Podcast
Questions and Answers
An elderly patient reports increased urinary frequency, nocturia, and occasional incontinence. Given the typical genitourinary changes associated with aging, which intervention should the nurse prioritize to manage these symptoms?
An elderly patient reports increased urinary frequency, nocturia, and occasional incontinence. Given the typical genitourinary changes associated with aging, which intervention should the nurse prioritize to manage these symptoms?
- Establishing a scheduled voiding regimen every 2 hours during the day. (correct)
- Administering diuretics in the morning to reduce fluid retention.
- Inserting an indwelling urinary catheter to prevent skin breakdown from incontinence.
- Encouraging the patient to limit fluid intake, especially before bedtime.
A patient is scheduled for a cystoscopy. What should the nurse emphasize when teaching the patient about expected post-procedure effects?
A patient is scheduled for a cystoscopy. What should the nurse emphasize when teaching the patient about expected post-procedure effects?
- A sensation of bladder fullness and pain requiring immediate catheterization.
- Severe abdominal cramping and inability to void for 24 hours.
- Bright red blood in the urine for several days post-procedure.
- Blood-tinged urine and a burning sensation with urination. (correct)
A patient is diagnosed with pyelonephritis. Which assessment finding would most strongly suggest the infection has ascended from the lower urinary tract rather than being caused by hematogenous spread?
A patient is diagnosed with pyelonephritis. Which assessment finding would most strongly suggest the infection has ascended from the lower urinary tract rather than being caused by hematogenous spread?
- A history of recurrent cystitis and recent urinary catheterization. (correct)
- Flank pain and costovertebral tenderness.
- Sudden onset of high fever and chills.
- Generalized malaise and decreased appetite.
A nurse is educating a group of nursing assistants in a long-term care facility about preventing UTIs in female residents. Which instruction should the nurse prioritize to reduce the risk of urethrovesical reflux?
A nurse is educating a group of nursing assistants in a long-term care facility about preventing UTIs in female residents. Which instruction should the nurse prioritize to reduce the risk of urethrovesical reflux?
An older adult is admitted with confusion, urinary incontinence, and foul-smelling urine. Which intervention should the nurse prioritize to address the patient's altered mental status?
An older adult is admitted with confusion, urinary incontinence, and foul-smelling urine. Which intervention should the nurse prioritize to address the patient's altered mental status?
A patient with a history of calcium oxalate renal calculi is receiving dietary education. Which combination of foods should the nurse advise the patient to avoid to minimize the risk of future stone formation?
A patient with a history of calcium oxalate renal calculi is receiving dietary education. Which combination of foods should the nurse advise the patient to avoid to minimize the risk of future stone formation?
A patient is undergoing extracorporeal shock wave lithotripsy (ESWL) for renal calculi. Post-procedure, the patient reports flank pain and hematuria. Which action should the nurse implement first?
A patient is undergoing extracorporeal shock wave lithotripsy (ESWL) for renal calculi. Post-procedure, the patient reports flank pain and hematuria. Which action should the nurse implement first?
A patient with urolithiasis is prescribed nifedipine. What therapeutic effect should the nurse explain to the patient regarding this medication?
A patient with urolithiasis is prescribed nifedipine. What therapeutic effect should the nurse explain to the patient regarding this medication?
A male patient who has undergone surgical removal of a bladder tumor with the creation of an ileal conduit is concerned about changes in his body image and sexual function. Which nursing intervention is most appropriate to address these concerns?
A male patient who has undergone surgical removal of a bladder tumor with the creation of an ileal conduit is concerned about changes in his body image and sexual function. Which nursing intervention is most appropriate to address these concerns?
A patient with a newly created ileal conduit is being discharged. Which statement indicates the need for further education regarding stoma care?
A patient with a newly created ileal conduit is being discharged. Which statement indicates the need for further education regarding stoma care?
A nurse is teaching a young male patient about testicular self-examination (TSE). Which statement by the patient indicates a correct understanding of the procedure?
