomiting, increased urination, increased sweating

Answer 21

cholinergic effects associated with bethanocol (a cholinergic)

Question 22

• Urethra (Urethritis)
• Bladder (Cystitis)

Answer 22

lower urinary system

Question 23

• Ureters (Ureteritis)…usually associated with bladder or kidney infection
• Kidneys (Pyelonephritis)
• *UTIs typically start in the urethra and spread upward to the bladder and can be found in both the lower or upper tract. If the infection is not treated promptly and correctly, it can spread to the ureters and kidneys. Pyelonephritis is extremely dangerous because the infection can enter the bloodstream and lead to sepsis….remember the kidneys are very vascular and work closely with the heart.
• When an infection exists in the urinary tract it leads to inflammation of the structure involved which leads to pain, spasms, dark/cloudy urine, etc.

Answer 23

upper urinary system

Question 24

these are one- way valves that connect at the ureters and bladder to prevent the backflow of urine into the ureters from the bladder…in certain conditions like VUR (vesicoureteral reflux) these valves are defected

Answer 24

o Ureterovesical Valves

Question 25

these muscles help squeeze the urine out of the bladder and prevent residual urine…sometimes these muscles become weak (diabetes, immobile patients who experience overextended bladder).

Answer 25

muscles of the bladder

Question 26

this keeps the urine traveling downward.

Answer 26

o Pressure created by the urine in the bladder

Question 27

it is normally sterile and possesses antiseptic qualities that can prevent bacteria from sticking to the lining of the bladder. In addition, the acidic conditions of the pH and amount of urea concentration can play a role in preventing a UTI….however, in some conditions, like uncontrolled diabetes mellitus where there are high amounts of glucose in the ___, the ____ can act as a medium for bacteria growth

Answer 27

urine

Question 28

has immune cells that work to fight off infection…a suppressed immune system decreases the cells effectiveness

Answer 28

• Lining of the urinary system

Question 29

it secretes a fluid that has antimicrobial properties to keep bacteria out…in men with enlarged prostates the amount of fluid secreted is decreased

Answer 29

• Prostate gland (males):

Question 30

present in and around the vagina are bacteria (lactobacilli) that keeps the area around the urethra acidic which prevents bacteria from migrating, especially E.coli from the rectum….however, if a woman experiences a hormonal change (pregnancy, menopause, birth control usage) the flora can be destroyed

Answer 30

• Normal flora in women

Question 31

The most common type of bacteria that causes a UTI is , which is usually from the GI system (rectum).

Answer 31

E. coli

Question 32

whats the acronym for causes of UTIs?

Answer 32

Hard to void

Question 33

Urinalysis (U/A): assesses for bacteria or WBCs in urine
* Nurse’s role: properly collecting urine sample and educating the patient how to do this….WHY? to prevent contamination to the specimen
o It is best to collect the urine when the bladder has been full for about 2-3 hours. It will be more concentrated….don’t want diluted urine.
 First wipe with an antiseptic wipe
 Void small amount into the toilet
 Then collect the urine (midstream) and fill cup halfway
 Keep the cup a few inches away from the urethra
* How to collect out of a Foley catheter? Use access port (found at the top of the tubing…never collect from the Foley collection bag)…..clean access port with antiseptic and use needless sterile syringe to withdraw urine.
Urine culture: to assess what bacteria is causing the UTI…so antibiotics can be ordered correctly
Cystoscopy: assesses the inside of the urethra and bladder (ordered for recurrent infections)

Answer 33

diagnostic measures for UTIs

Question 34

• Pain when voiding (burning)
• Persistent need to void but not a lot is voided or can’t void
• Strong odor to urine that is dark and cloudy (can have blood)
• Cramping in abdomen or pain at the costovertebral angle
  o Costovertebral angle is found under the 12th rib and between the spine. Lay non-dominate hand flat over the angle and make a fist with the dominate hand and firmly thump the fist onto the flat hand….if pain is experienced a kidney infection may be present (pyelonephritis).
• Spasms of the bladder or urethra
• Fever
• Increased WBC on U/A
  NOTE: In the geriatric population, confusion, sudden increase in falling, and agitation are typically seen rather than the typical signs and symptoms above…they are less likely to have a fever or pain.

Answer 34

s/s of UTIs

Question 35

Assess for signs and symptoms of UTI (catch it before it becomes complicated….many patients in the hospital setting are at risk for a UTI)
Maintain fluid status (intake and output) and monitor that urinary output is at least 30 cc/hr
Control pain with nonpharmacological and pharmacology methods:
* Warm sitz bath or heating pad
* Tylenol, NSAIDs, or Pyridium per MD order
o Pyridium “Phenazopyridine”: analgesic that will coat bladder wall and urethra to decrease spasms and help with urinary frequency/burning. However, that patient will void ORANGE-COLORED urine…this is a normal side effect…educate patient about this.
Monitor for complications (sepsis, renal failure)
Administer antibiotic medications per MD order… Sulfonamide “Bactrim” (educate patient about consuming 2.5 to 3 L of fluid/day to keep urine diluted due to crystalluria )…give antibiotic at same time every day to keep blood level constant because a decrease in blood levels can decrease the effectiveness of the medication.
* If antibiotics are ordered for treatment along with urine culture…COLLECT URINE CULTURE BEFORE starting the first dose of antibiotics
Encourage the patient to take in 2.5 to 3L of fluid per day. WHY? This keeps the urine diluted and helps the system flush out the infection. In addition, if the urine becomes concentrated this increases the risk of crystalluria in patients taking sulfonamides like Bactrim.
Encourage frequent voiding at least every 2-3 hours.
Remove indwelling catheter if present per MD order (remember a major cause of UTI)

Answer 35

nursing interventions for UTIs

Question 36

• Take all the antibiotics
• Wipe front to back
• Urinate immediately after intercourse
• Avoid tight pants or underwear (wear cotton underwear that is loose fitting)
• Avoid bubble bath, powders, and perfumes in the genital area
• Change sanitary pads often and avoid tampons
• Avoid caffeine and alcohol…irritate bladder
• Every 2-3 hours void

Answer 36

patient education for UTIs

Question 37

______: it is caused by an increase in intraabdominal pressure (laughing, coughing, sneezing) and a sphincter that can’t contract enough to prevent leakage
Most common type of incontinence in young women

Answer 37

Stress incontinence

Question 38

______: uninhibited contractions of the detrusor muscle, common in older individuals
Common in older individuals

Answer 38

 Urge

Question 39

______: most common type of incontinence, usually refers to a mix of urge and stress incontinence
MOST COMMON IN GENERAL

Answer 39

Mixed

Question 40

_____: when the bladder is so full it cannot hold in the urine
Common when there’s an obstruction or spinal cord injury

Answer 40

Overflow

Question 41

What is the mnemonic to remember the general causes of incontinence?

Answer 41

DRIP:
Delirium (drugs, acute illness)
Retention (hypocontractility, outflow obstruction)
Inflammation/Infection/Impacted stool
Polyuria (drugs, high output)