NURS 3511: Episodic And Common Health Challenges PDF

NURS 3511: Episodic and Common Health Challenges Key Terminology Micturition Complex neural response that allows the bladder to contract, the urethral sphincter to relax, and urine to leave the body through the urethra Voiding reflex As a child matures, voluntary control over the...

NURS 3511: Episodic and Common Health Challenges Key Terminology Micturition Complex neural response that allows the bladder to contract, the urethral sphincter to relax, and urine to leave the body through the urethra Voiding reflex As a child matures, voluntary control over the bladder emptying develops For adults, the first urge to void is usually felt when the bladder is half full of urine 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Common Alterations in Urinary Elimination Matching Exercise Urinary tract infections Involuntary leakage of urine Urinary incontinence An accumulation of urine caused by the inability of the bladder to empty Nocturia Diversion of urine to external source Urinary retention Commonly result from catheterization (CAUTI); may have other causes (hygiene) Urinary diversions Waking in the night to urinate 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges Urinary Tract Infections 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges Urinary Tract Infections Urinary tract infection (UTI) involve the lower urinary tract, causing cystitis, urethritis, and prostatitis in patients with male genitalia. Patients with female genitalia are more susceptible to infection because of the short urethra. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Tract Infections Causes of UTI can include obstruction of the urinary tract (e.g., benign prostatic hyperplasia in individuals with male genitalia, or pelvic organ prolapse in individuals with female genitalia), incomplete bladder emptying, and abnormal anatomy. 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges Urinary Tract Infections Older persons, patients using antibiotics, and patients with progressive underlying disease or decreased immunity are also at increased risk. UTI can spread to the upper tract, causing kidney infection (pyelonephritis) and possibly long- term kidney damage. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Tract Infections Bacteria can also spread to the bloodstream (bacteremia), leading to urosepsis. It is important to know that not all bacteriuria (bacteria in the urine) causes infection. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Clinical Manifestations Patients with lower UTIs may experience pain or a burning sensation during urination (dysuria). Fever, chills, nausea, vomiting, and malaise may develop as the infection worsens. Inflammation of the bladder (cystitis) causes a frequent and urgent sensation of the need to void and may cause incontinence. Confusion is sometimes the #1 sign in the older population 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Clinical Manifestations Irritation to the bladder and urethral mucosa results in blood-tinged urine (hematuria). Cloudy, foul-smelling urine or a change in urine colour, in the absence of other symptoms, does not indicate infection. If the infection spreads to the upper urinary tract (i.e., to the kidneys, causing pyelonephritis), rapid onset of flank or lower back pain, tenderness, fever, and chills can occur. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Catheter-associated UTI (CAUTI) Results in increased length of hospital stay, morbidity, and mortality for patients. Reduce unnecessary use of in-dwelling catheters in all settings and remove them as soon as clinically indicated; good perineal care 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Catheter-associated UTI (CAUTI) Commonly accepted indications for insertion of a urinary catheter are listed in Box 44.1. Catheters should never be inserted for nursing convenience. The duration of catheterization is the most important risk factor for the development of a CAUTI, hence the focus on avoiding unnecessary catheterization and timely removal. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Indications Post op or acute urinary retention Bladder outlet obstruction (ie. Gross hematuria, BPH, pelvic organ prolapse, urethral strictures) Need for accurate measurements of I & O Prolonged immobilization Continuous bladder irrigation (CBI) Administration of meds into bladder (cancer) Improve comfort at end of life Perioperative in selected surgical procedures 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Contraindications For perceived comfort in patients with urinary or fecal incontinence As a means for obtaining urine for tests when patients can voluntarily void Prolonged postoperative use without appropriate indications 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Incontinence Defined as any complaint of involuntary loss of urine It often occurs along with other lower urinary tract symptoms, Daytime frequency, nocturia, urgency Intermittent or slow stream, hesitancy) Postmicturition symptoms (e.g., postmicturition dribble). The psychosocial impact ranges from minor lifestyle changes to stigma, embarrassment, and self-imposed social isolation 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Incontinence Types (Table 44.1) Transient (due to another underlying condition such as UTI, limited mobility, emotions, medications, endocrine, delirium) Urgency (involuntary, overactive bladder) Stress (sneezing or coughing) Mixed (stress and urge) UI associated with chronic retention of urine Functional (inability to reach toilet) Neurogenic bladder dysfunction (underlying NS disorder) 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges Nursing Management: Urinary Incontinence Interventions Lifestyle modifications (fluid management, caffeine reduction) Toileting assistance / Voiding regimes / Bladder retraining Pelvic floor muscle rehabilitation Anti-continence devices (e.g. pessary inserted into vagina to support pelvic organ prolapse) Containment devices (e.g. condom catheter) 17  NURS 3511: Episodic and Common Health Challenges Nocturia Bothersome symptom defined as the need to get up at night on a regular basis to urinate Prevalence of nocturia increases with age and is seen in multiple conditions, including an overactive bladder prostate enlargement (men) excess urine production at night (nocturnal polyuria) associated with peripheral edema in heart failure obstructive sleep apnea loss of vasopressin (antidiuretic hormone) Polyuria can also occur in metabolic imbalances such as hyperglycemia and hypercalcemia. