C H A P T E R 5 2
Drugs affecting the urinary tract and the bladder
823
Gastrointestinal: liver evaluation
Genitourinary: urinary output
Laboratory tests: liver function tests, urinalysis, urine culture,
and sensitivity testing
Implementation
Obtain urine sample for culture and sensitivity test.
Provide comfort and safety measures: safety precautions,
skin care, nutrition.
Encourage eating acidifying foods and drinking lots of
fluids.
Teach hygiene measures.
Administer medication with food if GI upset is a problem.
Provide support and reassurance to deal with drug effects
and lifestyle changes.
Provide teaching to J.K. and her parents or caregivers
regarding drug name, dosage, adverse effects,
precautions, warnings to report, hygiene measures and
dietary changes as needed.
Evaluation
Evaluate drug effects: relief of symptoms, resolution of
infection.
Monitor for adverse effects: GI upset, headache, dizziness,
confusion, dysuria, pruritus, urticaria.
Monitor for drug–drug interactions as indicated, especially
use of antacids.
Evaluate the effectiveness of teaching program and comfort
and safety measures.
TEACHING FOR J.K.
• A urinary tract anti-infective such as hexamine hippurate
treats UTIs by destroying bacteria and by helping to
produce an environment that is not conducive to bacterial
growth.
• If this drug causes stomach upset, it can be taken with
food. It is important to avoid foods that alkalinise the
urine, such as citrus fruits and milk, because they decrease
the effectiveness of the drug. Cranberry juice is one
juice that can be used. As much fluid as possible (8 to
10 glasses of water a day) should be taken to help flush
out the bacteria and treat the infection.
• Avoid using any over-the-counter (OTC) medication
that might contain sodium bicarbonate (e.g. antacids,
baking soda) because these drugs alkalinise the urine and
interfere with the ability of hexamine hippurate to treat
the infection. Check with your healthcare provider before
using any OTC drug.
• Take the full course of your prescription. Do not use this
drug to self-treat any other infection.
• Common adverse effects of this drug may include the
following:
•
Stomach upset, nausea
: Taking the drug with food or
eating small, frequent meals may help.
•
Painful urination
: If this occurs, report it to your
healthcare provider. A dose adjustment may be needed.
• Report any of the following to your healthcare
provider:
skin rash or itching, severe GI upset, GI upset that
prevents adequate fluid intake, very painful urination (and
pregnancy in older women)
.
• The following can help to decrease UTIs:
• Avoid bubble baths.
• Void whenever you feel the urge; try not to wait.
• Always wipe from front to back, never from back to front.
• Tell any doctor, nurse or other healthcare provider
involved in your care that you are taking this drug.
Care considerations for people receiving
urinary tract anti-infectives
Assessment: History and examination
■
■
Assess for
contraindications or cautions
: any
history of allergy to antibiotics or anti-infectives
to avoid hypersensitivity reactions
; liver or renal
dysfunction
that might interfere with the drug’s
metabolism and excretion
; and current status
of pregnancy and breastfeeding,
which require
cautious use of the drug
.
■
■
Perform a physical assessment before therapy
to establish baseline data
and during therapy
to
determine the effectiveness of the drug and the
occurrence of any adverse effects associated with
drug therapy.
■
■
Inspect the skin
to evaluate for the development
of rash or hypersensitivity reactions.
■
■
Assess level of consciousness and monitor
orientation and reflexes
to evaluate any central
nervous system (CNS) effects of the drug.
■
■
Assess urinary elimination patterns, including
amount and episode frequency, and for complaints
of frequency, urgency, pain or difficulty voiding
to determine the effectiveness of therapy.
■
■
Monitor laboratory test results, including urinalysis
and urine culture and sensitivity,
to evaluate
effectiveness
and renal and hepatic function tests
to determine the need for possible dose adjustment
and to identify possible toxicity.
Implementation with rationale
■
■
Ensure that culture and sensitivity tests are
performed before therapy begins and are repeated
if the response is not as expected
to ensure
appropriate treatment of the infection.
