Urinary System Disorders: Nursing Care

• This chapter excerpt focuses on nursing care for patients with urinary system disorders, specifically addressing urinary tract infections (UTIs), urological obstructions like kidney stones, and cancers of the bladder and kidneys.
• It outlines causes and risk factors, common signs and symptoms, diagnostic tests, and relevant therapeutic interventions for each condition.
• The information emphasizes data collection, monitoring, and patient education as key components of nursing care, with a focus on managing pain and complications like infection, hydronephrosis, and altered body image.
• This chapter aims to equip nurses with the foundational knowledge needed to effectively care for patients experiencing a variety of urinary system ailments.

Urinary Tract Infections (UTIs)

• UTIs involve the invasion of the urinary tract by bacteria.
• The urinary tract is sterile beyond the urethra.
• UTIs are a common hospital-acquired infection.
• Bacteria typically ascend from the external urinary meatus.
• The bacterium Escherichia coli is the most common cause.
• Risk factors include incomplete bladder emptying, contamination in the perineal/urethral area, instrumentation, reflex from faulty valves, previous UTIs, female anatomy, aging changes, and genital piercing.
• Common signs and symptoms include urgency, frequency, burning, cloudy/foul-smelling urine, hematuria, and pelvic pain.
• Older adults may present with fatigue, confusion, or delirium.
• Cystitis presents with common UTI symptoms plus pelvic pain or pressure.
• Pyelonephritis presents with common UTI symptoms plus costovertebral tenderness, high fever, chills, nausea, and vomiting.
• Urethritis is inflammation of the urethra due to infection, irritant, or trauma.
• Cystitis is inflammation of the bladder wall due to infection.
• Pyelonephritis is an infection of the kidney(s).
• A serious complication is urosepsis, which is sepsis caused by a UTI and is common in older adults.
• Nursing data collection involves assessing predisposing factors (catheter, instrumentation, surgery), voiding pattern, signs/symptoms, and urine characteristics (volume, color, cloudiness, blood, odor).
• Nurses should review urinalysis and culture results.
• Nursing care involves administering antimicrobials, providing pain control (heat, urinary analgesic), monitoring symptoms, and monitoring intake/output.

Urological Obstructions

• Obstructed urine flow is always significant and can be partial or complete, unilateral or bilateral, and develop rapidly or slowly.
• Backward pressure damages kidney tissue and can lead to chronic kidney disease, distending the kidney (hydronephrosis).
• Urethral strictures involve narrowing of the urethra lumen due to scar tissue, caused by injury, STIs, trauma from catheters or surgery, cancer, or enlarged prostate.
• Urethral strictures occur more often in men than women.
• Signs/symptoms include diminished urinary stream, dysuria, frequency, and frequent UTIs.
• Treatments include catheterization, urethral dilation, endoscopic urethrotomy, and urethroplasty.
• Renal calculi (urolithiasis) are hard, small stones in the urinary tract; calculi is the term for stones.
• Nephrolithiasis refers to kidney stones, while ureterolithiasis refers to ureter stones.
• Concentrated urinary salts settle out, forming stones in the kidney, ureter, or bladder.
• Stones less than 5mm are easily passed in urine.
• Larger stones can be painful and require treatment.
• Etiology includes heredity, chronic dehydration, diet (high sodium, sugar, protein), obesity, and infection.
• Renal calculi are more common in men.
• Nephrolithiasis symptoms: Costovertebral angle pain and hematuria.
• Ureterolithiasis symptoms: Flank, side, or lower abdomen pain radiating to genitalia, intense urge to void, frequency, dysuria, reduced output, hematuria, nausea, and vomiting.
• Bladder stone symptoms: Hematuria and oliguria with obstruction of the bladder outlet.
• Prevention includes hydration, diet modification, and exercise.
• Diagnostic blood tests check calcium, uric acid, BUN, and creatinine levels.
• Urinalysis checks for hematuria, crystals, and urine pH.
• Other tests include two 24-hour urine collections, helical CT scan, renal ultrasound, abdominal x-ray, and IV pyelogram.
• Small stones are managed with hydration, analgesics, and alpha-blockers like Tamsulosin.
• Large/symptomatic stones are treated with IV fluids, pain control, thiazide diuretics, allopurinol, and lithotripsy (extracorporeal shock-wave lithotripsy).
• Complications include UTI, hydroureter, hydronephrosis, shock, sepsis, and chronic kidney disease.
• Nursing data collection includes health history, vital signs/temperature, pain assessment, urine straining, intake/output monitoring, and symptom monitoring.
• Nursing care includes pain management, urine straining, hydration, and patient teaching.
• Hydronephrosis occurs when obstruction causes urine backup, enlarging the kidney and increasing pressure, potentially leading to kidney damage.
• Treatment involves addressing the cause.
• Hydronephrosis signs/symptoms: Frequency, urgency, dysuria, and flank/back pain.
• Therapeutic interventions include treating the cause, urinary catheter insertion, stents, and nephrostomy tube placement.
• When managing a nephrostomy tube, prevent kinking or clamping and record urinary catheter and nephrostomy tube output separately.

Cancer of the Bladder

• It is the most common urinary tract cancer, occurring more often in men, typically between ages 50-70.
• Smoking doubles the risk, increasing with each cigarette. It can also be caused by industrial pollution.
• Early signs/symptoms: Painless hematuria.
• Late signs/symptoms: Pelvic pain, lower back pain, dysuria, and inability to void.
• Diagnostic tests include urinalysis (telomerase), urine cytology and culture, cystoscopy with biopsy, IV pyelogram, and CT scan.
• Therapeutic interventions include intravesical therapy, photodynamic therapy, and surgery.
• Surgical procedures include continent urinary diversion (Kock pouch, Indiana pouch, Mainz pouch, Florida pouch) and orthotopic bladder substitution (neobladder) such as Studer pouch, Hemi-Kock pouch, Ileal W–neobladder.
• Nursing care involves consulting a WOC nurse, providing pre-op and post-op care, monitoring urine output, assisting with body image coping, teaching care of urinary diversion/skin, and educating about signs/symptoms of infection.

Cancer of the Kidney

• It is among the top 10 cancers for both genders, typically occurring over age 55, and twice as often in men.
• Risk factors include smoking, obesity, hypertension, long-term kidney dialysis, and exposure to radiation/asbestos/industrial pollution.
• Late classic signs/symptoms: Hematuria, dull pain in the flank area, and a mass in the kidney area.
• Diagnostic tests include IV pyelogram, cystoscopy and pyelogram, ultrasound, CT scan, MRI, and renal biopsy.
• Therapeutic interventions include surgery (radical nephrectomy, nephron-sparing surgery), radiation therapy, immunotherapy, and chemotherapy.
• Nursing care encompasses pre-op/post-op care, monitoring urine output, monitoring for pneumothorax signs (shortness of breath, diminished breath sounds on affected side), and education.