Podcast
Questions and Answers
What is the primary reason for frequent voiding interventions in patients with urinary tract infections?
What is the primary reason for frequent voiding interventions in patients with urinary tract infections?
- To increase the concentration of antibiotics in the urinary tract.
- To promote patient comfort and reduce the sensation of urgency.
- To lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. (correct)
- To decrease bladder capacity and improve muscle tone.
In older adults, what unique symptom is most likely to indicate a urinary tract infection (UTI)?
In older adults, what unique symptom is most likely to indicate a urinary tract infection (UTI)?
- Hematuria.
- Fever and chills.
- Confusion and delirium. (correct)
- Dysuria and urgency.
A patient with urolithiasis is prescribed nifedipine. What is the rationale for using nifedipine, a calcium channel blocker, in the management of urolithiasis?
A patient with urolithiasis is prescribed nifedipine. What is the rationale for using nifedipine, a calcium channel blocker, in the management of urolithiasis?
- To dilate the ureter and alleviate smooth muscle spasm, aiding stone expulsion. (correct)
- To reduce inflammation and swelling in the urinary tract.
- To decrease blood pressure and reduce cardiac workload.
- To block calcium absorption in the kidneys, preventing further stone formation.
A nurse is educating a patient diagnosed with kidney stones about dietary modifications. Which instruction is most appropriate for patients with a history of oxalate stones?
A nurse is educating a patient diagnosed with kidney stones about dietary modifications. Which instruction is most appropriate for patients with a history of oxalate stones?
What is the primary rationale behind advocating for a liberal fluid intake in patients with neurogenic bladder?
What is the primary rationale behind advocating for a liberal fluid intake in patients with neurogenic bladder?
What is the most critical nursing intervention for a patient in the immediate postoperative period following a surgical procedure to create an ileal conduit for urinary diversion?
What is the most critical nursing intervention for a patient in the immediate postoperative period following a surgical procedure to create an ileal conduit for urinary diversion?
In managing a patient with a cutaneous ureterostomy, what assessment finding would necessitate immediate notification of the surgeon?
In managing a patient with a cutaneous ureterostomy, what assessment finding would necessitate immediate notification of the surgeon?
What is the primary advantage of a continent urinary diversion (e.g., Kock pouch) over a cutaneous urinary diversion (e.g., ileal conduit)?
What is the primary advantage of a continent urinary diversion (e.g., Kock pouch) over a cutaneous urinary diversion (e.g., ileal conduit)?
What is the most significant risk factor contributing to bladder cancer?
What is the most significant risk factor contributing to bladder cancer?
A patient is receiving intravesical bacille Calmette-Guérin (BCG) for bladder cancer. What key instruction should the nurse provide to the patient regarding post-treatment precautions?
A patient is receiving intravesical bacille Calmette-Guérin (BCG) for bladder cancer. What key instruction should the nurse provide to the patient regarding post-treatment precautions?
What nursing action is most essential when caring for a patient following a nephrostomy tube placement?
What nursing action is most essential when caring for a patient following a nephrostomy tube placement?
A patient with a history of frequent UTIs asks the nurse about using cranberry juice for prevention. What is the most accurate, evidence-based response?
A patient with a history of frequent UTIs asks the nurse about using cranberry juice for prevention. What is the most accurate, evidence-based response?
The nurse is caring for a client who has undergone a cystoscopy. Which of the following assessment findings should be reported to the physician immediately?
The nurse is caring for a client who has undergone a cystoscopy. Which of the following assessment findings should be reported to the physician immediately?
The nurse is teaching a male client how to perform a testicular self-examination (TSE). What is the most important instruction the nurse should provide?
The nurse is teaching a male client how to perform a testicular self-examination (TSE). What is the most important instruction the nurse should provide?
A nurse is caring for a group of older adult clients in a long-term care facility. What consideration is most crucial when planning interventions to prevent UTIs in this population?
A nurse is caring for a group of older adult clients in a long-term care facility. What consideration is most crucial when planning interventions to prevent UTIs in this population?
