NCLEX Review Guide: Acute Cystitis (Urinary Tract Infection)

Understanding Acute Cystitis

• Acute cystitis is inflammation of the bladder wall, most commonly caused by E. coli bacteria ascending from the urethra to the bladder.
• Women are at higher risk due to shorter urethra length (4cm vs 20cm in men), allowing easier bacterial migration from the perineal area.
• Risk factors include sexual activity, pregnancy, diabetes mellitus, immunosuppression, urinary retention, and catheter use.

Assessment Findings

• Classic triad: dysuria (painful urination), frequency, and urgency are the hallmark symptoms of acute cystitis.
• Additional symptoms include suprapubic pain, hematuria, cloudy/foul-smelling urine, and nocturia.
• Fever and flank pain indicate upper UTI (pyelonephritis) requiring immediate intervention

Laboratory Studies

• Urinalysis shows >10 WBCs/hpf, positive nitrites, positive leukocyte esterase, and possible RBCs indicating inflammation.
• Urine culture and sensitivity (C&S) identifies specific organism and appropriate antibiotic therapy; >100,000 CFU/mL confirms UTI.
• Clean-catch midstream specimen is preferred collection method to avoid contamination from perineal flora.

Priority Nursing Actions

1. Obtain clean-catch urine specimen before antibiotic administration for accurate culture results.
2. Administer prescribed antibiotics as ordered; first-line treatment is typically trimethoprim-sulfamethoxazole or nitrofurantoin.
3. Encourage increased fluid intake (2-3 L/day unless contraindicated) to flush bacteria from urinary tract.
4. Provide comfort measures including warm sitz baths, heating pad to lower abdomen, and urinary analgesics as prescribed.

Prevention & Self-Care

• Teach proper perineal hygiene: wipe front to back, urinate after sexual activity, and avoid harsh soaps or douches.
• Emphasize completing full antibiotic course even if symptoms resolve to prevent antibiotic resistance and recurrence.
• Recommend cranberry products and adequate hydration as preventive measures, though evidence for cranberry is limited.
• Instruct to seek immediate care for fever, flank pain, nausea/vomiting indicating possible pyelonephritis