NURS1067 Week 11: Management of Common Urinary Elimination Issues PDF

**WEEKLY OBJECTIVE** 1. **Key Signs and Symptoms of UTIs, UI, and UR** +-----------------------------------+-----------------------------------+ | **Urinary Tract Infections | | | (UTIs)** | | +===...

**WEEKLY OBJECTIVE** 1. **Key Signs and Symptoms of UTIs, UI, and UR** +-----------------------------------+-----------------------------------+ | **Urinary Tract Infections | | | (UTIs)** | | +===================================+===================================+ | **Category** | **Key Signs and Symptoms** | +-----------------------------------+-----------------------------------+ | **Lower UTI (Bladder, Urethra)** | \- Dysuria (painful urination) | | | | | | \- Urgency and frequency of | | | urination (often small amounts) | | | | | | \- Suprapubic discomfort or | | | pressure | | | | | | \- Cloudy, foul-smelling urine | | | | | | \- Hematuria (blood in the urine) | +-----------------------------------+-----------------------------------+ | **Upper UTI (Kidneys: | \- Flank pain or tenderness (at | | Pyelonephritis)** | the sides of the back, near the | | | kidneys) | | | | | | \- Fever and chills | | | | | | \- Nausea and vomiting | | | | | | \- General malaise or fatigue | +-----------------------------------+-----------------------------------+ | **General Symptoms (Common to | \- Burning sensation during | | Both)** | urination (common in both types) | | | | | | \- Fatigue and altered mental | | | status in older adults | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Urinary Incontinence (UI)** | | +===================================+===================================+ | **Type** | **Key Signs and Symptoms** | +-----------------------------------+-----------------------------------+ | **Stress Incontinence** | \- Leakage of urine during | | | physical activities that increase | | | abdominal pressure (e.g., | | | coughing, sneezing, laughing, | | | lifting). | +-----------------------------------+-----------------------------------+ | **Urge Incontinence** | \- Sudden, intense urge to | | | urinate followed by involuntary | | | leakage. | | | | | | \- Frequent urination, including | | | waking up at night (nocturia). | +-----------------------------------+-----------------------------------+ | **Mixed Incontinence** | \- Combination of stress and urge | | | symptoms: leakage with physical | | | activities and sudden urgency to | | | urinate. | +-----------------------------------+-----------------------------------+ | **Overflow Incontinence** | \- Frequent dribbling of urine. | | | | | | \- Weak urine stream, difficulty | | | starting urination, or feeling of | | | incomplete bladder emptying. | +-----------------------------------+-----------------------------------+ | **Functional Incontinence** | \- Inability to reach the toilet | | | in time due to physical or | | | cognitive impairments, despite | | | normal bladder control. | +-----------------------------------+-----------------------------------+ | **Transient Incontinence** | \- Temporary incontinence caused | | | by reversible factors (e.g., | | | UTIs, medications, acute | | | illnesses). | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Condition** | **Key Signs and Symptoms** | +===================================+===================================+ | **Urinary Tract Infections | Dysuria (painful or difficult | | (UTIs)** | urination), urgency, frequency, | | | suprapubic discomfort, cloudy or | | | foul-smelling urine, hematuria | | | (blood in the urine). | +-----------------------------------+-----------------------------------+ | **Urinary Incontinence (UI)** | -Clinical manifestations (signs | | | and symptoms) depend on the type | | | of urinary incontinence (see | | | *Types of Incontinence* table*)* | | | | | | -Types of incontinence: Stress, | | | Urge, Mixed, Functional, | | | Overflow, Transient | +-----------------------------------+-----------------------------------+ | **Urinary Retention (UR)** | Suprapubic pressure, | | | restlessness, overflow | | | incontinence, frequent small | | | voids, bladder distention. | +-----------------------------------+-----------------------------------+  +-----------------------+-----------------------+-----------------------+ | **Urinary Retention | | | | (UR)** | | | +=======================+=======================+=======================+ | **Category** | **Key Signs and | **Notes** | | | Symptoms** | | +-----------------------+-----------------------+-----------------------+ | **Acute Urinary | \- Sudden and | **Acute UR is a | | Retention** | complete inability to | medical emergency** | | | urinate. | requiring **immediate | | | | intervention** (e.g., | | | \- Severe lower | catheterization). | | | abdominal pain and | | | | discomfort. | | | | | | | | \- Bladder distention | | | | (palpable or | | | | visible). | | | | | | | | \- Restlessness and | | | | agitation. | | +-----------------------+-----------------------+-----------------------+ | **Chronic Urinary | \- Frequent urination | **Chronic UR** may | | Retention** | in small amounts. | lead to complications | | | | like bladder | | | \- Weak or | infections or kidney | | | interrupted urine | damage if untreated. | | | stream. | | | | | | | | \- Feeling of | | | | incomplete bladder | | | | emptying. | | | | | | | | \- Overflow | | | | incontinence | | | | (dribbling of urine). | | +-----------------------+-----------------------+-----------------------+ | **General Symptoms | \- Suprapubic | | | (Common to Both)** | pressure or | | | | tenderness. | | | | | | | | \- Postvoid residual | | | | volume \>100 mL | | | | (measured via bladder | | | | scan). | | | | | | | | \- Diaphoresis | | | | (sweating) due to | | | | discomfort. | | +-----------------------+-----------------------+-----------------------+ **2. Basic Nursing Assessments for UTIs, UI, and UR** +-----------------------------------+-----------------------------------+ | **Urinary Tract Infection (UTI)** | | +===================================+===================================+ | **Assessment Area** | **Key Considerations** | +-----------------------------------+-----------------------------------+ | **Health History** | \- Previous history of UTIs or | | | other urinary disorders. | | | | | | \- Any underlying conditions | | | (e.g., diabetes, immune | | | deficiencies) that increase | | | susceptibility. | | | | | | \- Current medications (e.g., | | | antibiotics, immunosuppressants, | | | diuretics). | | | | | | \- Recent sexual activity, use of | | | birth control (e.g., diaphragm, | | | spermicides), or catheter use. | +-----------------------------------+-----------------------------------+ | **Vital Signs** | \- **Monitor for signs of | | | infection**: fever, elevated | | | heart rate, low blood pressure. | | | | | | \- Assess for systemic signs of | | | infection like chills or | | | hypotension. | +-----------------------------------+-----------------------------------+ | **Urine Characteristics** | **- Color:** Cloudy, | | | foul-smelling urine may indicate | | | infection. | | | | | | **- Odor:** Strong, unpleasant | | | odor could be a sign of UTI. | | | | | | **- Presence of blood | | | (Hematuria):**) can be a sign of | | | UTI. | | | | | | **- Frequency and urgency:** | | | Monitor for increased frequency, | | | urgency, and painful urination | | | (dysuria). | +-----------------------------------+-----------------------------------+ | **Physical Assessment** | **-** Palpate the suprapubic area | | | for tenderness or discomfort. | | | | | | \- Assess for flank pain | | | (indicating a possible upper UTI | | | or pyelonephritis). | +-----------------------------------+-----------------------------------+ | **Laboratory Tests** | **- Urinalysis:** Look for signs | | | of infection such as leukocytes | | | (WBCs), nitrites, and bacteria. | | | | | | **- Urine Culture and | | | Sensitivity:** To identify the | | | causative organism and select | | | appropriate antibiotics | +-----------------------------------+-----------------------------------+ | **Hydration Status** | **-** Assess for signs of | | | dehydration (e.g., dry mouth, | | | reduced urine output). | | | | | | **-** Encourage fluid intake to | | | help flush bacteria from the | | | urinary tract. | +-----------------------------------+-----------------------------------+  +-----------------------------------+-----------------------------------+ | **Urinary Incontinence (UI)** | | +===================================+===================================+ | **Assessment Area** | **Key Considerations** | +-----------------------------------+-----------------------------------+ | **Health History** | \- Determine onset, duration, and | | | frequency of incontinence | | | episodes. | | | | | | \- Assess for underlying | | | conditions (e.g., pregnancy, | | | menopause, prostate issues, | | | neurological disorders). | | | | | | \- Review history of surgeries or | | | trauma to the pelvic region. | | | | | | \- Identify use of medications | | | (e.g., diuretics, | | | anticholinergics) that may | | | influence bladder control. | +-----------------------------------+-----------------------------------+ | **Urinary Patterns** | \- Maintain a **bladder log** to | | | track voiding times, fluid | | | intake, and leakage episodes. | | | | | | \- Assess for urgency, frequency, | | | and volume of urine. | +-----------------------------------+-----------------------------------+ | **Functional Assessment** | \- Evaluate mobility and | | | cognitive function that may | | | affect the ability to reach the | | | toilet on time. | | | | | | \- Assess environment for | | | barriers to toileting (e.g., | | | inaccessible bathroom, clothing). | +-----------------------------------+-----------------------------------+ | **Perineal Skin Integrity** | \- Inspect for signs of | | | irritation, redness, or breakdown | | | due to prolonged contact with | | | urine. | | | | | | \- Assess hygiene practices to | | | prevent infection and maintain | | | skin health. | +-----------------------------------+-----------------------------------+ | **Physical Examination** | \- Palpate the bladder for | | | distention or tenderness. | | | | | | \- Perform a pelvic exam if | | | indicated (stress incontinence). | | | | | | \- Assess for prolapse in women | | | or an enlarged prostate in men. | +-----------------------------------+-----------------------------------+ | **Diagnostic Testing** | \- **Postvoid residual (PVR) | | | volume measurement** using a | | | **bladder scanner**. | | | | | | \- Urinalysis to rule out | | | infections or other underlying | | | conditions. | | | | | | \- Urodynamic studies to evaluate | | | bladder function if indicated. | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Urinary Retention (UR)** | | +===================================+===================================+ | **Assessment Area** | **Key Considerations** | +-----------------------------------+-----------------------------------+ | **Health History** | \- Ask about the onset, duration, | | | and frequency of difficulty | | | urinating. | | | | | | \- Review any history of | | | neurological disorders, | | | surgeries, or conditions like BPH | | | or bladder obstruction. | | | | | | \- Assess for use of medications | | | that may cause retention (e.g., | | | anticholinergics, opioids). | +-----------------------------------+-----------------------------------+ | **Urinary Patterns** | \- Assess for signs of incomplete | | | bladder emptying (e.g., small | | | voids, frequent urination). | | | | | | \- Note episodes of dribbling or | | | overflow incontinence. | +-----------------------------------+-----------------------------------+ | **Physical Examination** | \- Palpate the bladder for | | | distention, tenderness, or | | | firmness above the pubic | | | symphysis. | | | | | | \- Observe for signs of | | | discomfort or restlessness. | | | | | | \- Check for suprapubic pain or | | | pressure. | +-----------------------------------+-----------------------------------+ | **Bladder Function** | \- Measure postvoid residual | | | (PVR) volume using a bladder | | | scanner to evaluate incomplete | | | bladder emptying. | | | | | | \- Observe for a weak or | | | intermittent urine stream during | | | voiding. | +-----------------------------------+-----------------------------------+ | **Hydration and Output** | \- Monitor fluid intake and urine | | | output to identify changes in | | | patterns or imbalances. | | | | | | \- Assess for signs of oliguria | | | (low urine output). | +-----------------------------------+-----------------------------------+ | **Perineal Skin Integrity** | \- Inspect for skin breakdown or | | | irritation due to overflow | | | incontinence or dribbling. | +-----------------------------------+-----------------------------------+ | **Diagnostic Testing** | \- Conduct urinalysis to rule out | | | infections or hematuria. | | | | | | \- Imaging studies (e.g., | | | ultrasound, CT scan) to identify | | | possible obstructions. | | | | | | \- Perform urodynamic studies if | | | retention is chronic or related | | | to functional issues. | +-----------------------------------+-----------------------------------+ **3. Significant Potential Complications and Appropriate Nursing Interventions for UTIs, UI, and UR** ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ **Urinary Tract Infection (UTI)** ----------------------------------- ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- **Complication** **Description** **Nursing Interventions** **Pyelonephritis** Infection spreads to the kidneys, causing flank pain, fever, chills, nausea, and vomiting. \- Monitor for signs of systemic infection (e.g., fever, elevated WBC count).\ - Administer prescribed antibiotics promptly to prevent further kidney damage.\ - Encourage fluid intake to flush bacteria and reduce irritation. **Sepsis** Severe infection enters the bloodstream, leading to systemic inflammatory response and organ failure. \- Monitor vital signs closely for hypotension, tachycardia, and fever.\ - Administer IV antibiotics and fluids as prescribed.\ - Ensure early recognition of systemic symptoms for timely intervention. **Recurrent UTIs** Repeated infections due to incomplete treatment or persistent risk factors. \- Educate the patient on completing antibiotics and proper hygiene practices.\ - Identify and address underlying risk factors (e.g., incomplete bladder emptying, catheter use). **Bladder Damage** Chronic or untreated UTIs can weaken the bladder wall, reducing its function. \- Monitor voiding patterns and perform postvoid residual measurements to assess bladder function.