Nursing 124/125: Urinary Elimination

• Nursing 124/125 at Lincoln Memorial University Caylor School of Nursing in Spring 2024 covers alterations in urinary elimination.
• Upon completing the unit, students will demonstrate mastery of objectives related to urinary elimination in clinical, campus laboratory, individual/group conferences, and written materials.

Key Objectives

• Define and use key terms from assigned readings.
• Utilize therapeutic communication to assess urinary elimination needs.
• Differentiate between normal and abnormal urine characteristics.
• Outline nursing responsibilities for urinary tract diagnostic tests.
• Apply the nursing process to care for individuals with common urinary elimination problems.
• Demonstrate appropriate nursing interventions for ineffective responses to urinary elimination.
• Identify different types and treatments for urinary incontinence.
• Differentiate between continent and incontinent urinary diversions and implement appropriate care.
• Discuss the psychosocial impact of bladder cancer and adaptation to urinary diversion systems.
• Utilize the RAM nursing process to care for adults with renal/urinary disorders like inflammatory or obstructive disorders, genitourinary trauma or cancer.
• Identify the physiological action, use, side effects, and nursing implications of drugs managing urinary elimination needs.
• Identify treatments for erectile dysfunction.
• Utilize the nursing process to plan care for patients undergoing prostatectomy.
• Identify/discuss clinical manifestations of testicular cancer and related nursing care.
• Calculate dosages for IV, IM, and oral medications.

Topical Outline: Assessment of Renal/Urinary System

• Assessments include nursing history and physical assessments.

Common Diagnostic Exams

• Blood Tests
• Urinalysis
• Kidney, Ureter, & Bladder (KUB)
• Intravenous Urography
• CT
• Cystography and Cystourethrography
• Renography
• Ultrasonography
• Cystoscopy and Cystourethroscopy
• Urodynamic Studies
• Kidney Biopsy

RAM Nursing Process for Patients with Urinary Problems

• Focus areas include continence, incontinence, and types/management of urinary incontinence:
  • Non-surgical management
  • Surgical interventions
  • Medications
  • Home care management
  • Self-management education

Urinary Tract Infections

• Lower UTIs: cystitis (uncomplicated/complicated), catheter-associated UTI (CAUTI), interstitial cystitis, urethritis.
• Upper UTIs: acute and chronic pyelonephritis.
• Urolithiasis
• Urothelial (Bladder) Cancer
• Urinary diversions: ileal conduit (ileal loop), cutaneous ureterostomy, Kock pouch, sigmoidostomy.

RAM Nursing Process for Patients with Renal Disorders

• Congenital Disorders: polycystic kidney disease.
• Obstructive Disorders: urethral stricture, nephrostomy.
• Degenerative Disorders: nephrosclerosis.
• Renal Cell Carcinoma
• Kidney Trauma

RAM Nursing Process for Males with Reproductive Problems

• Benign Prostatic Hyperplasia (BPH): nonsurgical and surgical management including transurethral resection of the prostate (TURP).
• Prostatitis
• Prostate Cancer
• Testicular Cancer
• Erectile Dysfunction

Genitourinary Diagnostic Exams

• KUB (Kidney, Ureters, Bladder)

  • Purpose: X-ray to visualize stones, strictures, calcifications, or obstructions.
  • Preparation: None
  • Procedure: Lie flat and still.
  • Post-Care: None

• Intravenous Urography

  • Purpose: Visualize kidneys, renal pelvis, ureters, and bladder.
  • Preparation: Informed consent, laxative or bowel prep, NPO after midnight, avoid Benadryl/Glucophage, assess iodine/shellfish allergies.
  • Procedure: Lie flat and still, injection of IV dye, X-rays taken after injection.
  • Post-Care: Encourage fluid intake to excrete dye, monitor BUN & creatinine.

• CT

  • Purpose: Provides 3D information about kidneys, ureters, bladder, and tissue; detects tumors, cysts, abscesses, masses, obstructions, and renal blood vessels.
  • Preparation: No consent unless contrast; check dye allergies and creatinine levels.
  • Procedure: Lie flat and still, injection of IV dye, X-rays taken after injection.
  • Post-Care: Encourage fluid intake to excrete dye, monitor BUN & creatinine.

