Cystitis Nursing Care Plans Diagnosis and Interventions
Cystitis NCLEX Review and Nursing Care Plans
Cystitis is a medical condition that involves the inflammation and/or infection of the bladder.
Escherichia coli are the most common bacteria that cause cystitis. However, foreign body objects, drugs, and radiation therapy may also cause non-infectious cystitis.
Most cases of cystitis are mild, but it can turn into a serious health issue if left untreated and starts to affect the kidneys.
Signs and Symptoms of Cystitis
- Fever( usually low grade)
- Urinary frequency and urgency and passing small amounts of urine
- A burning sensation upon urinating
- Blood in the urine (hematuria)
- Passing cloudy or strong-smelling urine
- Pelvic discomfort
- Pain when urinating
- A feeling of pressure in the lower abdomen
- Cloudy and/or smelly urine
Causes of Cystitis
Bacterial cystitis is usually caused by E.coli bacteria. E.coli are actually a part of the normal gut flora. In the intestines and anus, E.coli are harmless.
However, improper wiping (back to front instead of front to back) especially in women may cause the E.coli to enter the urinary tract. Sexual intercourse can also cause bacterial cystitis.
Some cases of cystitis are non-infectious, which means that they are caused by agents other than microbes.
Cystitis can be caused by drugs (such as chemotherapy agents ifosfamide and cyclophosphamide), radiation therapy, foreign body (such as long-term catheter use), and chemicals that may cause an allergic reaction in the bladder (such as feminine hygiene soaps or sprays, bubble bath, and spermicidal jellies).
It may also be a complication of other serious diseases, such as kidney stones, enlarged prostate, spinal cord problems, and diabetes.
Complications of Cystitis
- Pyelonephritis. If left untreated, bacteria in the bladder can spread to the kidneys and cause a more serious infection. The patient with pyelonephritis is at high risk for permanent kidney damage.
- Hematuria. An infection in the bladder may cause inflammation and minor bleeding, which is evidenced by the presence of blood in the urine. This is rarely seen in bacterial cystitis. Chemotherapy and/or radiation therapy-induced cystitis are more likely to result in hematuria.
Diagnostic Tests for Cystitis
- Urinalysis – mid-stream urine sample is required to perform a quick urine dipstick
- Urine Culture and Sensitivity –if there is a presence of blood and/or WBCs in the urine, the doctor may ask to send the sample to the lab for culture
- Cystoscopy – insertion of a thin tube with camera and light into the bladder to view the urinary tract; some tissues may be collected for further analysis (biopsy)
Treatment for Cystitis
- Antibiotics. The most important management for cystitis is to give a course of appropriate antibiotics to which the causative bacteria is sensitive. The course usually lasts from 3 days to a week and this depends on how severe the infection is.
- Drink plenty of water. It is recommended to drink plenty of fluids, especially water, before a chemotherapy or radiotherapy session (if not contraindicated). It is also advisable to drink a full glass of water and empty the bladder after sexual intercourse.
Cystitis Nursing Diagnosis
Nursing Care Plan for Cystitis 1
Nursing Diagnosis: Impaired Urinary Elimination secondary to the disease process of cystitis as evidenced by frequent urination, burning sensation upon elimination, pelvic discomfort, cloudy and fishy urine
Desired outcome: The patient will re-establish a normal urine elimination pattern, odour-free and clear urine, and maintain a balanced input and output.
|Cystitis Nursing Interventions||Rationale|
|Assess the patient’s vital signs and monitor input and output. Collect a urine sample, and send for urinalysis and culture.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.|
|Advice the patient to drink plenty of fluids, especially water.||To flush the bacteria out of the bladder.|
|Administer prescribed antibiotics for cystitis.||To treat the underlying infection.|
|If the patient has an indwelling catheter, assess for any signs of infection, placement, and kinking of the tubes. Review the need for continuous use of catheter.||To check if the cystitis is caused by long-term use and/or an infected catheter. The patient may benefit from bladder retraining instead of unnecessary continued use of catheter.|
Nursing Care Plan for Cystitis 2
Nursing Diagnosis: Acute Pain secondary to the disease process of cystitis, as evidenced by pain score of 8 out 10 when urinating with burning sensation and bladder discomfort
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10 and verbalization of a more comfortable elimination.