A nurse is teaching a young male patient about testicular self-examination (TSE). Which statement by the patient indicates a correct understanding of the procedure?
A nurse is caring for a patient who has undergone a nephrostomy. Which assessment finding should the nurse report immediately to the physician?
A nurse is caring for a patient who has undergone a nephrostomy. Which assessment finding should the nurse report immediately to the physician?
A patient with a ureteral injury following blunt abdominal trauma is being managed with a ureteral stent. What teaching point should the nurse emphasize to the patient regarding the stent?
A patient with a ureteral injury following blunt abdominal trauma is being managed with a ureteral stent. What teaching point should the nurse emphasize to the patient regarding the stent?
Following a motor vehicle accident, a patient presents with scrotal swelling and blood at the urinary meatus. Before attempting to insert a urinary catheter, what initial action should the nurse take?
Following a motor vehicle accident, a patient presents with scrotal swelling and blood at the urinary meatus. Before attempting to insert a urinary catheter, what initial action should the nurse take?
The nurse is caring for a patient with a neurogenic bladder due to a spinal cord injury. Which intervention is most crucial to prevent complications associated with urinary retention and stasis?
The nurse is caring for a patient with a neurogenic bladder due to a spinal cord injury. Which intervention is most crucial to prevent complications associated with urinary retention and stasis?
A patient is prescribed oxybutynin for urge incontinence. What adverse effect should the nurse educate the client about?
A patient is prescribed oxybutynin for urge incontinence. What adverse effect should the nurse educate the client about?
A patient is being treated for a UTI with sulfamethoxazole. Which instruction is most important for the nurse to provide the patient?
A patient is being treated for a UTI with sulfamethoxazole. Which instruction is most important for the nurse to provide the patient?
For a postoperative patient who has undergone bladder surgery, which nursing intervention is the most effective in preventing deep vein thrombosis (DVT)?
For a postoperative patient who has undergone bladder surgery, which nursing intervention is the most effective in preventing deep vein thrombosis (DVT)?
A patient is scheduled for a renal angiography. What instruction should the nurse provide to the patient about potential post-procedure complications?
A patient is scheduled for a renal angiography. What instruction should the nurse provide to the patient about potential post-procedure complications?
Which of the following is most important for a nurse to understand about the kidney?
Which of the following is most important for a nurse to understand about the kidney?
What should the nurse prioritize when caring for a client with urinary incontinence?
What should the nurse prioritize when caring for a client with urinary incontinence?
A client reports taking phenazopyridine for UTI symptoms. Which teaching point is most important for the nurse to include?
A client reports taking phenazopyridine for UTI symptoms. Which teaching point is most important for the nurse to include?
The older adult is at greatest risk for development of UTI due to what contributing factor?
The older adult is at greatest risk for development of UTI due to what contributing factor?
What would the nurse expect to find when performing a physical assessment of the bladder?
What would the nurse expect to find when performing a physical assessment of the bladder?
Why should a patient be encouraged to void frequently?
Why should a patient be encouraged to void frequently?
UTI is most commonly caused by which organism?
UTI is most commonly caused by which organism?
Elderly adults are susceptible to kidney injury due to what type of structural change?
Elderly adults are susceptible to kidney injury due to what type of structural change?
Which of the following assessment results should the nurse expect to find with a patient complaining of Pyelonephritis?
Which of the following assessment results should the nurse expect to find with a patient complaining of Pyelonephritis?
Following a bladder surgery which nursing diagnosis is the most imporant?
Following a bladder surgery which nursing diagnosis is the most imporant?
If a patient comes in the hospital with low back pain, nausea and committing, headache, malaise with painful urination what does that mean?
If a patient comes in the hospital with low back pain, nausea and committing, headache, malaise with painful urination what does that mean?
What is the best thing for someone to do to avoid a UTI?
What is the best thing for someone to do to avoid a UTI?
A patient with Nephrolithiasis complains they have nausea, vomiting, diaphoresis and they have blood in their urine. Where is that pain the most likely to be located?