\ - Encourage scheduled voiding to prevent overdistention. **Kidney Damage** Long-term infections can lead to scarring or reduced kidney function, especially in children. \- Monitor renal function tests (e.g., creatinine, BUN) for early detection of damage.\ - Encourage follow-ups with a nephrologist if chronic kidney involvement is suspected. **Urosepsis** Infection originating in the urinary tract spreads systemically, causing life-threatening conditions. \- Recognize early symptoms of urosepsis, such as altered mental status, low blood pressure, and tachycardia.\ - Administer IV fluids and vasopressors if needed to maintain blood pressure. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Incontinence (UI)** ------------------------------- --------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- **Complication** **Description** **Nursing Interventions** **Skin Breakdown** Prolonged contact with urine can cause irritation, maceration, and increased risk of pressure injuries. \- Maintain skin integrity with regular cleansing and use of barrier creams.\ - Ensure frequent changing of incontinence pads or briefs.\ - Monitor skin for signs of redness, irritation, or breakdown. **Infection (UTI)** Increased risk of urinary tract infections due to retained urine or contamination from leakage. \- Promote proper perineal hygiene (front to back cleaning).\ - Encourage hydration to dilute urine and flush bacteria.\ - Monitor for signs of UTI (e.g., dysuria, foul-smelling urine). **Social Isolation** Embarrassment and fear of accidents can lead to withdrawal from social interactions and activities. \- Provide emotional support and education to reduce stigma.\ - Encourage participation in bladder training and pelvic floor exercises.\ - Explore appropriate absorbent products to enhance confidence. **Falls and Injuries** Urgency and rushing to the bathroom can increase the risk of falls, particularly in older adults. \- Ensure a safe environment by removing trip hazards and providing access to an easily accessible bathroom.\ - Encourage scheduled voiding to prevent urgency episodes.\ - Use assistive devices if necessary (e.g., bedside commodes). **Depression/Anxiety** Emotional distress related to loss of bladder control and perceived loss of independence. \- Encourage open communication about incontinence concerns.\ - Refer to counseling or support groups if needed.\ - Develop a personalized care plan to address emotional and physical needs. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Retention (UR)** ------------------------------------- ----------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- **Complication** **Description** **Nursing Interventions** **Urinary Tract Infections (UTIs)** Incomplete bladder emptying creates a breeding ground for bacteria, increasing the risk of infection. \- Monitor for signs of infection (e.g., dysuria, fever, cloudy urine).\ - Encourage hydration to promote frequent voiding.\ - Perform postvoid residual assessments and initiate catheterization if indicated. **Hydronephrosis** Backflow of urine into the kidneys due to prolonged retention can cause swelling and kidney damage. \- Monitor for flank pain and changes in renal function (e.g., creatinine levels).\ - Ensure timely bladder emptying using techniques such as double voiding or catheterization.\ - Notify the physician promptly for significant bladder distention or suspected kidney involvement. **Bladder Damage** Chronic overdistension of the bladder may weaken or damage the detrusor muscle, reducing bladder contractility. \- Schedule toileting to prevent overdistension.\ - Educate the patient on double voiding techniques to ensure complete emptying.\ - Use intermittent catheterization to relieve retention and prevent further damage. **Overflow Incontinence** Continuous dribbling of urine due to a full bladder exceeding its capacity, causing leakage. \- Encourage scheduled voiding to reduce bladder overfilling.\ - Use protective undergarments as needed and maintain skin integrity.\ - Perform bladder scans regularly to monitor residual volume. **Kidney Damage** Chronic retention can lead to kidney dysfunction or failure from prolonged backpressure. \- Monitor renal function tests (e.g., BUN, creatinine) regularly.\ - Collaborate with a physician for early intervention in cases of suspected kidney involvement.\ - Educate the patient on recognizing early signs of complications like flank pain or changes in urine output. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **4. Nursing Implications for Key Diagnostics, Common Medical Treatments, and Pharmacological Treatments for Clients with UTIs, UI, and UR** --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Tract Infection (UTI)** ----------------------------------- ------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------- **Aspect** **Key Details** **Nursing Implications** **Key Diagnostics** **Urinalysis**: Identifies presence of bacteria, WBCs, nitrites, blood, and protein. \- Collect a clean-catch or midstream urine sample.