A patient with acute pyelonephritis is prescribed intravenous antibiotics. What is the most significant indicator that the treatment is effective?
A patient with acute pyelonephritis is prescribed intravenous antibiotics. What is the most significant indicator that the treatment is effective?
A client post kidney transplant exhibits symptoms of rejection. What specific symptom should the nurse monitor to recognize acute rejection?
A client post kidney transplant exhibits symptoms of rejection. What specific symptom should the nurse monitor to recognize acute rejection?
A nurse is caring for a patient with nephrolithiasis experiencing severe renal colic. What nursing intervention is of utmost importance during the initial phase of management?
A nurse is caring for a patient with nephrolithiasis experiencing severe renal colic. What nursing intervention is of utmost importance during the initial phase of management?
When providing discharge instructions to a patient post-ESWL for renal calculi, what statement by the patient indicates an understanding?
When providing discharge instructions to a patient post-ESWL for renal calculi, what statement by the patient indicates an understanding?
Which action is most important for the nurse to perform when administering sulfonamides for a urinary tract infection?
Which action is most important for the nurse to perform when administering sulfonamides for a urinary tract infection?
Knowing the factors contributing to UTIs is important for prevention. Which of the following is a risk factor for developing a UTI?
Knowing the factors contributing to UTIs is important for prevention. Which of the following is a risk factor for developing a UTI?
What is the rationale for using anticholinergic medications such as oxybutynin in the treatment of urge incontinence?
What is the rationale for using anticholinergic medications such as oxybutynin in the treatment of urge incontinence?
What assessment finding is most indicative of fluid volume overload when caring for a patient with altered kidney function?
What assessment finding is most indicative of fluid volume overload when caring for a patient with altered kidney function?
The nurse is caring for a patient with genitourinary trauma from a motor vehicle accident. Which immediate intervention will reduce secondary injury?
The nurse is caring for a patient with genitourinary trauma from a motor vehicle accident. Which immediate intervention will reduce secondary injury?
Medications such as Prednisone and methylprednisolone are used for the treatment of inflammatory disorders. The nurse knows these medications are contraindicated in certain populations. Which is a contraindication of their use?
Medications such as Prednisone and methylprednisolone are used for the treatment of inflammatory disorders. The nurse knows these medications are contraindicated in certain populations. Which is a contraindication of their use?
What information is important to have prior to a kidney biopsy?
What information is important to have prior to a kidney biopsy?
While caring for the patient post-op cystoscopy, which of the following is NOT an expected order?
While caring for the patient post-op cystoscopy, which of the following is NOT an expected order?
The nurse needs to teach the nursing assistants ways to decrease the incidence of UTIs in a long-term care facility. Which information is MOST IMPORTANT to share? (Select all that apply).
The nurse needs to teach the nursing assistants ways to decrease the incidence of UTIs in a long-term care facility. Which information is MOST IMPORTANT to share? (Select all that apply).
A patient comes to the clinic. The patient complains of blood in the the urine, voiding frequently, and pain with urination. After testing, the patient is diagnosed with a UTI. A urinalysis reveals positive nitrites, positive leukocyte esterase, and a bacteria count of 150,000 CFU/mL. What does the bacteria colony count indicate?
A patient comes to the clinic. The patient complains of blood in the the urine, voiding frequently, and pain with urination. After testing, the patient is diagnosed with a UTI. A urinalysis reveals positive nitrites, positive leukocyte esterase, and a bacteria count of 150,000 CFU/mL. What does the bacteria colony count indicate?
When providing teaching to a client about how to prevent calcium build up in the urinary systems, the nurse would emphasize the need to avoid
When providing teaching to a client about how to prevent calcium build up in the urinary systems, the nurse would emphasize the need to avoid
Which statement is accurate of urinary incontinence?
Which statement is accurate of urinary incontinence?
After reviewing the types of urinary incontinence with the client, which statement indicates the client has an understanding of stress incontinence?