A patient with Nephrolithiasis complains they have nausea, vomiting, diaphoresis and they have blood in their urine. Where is that pain the most likely to be located?
A patinet has impaired mobility and needs intermitten cathaterization. What is the goal with that?
A patinet has impaired mobility and needs intermitten cathaterization. What is the goal with that?
Which instruction is the most correct when teaching a patient about what they should do to prevent another renal stone?
Which instruction is the most correct when teaching a patient about what they should do to prevent another renal stone?
Trauma to the ureter can occur from which of the following?
Trauma to the ureter can occur from which of the following?
Which of the following is correct about treatment for a person with bladder caner?
Which of the following is correct about treatment for a person with bladder caner?
Following a bladder cancer surgeries, it is important to monitor what?
Following a bladder cancer surgeries, it is important to monitor what?
How would you diagnose a problem for the testies?
How would you diagnose a problem for the testies?
Which information should the nurse teach a male client about testicular self-examination?
Which information should the nurse teach a male client about testicular self-examination?
A patient with a history of recurrent UTIs is prescribed nitrofurantoin. Which statement indicates the patient understands the teaching regarding this medication?
A patient with a history of recurrent UTIs is prescribed nitrofurantoin. Which statement indicates the patient understands the teaching regarding this medication?
An older adult patient is diagnosed with a UTI and presents with new-onset confusion. Which intervention is most critical for the nurse to implement?
An older adult patient is diagnosed with a UTI and presents with new-onset confusion. Which intervention is most critical for the nurse to implement?
A nurse is caring for a patient post-cystoscopy. Which finding requires immediate intervention?
A nurse is caring for a patient post-cystoscopy. Which finding requires immediate intervention?
Following a motor vehicle accident, a patient is diagnosed with a ureteral injury. What is the rationale for using a ureteral stent in the management of this condition?
Following a motor vehicle accident, a patient is diagnosed with a ureteral injury. What is the rationale for using a ureteral stent in the management of this condition?
A patient with a neurogenic bladder is on intermittent catheterization. Which parameter should the nurse monitor to determine the effectiveness of this intervention?
A patient with a neurogenic bladder is on intermittent catheterization. Which parameter should the nurse monitor to determine the effectiveness of this intervention?
A patient with urge incontinence is prescribed oxybutynin. What mechanism of action explains how this medication helps manage their symptoms?
A patient with urge incontinence is prescribed oxybutynin. What mechanism of action explains how this medication helps manage their symptoms?
A patient with a history of calcium oxalate renal calculi asks the nurse for dietary advice. Which recommendation is most appropriate?
A patient with a history of calcium oxalate renal calculi asks the nurse for dietary advice. Which recommendation is most appropriate?
A patient is scheduled for a renal angiography. Which pre-procedure assessment is most important for the nurse to perform?
A patient is scheduled for a renal angiography. Which pre-procedure assessment is most important for the nurse to perform?
An elderly male patient is diagnosed with benign prostatic hyperplasia (BPH). Which statement indicates he needs further teaching about managing his condition?
An elderly male patient is diagnosed with benign prostatic hyperplasia (BPH). Which statement indicates he needs further teaching about managing his condition?
A patient undergoing treatment for bladder cancer with intravesical bacille Calmette-Guérin (BCG) instillation is being discharged. Which instruction is most important for the nurse to emphasize?
A patient undergoing treatment for bladder cancer with intravesical bacille Calmette-Guérin (BCG) instillation is being discharged. Which instruction is most important for the nurse to emphasize?
Following a nephrectomy, a patient develops paralytic ileus. Which intervention is most appropriate for the nurse to implement?
Following a nephrectomy, a patient develops paralytic ileus. Which intervention is most appropriate for the nurse to implement?
A patient who has undergone surgical removal of a bladder tumor and creation of an ileal conduit reports feeling anxious and concerned about changes in body image and sexual function. Which nursing intervention is most appropriate?
A patient who has undergone surgical removal of a bladder tumor and creation of an ileal conduit reports feeling anxious and concerned about changes in body image and sexual function. Which nursing intervention is most appropriate?