\ - Educate the patient on proper sample collection to avoid contamination. **Urine Culture and Sensitivity**: Identifies the causative organism and guides antibiotic therapy. \- Ensure sterile technique when collecting samples.\ - Label and transport the sample to the lab promptly. **Imaging Studies (e.g., Ultrasound, CT scan)**: Evaluates anatomical abnormalities or obstructions. \- Prepare the patient for diagnostic imaging if required (e.g., explain procedures, assess for contrast allergies if needed). **Common Medical Treatments** **Antibiotics**: The cornerstone of treatment to eradicate the infection. \- Administer antibiotics as prescribed and monitor for adverse reactions.\ - Educate the patient on completing the full course of antibiotics. **Hydration**: Promotes flushing of bacteria from the urinary tract. \- Encourage increased fluid intake unless contraindicated (e.g., heart failure, kidney disease). **Symptom Management**: Local heat application for comfort in case of suprapubic pain. \- Provide warm compresses or suggest warm showers to alleviate discomfort. **Pharmacological Treatments** **Trimethoprim/sulfamethoxazole (TMP/SMX)**: Common for uncomplicated UTIs. \- Monitor for allergic reactions (e.g., rash, itching).\ - Educate on avoiding sun exposure due to increased photosensitivity. **Nitrofurantoin**: Used for lower UTIs. \- Administer with food to reduce gastrointestinal side effects.\ - Monitor for pulmonary reactions, especially in long-term use. **Fluoroquinolones (e.g., Ciprofloxacin)**: Used for complicated or recurrent UTIs. \- Monitor for side effects like tendon pain (risk of tendonitis or rupture).\ - Avoid use in pregnant patients unless necessary. **Analgesics (e.g., Phenazopyridine)**: Provides relief from burning and pain during urination. \- Educate the patient that this may turn urine orange/red and is not a cause for concern.\ - Use for a limited duration as prescribed. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Incontinence (UI)** -------------------------------- -------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- **Aspect** **Key Details** **Nursing Implications** **Key Diagnostics** **Bladder Diary**: Tracks voiding patterns, fluid intake, and leakage episodes. \- Assist the patient in maintaining an accurate bladder log to identify patterns and triggers. **Postvoid Residual (PVR) Measurement**: Evaluates incomplete bladder emptying. \- Use a bladder scanner or catheterization to measure PVR and assess for retention. **Urodynamic Testing**: Assesses bladder function and detrusor muscle activity. \- Prepare the patient by explaining the procedure and ensuring comfort during testing. **Pelvic Exam**: Identifies structural issues such as prolapse or weakened pelvic muscles. \- Provide privacy and ensure patient comfort during the exam.\ - Educate about the relevance of findings to UI. **Common Medical Treatments** **Pelvic Floor Muscle Training (Kegel Exercises)**: Strengthens muscles to improve continence. \- Teach proper technique and encourage adherence to daily practice. **Bladder Training**: Establishes a schedule for voiding to reduce urgency and frequency. \- Assist in creating a toileting schedule and provide positive reinforcement for adherence. **Environmental Modifications**: Improves access to toileting for functional incontinence. \- Ensure the patient's environment is safe and accessible (e.g., bedside commodes, grab bars). **Absorbent Products**: Temporary management for incontinence episodes. \- Educate on proper use of products and emphasize that they are not a solution, but a tool for support. **Pharmacological Treatments** **Antimuscarinics (e.g., Oxybutynin, Tolterodine)**: Relaxes the bladder muscle for urge incontinence. \- Monitor for side effects such as dry mouth, constipation, and blurred vision.\ - Educate the patient to avoid dehydration. **Beta-3 Adrenergic Agonists (e.g., Mirabegron)**: Helps relax the bladder and increase capacity. \- Monitor for increased blood pressure as a potential side effect.\ - Educate on proper administration and adherence. **Topical Estrogen**: Improves bladder control in postmenopausal women by enhancing tissue health. \- Educate on correct application and monitor for side effects like irritation. **Alpha-Blockers (e.g., Tamsulosin)**: Used for overflow incontinence caused by an enlarged prostate. \- Monitor for hypotension and educate on slow position changes to avoid dizziness. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Retention (UR)** -------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- **Aspect** **Key Details** **Nursing Implications** **Key Diagnostics** **Postvoid Residual (PVR) Measurement**: Assesses the amount of urine left in the bladder after voiding. \- Use a bladder scanner or intermittent catheterization to measure PVR.