interventions for clients with urinary problems. cystitis inflammation of the bladder most...
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CystitisCystitis
Inflammation of the bladderInflammation of the bladder Most commonly caused by bacteria Most commonly caused by bacteria
that move up the urinary tract from the that move up the urinary tract from the external urethra to the bladder, external urethra to the bladder, viruses, fungi, or parasitesviruses, fungi, or parasites
Catheter-related infections common Catheter-related infections common during hospital stayduring hospital stay
Incidence and Prevalence of Incidence and Prevalence of CystitisCystitis Frequenct urge to urinateFrequenct urge to urinate Dysuria Dysuria Urgency Urgency Urinalysis needed when testing for Urinalysis needed when testing for
leukocyte esteraseleukocyte esterase Type of organism confirmed by urine Type of organism confirmed by urine
cultureculture Other diagnostic assessmentsOther diagnostic assessments
Drug TherapyDrug Therapy
Urinary antisepticsUrinary antiseptics AntibioticsAntibiotics AnalgesicsAnalgesics AntispasmodicsAntispasmodics Antifungal agentsAntifungal agents Long-term antibiotic therapy for Long-term antibiotic therapy for
chronic, recurring infectionschronic, recurring infections
Nonsurgical Nonsurgical ManagementManagement
Urinary eliminationUrinary elimination Diet therapy includes all food groups, Diet therapy includes all food groups,
calorie increase due to increase in calorie increase due to increase in metabolism caused by the infection, metabolism caused by the infection, fluids, possible intake of cranberry fluids, possible intake of cranberry juice preventivelyjuice preventively
Other pain relief measures, such as Other pain relief measures, such as warm sitz bathswarm sitz baths
UrethritisUrethritis
Inflammation of the urethra that Inflammation of the urethra that causes symptoms similar to urinary causes symptoms similar to urinary tract infectiontract infection
Caused by sexually transmitted Caused by sexually transmitted infections; treat with antibiotic therapyinfections; treat with antibiotic therapy
Estrogen vaginal cream for Estrogen vaginal cream for postmenopausal womenpostmenopausal women
Urethrala StricturesUrethrala Strictures Narrowing of the urethraNarrowing of the urethra Most common symptom—obstruction Most common symptom—obstruction
of urine flowof urine flow Surgical treatment by urethroplasty—Surgical treatment by urethroplasty—
best chance of long-term curebest chance of long-term cure Dilation of the urethra—a temporary Dilation of the urethra—a temporary
measuremeasure UrethroplastyUrethroplasty
Urinary IncontinenceUrinary Incontinence
Five types of incontinence include:Five types of incontinence include: StressStress UrgeUrge Mixed Mixed Overflow Overflow FunctionalFunctional
Collaborative ManagementCollaborative Management
Assessment includes a thorough Assessment includes a thorough client history.client history.
Clinical manifestations for urethral or Clinical manifestations for urethral or uterine prolapseuterine prolapse
Laboratory assessment by urinalysisLaboratory assessment by urinalysis Radiographic assessment, especially Radiographic assessment, especially
before surgerybefore surgery Other diagnostic assessmentsOther diagnostic assessments
Stress Urinary IncontinenceStress Urinary Incontinence
Interventions include:Interventions include: Keeping a diary, behavioral interventions, Keeping a diary, behavioral interventions,
diet modification, and pelvic floor diet modification, and pelvic floor exercisesexercises
Drug therapy: estrogen Drug therapy: estrogen SurgerySurgery Collection devices and vaginal cone Collection devices and vaginal cone
weightsweights
Surgical ManagementSurgical Management
Preoperative carePreoperative care Operative procedureOperative procedure Postoperative carePostoperative care
Assess for and intervene to prevent or Assess for and intervene to prevent or detect complications.detect complications.
Secure urethral catheter.Secure urethral catheter.
Urge Urinary IncontinenceUrge Urinary Incontinence Interventions include:Interventions include:
Drugs: anticholinergics, possibly Drugs: anticholinergics, possibly antihistamines, othersantihistamines, others
Diet therapy: avoid caffeine and alcoholDiet therapy: avoid caffeine and alcohol Behavioral interventions: exercises, Behavioral interventions: exercises,
bladder training, habit training, electrical bladder training, habit training, electrical stimulationstimulation
Reflux Urinary IncontinenceReflux Urinary Incontinence
Interventions include:Interventions include: Surgery to relieve the obstructionSurgery to relieve the obstruction Intermittent catheterizationIntermittent catheterization Bladder compression and intermittent Bladder compression and intermittent
self-catheterizationself-catheterization Drug therapyDrug therapy Behavioral interventionsBehavioral interventions
Functional Urinary Functional Urinary IncontinenceIncontinence Interventions include:Interventions include:
Treatment of reversible causesTreatment of reversible causes If incontinence is not reversible, urinary If incontinence is not reversible, urinary
habit traininghabit training Final strategy—containment of urine and Final strategy—containment of urine and
protection of the client’s skinprotection of the client’s skin Applied devicesApplied devices Urinary catheterization Urinary catheterization
UrolithiasisUrolithiasis
Presence of calculi (stones) in the Presence of calculi (stones) in the urinary tracturinary tract
Collaborative managementCollaborative management History of urologic stonesHistory of urologic stones Clinical manifestationsClinical manifestations Laboratory assessmentLaboratory assessment Radiographic assessmentRadiographic assessment Other diagnostic testsOther diagnostic tests
InterventionsInterventions Drug therapyDrug therapy Opioid analgesics—often used to control Opioid analgesics—often used to control
painpain Nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs Pain medications at regular intervalsPain medications at regular intervals Constant delivery systemConstant delivery system Spasmolytic drugs—important for relief of Spasmolytic drugs—important for relief of
painpain Complementary and alternative therapyComplementary and alternative therapy
LithotripsyLithotripsy
Extracorporeal shock wave lithotripsy uses Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to sound, laser, or dry shock wave energy to break the stone into small fragments.break the stone into small fragments.
