McKenna's Pharmacology for Nursing, 2e

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. ■ ■ 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.

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.

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.