\ - Educate the patient on the purpose of this test and what to expect. **Urinalysis**: Detects infection, hematuria, or other abnormalities that may contribute to retention. \- Collect a clean-catch or sterile catheterized sample and transport it promptly to the lab.\ - Educate on proper sample collection techniques. **Imaging Studies (e.g., Ultrasound, CT scan)**: Evaluates structural obstructions like enlarged prostate or tumors. \- Prepare the patient by explaining the procedure and assessing for allergies if contrast is used. **Urodynamic Studies**: Measures bladder pressure and functionality. \- Explain the procedure to alleviate anxiety.\ - Monitor for discomfort during and after the test. **Common Medical Treatments** **Intermittent Catheterization**: Used to relieve acute or chronic retention. \- Use sterile technique to prevent infection.\ - Teach the patient or caregiver how to perform self-catheterization if indicated. **Indwelling Catheterization**: Provides continuous drainage in severe cases. \- Monitor for signs of infection (e.g., cloudy urine, fever).\ - Perform regular catheter care to prevent complications. **Surgical Interventions**: Includes procedures like transurethral resection of the prostate (TURP) for obstructive causes. \- Prepare the patient for surgery with preoperative education.\ - Monitor for post-surgical complications like bleeding or infection. **Pharmacological Treatments** **Alpha-Blockers (e.g., Tamsulosin)**: Relaxes the muscles in the bladder neck and prostate for improved urine flow. \- Monitor for side effects like dizziness and orthostatic hypotension.\ - Educate the patient to rise slowly from seated positions. **5-Alpha Reductase Inhibitors (e.g., Finasteride)**: Reduces prostate size in cases of benign prostatic hyperplasia (BPH). \- Educate the patient that effects may take several months.\ - Monitor for side effects like decreased libido or erectile dysfunction. **Cholinergics (e.g., Bethanechol)**: Stimulates bladder contractions to improve emptying. \- Monitor for side effects like abdominal cramping or hypotension.\ - Administer as prescribed and educate on timing around meals. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **5. Nursing Process Plan of Care for Clients with UTIs, UI, and UR** ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Tract Infection (UTI)** ----------------------------------- ----------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- **Step** **Key Actions** **Example** **Assessment** \- Gather health history: Previous UTIs, recent urinary symptoms (e.g., dysuria, urgency, frequency). \- Patient reports dysuria and urgency with cloudy, foul-smelling urine over the past 3 days. \- Perform a physical examination: Assess suprapubic tenderness, vital signs (e.g., fever, tachycardia). \- Patient has a low-grade fever (38°C) and suprapubic discomfort. \- Conduct urinalysis and urine culture to confirm infection and identify causative organism. \- Urinalysis shows bacteria, WBCs, and nitrites; culture pending. **Diagnosis** \- Identify nursing diagnoses: \- **Acute pain** related to bladder inflammation.\ - **Risk for infection** related to inadequate antibiotic compliance. \- Prioritize based on symptoms and risks. **Planning** \- Establish goals with measurable outcomes: \- Patient will report reduced dysuria and urgency within 48 hours of starting antibiotics.\ - Patient will maintain adequate hydration. \- Set priorities to address pain and infection prevention. **Implementation** \- Administer prescribed antibiotics as ordered and monitor for adverse effects. \- Administer Trimethoprim/Sulfamethoxazole (TMP/SMX) twice daily as prescribed. \- Encourage increased fluid intake to dilute urine and flush bacteria. \- Educate patient to drink at least 6--8 glasses of water per day unless contraindicated. \- Provide patient education on completing the full course of antibiotics and monitoring for recurring symptoms. \- Teach patient to report persistent symptoms or fever after 48 hours of antibiotic therapy. \- Promote proper hygiene practices to prevent reinfection (e.g., wiping front to back, urinating after intercourse). \- Provide hygiene instruction during patient discharge teaching. **Evaluation** \- Assess patient's response to interventions: \- Patient reports reduced dysuria and urgency within 48 hours.\ - Patient demonstrates understanding of antibiotic adherence and proper hygiene practices. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ **Urinary Incontinence (UI)** ------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- **Step** **Key Actions** **Example** **Assessment** \- Gather health history: Type, frequency, and severity of incontinence; history of pregnancies, surgeries, or neurological conditions. \- Patient reports stress incontinence with urine leakage during coughing and sneezing. \- Perform a physical assessment: Assess pelvic floor strength, bladder distention, and skin integrity. \- No signs of bladder distention; perineal area shows mild irritation from frequent leakage. \- Collect diagnostic data: Bladder diary, postvoid residual (PVR) measurement, urinalysis to rule out infections. \- Patient's bladder diary indicates frequent daytime leakage but no nighttime episodes. **Diagnosis** \- Identify nursing diagnoses: \- **Impaired urinary elimination** related to weak pelvic floor muscles.\ - **Risk for impaired skin integrity** related to frequent exposure to urine. \- Prioritize based on symptoms and risks. **Planning** \- Establish goals with measurable outcomes: \- Patient will report a reduction in leakage episodes within two weeks of initiating pelvic floor exercises.\ - Patient's perineal skin will remain intact and irritation-free during treatment. \- Set priorities to address incontinence and prevent complications such as skin breakdown or infection. **Implementation** \- Teach pelvic floor exercises (e.g., Kegels) to strengthen bladder control. \- Instruct the patient to perform 10 repetitions of pelvic floor exercises, three times daily. \- Educate on bladder training techniques, such as scheduled voiding, to reduce urgency and frequency. \- Encourage patient to void every 2--3 hours, gradually extending intervals as bladder control improves. \- Promote proper perineal care to maintain skin integrity and prevent irritation or infection. \- Use a barrier cream and ensure perineal area is cleaned gently after episodes of leakage. \- Encourage lifestyle modifications, such as weight loss, avoiding bladder irritants (e.g., caffeine, alcohol), and fluid management. \- Advise patient to limit fluid intake in the evening to reduce nocturia. \- Provide information on absorbent products and ensure the patient knows they are temporary measures, not a solution. \- Recommend appropriate incontinence pads for daytime use. **Evaluation** \- Assess the patient's response to interventions: \- Patient reports fewer leakage episodes within two weeks.\ - Patient demonstrates correct pelvic floor exercise technique.\ - Perineal skin remains intact and irritation-free. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Urinary Retention (UR)** ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- **Step** **Key Actions** **Example** **Assessment** \- Gather health history: Onset, duration, and severity of retention; any associated symptoms like pain, dribbling, or weak urine stream. \- Patient reports difficulty starting urination, frequent dribbling, and feeling of incomplete emptying for two weeks. \- Perform a physical assessment: Palpate for bladder distention, assess suprapubic tenderness, and monitor vital signs. \- Bladder is palpable and firm above the pubic symphysis; patient reports mild suprapubic discomfort. \- Conduct diagnostic tests: Postvoid residual (PVR) measurement, urinalysis to rule out UTI, imaging studies to identify obstruction. \- PVR is 300 mL; urinalysis shows no infection; ultrasound indicates no anatomical abnormalities. **Diagnosis** \- Identify nursing diagnoses: \- **Urinary retention** related to impaired bladder contractility.\ - **Risk for infection** related to incomplete bladder emptying. \- Prioritize based on the severity of retention and potential for complications like infection or kidney damage. **Planning** \- Establish goals with measurable outcomes: \- Patient will void with complete bladder emptying within 48 hours of treatment initiation.\ - Patient will demonstrate understanding of bladder management techniques by discharge. \- Set priorities to address acute retention and prevent complications. **Implementation** \- Relieve retention through appropriate interventions, such as intermittent or indwelling catheterization. \- Perform sterile intermittent catheterization to drain the bladder. \- Teach double voiding or scheduled toileting techniques to promote bladder emptying. \- Encourage patient to void, wait 3--5 minutes, and try voiding again to ensure complete emptying. \- Administer prescribed medications, such as alpha-blockers (e.g., tamsulosin) to relax the bladder neck and prostate. \- Educate patient on potential side effects like dizziness and advise slow position changes. \- Encourage adequate hydration to maintain kidney function and reduce risk of infection. \- Advise the patient to drink 6--8 glasses of water daily unless contraindicated. \- Promote lifestyle modifications: Address constipation, avoid bladder irritants, and encourage regular voiding schedules. \- Educate on a high-fiber diet to prevent constipation and ensure proper bladder function. \- Provide emotional support, as urinary retention can cause embarrassment or anxiety. \- Discuss patient concerns and reassure them about the management plan. **Evaluation** \- Assess the patient's response to interventions: \- Patient voids with reduced PVR (\