After reviewing the types of urinary incontinence with the client, which statement indicates the client has an understanding of stress incontinence?
The nurse is caring for a client who is incontinent from frequent urination. What can the nurse implement to promote continence?
The nurse is caring for a client who is incontinent from frequent urination. What can the nurse implement to promote continence?
The client is admitted for the removal of calculi in the kidney. The nurse anticipates which of the following interventions for renal calculi?
The client is admitted for the removal of calculi in the kidney. The nurse anticipates which of the following interventions for renal calculi?
The laboratory results for urinary calculi come back as uric acid. As the nurse provides education on what foods to avoid for this situation, which does the nurse mention?
The laboratory results for urinary calculi come back as uric acid. As the nurse provides education on what foods to avoid for this situation, which does the nurse mention?
Which is not a manifestation of renal calculi?
Which is not a manifestation of renal calculi?
What is the best time to teach men to perform testicular self examinations.
What is the best time to teach men to perform testicular self examinations.
A patient with a history of urolithiasis is prescribed a thiazide diuretic. What is the primary mechanism by which thiazide diuretics help prevent the recurrence of calcium-based kidney stones?
A patient with a history of urolithiasis is prescribed a thiazide diuretic. What is the primary mechanism by which thiazide diuretics help prevent the recurrence of calcium-based kidney stones?
What is the primary rationale for administering sodium bicarbonate to a patient with uric acid nephrolithiasis?
What is the primary rationale for administering sodium bicarbonate to a patient with uric acid nephrolithiasis?
What is the underlying reason for bladder spasms following a cystoscopy, and how might these spasms affect a patient's recovery?
What is the underlying reason for bladder spasms following a cystoscopy, and how might these spasms affect a patient's recovery?
A male patient reports experiencing erectile dysfunction and lower back pain. What genitourinary condition should be suspected?
A male patient reports experiencing erectile dysfunction and lower back pain. What genitourinary condition should be suspected?
An older adult patient is suspected of having a urinary tract infection (UTI) but does not exhibit typical symptoms such as dysuria or fever. Which symptom is most indicative of a UTI in this population?
An older adult patient is suspected of having a urinary tract infection (UTI) but does not exhibit typical symptoms such as dysuria or fever. Which symptom is most indicative of a UTI in this population?
A patient with a neurogenic bladder is prescribed intermittent catheterization. What instruction is the most critical for the nurse to emphasize to prevent complications?
A patient with a neurogenic bladder is prescribed intermittent catheterization. What instruction is the most critical for the nurse to emphasize to prevent complications?
Following a nephrostomy tube placement, a patient reports continuous flank pain despite prescribed analgesics. What is the most appropriate initial nursing intervention?
Following a nephrostomy tube placement, a patient reports continuous flank pain despite prescribed analgesics. What is the most appropriate initial nursing intervention?
A patient undergoing intravesical bacille Calmette-Guérin (BCG) treatment for bladder cancer reports flu-like symptoms, including fever and chills. What is the most appropriate nursing action?
A patient undergoing intravesical bacille Calmette-Guérin (BCG) treatment for bladder cancer reports flu-like symptoms, including fever and chills. What is the most appropriate nursing action?
A nurse is caring for a patient who had an ESWL. What indicates a complication from the procedure?
A nurse is caring for a patient who had an ESWL. What indicates a complication from the procedure?
Why is it important to consult with the provider prior to administering sulfonamides?
Why is it important to consult with the provider prior to administering sulfonamides?
A patient reports urinary incontinence after a stroke. What type of incontinence is most likely the cause?
A patient reports urinary incontinence after a stroke. What type of incontinence is most likely the cause?
When providing education to a client about urolithiasis and kidney stones, what should the nurse emphasize?
When providing education to a client about urolithiasis and kidney stones, what should the nurse emphasize?
A patient is recovering from urolithiasis. The nurse knows that what medication helps with the spasms?
A patient is recovering from urolithiasis. The nurse knows that what medication helps with the spasms?
A patient is diagnosed with bladder cancer. The nurse knows that what is the biggest risk factor?