Client undergoes conscious sedationClient undergoes conscious sedation Topical anesthetic cream is applied to skin Topical anesthetic cream is applied to skin
site of stone.site of stone. Continuous monitoring is by Continuous monitoring is by
electrocardiographyelectrocardiography
Surgical ManagementSurgical Management
Minimally invasive surgical proceduresMinimally invasive surgical procedures StentingStenting Retrograde ureteroscopyRetrograde ureteroscopy Percutaneous ureterolithotomy and Percutaneous ureterolithotomy and
nephrolithotomynephrolithotomy Open surgical proceduresOpen surgical procedures
Preoperative carePreoperative care Operative procedureOperative procedure
Postoperative CarePostoperative Care
Routine postoperative care procedures for Routine postoperative care procedures for assessment of bleeding, urine, and assessment of bleeding, urine, and adequate fluid intakeadequate fluid intake
Strained urineStrained urine Infection preventionInfection prevention Drug therapyDrug therapy Diet therapyDiet therapy Prevention of obstructionPrevention of obstruction
Drug TherapyDrug Therapy
Drug selection to prevent obstruction Drug selection to prevent obstruction depends on what is forming the stone:depends on what is forming the stone: CalciumCalcium OxalateOxalate Uric acidUric acid CystineCystine
Urothelial CancerUrothelial Cancer
Collaborative managementCollaborative management AssessmentAssessment Diagnostic assessmentDiagnostic assessment Nonsurgical managementNonsurgical management
Prophylactic immunotherapyProphylactic immunotherapy ChemotherapyChemotherapy Radiation therapyRadiation therapy
Surgical ManagementSurgical Management
Preoperative carePreoperative care Operative proceduresOperative procedures Postoperative care includes:Postoperative care includes:
Collaboration with enterostomal therapistCollaboration with enterostomal therapist Kock’s pouchKock’s pouch NeobladderNeobladder
Bladder TraumaBladder Trauma
Causes may be due to injury to the Causes may be due to injury to the lower abdomen or stabbing or lower abdomen or stabbing or gunshot wounds.gunshot wounds.
Surgical intervention is required.Surgical intervention is required. Fractures should be stabilized before Fractures should be stabilized before
bladder repair.bladder repair.
HemodialysisHemodialysis
Hospital, dialysis centerHospital, dialysis center Pt’s blood moves from implanted Pt’s blood moves from implanted
shunt in arm artery shunt in arm artery tube tube machine machine exchange of wastes, fluids, exchange of wastes, fluids, electrolyteselectrolytes Semipermeable membrane Semipermeable membrane
separates pts blood from dialysis separates pts blood from dialysis fluidfluid
HemodialysisHemodialysisConstituents move between the 2 Constituents move between the 2
compartmentscompartmentsEx: wastes in blood Ex: wastes in blood dialysate dialysatebicarbonate in dialysate bicarbonate in dialysate blood bloodBlood cells, proteins remain in Blood cells, proteins remain in
bloodbloodMovement by ultrafiltration, Movement by ultrafiltration,
diffusion, osmosisdiffusion, osmosis Blood to pt veinBlood to pt vein
Peritoneal DialysisPeritoneal Dialysis
Administered in unit or at homeAdministered in unit or at home At night or continuouslyAt night or continuously
CAPD (continuous ambulatory CAPD (continuous ambulatory peritoneal dialysis)peritoneal dialysis)
Peritoneal membrane serves as Peritoneal membrane serves as semipermeable membranesemipermeable membrane
Catheter w/ entry and exit points Catheter w/ entry and exit points implantedimplanted
Dialyzing fluid instilled in catheter into Dialyzing fluid instilled in catheter into cavitycavity
Peritoneal DialysisPeritoneal Dialysis Remains there Remains there Allows exchange of wastes and Allows exchange of wastes and
electrolytes to occurelectrolytes to occur Dialysate drained from by gravity Dialysate drained from by gravity
from cavity into containerfrom cavity into container Requires more time than hemoRequires more time than hemo ComplicationsComplications
Infection in peritoneal cavityInfection in peritoneal cavity