NDOLA UNIVERSITY COLLEGE OF NURSING

LESSON PLAN

COURSE TITLE: Medicine

TOPIC OF THE LESSON: cystitis
PRESENTER: Michael Kawalika Calvin
SUPERVISOR: Mrs Hatontola/Ms Sakanyi
AUDIENCE: 2nd year students
GROUP SIZE: 42
DATE: 20/07/2018
TIME REQUIRED: 2 hours
VENUE: Class
LANGUAGE: English
TEACHING METHOD: lecture/ discussion
AUDIO VISUAL AIDS: Laptop, LCD, Flip Chart, white board markers.
Introduction

Urinary tract infections are one of the most common infections affecting humans. Urinary Tract Infections involves an inflammation of some
portion of the urinary tract usually caused by bacteria.Cystitis also called bladder infection is an inflammation of the bladder. Most of the time,
the inflammation is caused by a bacterial infection, and it's called a urinary tract infection (UTI). A bladder infection can be painful and
annoying, and it can become a serious health problem if the infection spreads to the kidneys
General objective
At the end of the lecture/discussion students should be able to acquire knowledge on cystitis.

Specific objective

1. Define cystitis.
2. State the types of cystitis.
3. Mention the causes of cystitis.
4. Sate the predisposing factors of cystitis
5. State the signs and symptoms of cystitis.
6. Describe the management of cystitis.
7. State the complication of cystitis.

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1.Define DEFINITION Lecture/ Laptop, Explaining, Listening, What is cystitis?
cystitis. Cystitis is one of the diseases of the urinary tract infections that
Discussion LCD, Asking asking and
cause inflammation of the urinary bladder (Lewis H.S et al 2010)
Pictures questions answering
Cystitis is a bladder infection characterised by inflammation of questions
the urinary bladder.(Healthhype.com)

2. State the TYPES OF CYSTITIS Lecture/ Laptop, Explaining, Listening, What are the
types of types of cystitis?
There are several different types of cystitis which may be Discussion LCD, Asking asking and
cystitis.
broadly categorized as bacterial or non-bacterial cystitis. The Pictures questions answering
latter, non-bacterial cystitis, comprises a number of causes questions
including other infections (fungi, parasites and viruses) and non-
infectious causes. Mechanical trauma as is seen with long term
catheterization may lead to bacterial cystitis or inflammation in
the absence of an infection.
Infectious cystitis-Arises as a result of an infection, mainly
bacteria.
Chemical cystitis-Associated with hypersensitivity to certain

chemicals like soap, bubble bath and spermicidal gel. Drug-

Laptop,
induced cystitis may be seen in patients use chemotherapeutic
LCD, Listening,
State the types What are types

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of cystitis drugs. Lecture/ Pictures Explaining, asking and of cystitis?
Discussion Asking answering
Radiation cystitis-Arises as a result of radiation therapy often in
questions questions
the treatment of pelvic tumors.

Tuberculosis cystitis-Follows renal tuberculosis.

Interstitial cystitis-A chronic bladder inflammation where the

cause and pathophysiology is unclear.

3.Mention the CAUSES OF BLADDER INFECTION Lecture/ Laptop, Explaining, Listening, What is the
causes of cause of
There are a number of microorganisms that may cause a bladder Discussion LCD, Asking asking and
cystitis. cystitis?
infection. Some of the organisms include : Pictures questions answering
Bacteria questions
 Escherichia coli Escherichia coli
 Gram positive cocci e.g. staphylococcus & streptococcus
 Proteus mirabilis
 Streptococcus fecalis
 Staphylococcus saprophyticus Laptop,
Mention the What is the
 Klebsiella spp LCD,
causes of cause of
cystitis  Chlamydia trachomatis Lecture/ Pictures Explaining, Listening, cystitis?
Asking asking and

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 Mycobacterium tuberculosis Discussion questions answering
Virus questions
 Herpes simplex (HSV-1 and HSV-2)
 Adenoviruses
Fungus
 Candida albicans
 Cryptococcal spp
Parasites
 Schistosoma haematobium
4. State the PREDISPOSING FACTORS Lecture/ Laptop, Explaining, Listening, What is
predisposing predisposing
1. Sexually active women. Sexual intercourse can result in Discussion LCD, Asking asking and
factors of factors of
cystitis. bacteria spreading into the urethra. but even sexually inactive Pictures questions answering cystitis?
girls and women are susceptible to lower urinary tract infections questions
because the female genital area often harbors bacteria that can
cause cystitis

2.Use certain types of birth control. Women who use Laptop,

diaphragms are at increased risk of a UTI. -diaphragms that LCD, Listening,
State the What is
contain spermicidal agents further increase your risk.. Lecture/ Pictures Explaining, asking and
predisposing predisposing
factors of 3.Menopause. altered hormone levels in postmenopausal women Asking answering factors of

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cystitis. are often associated with UTIs Discussion questions questions cystitis?
4.Interference with the flow of urine. This can occur in
conditions such as a stone in the bladder or, in men, an enlarged
prostate.
5.Changes in the immune system. This can happen with certain
conditions, such as diabetes, HIV infection and cancer treatment.
A depressed immune system increases the risk infections.
6.Prolonged use of bladder catheters. These tubes may be
needed in people with chronic illnesses or in older adults.
Prolonged use can result in increased vulnerability to bacterial
infections as well as bladder tissue damage.