A patient reports experiencing stress incontinence. Which intervention should the nurse recommend as a first-line treatment?
A patient reports experiencing stress incontinence. Which intervention should the nurse recommend as a first-line treatment?
A young male patient is being taught about testicular self-examination (TSE). Which statement indicates a correct understanding of the procedure?
A young male patient is being taught about testicular self-examination (TSE). Which statement indicates a correct understanding of the procedure?
What is the priority nursing intervention for a patient immediately post-op after undergoing urinary diversion surgery?
What is the priority nursing intervention for a patient immediately post-op after undergoing urinary diversion surgery?
A patient is scheduled to undergo extracorporeal shock wave lithotripsy (ESWL) for renal calculi. Post-procedure, the patient reports flank pain and hematuria. Which action should the nurse implement first?
A patient is scheduled to undergo extracorporeal shock wave lithotripsy (ESWL) for renal calculi. Post-procedure, the patient reports flank pain and hematuria. Which action should the nurse implement first?
The nurse is educating a patient on risk factors for testicular cancer. Which of the following is a risk factor for testicular cancer?
The nurse is educating a patient on risk factors for testicular cancer. Which of the following is a risk factor for testicular cancer?
A patient is suspected of of having bladder cancer. What would the nurse expect the provider to order?
A patient is suspected of of having bladder cancer. What would the nurse expect the provider to order?
A patient who has undergone transurethral resection of a bladder tumor (TURBT) calls the clinic complaining of increased bleeding, dysuria, and fever. What should the nurse advise the patient to do?
A patient who has undergone transurethral resection of a bladder tumor (TURBT) calls the clinic complaining of increased bleeding, dysuria, and fever. What should the nurse advise the patient to do?
A patient reports urinary incontinence only when laughing, coughing, or sneezing. Which type of incontinence does the nurse suspect?
A patient reports urinary incontinence only when laughing, coughing, or sneezing. Which type of incontinence does the nurse suspect?
The nurse is providing discharge instructions to a patient following a nephrostomy. Which statement indicates the teaching was effective?
The nurse is providing discharge instructions to a patient following a nephrostomy. Which statement indicates the teaching was effective?
A patient is receiving sulfamethoxazole-trimethoprim for a UTI. Which assessment finding is most indicative of a potential adverse effect of this medication?
A patient is receiving sulfamethoxazole-trimethoprim for a UTI. Which assessment finding is most indicative of a potential adverse effect of this medication?
A patient asks the nurse for advice on preventing recurrent UTIs. Besides increasing fluid intake, which recommendation is most appropriate?
A patient asks the nurse for advice on preventing recurrent UTIs. Besides increasing fluid intake, which recommendation is most appropriate?
What is most important for the nurse to assess regarding a patient coming in with pyelonephritis?
What is most important for the nurse to assess regarding a patient coming in with pyelonephritis?
Which statement by a patient with a history of renal calculi indicates a need for further education?
Which statement by a patient with a history of renal calculi indicates a need for further education?
A patient newly diagnosed with a neurogenic bladder is prescribed self-catheterization. What is the most important principle for the nurse to emphasize during patient education?
A patient newly diagnosed with a neurogenic bladder is prescribed self-catheterization. What is the most important principle for the nurse to emphasize during patient education?
A patient with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). The nurse understands that this procedure is contraindicated in patients with which condition?
A patient with urolithiasis is scheduled for extracorporeal shock wave lithotripsy (ESWL). The nurse understands that this procedure is contraindicated in patients with which condition?
The nurse is providing dietary education to prevent renal calculi and knows the education was effective if they state:
The nurse is providing dietary education to prevent renal calculi and knows the education was effective if they state:
A patient is diagnosed with urge urinary incontinence. The nurse anticipates the health care provider will prescribe:
A patient is diagnosed with urge urinary incontinence. The nurse anticipates the health care provider will prescribe:
The nurse is caring for a post-operative client, what should the nurse monitor post-operatively?