A patient is diagnosed with bladder cancer. The nurse knows that what is the biggest risk factor?
A patient is being seen for a testicular self-exam. What information should the nurse include in order to ensure proper testicular health?
A patient is being seen for a testicular self-exam. What information should the nurse include in order to ensure proper testicular health?
To decrease catheter associated urinary tract infections (CAUTIs), which is the best information for the nurse to share with the nursing assistants?
To decrease catheter associated urinary tract infections (CAUTIs), which is the best information for the nurse to share with the nursing assistants?
A patient reports continuous leakage of urine. The nurse recognizes that this is what kind of urinary incontinence?
A patient reports continuous leakage of urine. The nurse recognizes that this is what kind of urinary incontinence?
The health-care provider orders a 24-hour urine test. What important information does the nurse include when teaching the patient?
The health-care provider orders a 24-hour urine test. What important information does the nurse include when teaching the patient?
The nurse knows that oxybutynin (Ditropan) used for urge incontinence should have what teaching point to the client?
The nurse knows that oxybutynin (Ditropan) used for urge incontinence should have what teaching point to the client?
A client is diagnosed with acute pyelonephritis and is prescribed intravenous antibiotics. Which assessment finding is most indicative of effective treatment?
A client is diagnosed with acute pyelonephritis and is prescribed intravenous antibiotics. Which assessment finding is most indicative of effective treatment?
A patient with a history of calcium oxalate kidney stones is receiving dietary education. Which of the following instructions is MOST appropriate?
A patient with a history of calcium oxalate kidney stones is receiving dietary education. Which of the following instructions is MOST appropriate?
A patient is diagnosed with a neurogenic bladder. Which long-term complication is most important for the nurse to monitor?
A patient is diagnosed with a neurogenic bladder. Which long-term complication is most important for the nurse to monitor?
A patient is admitted with renal calculi. What clinical manifestation would the nurse expect to see?
A patient is admitted with renal calculi. What clinical manifestation would the nurse expect to see?
The clinical instructor and nursing student are discussing the differences between lower and upper UTIs. What should the clinical instructor include in teaching?
The clinical instructor and nursing student are discussing the differences between lower and upper UTIs. What should the clinical instructor include in teaching?
A patient is admitted with genitourinary trauma due to a motor vehicle accident. What is the BEST action for the nurse to take after patient stabilization?
A patient is admitted with genitourinary trauma due to a motor vehicle accident. What is the BEST action for the nurse to take after patient stabilization?
A patient who underwent cystoscopy is complaining that they cannot pee, and they feel as though they have to. What is the first step the nurse will take?
A patient who underwent cystoscopy is complaining that they cannot pee, and they feel as though they have to. What is the first step the nurse will take?
List the best time to educate male the client about performing a testicular exam?
List the best time to educate male the client about performing a testicular exam?
When reviewing the laboratory findings for the patient, the nurse anticipates what would be abnormal in the patient with pyelonephritis?
When reviewing the laboratory findings for the patient, the nurse anticipates what would be abnormal in the patient with pyelonephritis?
A renal biopsy is ordered for the client. In preparation for the biopsy, what lab value is most important for the nurse to assess?
A renal biopsy is ordered for the client. In preparation for the biopsy, what lab value is most important for the nurse to assess?
List potential causes of urinary retention.
List potential causes of urinary retention.
A client is scheduled for urinary diversion. Which nursing diagnosis would the nurse include in the plan of care preoperatively?
A client is scheduled for urinary diversion. Which nursing diagnosis would the nurse include in the plan of care preoperatively?
A patient with a suprapubic catheter may have what advantages over the patient with the Foley catheter?
A patient with a suprapubic catheter may have what advantages over the patient with the Foley catheter?
The nurse should educate the client with renal calculi to report what signs and symptoms?
The nurse should educate the client with renal calculi to report what signs and symptoms?
The nurse knows that in order to decrease the development of CAUTIs, the catheter bag should be...