5. State the Signs and symptoms Lecture/ Laptop, Explaining, Listening, What are the
sign and signs and
LCD, Asking asking and

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symptoms of Discussion Pictures questions answering symptoms
cystitis.  A strong, persistent urge to urinate cystitis.
questions
 A burning sensation when urinating
 Passing frequent, small amounts of urine
 Blood in the urine (hematuria)
 Passing cloudy or strong-smelling urine
 Pelvic discomfort-pain in the lower tummy, lower back.
 A feeling of pressure in the lower abdomen
 Bladder pressure and pain that gets worse as the bladder
fills up.

6. Describe the MANAGEMENT OF PATIENT WITH CYSTITIS Lecture/ Laptop, Explaining, Listening, How would you
management manage a
INVESTIGATIONS Discussion LCD, Asking asking and
of cystitis. patient with
 History taking and clinical picture Urine examination Pictures questions answering cystitis?

may reveal WBCs and bacteria questions

 Mid-stream urine for culture and sensitivity

 Cystoscopy .Inserts a cystoscope (a thin tube with a camera

used to view into the urethra to look for problems or to get
a tissue sample for more testing (biopsy).
Describe the Lecture/ Laptop, Explaining, Explaining,
management  Imaging. An ultrasound, CT scan, and MRI can show How would you

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of cystitis. tumors, kidney stones etc. Discussion LCD, Asking Asking manage cystitis?
 Intravenous urogram (IVU). It’ X-ray that uses contrast Pictures questions questions
dye to take images of the kidneys, ureters, and bladder.
 Voiding cystourethrography.A dye is inserted into the
bladder to see if any urine flows backward from the bladder
toward the kidneys.
 Retrograde urethrography. This test uses contrast dye to
find problems in the urethra.
 Urine Culture and sensitivity.

TREATMENT

Treatment depends on culture and sensitivity

Appropriate antibiotics may be prescribed
1.Ciprofloxacin
Presentation:250mg-500mg
Indication: gram negative and gram positive bacterial infections
Dose:500mg twice daily.
Side effects: diarrhoea, abdominal pain, white patches in the Laptop,
Describe the mouth or on the tongue, joint pain. Lecture/ LCD, Explaining, Explaining, How would you
management manage cystitis?
Pictures Asking Asking

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of cystitis 2.Norfloxacin Discussion questions questions
Presentation:400mg
Indication: Urinary tract infections
Dose: 400mg twice daily
Side effects:anxiety,tinnitus,dermatitis
Contra-indications: hypersensitive to 4-quinolones or quinolone
group of anti-bacterial
3.niflofurantoin
Presentation: tablets 50mg 100mg
Indications: urinary infections due to strains E coli, enterococci,
staphylococcus aureus.
Dose: 50mg qid for 7 days
Side effects: dermatitis, rash and pruritis
4.Paracetamol
Presentation:500mg
Indication: Pain killer Laptop,
Dose:1g tds 3days LCD,
Describe the
Side effects: nausea and vomiting, diarrhoea. Pictures Explaining, Explaining,
management
of cystitis Lecture/ Asking Asking How would you
NURSING MANAGEMENT manage cystitis?
questions

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Discussion questions
Aims
 To relieve symptoms and promote healing of ulcer.
 To reduce anxiety
 Maintain nutrition requirements
 Provide knowledge about disease and management.
 To Prevent complications
Hospitalization is not always necessary, however, if patient can
not adhere to treatment regimen or home situation is not
conducive, the patient may be hospitalized until symptoms are
relieved and patient and relatives appreciate treatment plan.
Treatment and care is individualized for all patients
ENVIRONMENT
Structuring the environment and activities may help with coping
with the disease in the initial phase. Patient is nursed in a general
medical ward. Environment should be clean, well ventilated to
promote air circulation and quite to promote rest. It should be Laptop,
Well-ventilated room, free from infection, reverse barrier nursing LCD,
Describe the to prevent infection. Pictures Explaining,
management POSITION/REST Asking Explaining,
of cystitis How would you
A patient is positioned in a most comfortable position to Lecture/ questions Asking manage cystitis?
promote comfort. Ensure noise free environment to promote rest

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and comfort. Do nursing activities collectively to avoid Discussion questions
disturbances thereby promoting rest
PAIN RELIEF

Assess the patient’s pain by asking him/her and observing for

non-verbal signs of pain such as grimacing and rubbing the
affected area. Administer prescribed analgesics such Panadol to
relieve pain and promote comfort. Administer also other
prescribed medication to help in healing. Provide diversional
therapy such as reading books watching TV to relieve pain. You
have to know the mode of actions, side effects of the drugs and
possible drug interactions
PSYCHOLOGICAL CARE
Explain the disease process, importance of medication, explain
all procedures of the patient and involve significant others in the
care to reduce apprehension and gain co-operation. Assist patient Laptop,

to explore feelings concerning the nature of the illness. Reassure LCD,

Describe the
management patient and family that the disease is treatable and the medical Pictures Explaining,
of cystitis How would you
team are doing all they can to make sure that normal function Asking Explaining,
manage cystitis?
return. Explain that length of time that these treatments are Lecture/ questions Asking