The nurse is caring for a post-operative client, what should the nurse monitor post-operatively?
The nurse educator on a medical-surgical unit is presenting information on CAUTI prevention. Which statement if made by one of the nurses, indicated a need for further education?
The nurse educator on a medical-surgical unit is presenting information on CAUTI prevention. Which statement if made by one of the nurses, indicated a need for further education?
A patient with a history of nephrolithiasis is prescribed thiazide diuretics. What is the expected outcome of this medication in preventing future stone formation?
A patient with a history of nephrolithiasis is prescribed thiazide diuretics. What is the expected outcome of this medication in preventing future stone formation?
A patient who underwent a nephrectomy is at risk of developing acute peritonitis. Which assessment finding should the nurse prioritize?
A patient who underwent a nephrectomy is at risk of developing acute peritonitis. Which assessment finding should the nurse prioritize?
A male patient is newly diagnosed with testicular cancer. What is the most appropriate nursing intervention to address his potential anxiety and concerns?
A male patient is newly diagnosed with testicular cancer. What is the most appropriate nursing intervention to address his potential anxiety and concerns?
Flashcards
Lower UTI
Lower UTI
Involves lower urinary tract- bladder and structures below.
Upper UTI
Upper UTI
Involves upper urinary tract, including the kidneys and ureters.
Cystitis
Cystitis
Inflammation of the urinary bladder.
Prostatitis
Prostatitis
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Urethritis
Urethritis
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Urethrovesical reflux
Urethrovesical reflux
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Ureterovesical reflux
Ureterovesical reflux
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Urge incontinence
Urge incontinence
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Stress incontinence
Stress incontinence
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Functional incontinence
Functional incontinence
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Iatrogenic incontinence
Iatrogenic incontinence
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Mixed incontinence
Mixed incontinence
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Overflow incontinence
Overflow incontinence
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Transient incontinence
Transient incontinence
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Urinary retention
Urinary retention
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Neurogenic bladder
Neurogenic bladder
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Urolithiasis/Nephrolithiasis
Urolithiasis/Nephrolithiasis
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Sulfonamides
Sulfonamides
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Urinary Antiseptics
Urinary Antiseptics
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Genitourinary Trauma Management
Genitourinary Trauma Management
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Calcium Channel Blockers
Calcium Channel Blockers
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Testicular Cancer
Testicular Cancer
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Testicular Self-Exam
Testicular Self-Exam
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Study Notes
- Unit 5 concerns the nursing management of patients experiencing health deviations related to elimination.
- Professor Ruth Thuo MSN-RN developed this chapter for review.
Required Readings
- Hinkle, chapters 47, 49, and 53 are required reading.
- Karch, chapters 9, 15, 41, and 52 are required reading.
- The Kaplan Renal-Urologic System A is required reading.
Objectives
- Explain key terms and medical terminology related to altered genitourinary function.
- Apply knowledge of the pathophysiology of selected genitourinary disorders in adults and children
- Adults and children disorders include: hypospadias/epispadias, cryptorchidism, nephrotic syndrome, glomerulonephritis, urolithiasis, Wilms tumor, enuresis, male reproductive disorders, prostate disease, bladder cancer, cancer of the testes, renal calculi, and urinary diversions.
- Apply the nursing process in the maintenance of health and promotion of self care of the adult patient with altered GU function or genitourinary disorders.
- Relate diagnostic tests to patients with altered genitourinary function.
- Apply pharmacotherapeutics to treat patients with selected genitourinary diseases.
- Determine normal developmental changes and changes of aging as they pertain to patients with genitourinary diseases.
- Articulate the nursing responsibilities regarding the nutritional requirements of patients with altered genitourinary function.
- Develop health promotion and maintenance practices as they relate to patients with altered genitourinary function.
- Determine unique teaching/learning needs of patients with altered genitourinary function.
- Demonstrate the ability to deliver dignified nursing care, considering the diverse cultural needs of patients with altered GU function.
