Interventions for Clients with Urinary Problems

Cystitis  Inflammation of the bladder  Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder, viruses, fungi, or parasites  Catheter-related infections common during hospital stay

Incidence and Prevalence of Cystitis  Frequenct urge to urinate  Dysuria  Urgency  Urinalysis needed when testing for leukocyte esterase  Type of organism confirmed by urine culture  Other diagnostic assessments

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

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

Catheter

Urethritis  Inflammation of the urethra that causes symptoms similar to urinary tract infection  Caused by sexually transmitted infections; treat with antibiotic therapy  Estrogen vaginal cream for postmenopausal women

Urethrala Strictures  Narrowing 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  Five types of incontinence include:  Stress  Urge  Mixed  Overflow  Functional

Collaborative Management  Assessment includes a thorough client history.  Clinical manifestations for urethral or uterine prolapse  Laboratory assessment by urinalysis  Radiographic assessment, especially before surgery  Other diagnostic assessments

Stress Urinary Incontinence  Interventions include:  Keeping a diary, behavioral interventions, diet modification, and pelvic floor exercises  Drug therapy: estrogen  Surgery  Collection devices and vaginal cone weights

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

Urge Urinary Incontinence  Interventions include:  Drugs: anticholinergics, possibly antihistamines, others  Diet therapy: avoid caffeine and alcohol  Behavioral interventions: exercises, bladder training, habit training, electrical stimulation

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

Urolithiasis  Presence of calculi (stones) in the urinary tract  Collaborative management  History of urologic stones  Clinical manifestations  Laboratory assessment  Radiographic assessment  Other diagnostic tests

IVP (Intravenous Pyelography)

Interventions  Drug therapy  Opioid analgesics—often used to control pain  Nonsteroidal anti-inflammatory drugs  Pain medications at regular intervals  Constant delivery system  Spasmolytic drugs—important for relief of pain  Complementary and alternative therapy

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

Surgical Management  Minimally invasive surgical procedures  Stenting  Retrograde ureteroscopy  Percutaneous ureterolithotomy and nephrolithotomy  Open surgical procedures  Preoperative care  Operative procedure

Postoperative Care  Routine postoperative care procedures for assessment of bleeding, urine, and adequate fluid intake  Strained urine  Infection prevention  Drug therapy  Diet therapy  Prevention of obstruction

Drug Therapy  Drug selection to prevent obstruction depends on what is forming the stone:  Calcium  Oxalate  Uric acid  Cystine

Urothelial Cancer  Collaborative management  Assessment  Diagnostic assessment  Nonsurgical management  Prophylactic immunotherapy  Chemotherapy  Radiation therapy

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

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.

Hemodialysis  Hospital, dialysis center  Pt’s blood moves from implanted shunt in arm artery  tube  machine  exchange of wastes, fluids, electrolytes  Semipermeable membrane separates pts blood from dialysis fluid

Hemodialysis  Constituents move between the 2 compartments  Ex: wastes in blood  dialysate bicarbonate in dialysate  blood Blood cells, proteins remain in blood Movement by ultrafiltration, diffusion, osmosis  Blood to pt vein

Peritoneal Dialysis  Administered in unit or at home  At night or continuously  CAPD (continuous ambulatory peritoneal dialysis)  Peritoneal membrane serves as semipermeable membrane  Catheter w/ entry and exit points implanted  Dialyzing fluid instilled in catheter into cavity

Peritoneal Dialysis  Remains there  Allows exchange of wastes and electrolytes to occur  Dialysate drained from by gravity from cavity into container  Requires more time than hemo  Complications  Infection in peritoneal cavity

Peritoneal Dialysis

ESWL.Extracorporeal shock- wave lithotripsy (ESWL)