The nurse knows that in order to decrease the development of CAUTIs, the catheter bag should be...
During a clinic visit, a patient diagnosed with testicular cancer expresses concerns about fertility. What is the nurse's best response?
During a clinic visit, a patient diagnosed with testicular cancer expresses concerns about fertility. What is the nurse's best response?
What is the MOST important consideration when providing care to an older adult patient with a urinary tract infection (UTI)?
What is the MOST important consideration when providing care to an older adult patient with a urinary tract infection (UTI)?
A patient is prescribed phenazopyridine (Pyridium) for UTI symptom management. What adverse effect should the nurse teach the client?
A patient is prescribed phenazopyridine (Pyridium) for UTI symptom management. What adverse effect should the nurse teach the client?
Determine which statement is correct regarding genitourinary trauma.
Determine which statement is correct regarding genitourinary trauma.
Which of the following is indicative for the use of urinary diversion?
Which of the following is indicative for the use of urinary diversion?
Flashcards
Urinary Tract Infection (UTI)
Urinary Tract Infection (UTI)
Infection caused by pathogenic microorganisms in the urinary tract.
Pyelonephritis
Pyelonephritis
Infection of the upper urinary tract, specifically the kidneys.
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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Vesicoureteral reflux
Vesicoureteral reflux
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Urinary Incontinence
Urinary Incontinence
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Stress Incontinence
Stress Incontinence
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Urge Incontinence
Urge 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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Ureteral Colic
Ureteral Colic
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Cystoscopy
Cystoscopy
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Extracorporeal Shock Wave Lithotripsy (ESWL)
Extracorporeal Shock Wave Lithotripsy (ESWL)
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Percutaneous Nephrolithotomy
Percutaneous Nephrolithotomy
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Urinary Diversion
Urinary Diversion
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Ileal Conduit
Ileal Conduit
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Cutaneous Ureterostomy
Cutaneous Ureterostomy
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Vesicostomy
Vesicostomy
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Nephrostomy
Nephrostomy
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Indiana Pouch
Indiana Pouch
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Kock Pouch
Kock Pouch
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Ureterosigmoidostomy
Ureterosigmoidostomy
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Testicular Cancer
Testicular Cancer
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Calcium Channel Blockers
Calcium Channel Blockers
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Loop Diuretics
Loop Diuretics
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Nifedipine
Nifedipine
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Sulfonamides
Sulfonamides
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Urinary Antiseptics
Urinary Antiseptics
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Glucocorticoid
Glucocorticoid
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Study Notes
- Unit 5 focuses on nursing management for patients experiencing health deviations related to elimination.
- Kaplan Renal-Urologic System A, Hinkle chapters 47, 49, 53, and Karch chapters 9, 15, 41, 52 are required readings.
Objectives
- Explain key terms and medical terminology related to genitourinary alterations
- Apply pathophysiology knowledge to selected genitourinary disorders in adults and children, including:
- Hypospadias/epispadias
- Cryptorchidism
- Nephrotic syndrome
- Glomerulonephritis
- Urolithiasis
- Wilms tumor
- Enuresis
- Male reproductive disorders
- Prostate disease
- Bladder cancer
- Testicular cancer
- Renal calculi
- Urinary diversions
- Apply the nursing process for adult patients with altered genitourinary function
- Relate diagnostic tests to patients with altered genitourinary function
- Apply pharmacotherapeutics to the treatment of selected genitourinary diseases
- Determine normal developmental and aging changes pertinent to patients with genitourinary diseases
- Articulate nursing responsibilities for nutritional requirements in patients with altered genitourinary function
- Develop health promotion and maintenance practices for altered genitourinary function
- Determine unique teaching/learning needs for altered genitourinary function
- Demonstrate dignified nursing care considerate of diverse cultural needs
- Utilize effective verbal and non-verbal communication skills
- Discuss principles of safety and efficient use of system resources for elimination-related health deviations
Physical Assessment
- Palpation of the costovertebral angle is part of renal assessment; see Figures 47-5 & 47-7.