- Employ verbal and non-verbal communication techniques effectively when delivering care to patients experiencing common health care deviations.
- Discuss principles of safety and efficient use of systems resources in the care of patients experiencing common health care deviations related to elimination.
Physical Assessment
- Empty bladder is not palpable.
- Dullness indicates residual urine.
- A midline mass indicates full bladder.
- Palpate the costovertebral angle (12th rib and spine), referencing Figures 47-5 and 47-7.
- Peripheral edema may indicate reduced kidney function.
- Identifying characteristics of genitourinary pain can be found in table 47-2.
Diagnostic Studies
- Urinalysis and urine culture are common diagnostic tools.
- See table 53-5 for renal function tests.
- Ultrasonography, also known as KUB, is a non-invasive diagnostic method.
- CT and MRI scans are valuable for detailed imaging.
- Nuclear scans can assess kidney function and identify abnormalities.
- Endoscopic procedures allow direct visualization of the urinary tract.
- Biopsies are performed to diagnose and stage cancers and other kidney diseases.
- IV urography involves injecting contrast dye and taking X-rays of the urinary tract.
- Retrograde pyelography involves injecting contrast dye into the ureters to visualize the kidneys and ureters.
- Cystography is and X-ray visualization of the bladder after injecting contrast dye.
- Renal angiography visualizes the renal blood vessels using contrast dye and X-rays.
- See Chart 53-4 for additional diagnostic information. Urine Cultures:
- Useful for identifying the specific organism responsible for a UTI.
- A colony count greater than 100,000 CFU/mL of urine on a clean-catch midstream or catheterized specimen indicates infection.
- A multiple-test dipstick often includes testing for WBCs (leukocyte esterase test) and nitrite testing.
- Tests for sexually transmitted infections are important in acute urethritis
- STIs examples are Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex, or acute vaginitis infections which cause symptoms similar to those of UTIs.
- X-ray, CT scan, ultrasonography, and kidney scans are useful for detect pyelonephritis or abscesses, obstruction, tumors and cysts. 24-hour Urine testing
- Renal clearance can be tested through 24-hour urine testing.
- Creatinine clearance, reflecting renal function can be assessed via 24-hour urine testing.
- Progression of renal disease can be monitored using 24-hour urine testing.
- Serum creatinine values should be between 0.6-1.2 mg/dL.
- Blood urea nitrogen(BUN) values should be between 7-18 mg/dL.
Cystoscopy
- Operative procedure to view structure of bladder via flexible tube
- Pre-procedure: NPO, premedication, anesthesia, and consent required
- Post-procedure: monitor output, blood-tinged urine, and burning
Kidney Functions
- Control BP
- Control water balance
- Excrete waste products
- Regulate electrolyte levels
- Regulate acid base balance
- Regulate red blood cell production via erythropoietin, which stimulates bone marrow to produce RBCs
- Renal clearance
- Secrete prostaglandins
- Synthesize vitamin D into active form
- Urine formation
Management of Patients with Urinary Disorders
- It’s important to cover the management of patients with urinary disorders
Factors Contributing to UTI
- Bacterial invasion of the urinary tract
- Urethrovesical reflux
- Uropathogenic bacteria
- Shorter urethra in women
Risk Factors for UTI
- Instrumentation, such as catheters
- Preexisting conditions, such as diabetes or pregnancy
- Immobility
- Incomplete bladder emptying
- Obstruction
- Immunosuppression
Urinary Tract Infections (UTI)
- UTIs are caused by pathogenic microorganisms in the urinary tract.
- UTIs are classified by location:
- Lower urinary tract
- Structures below the bladder
- Upper urinary tract, involving the kidneys and ureters.
- Lower urinary tract
- UTIs are the second most common infection in the body.
- 50% of all hospital-acquired infections are catheter-associated urinary tract infections (CAUTI) in patients with indwelling urinary catheters.