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Retention Accumulation of urine in the bladder due to the bladder’s inability to empty. Normally, urine production slowly fills the bladder and prevents activation of stretch receptors until the bladder distends to a certain extent. The micturition reflex then occurs, and the bladder empties. With urinary retention, the bladder becomes unable to respond to the micturition reflex and thus is unable to empty. Urine continues to collect in the bladder, causing feelings of pressure, discomfort, tenderness over the symphysis pubis, restlessness, and diaphoresis. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Retention As retention progresses, overflow incontinence may occur. Pressure in the bladder builds to a point at which the urethral sphincter is unable to hold back urine, and a small volume escapes. Urinary retention results from an underactive or acontractile detrusor muscle or urethral obstruction. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Retention Acute urinary retention can occur postpartum or following urogenital surgery because of medication adverse effects (e.g., anticholinergic adverse effects) or from fecal impaction. Postoperative urinary retention (POUR) is a type of acute urinary retention that can result from general, spinal, and regional anaesthetics; by suppressing micturition control and reflexes at the central nervous and peripheral nervous systems, it blocks neural transmission in the sacral spinal cord. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Retention Chronic urinary retention can occur in individuals with male genitalia with prostate enlargement and in individuals with female genitalia who have pelvic organ prolapse or urethral stricture, or in conditions that alter motor and sensory innervation of the bladder. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Retention Key signs of acute urinary retention are the absence of urine output over several hours, bladder distension, restlessness, diaphoresis, and moderate-to-extreme abdominal discomfort. A patient under the influence of anaesthetics or analgesics may feel only pressure, but an alert patient experiences severe pain as the bladder distends beyond its normal capacity. Intermittent catheterization may be needed to empty the bladder and reduce the risk of overflow incontinence and UTI 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Safety Alert: Autonomic Dysreflexia Bladder distension can trigger autonomic dysreflexia in individuals with spinal cord injury above the T6 level. Dysregulation of the autonomic nervous system triggers an uncoordinated autonomic response that could result in potentially life-threatening hypertension. Immediate recognition and correction of the disorder (irrigating or changing the Foley catheter) can be life-saving. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Diversion A urinary stoma to divert the flow of urine from the kidneys directly to the abdominal surface is a urinary diversion. It can be created for several reasons, including cancer of the bladder, trauma, radiation injury to the bladder, fistulas, and chronic cystitis. A urinary diversion may be temporary or permanent. The patient with an incontinent urinary diversion must wear an ostomy appliance continuously because no sphincter control exists to regulate urine flow. Local irritation and skin breakdown occur when urine comes in contact with the skin for long periods. 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges GU Fistula 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Diversion The ileal conduit involves separating a loop of intestinal ileum with its blood supply intact. The ureters are implanted into the isolated segment of the ileum, with the remaining ileum reconnected. The isolated ileal segment can then be used as a conduit for continuous urine drainage - stoma 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Diversion The orthotopic neobladder is an internal pouch created with the ileum and is reconnected to the urethra. Patients will void via the urethra but may need to perform intermittent catheterization. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Diversion The Indiana pouch is a continent internal pouch created from the ileum. A portion of the Indiana pouch is connected to the abdominal wall and acts as a continent nipple, and intermittent catheterization is needed for emptying. 3511_Week8_Peniston_2024 NURS 3511: Episodic and Common Health Challenges Ideal Urinary Stoma It is symmetrical, has no skin breakdown, and protrudes about 1.5 cm. The mucosa is a healthy red, and the configuration is flat when the patient is upright and supine. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinary Stoma and Pouch A urinary diversion poses threats to a patient’s body image, and adjustment to it takes time. Although a normal lifestyle is possible with a stoma, adjustment can be difficult, and each person will cope differently. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Nursing Considerations: Urinary Elimination Infection control and hygiene: the urinary tract is considered to be sterile Must use infection-control principles to prevent and spread of UTIs Duration of catheterization is the most important risk factor for developing a UTI Medical and surgical asepsis (providing care vs. catheterization) 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Nursing Considerations: Urinary Elimination Growth and Development Changes in kidney and bladder function occur with aging Less effective emptying, increased susceptibility to UTIs, and elevated postvoid residual volume (PVR) – the volume remaining in the bladder after a void) 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Nursing Considerations: Urinary Elimination Psychological Considerations Urinary elimination problems may result in alterations of sexuality and self-concept Embarrassment leads to delays in seeking help Self-isolation Cultural Considerations around urinary needs 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Assessment of Urine Colour Pale straw colour to amber depending on its concentration Bleeding from kidneys or ureters can cause dark red urine Bleeding from the bladder or urethra causes urine to become bright red Medications and food can discolour urine Dyes in diagnostic tests Dark amber from bilirubin (liver dysfunction)  NURS 3511: Episodic and Common Health Challenges Assessment of Urine Clarity Normal urine appears transparent at voiding but may become cloudy if left standing. In patients with renal disease, urine may appear cloudy or foamy because of high protein concentrations. Urine also will appear thick and cloudy as a result of bacteria.  NURS 3511: Episodic and Common Health Challenges Assessment of Urine Odour Urine has a characteristic odour. The more concentrated the urine, the stronger the odour. Stagnant urine has an ammonia odour, which is common in patients who are repeatedly incontinent. A sweet or fruity odour occurs from acetone or acetoacetic acid (by- products of incomplete fat metabolism) seen with diabetes mellitus or starvation.  NURS 3511: Episodic and Common Health Challenges Urine Testing: Collection Techniques Clean-Catch Midstream Collection: Instruct the patient to clean the urethral area, begin urinating, and then collect a midstream sample in a sterile container. 24-Hour Urine Collection: Used to assess kidney function by collecting all urine over a 24-hour period. Patients are instructed to discard the first urine of the day and then collect all subsequent urine in a provided container. Catheterized Sample: Collected by a healthcare professional directly from a catheter, ensuring sterility in patients with a catheter in place.  NURS 3511: Episodic and Common Health Challenges Urine Testing Urinalysis Specific gravity Urine culture  NURS 3511: Episodic and Common Health Challenges Urinalysis Color, Clarity, Odour pH (Acidity): Normal urine pH ranges from 4.5 to 8. High pH may suggest infection, while low pH can indicate a high-protein diet or certain medications. Protein: Normally absent or present in very small amounts. Protein in the urine (proteinuria) can indicate kidney disease or infection. Glucose: Normally absent. The presence of glucose (glycosuria) suggests high blood sugar levels, commonly seen in uncontrolled diabetes. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Urinalysis Ketones: Normally absent. The presence of ketones (ketonuria) can indicate uncontrolled diabetes, starvation, or a low-carbohydrate diet. Leukocyte Esterase and Nitrites: Indicators of infection. Leukocyte esterase suggests white blood cells in urine, while nitrites are produced by certain bacteria. Blood: Normally absent. Blood in urine (hematuria) can indicate infection, trauma, kidney stones, or other kidney conditions. Bilirubin and Urobilinogen: Normally absent. The presence of bilirubin suggests liver or gallbladder disease. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Diagnostic Examinations (table 44.5) Noninvasive examination Invasive examination  NURS 3511: Episodic and Common Health Challenges Common responsibilities before an examination include the following: Witnessing a signed consent (if agency policy allows) Administering bowel preparation medications (check agency policy) Ensuring that the patient receives the appropriate pretest diet (clear liquids) or nothing by mouth (NPO), as needed Does the patient need an empty bladder (cystoscopy)  NURS 3511: Episodic and Common Health Challenges Common post-procedure interventions may include the following: Assessing intake and output Observing characteristics of urine (colour, clarity, presence of blood)  NURS 3511: Episodic and Common Health Challenges Health Promotion Promoting regular micturition Stimulating micturition reflex (sitting vs. standing; sensory stimuli) Maintaining elimination habits Maintaining adequate fluid intake Promoting complete bladder emptying (double voiding, intermittent catheterization, bladder scanning) Preventing infection (good perineal hygiene, hand washing, drinking fluids) Catheters and incontinence products Use of a urinary catheter requires a prescriber’s order. Incontinence alone is not a reason to insert a urinary catheter.  NURS 3511: Episodic and Common Health Challenges Class Learning Outcomes (cont.) 5. Compare common alterations in urinary elimination. 6. Describe the nursing implications of common diagnostic tests of the urinary system. 7. Discuss nursing measures to promote normal micturition and to reduce episodes of incontinence. 8. Describe the nursing and collaborative care for a client with chronic renal failure / chronic kidney disease. 9. Describe the indications for peritoneal and hemodialysis. 10.Describe the nursing care for a client receiving peritoneal and hemodialysis. 3511_Week8_Peniston_2024  NURS 3511: Episodic and Common Health Challenges Chronic Kidney Disease (CKD) Involves progressive, irreversible loss of kidney function Chronic renal failure Defined as presence of Kidney damage Pathological abnormalities (destruction of nephrons in both kidneys) Markers of damage Blood, urine, imaging tests Glomerular filtration rate (GFR) – urine creatine clearance