Urinary disorders Sum 10 NOTES

Chapter 45Management of Patients with Urinary Disorders : 

1 Chapter 45Management of Patients with Urinary Disorders

Urinary Tract Infection (UTI) : 

2 Urinary Tract Infection (UTI) Classifications: 1. Upper UTIs are known as Pylonephritis. 2. Lower UTIs: a. Urethritis (inflammation of the urethra) b. Cystitis. (inflammation of the bladder) c. Prostatitis (inflammation of the prostate gland) Predisposing Factors Symptoms

Urinary Tract Infection (cont’d) : 

3 Urinary Tract Infection (cont’d) Diagnostic tests: 1. Urine analysis. 2. Urine culture. 3. WBCs. 4. IVP

Urinary Tract Infection (con’t) : 

Urinary Tract Infection (con’t) Pharmacologic Treatment Bactrim, Septra (ATI pg. 76)- SULFA-observe for bleeding; can cause a blood disorder; monitor for renal toxcity-may need reduced dose Microdantin (ATI pg. 78)-brown discoloration Cipro (ATI pg. 87)-achilles tendon rupture (posterior leg-pain , redness, swelling) Pyridium – urinary analgesic; changes the urine orange Other treatment 4

Urinary Incontinence : 

Urinary Incontinence An underdiagnosed and underreported problem that can significantly impact the quality of life and decrease independence and may lead to compromise of the upper urinary system Involuntary loss or urine from the bladder Risk factors 5

Types of Urinary Incontinence : 

Types of Urinary Incontinence Stress- most common, leak when straining the abdomen such as coughing, sneezing, lifting Urge- unable to suppress the sudden need to urinate; usually from infection irritating the bladder; tx infection Reflex-absence of normal sensation often seen with spinal cord injury (unaware of the need to void) Overflow-loss of urine associated with overdistended bladder Functional-cognitive impairement (dementia or alzeheimers) make if difficult to identify need to void Iatrogenic –involuntary loss due to medication Mixed incontinence- stress and urge

Medical Management : 

Medical Management Behavioral Therapy-Kegel exercises, bladder training-void every 2-3hrs Medications-anticholinergic, tricyclic antidep. Surgery OTHERS: Increase fluids, more concentrated urine increases urge, no diuretics at PM, avoid bladder irritants-alcohol, caffeine, stop smoking bc cough increases incontinence. 7

Urinary Retention : 

Urinary Retention Inability of the bladder to empty completely Residual urine: amount of urine left in the bladder after voiding Causes include age (50 to 100 mL in adults older than age 60 due to decreased detrusor muscle activity), diabetes, prostate enlargement, pregnancy, neurologic disorders, and medications Provide nursing measures to promote voiding

Urolithiasis(Uro-lith-i-asis) : 

9 Urolithiasis(Uro-lith-i-asis) Urolithiasis: The process of forming stones in the kidney, bladder, and/or urethra (urinary tract). Possible Etiology: 1. Immobility. (slows renal drainage) 2. Hypercalcemia. (increased Ca in blood and urine promote precipitation of calcium and formation of stones) 3. UTIs. 4. Urine stasis. 5. Elevated uric acid levels seen in gout

Urolithiasis (cont’d) : 

10 Urolithiasis (cont’d) Clinical Manifestations: 1. Pain 2. Nausea and vomiting accompanying severe pain. 3. Fever and chills. 4. Hematuria. 5. Rarely, oliguria or anuria. 6. Bladder distension (urine retention)

Urolithiasis (cont’d) : 

11 Urolithiasis (cont’d) Diagnostic tests: 1. KUB radiograph reveals visible calculi. 2. IVP (Intravenous Pyelogram) determines size and location of calculi. 3. Renal Ultrasonography reveals obstructive changes.

Medical Management : 

Medical Management Pain medications Nutritional therapy Interventional Procedures Ureteroscopy-visualize , destroy and remove Lithotripsy-break up stones via shock waves and then voided (lie on exam table on water filled cushion) Percutaneous stone removal- use a scope to go in through the skin and retrieve the stone 12

Urinary diversions : 

Urinary diversions Performed to divert urine from the bladder to a new exit site usually through a stoma Incontient Urinary Diversions Ileal conduit urinary diversion Continent Ileal Diversions Indiana Pouch Ureterosigmoidostomy-ureters into the sigmoid colon-voiding occurs from rectum