Upper Urinary Tract Infection: Pyelonephritis
- Acute pyelonephritis symptoms
- Chills, fever, symptoms of UTI
- Low back/flank pain
- Costovertebral tenderness
- Generalized malaise
- Chronic pyelonephritis symptoms
- Inflammation and infection of the kidney
Urinary Tract Infections (Cont.)
- Upper UTIs
- Pyelonephritis: acute and chronic
- S/S chills, fever, leukocytosis, bacteriuria, and pyuria
- Low back pain, flank pain, nausea and vomiting, headache, malaise, and painful urination
- Physical examination reveals pain, tenderness in the area of the costovertebral angle
- Lower UTIs
- Cystitis: inflammation of the urinary bladder
- Prostatitis: inflammation of the prostate gland
- Urethritis: inflammation of the urethra
Urethrovesical and Ureterovesical Reflux
- Urethrovesical reflux
- Backward flow of urine from the urethra into the bladder
- Brings bacteria from anterior portions of the urethra into the bladder
- Ureterovesical or Vesicoureteral Reflux
- Backward flow of urine from the bladder into one or both ureters
- Caused by impairment of the ureterovesical valve
- Bacteria reaches the kidneys and destroys them.
Gerontologic Considerations
- Older adults are susceptible to kidney injury due to renal structural and functional changes.
- Sclerosis of the glomerulus and renal vasculature
- Decreased blood flow
- Decreased GFR
- Altered tubal function and acid-base balance
- Other factors
- Incomplete emptying of bladder
- Urinary stasis
- Decreased nerve innervations
- Decreased drug clearance can lead to increased drug-drug interactions
- Cognitive impairment
- Frequent use of antimicrobial agents
- High incidence of multiple chronic medical conditions
- Immune compromised
- Low fluid intake and excessive fluid loss
- Obstructed flow of urine
- Urethral strictures
- Neoplasms
- Clogged indwelling catheter
- Poor hygiene practices
- Escherichia coli is the most common organism seen in older patients in the community or hospital.
- Patients with indwelling catheters are more likely to be infected by Proteus, Klebsiella, Pseudomonas, or Staphylococcus.
- Early symptoms of UTI in postmenopausal women and older adults include malaise, nocturia, urinary incontinence, or a complaint of foul-smelling urine.
- Additional possible symptoms include burning, urgency, fever, incontinence and delirium.
- Treatment regimens are generally the same as those for younger adults.
- Age-related changes in intestinal absorption, decreased kidney function and hepatic flow may necessitate alterations in the antimicrobial regimen.
- Kidney function must be monitored, and medication dosages should be altered accordingly.
Nursing interventions for UTIs
- Relieving pain includes relieving bladder irritability and pain.
- Medications as prescribed: antibiotics, analgesics, and antispasmodics
- Application of heat to the perineum to relieve pain and spasm
- Increased fluid intake to promote renal blood flow and to flush the bacteria from the urinary tract.
- Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol
- Frequent voiding to lower urine bacterial counts, reduce urinary stasis, and prevent reinfection
- Fluid management 1500-1600 ml a day
- Avoid caffeinated products
- Establish voiding schedule at every 2 hours
- Bladder retraining by extending voiding schedule
- Pelvic muscle exercises which are "Kegel exercises" 2-3 times a day
Medications for UTIs
- Sulfonamides
- Mechanism by inhibiting folic acid synthesis
- Absorbed in the GI tract, peak hours 3-6
- Adverse effects: GI distress, abdominal pain, hepatic injury, nephrotoxicity, photosensitivity, Steven-Johnson syndrome
- Contraindications: Allergy, pregnant, renal disease, kidney stones
- Urinary Antiseptics: Nitrofurantoin, phenazopyridine, trimethoprim sulfamethazole
- Directly destroy bacteria by interfering with cell wall and causes urine acidification
- Contraindications: Allergy, renal dysfunction, pregnancy, lactation
- Adverse effects: Headache, dizziness, nausea, diarrhea, vaginal irritation
Altered Voiding Dysfunction:
- Urinary incontinence,- unplanned, involuntary, or uncontrolled loss of urine from the bladder.