|Cystitis Nursing Interventions||Rationale|
|Administer prescribed painkillers.||To alleviate pain and discomfort|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To assess and monitor the effectiveness of pain relief medication.|
|If the patient has an indwelling catheter, assess for placement and kinking of the tubes. Review the need for continuous use of catheter.||Tube kinking and wrong catheter placement prevent the urine to flow from the bladder to the urine bag via gravity, causing the urine to pool in the bladder which then results to bladder distention and discomfort.|
|Encourage the patient to have a warm sitz bath.||Warm sitz bath soothes the pelvic and urinary tract muscles, providing more comfort to the patient.|
Nursing Care Plan for Cystitis 3
Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with the nature and treatment of Cystitis as evidenced by multiple questions and verbalization of inaccurate information regarding causes and treatment regimen for the disease
Desired Outcome: The patient would be able to verbalize understanding of the condition, control risk factors, and comprehend the importance of treatment regimen in relation to cystitis.
|Cystitis Nursing Interventions||Rationale|
|Evaluate the learner’s (i.e., patient, family or caregiver) ability to learn and desire to take part in performing care. Include the motivation of the learner in learning a new care regimen.||Learning styles differ from every person. Distinguishing the learner’s cognitive impairments will help in addressing the necessary modifications in the teaching style utilized. Recognizing the motivation of the learner to learn new knowledge and skills is valuable in formulating appropriate regimen for the patient’s condition.|
|Determine the learning needs and priorities of the learner in relation to the care plan.||Acknowledging the base knowledge of the patient in relation to the condition will address the most needed care skill that needs to be learned, therefore preventing wasting of precious time.|
|Permit the learner to verbalize and open up previous experiences about health teaching given.||Knowing the previous experiences of learners with regards to learning care regimens will help in building treatment plans and goals that are best suited and customized for the retention of information. This is because some patients, particularly older patients, correlate their previous experiences into learning new skills and knowledge.|
|Evaluate learning barriers of the patient (e.g., perceived changes in routine, financial constraints, cultural background, lack of support team, etc.)||Learning barriers, such as financial constraints and cultural differences, will greatly affect the learner’s motivation and the output of treatment goals. Recognizing these barriers early on can assist the team in tailoring appropriate interventions without sacrificing the quality of care given to the patient.|
|Ensure to provide a calm and peaceful environment, free from interruptions and open for trust and collaboration.||A calm environment is highly conducive in learning in order for the learner to process new information effectively. Reflecting mutual respect in the teaching environment ensures cooperation and collaboration by the patient while respecting boundaries and differences.|
|Involve the patient in formulating outcomes in relation to his care goals, including recognizing the most significant instructions that need to be learned.||Active patient involvement in his care promotes the patient’s self-esteem that will improve compliance with the prescribed treatment regimen.|
|Assist the patient on the integration of newly acquired information regarding the disease into his daily life.||This method ensures that the patient is able to adjust to his daily routine in order to comply with the treatment regimen without sacrificing the quality.|
|Deliver instructions as clear as possible, free from medical jargon and confusing words. Ensure that explanations and demonstrations are easy to follow within the level of competence of the patient.||Patients are inclined to comply with the treatment regimen if given basic information of what is essential for their well-being. Easy to understand demonstrations will allow the patient to embrace teaching more openly in order to achieve the desired output.|
|Clarify with the patient about the risk factors, prevention and management of cystitis in easy to understand language.||Enlightening the patient of the mechanisms that surround cystitis will ensure that the patient will take better health choices in managing the disease and preventing future incidences.|
|Educate the patient about methods in preventing cystitis such as: Significance of frequent bladder emptying Perineal hygiene after bowel movement Avoid wearing tight fitting undergarments constructed from non-breathable material. Hygienic measures (showering rather than use of bathtubs.)||The goal of health teaching is to resolve the current infection and avoid recurrence of cystitis. Frequent bladder emptying prevents distention that will compromise circulation in the bladder, thus predisposing the patient to develop infection. Perineal hygiene prevents unnecessary migration of opportunistic pathogens into the urethra that may cause cystitis. Tight clothing with unbreathable materials can trap moisture, therefore creating a fitting environment for bacterial proliferation. Bacteria that are present in the bathtub may have the opportunity to cause cystitis.|
Nursing Care Plan for Cystitis 4
Risk for Ineffective Tissue Perfusion (Renal)
Nursing Diagnosis: Risk for Ineffective Tissue Perfusion (Renal) related to tissue edema and inflammation secondary to cystitis
- The patient will be able to maintain normal physiologic renal parameters with no further worsening or repetition of deficits.