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necessary varies with the cause and extent of damage. The Discussion questions
patient and family need assistance, explanation, and support
during this period. However, high levels of anxiety and fear may
necessitate repeated explanation and clarification by the nurse is
done to relieve anxiety.
OBSERVATIONS- Observe general condition of patient to see
whether improving, static or worsening. Monitor vital signs such
as temperature, pulse, respirations and blood pressure and record
the findings. High temperature indicates presence of infection,
rapid pulse and low BP will indicate bleeding. Observe urine
colour, consistency, amount and odour if abnormal document the
findings and report to the attending physician. Patient should be
weighed daily to check if there is weight loss indicative of
depreciating nutrition status. Laptop,
LCD,
Describe the NUTRITION AND FLUIDS
Pictures
management Provide nutritious balanced meals containing proteins and
of cystitis Explaining,
vitamins to promote healing, carbohydrates to provide energy How would you
Asking Explaining,
and vitamins to boost the immunity. Give fluids either orally or manage cystitis?
Lecture/ questions Asking
intravenously to prevent dehydration and also to flush out toxins.

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EXERCISES Discussion questions

Initially patient may be on total bed rest but as the condition

improves, encourage patient to do passive exercises to prevent
complications such as deep vein thrombosis and to promote
blood circulation
HYGIENE
If condition is bad and patient is unable to bath herself assist the
patient with activities of daily living, do bed bath to promote
hygiene, comfort and blood circulation. Do oral care to prevent
mouth infections and promote appetite. Do nail care also to
prevent accumulation of dirt. Change bed linen when soiled or
dirty

Laptop,
Describe the
management LCD,
of cystitis
Pictures
PREVENTION
Explaining, How would you
Drink plenty of liquids, especially water. Drinking lots of prevent cystitis?
Asking Explaining,
fluids is especially important if you're getting chemotherapy or
Lecture/ questions Asking
radiation therapy, particularly on treatment days.

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Discussion questions
Urinate frequently. If you feel the urge to urinate, don't delay
using the toilet.
Wipe from front to back after a bowel movement. This
prevents bacteria in the anal region from spreading to the vagina
and urethra.
Take showers rather than tub baths. If you're susceptible to
infections, showering rather than bathing may help prevent them.
Gently wash the skin around the vagina and anus. Do this
daily, but don't use harsh soaps or wash too vigorously. The
delicate skin around these areas can become irritated.
Empty your bladder as soon as possible after intercourse.
Drink a full glass of water to help flush bacteria.
Avoid using deodorant sprays or feminine products in the
genital area. These products can irritate the urethra and bladder.
7.State the COMPLICATIONS Lecture/ Laptop, Explaining, Listening, What are the
complication complication of
Kidney infection. An untreated bladder infection can lead to Discussion LCD, Asking asking and
of cystitis cystitis?
kidney infection, also called pyelonephritis. Kidney infections Pictures questions answering
may permanently damage your kidneys. questions
Young children and older adults are at the greatest risk of kidney

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damage from bladder infections because their symptoms are
often overlooked or mistaken for other conditions.
Blood in the urine. With cystitis, you may have blood cells in
your urine that can be seen only with a microscope (microscopic
hematuria) and that usually resolves with treatment. If blood cells
remain after treatment, your doctor may recommend a specialist
to determine the cause. Blood in the urine that you can see (gross
hematuria) is rare with typical, bacterial cystitis, but this sign is
more common with chemotherapy- or radiation-induced cystitis.
Septicaemia
 Scar tissue formation
 Cancer of the bladder

SUMMARY

Cystitis is one of the UTIs commonly caused by e.coli, streptococcus & staphylococcus pyogens other risk factors include catheterization,
cystoscopy, neurological disorders of the bladder e.t.c.symptoms include frequency, dysuria, suprapubic tenderness. The treatment is by
administration of appropriate antibiotics after culture and sensitivity.

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ASSIGNMENT
Read and make short notes on pyelitis. Assignment will checked in the next lecture.

REFERENCE
Lewis H.S et al. (2004).Medical-Surgical Nursing Assessment and Management of Clinical Problems.6th edition, Mosby, St Louis S.

th
Aronovitch. (2003).Medical-Surgical Nursing Health and Illness Perspective. 7 Edition, Mosby

M.S. Lewis Et Al. (1996).Medical-Surgical Nursing Assessment and Management of Clinical Problems. Mosby, St Louis.

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S.Aronovitch. (2003).Medical-Surgical Nursing Health and Illness Perspective. 7th Edition, Mosby USA.

Smeltzer S.C et al. (2010). Medical –Surgical Nursing 10th Edition, Elsevier, St Louis.

T.R. Harrison. (2001).Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill Company, USA.

www.healthhype.com. Access on 19/07/18. 12:23 hours

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