- Urinary retention- inability to completely empty the bladder when attempting to void
- Neurogenic bladder- dysfunction resulting from a disorder of the nervous system that leads to urinary incontinence.
- Urolithiasis/nephrolithiasis- stones/calculi in the urinary tract and kidney.
- Genitourinary trauma- injuries to the flank, back, or upper abdomen; blunt trauma accounts for 85%
Additional Information on Urinary Incontinence
- Affects more than 25 million adults in the United States
- It is frequently under-diagnosed and under-reported!
- Affects women and men equally
- Can be a symptom of multiple different disorders and diseases
Types of Urinary Incontinence:
- Stress incontinence- is the result of exertion, sneezing, or coughing predominantly affects women after vaginal births
- Urge incontinence- is the involuntary loss of urine due to a strong urge to void that you cant control
- Functional incontinence- is due to physical or cognitive impairments (ex. Alzheimer's dementia)
- Iatrogenic incontinence- is the involuntary loss of urine due to extrinsic medical factor or medications
- Mixed incontinence- the involuntary leakage associated with urge to void and can happen when sneezing/coughing
- Overflow incontinence- Results in the continual leakage of urine from an over distended bladder.
Transient incontinence
- Is temporary and is resolved after the cause is identified and treated
- Caused by:
- Delirium
- Infection
- Atrophic urethritis
- Excess Urine Output
- Restricted Mobility
- Stool impaction
Plan of care for urinary incontinence
- Educate verbally and in writing
- Develop and use a voiding log or diary
- Involve the patient in behavioral interventions such as doing Kegel exercises using a voiding diary and verbally giving instructions and positive encouragement.
Urinary Retention
- Defined by the inability of bladder to completely empty
- Some may experiences 50-100ml of residual urine
Causes of urinary retention include
- Post op spasms
- Neurologic disorders
- Medications
Diagnosing Urolithiasis and Nephrolithiasis
- May cause infection which results in pyelonephritis
- Presents with excruciating deep pain
Management
- Main objective is to treat pain, use opioid analgesics
- Remove stones by fragmentation if greater than 1cm in diameter.
Treatment options for Renal Stones
- Use calcium channel blockers such as Nifedipine to relax muscles
- Use loop diuretics to help promote elimination
- Use glucocorticoids as another option for medication.
Patient Education should include
- Diet restrictions
- Urine pH monitoring
- Importance of fluid intake
Genitourinary trauma
- Can result form motor vehicles or sports accidents.
- Can happen from a pelvic fracture to the bladder
Medical management should assess
Assess the hemorrhage amount, levels of pain, any possible infections that can develop.
Bladder Cancer
- Occurs in adults over the age of 65.
- More prevalent in men than women
- Cancer can be caused by prostate, colon or rectum.
- Patients should be aware that tobacco use is leading cause for this.
- Immediately monitor vital signs, provide skin & stoma care to prevent cancer
Educate patients on
- Providing at home education and how to manage a home ostomy.
- Provide any support by listening to any and all challenges the patient is facing.
- Encourage a healthy and positive attitude.
What to monitor in urinary diversions:
- Assess stoma & any changes to urine flow or any skin changes
- Preventative care should emphasize maintaining skin integrity.
Important Post-op Precaution for urinary diversion
- Monitor urine, stoma and provide a high concentration of supportive and positive words.
Pre-op Nursing Interventions for urinary diversion
- Assess the patient's anxiety, educate the plan of care and ensure the nurse is providing a well balanced meal or nutrition with what the patient can consume.
Managing urinary diversions
- Address any post operative risks such as impaired skin or body image.
Testicular cancer Facts
- Affects men from 15 to 40 which is very treatable through self exams.
- Encourage a monthly testicular self exam.
- Orchiectomy open or laparoscopic can help with the cancer
Nursing Management of Testicular Cancer
- Assessment of physical and psychological status is key.
- Support of coping is key.
- Address issues of body image and sexuality is an important step in providing counseling.
- Encourage a positive attitude of recovery.
- Patient education on TSE.
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