- Peripheral edema is a possible sign of reduced kidney function
- Review Table 47-2 for identifying characteristics of genitourinary pain.
Bladder Assessment
- An empty bladder is typically not palpable.
- Dullness upon percussion indicates residual urine.
- A midline mass suggests a full bladder.
Diagnostic Studies
- Commonly used diagnostic studies include urinalysis, urine culture, renal function tests & ultrasonography (KUB).
- CT scans, MRI, nuclear scans and endoscopic procedures can be used.
- Biopsies, IV urography, retrograde pyelography, cytography, and renal angiography are also utilized.
Urine Culture
- Urine cultures are useful for identifying the microorganism responsible for a UTI.
- An indication of infection is a colony count of >100,000 CFU/mL on a clean-catch midstream or catheterized specimen.
- Multiple test dipsticks often include testing for WBCs (leukocyte esterase test) and nitrite testing
- Conduct testing for sexually transmitted infections in cases of acute urethritis or acute vaginitis infections which cause similar symptoms to UTIs.
- X-rays, CT scans, ultrasonography, and kidney scans are useful for detecting pyelonephritis, abscesses, obstructions, tumors, & cysts
24-Hour Urine Testing
- Assesses renal clearance and function.
- May reflect the progression of renal disease.
Serum Creatinine
- The normal range is 0.6-1.2 mg/dL.
BUN
- The normal range for blood urea nitrogen is 7-18 mg/dL.
Cystoscopy
- A cystoscopy is an operative procedure
- NPO, premedication, and anesthesia may be required.
- Patient consent is required for undergoing a cystoscopy
- Monitor urine output levels post-cystoscopy.
- Blood-tinged urine and a burning sensation may occur after the procedure.
Kidney Functions
- Kidneys perform these critical functions:
- Blood pressure control
- Water balance
- Waste excretion
- Electrolyte regulation
- Acid-base balance
- Erythropoietin production
- Renal clearance
- Prostaglandin secretion
- Vitamin D synthesis to active form
- Urine formation
Factors Contributing to UTIs
- Contributing factors include:
- Bacterial invasion
- Urethrovesical reflux
- Uropathogenic bacteria
- Shorter urethra in women
- Risk factors include:
- Instrumentation (e.g., catheters)
- Preexisting conditions (e.g., diabetes, pregnancy)
- Immobility
- Incomplete bladder emptying
- Obstruction
- Immunosuppression
Urinary Tract Infections (UTIs)
- UTIs are caused by pathogenic microorganisms.
- Classified by location:
- Lower UTI: bladder and structures below
- Upper UTI: kidneys and ureters
- UTIs are the second most common type of infection.
- 50% of infections acquired in hospitals are catheter associated UTIs (CAUTIs)
Upper UTI: Pyelonephritis
- Acute pyelonephritis symptoms:
- Chills
- Fever
- UTI symptoms
- Low back/flank pain
- Costovertebral tenderness
- Generalized malaise
- It can also be chronic
Upper and Lower UTIs
- Upper:
- Pyelonephritis (acute or chronic)
- Symptoms: chills, fever, leukocytosis, bacteriuria, pyuria, low back/flank pain, nausea, vomiting, headache, malaise, painful urination
- Physical exam findings: pain and tenderness in the costovertebral angle
- Pyelonephritis (acute or chronic)
- Lower:
- Cystitis is an inflammation of the urinary bladder.
- Urethritis is an inflammation of the urethra.
- Prostatitis is an inflammation of the prostate gland that can occur in men.
Urethrovesical and Ureterovesical Reflux
- In urethrovesical reflux, urine flows backward from the urethra into the bladder, carrying bacteria.
- In ureterovesical (vesicoureteral) reflux, urine flows backward from the bladder into one or both ureters due to ureterovesical valve impairment.
- This results in bacteria reaching and destroying the kidneys.