- The patient will be able to demonstrate lifestyle changes in order to prevent unnecessary complications of cystitis.
|Cystitis Nursing Interventions||Rationale|
|Define the factors related to the situation of the patient with cystitis and the possible body system that may be affected.||Defining the factors will enable the healthcare team to assess the causative and contributing factors for the disease.|
|Observe the characteristics of the patient’s urine, especially the specific gravity.||Deviations in the patient’s urine, such as color changes and specific gravity abnormalities, can be an indication for hematuria and proteinuria, both of which are manifestations of an emerging renal impairment.|
|Inquire with the patient his voiding pattern routine.||Identifying the patient’s usual routine from his current state allows for the comparison of any deviations that the patient may have. It is crucial information in order to determine deviations from the baseline of the patient.|
|Observe the presence, location, intensity and duration of the patient’s pain.||Because of the infective and inflammatory processes of cystitis, presence of pain usually accompanies the condition. Recognizing and assessing the mechanisms around the patient’s pain allows for timely intervention and prevention of complications.|
|Monitor the patient’s consciousness and laboratory values, especially renal-specific results such as Blood urea nitrogen (BUN) and creatinine levels.||Elevations in the patient’s BUN and creatinine levels can alter the consciousness, indicating the worsening of the cystitis and onset of early renal impairment.|
|Monitor the patient’s vital signs, especially the blood pressure (BP). Take note of the usual ranges of the patient’s BP.||An impending renal impairment will increase the patient’s glomerular filtration rate (GFR). An increase in the patient’s GFR also increases his renin levels, an enzyme responsible for blood pressure and electrolyte balance that will likewise increase his blood pressure.|
|Evaluate the patient’s urine output and body weight regularly.||Monitoring for the patient’s urine output and body weight are helpful methods in evaluating renal perfusion and function. Deviations from the normal can indicate a worsening cystitis and onset of early renal impairment.|
|Allow for the discussion of the patient’s perception of the disease, especially the complications that may arise.||Open discussion of the condition not only allows the patient to verbalize his concerns and alleviate his anxiety but also provides opportunities for the healthcare provider to give clarifications to misconceptions and offer emotional support to the patient.|
|Recognize the required lifestyle changes and assist with incorporating the disease into the patient’s daily routine.||Helping the patient adjust with the condition will allow him to employ the necessary modifications in order to comply with the treatment regimen without sacrificing quality. It also ensures the promotion of the patient’s wellness and avoidance of complications.|
|Recognize the patient’s emotional state, focusing on factors that may improve or limit the treatment regimen.||Sickness and infirmary can affect the patient’s emotions. Recognizing any deviations would allow the healthcare team to assist the patient in redirecting anxious or depressive thoughts into productive methods for the patient’s healing.|
|Give positive signs of improvement such as better vital signs of the patient, etc.||Positive feedback of improving vital signs is one way of showing encouragement to the patient. It enables the patient to recognize these changes as points towards his recovery.|
|Render physiologic support to the patient and family as much as possible. Enforce a calm attitude when addressing concerns.||Stress of illness can affect both the patient and family. Employing a calm attitude in addressing their concerns promotes trust and reassurance to the prescribed treatment regimen.|
|Encourage the patient towards a positive outlook despite the condition. Suggest the use of relaxation techniques.||Guiding the patient towards positivity enhances the patient’s sense of well-being. The use of relaxation techniques can assist the patient to control feelings of apprehension and uncertainties.|
Nursing Care Plan for Cystitis 5
Nursing Diagnosis: Hyperthermia related to inflammation and infectious processes secondary to cystitis as evidenced by elevated body temperature beyond normal limits and the skin being warm to touch.