• Cystography & Cystourethrography

  • Purpose: Outline bladder shape and detect urinary reflux.
  • Preparation: None listed
  • Procedure: Instillation of dye into bladder via catheter; X-rays from front, back, and side.
  • Post-Care: Monitor for infection; encourage fluid intake to dilute urine.

• Renography

  • Purpose: Provides information about renal blood flow.
  • Preparation: None
  • Procedure: IV dye injection, pictures of radioactive emissions recorded.
  • Post-Care: Monitor UOP changes, encourage voiding, assess BP frequently if indicated.

• Ultrasonography

  • Purpose: Visualize kidneys, ureters, bladder, and other tissues; identify obstructions, tumors, cysts, and masses.
  • Preparation: Requires a full bladder.
  • Procedure: Prone/supine position, US gel applied. -Post-Care: Captopril was used; skin care to remove US gel.

• Bladder Scanner

  • Purpose: Determine retained urine volume/bladder distention.
  • Preparation: None
  • Procedure: Supine position; use "male" setting on post-hysterectomy females.
  • Post-Care: Same as above.

• Cystoscopy & Cystourethroscopy

  • Purpose: Diagnosis or treatment; discover abnormalities of bladder wall/occlusions in ureter or urethra.
  • Preparation: Informed consent, pre-operative checklist, NPO after MN.
  • Procedure: Cystoscope or urethroscope introduction after sedation.
  • Post-Care: Watch for bleeding & infection, monitor UOP, pink-tinged UOP expected, encourage oral intake, monitor for infection & UOP.

• Urodynamic Studies

  • Purpose: Examine the process of voiding.
  • Preparation: Perform catheterization.
  • Procedure: Dependent upon exam.
  • Post-Care: Monitor for infection & UOP.

• Renal Biopsy

  • Purpose: Test for glomerular disease
  • Preparation: Informed consent, NPO 4-6 hours before, coagulation studies.
  • Procedure: Insertion of needle to obtain tissue sample.
  • Post-Care: Monitor bleeding at biopsy site & hematuria; lie flat for 2-6 hours to prevent bleeding.

Medication List

• 5 Alpha Reductase Inhibitor
  • Finasteride (Proscar)
• Alpha-adrenergic agonists
  • Midodrine (ProAmatine, Orvaten)
• Alpha Blocker
  • Tamsulosin hydrochloride (Flomax)
  • Terazosin (Hytrin)
• Analgesic
  • Phenazopyridine (Pyridium)
• Androgen
  • Testosterone (Androgel)
• Antibiotics
  • Aminoglycoside
  • Gentamicin (Garamycin)
  • Cephalosporins
  • Cefaclor (Ceclor)
  • Cefixime (Suprax)
  • Cefpodoxime (Vantin)
  • Cephalexin (Keflex)
  • Ciprofloxacin (Cipro)
  • Omnicef (Cefdinir)
  • Nitrofurantoin (Macrobid, Macrodantin)
  • Penicillin
  • Amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin)
  • Phosphonic acid antibiotic
  • Fosfomycin (Monurol)
  • Sulfonamides
  • Sulfamethoxazole/Trimethoprim or co-trimoxazole (Bactrim, Septra)
  • Tetracyclines
    • Tetracycline
• Anticholinergic
  • Oxybutynin (Ditropan, Gelnique, Oxytrol)
  • Propantheline (Pro-Banthine)
• Anticoagulant
  • Heparin Sodium
  • Warfarin (Coumadin)
• Antifungal
  • Fluconazole (Diflucan)
• Antimuscarinics
  • Darifenacin (Enablex)
• Antispasmodics
  • Flavoxate HCL (Urispas)
  • Hyoscyamine (Cytospaz)
  • Solifenacin (Vesicare)
• Beta-3 adrenergic agonists
• Mirabegron (Myrbetriq)
• Diuretic
  • Loop Diuretics
  • Bumetanide (Bumex)
  • Furosemide (Lasix)
  • Torsemide (Demadex)
  • Osmotic Diuretic
    • Mannitol (Osmitrol)
  • Potassium Sparing/Aldosterone Antagonist
    • Spironolactone (Aldactone)
  • Thiazides
    • Hydrochlorothiazide (HCTZ) (Hydrodiuril, Esidrix, Microzide)
  • Phosphodiesterase (PDE) inhibitor
    • Sildenafil citrate (Viagra)
    • Tadalafil (Cialis)
• Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Duloxetine (Cymbalta)
• Tricyclic antidepressants
  • Amitriptyline (Elavil)