Gerontologic Considerations
- Older adults are more susceptible to kidney injury due to structural and functional changes:
- Glomerular sclerosis
- Decreased blood flow
- Decreased GFR
- Altered tubal function and acid-base balance
- Also at an increased risk of:-
- Incomplete bladder emptying
- Decreased drug clearance
- Cognitive impairment
- Frequent use of antimicrobial agents
- Multiple chronic medical conditions
- Immune compromise
- Low fluid intake
- Obstructed urine flow
- Poor hygiene practices
- Escherichia coli is the most common organism in older patients in the community or hospital setting
- Older people with indwelling catheters are more likely to be infected by Proteus, Klebsiella, Pseudomonas, or Staphylococcus
- Early UTI symptoms in older adults and postmenopausal women: malaise, nocturia, urinary incontinence, foul-smelling urine; possibly burning, urgency, fever, incontinence, delirium
- Treatment regimens are generally the same for all adults, but consider age-related changes, kidney function, and hepatic flow, then alter the antimicrobial regimen accordingly
Nursing Process: Assessment
- Includes assessment of:
- Symptoms
- Presentation
- Association
- Age
- Analysis
- Diagnosis
Potential Complications
- Include:
- Sepsis (urosepsis)
- Acute kidney injury
- Chronic kidney disease
Nursing Interventions for UTIs
- Interventions include:
- Relieving pain and bladder irritability
- Prescribed medications: antibiotics, analgesics, antispasmodics
- Perineal heat application
- Increased fluid intake
- Avoiding urinary tract irritants: coffee, tea, citrus, spices, cola, alcohol
- Frequent voiding
Nursing Interventions for Incontinence
- Fluid management: 1500-1600 mL/day
- Avoid caffeinated products
- Establish a scheduled voiding to occur every 2 hours
- Bladder retraining, voiding schedule should be extended
- Pelvic floor muscle exercises (Kegel), 2-3 times/day
Sulfonamides
- Inhibit folic acid synthesis.
- Rapidly absorbed in the GI tract, reaching peak in 3-6 hours.
- Adverse effects: Gl disturbances, anorexia, hepatic injury, sensitivity to light, Steven-Johnson syndrome.
- Contraindicated with allergies, when pregnant or breastfeeding, renal disease or kidney stones.
Urinary Antiseptics
- Nitrofurantoin, phenazopyridine, trimethoprim sulfamethazole
- Act within the urinary tract to destroy bacteria by direct antibiotic effect or acidification of urine
- Contraindicated with allergy, renal dysfunction, pregnancy or lactation
- Adverse effects: headache, dizziness, nausea, diarrhea, vaginitis.
Adult Voiding Dysfunction
- Encompasses conditions like urinary incontinence, urinary retention, and neurogenic bladder
Urinary Incontinence
- Unplanned, involuntary, or uncontrolled loss of urine.
- Affects over 25 million adults in the United States.
- It is underdiagnosed and underreported.
- More information on risk factors can be found in chart 55-6
- Symptom of many possible disorders
Types of Urinary Incontinence
- Stress: Exertion, sneezing, coughing, or changing position, predominantly affects women who have had vaginal deliveries.
- Urge: Involuntary urine loss associated with a strong, irrepressible urge to void
- Functional: Physical or cognitive impairment (e.g., Alzheimer's) hinders identification of or response to the need to void.
- Iatrogenic: Involuntary urine loss due to extrinsic medical factors, such as medications
- Mixed: Involuntary leakage associated with urgency, exertion, effort, sneezing, or coughing
- Overflow: Continual leakage of urine from an overdistended bladder
Transient Incontinence
- Resolved once the cause is identified and treated.
- Possible causes include:
- Delirium
- Infection
- Atrophic urethritis
- Psychological issues
- Pharmaceutical use
- Excess urine output
- Restricted mobility
- Stool impaction
Patient Education on Urinary Health
- Education is essential
- Incontinence is not inevitable, provide encouragement and support
- Education should be verbal and in writing - chart 55-9
- Develop voiding logs or diaries
- Teach Behavioral interventions such as Kegel exercises and develop voiding diary/schedule
- Biofeedback, verbal instruction (prompted voiding), and physical therapy
- Educate on medication related to pharmacologic therapy
- Strategies for promoting continence
Urinary Retention
- Inability of the bladder to empty completely.