Desired Outcome: Within 8 hours of nursing intervention, the patient will be able to maintain core temperature within the normal limits.
|Cystitis Nursing Interventions||Rationale|
|Recognize the clinical manifestations of elevated body temperature.||The normal body temperature ranges from 36 to 37.5 ° Celsius. Other manifestations of elevated body temperature include sweating, shivering, headache, skin warm to touch and body malaise.|
|Facilitate the regular monitoring of the patient’s vital signs, especially the temperature.||Deviations in vital signs will prompt the healthcare team to employ the appropriate medical intervention and to monitor effectivity of the treatment regimen.|
|Loosen the patient’s clothing. Likewise, remove excessive clothing and covers.||Evaporative cooling is achieved when the patient’s skin is exposed to room air. It promotes decreases in heat in order to control the patient’s fever.|
|Utilize hypothermia blankets or cooling blankets as necessary.||Cooling blankets are designed to circulate temperature-controlled water in the device so that the body’s core temperature is controlled quickly. It is prudent to set the device’s temperature just 1° Celsius below the patient’s current temperature to prevent shivering.|
|Render tepid sponge bath as needed.||A tepid sponge bath is an example of a non-pharmacological method for fever. It works by the concept of evaporative cooling wherein tepid water is applied in the patient’s skin to allow for cooling and lowering of fever. Avoid the use of alcohol for it may rapidly cool the patient’s skin, causing shivering.|
|Utilize ice packs as tolerated by the patient.||Application of ice packs works by the process of surface cooling. Ice packs placed on the patient’s groin area, axillae, neck and chest is one way of decreasing the body’s core temperature. However, remove the ice packs once body temperature registers at 39° Celsius to avoid over cooling. (O’Connor, 2017).|
|Observe the rise and fall of the patient’s temperature during the cooling process.||Prolonged exposure to cold can negatively affect the skin’s integrity. When using ice packs, ensure that they are covered with towels to prevent direct skin contact. Likewise, regularly adjust the cold application sites to prevent cold damage to the patient’s skin.|
|Anticipate for infusion of cooled intravenous normal saline solutions as ordered.||Intravenous infusion of cooled normal saline solutions is another way for lowering the patient’s core temperature. It is applied by instilling an 18ml/kg ratio and given over 10-20 minutes. Patient’s given cooled infusions are usually sedated to prevent shivering.|
|Modify environmental factors such as room temperature, bed linens as necessary.||Adjusting the patient’s room temperature can help in cooling a patient with fever. Modifying the number and type of linens used by the patient will help regulate the core temperature.|
|Adjust the applied cooling methods in relation to the patient’s biological response. Observe the development of shivering.||Unwarranted cooling or rapid cooling measures may cause shivering that will increase the patient’s metabolic rate and temperature. The presence of shivering will hinder the cooling efforts of a patient with fever.|
|Ensure that the patient’s side rails are up all the time. Lower the height of the bed to the lowest level possible.||Patients with fever, especially high grade temperatures, are prone to develop seizures. Employing these measures ensures patient safety.|
|Ensure that patient’s clothing and bed linens are kept dry at all times.||Dry clothing and linens promotes the patient’s comfort. This also prevents chilling because diaphoresis happens after the breaking of the patient’s fever (defervescence).|
|Encourage increased oral fluid intake.||Ingesting cool liquids can assist in lowering the body’s temperature, if the patient can tolerate it. In addition, oral fluids replenish fluid losses brought about by the fever.|
|Administer antipyretics as ordered.||Antipyretics are medications that lower the patient’s body temperature. They work by inhibiting the enzyme cyclooxygenase (COX) and interrupting the creation of inflammatory prostaglandins.|
More Cystitis Nursing Diagnosis
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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