nursing care of the patient with urinary problems

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Chapter 69:

Chapter 69 Care of Patients with Urinary Problems

Cystitis :

Cystitis Inflammation of the bladder Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder Catheters are the most common factor placing patients at risk for UTIs in the hospital setting

Cystitis (Cont’d):

Cystitis (Cont ’ d) Frequent urge to urinate Dysuria Urgency Urinalysis needed when testing for leukocyte esterase Type of organism confirmed by urine culture Other diagnostic assessments

Sites of Infectious Processes:

Sites of Infectious Processes Fig. 44-1

Drug Therapy:

Drug Therapy Urinary antiseptics Antibiotics Analgesics Antispasmodics Antifungal agents Long-term antibiotic therapy for chronic, recurring infections

Urinary Tract Infection Drug Therapy:

Urinary Tract Infection Drug Therapy Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric, uncomplicated, or initial Fluoroquinolones (Cipro) Nitrofurantoin (Macrobid) Pyrdium

Nonsurgical Management:

Nonsurgical Management Urinary elimination Diet therapy includes all food groups, calorie increase because of increase in metabolism caused by the infection, fluids, possible intake of cranberry juice preventively Other pain-relief measures, such as warm sitz baths

Urethritis :

Urethritis Inflammation of the urethra that causes symptoms similar to urinary tract infection Patient-centered collaborative care

Urethral Strictures :

Urethral Strictures Narrowed areas of the urethra Most common symptom—obstruction of urine flow Surgical treatment by urethroplasty—best chance of long-term cure Dilation of the urethra—a temporary measure Urethroplasty

Urinary Incontinence:

Urinary Incontinence Five types of incontinence are: Stress incontinence Urge incontinence Mixed incontinence Overflow incontinence Functional incontinence

Collaborative Management :

Collaborative Management Patient history Physical assessment Laboratory assessment Imaging assessment Other diagnostic assessment

Stress Urinary Incontinence:

Stress Urinary Incontinence Interventions include: Keeping a diary, behavioral interventions, diet modification, and pelvic floor (Kegel) exercises Diet therapy Drug therapy —e strogen Surgery Vaginal cone therapy

Interventions for Stress incontinence:

Interventions for Stress incontinence Exercise therapy - Kegel exercises, vaginal cone therapy Diet therapy Drug therapy Surgical management

Surgical Management :

Surgical Management Preoperative care Operative procedure Postoperative care: Assess for and intervene to prevent or detect complications. Secure urethral catheter.

Urge Urinary Incontinence :

Urge Urinary Incontinence Interventions include: Drugs —a nticholinergics, possibly antihistamines, others Diet therapy —a void caffeine and alcohol Behavioral interventions —e xercises, bladder training, habit training, electrical stimulation

Reflux Urinary Incontinence:

Reflux Urinary Incontinence Interventions include: Surgery to relieve the obstruction Intermittent catheterization Bladder compression and intermittent self-catheterization Drug therapy Behavioral interventions

Functional Urinary Incontinence:

Functional Urinary Incontinence Interventions include: Treatment of reversible causes If incontinence is not reversible, urinary habit training Final strategy—containment of urine and protection of the patient ’ s skin Applied devices Urinary catheterization

Community-Based Care:

Community-Based Care Home care management Health teaching Health care resources

Urolithiasis :

Urolithiasis Presence of calculi (stones) in the urinary tract Assessment Pain-relief measures: Drug therapy Complementary and alternative therapy Lithotripsy Surgical management Minimally invasive surgery Open surgical procedures

Lithotripsy :

Lithotripsy Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to break the stone into small fragments. Patient undergoes conscious sedation. Topical anesthetic cream is applied to skin site of stone. Continuous monitoring is by electrocardiography.

Urothelial Cancer:

Urothelial Cancer Malignant tumors of the urothelium, the lining of the transitional cells in the kidney, renal pelvis, ureters, urinary bladder, and urethra Physical assessment Clinical manifestations Psychosocial assessment Diagnostic assessment

Surgical Management:

Surgical Management Preoperative care Operative procedures Postoperative care includes: Collaboration with enterostomal therapist Kock ’ s pouch Neobladder

Community-Based Care:

Community-Based Care Health teaching Health care resources

Bladder Trauma:

Bladder Trauma Causes may be due to injury to the lower abdomen or stabbing or gunshot wounds. Surgical intervention is required. Fractures should be stabilized before bladder repair.

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