- Characterized by residual urine.
- Causes:
- 50-100 mL of residual urine can remain in adults after voiding
- Postoperative spasms
- Diabetes
- Prostatic enlargement,
- Urethral pathology
- Trauma
- Pregnancy,
- Neurologic disorder
- Medications
Neurogenic Bladder
- Dysfunction of the nervous system that leads to retention or incontinence.
- Types: spastic (reflex) and flaccid.
- Complications: infections from urinary stasis and catheterization, renal calculi, impaired skin integrity, urinary incontinence or retention.
- Management:
- Continuous, intermittent, or self-catheterization
- external condom-type catheter
- Diet low in calcium
- Mobility and ambulation
- Encourage A liberal fluid intake to reduce bacterial count
- Decrease the concentration of calcium in the urine, and reduce the precipitation of urinary crystals and subsequent stone formation.
- A bladder retraining program may be effective in treating a spastic bladder or urine retention.
- A flaccid bladder, the patient may be taught to "double void."
Anticholinergic Urinary Antispasmodics
- Oxybutynin directly relaxes smooth muscle in the bladder by inhibiting acetylcholine.
- Contraindicated with allergy, urinary obstruction, acute hemorrhage, renal or hepatic dysfunction.
- Adverse effects: drowsiness, dizziness, blurred vision, tachycardia, dry mouth, nausea, urinary hesitancy, decreased sweating.
Urolithiasis and Nephrolithiasis
- Calculi, also known as stones in the urinary tract or kidney.
- Made of calcium or uric acid.
- Cause- infection, urinary stasis, and immobility, altered calcium metabolism.
- Medications include antacids, acetazolamide, vitamin D, laxatives, and high doses of aspirin.
- Manifestations depend on the location and the size of the stones.
- Infection can be present, as well as excruciating pain and discomfort.
- Nausea and vomiting may be present as well as diarrhea and abdominal discomforts
- Stones lodged in the ureter cause acute excruciating pain that radiates down the thigh. It also causes bloody urine
- Relieve pain until its cause can be eliminated.
- Opioid analgesic or NSAIDs and lithotripsy can aid in stone removal.
Urinary Calculi Clinical Manifestations and Diagnosis
- Manifestations: Often with nausea and vomiting, and an agonizing flank pain that may radiate to the groin, testicles, or abdominal area.
- May include hematuria, dysuria, and urinary frequency
- Sharp, sudden, or severe pain dependent on stone movement
- Diagnosis: Ultrasound, intravenous pyelogram, stone analysis, etc.
- Risk factors: infection, urinary stasis & retention, dehydration, increased uric acid or urinary oxalate
Intervention Procedure for Renal Calculi
- Include:
- Cystoscopy with capture and removal
- Extracorporeal shock wave lithotripsy (ESWL)
- Percutaneous nephrolithotomy
Medical Management for Renal Stones
- Goals include eradicating the stone, determining stone type, preventing nephron destruction, controlling pain and infection, and relieving obstruction
- Opioid analgesic agents and NSAIDs are given for pain.
- Fluids are encouraged
- Aids in downward passage and diluting urine
- High urine output
Medications for Stone Management
- Nifedipine (Procardia)
- Decreases blood pressure, cardiac workload and myocardial oxygen consumption
- Blocks movement of calcium ions, causing decreased cardiac contractility
- The smooth muscle spasm in the ureter is relieved, can relieve kidney stone pain
- Furosemide (Lasix)
- Decreases body's reabsorption of sodium and chloride
- Contraindicated in severe renal failure.
- Adverse effects: Hypotension, hypokalemia, etc.
- Prednisone, methylprednisolone sodium succinate, betamethasone, dexamethasone, hydrocortisone
- short term treatment of inflammatory disorders
- Contraindicated in people with infections
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