1. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Care of Patients with Urinary Problems

2. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Risk factors for urinary problems ◦ Nephron replication decreases with age ◦ Medications can be toxic to the kidneys ◦ Chronic disease can stress the kidney  Health promotion techniques  Teaching plan 2

3. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Inflammation of bladder  Most commonly caused by bacteria moving up urinary tract from external urethra to bladder  Catheters: High risk factor in developing nosocomial cystitis 3

4. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Frequent urge to urinate  Dysuria  Urgency  Urinalysis needed when testing for leukocyte esterase  Organism type confirmed by urine culture  Other diagnostic assessments 4

5. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Inflammation of urethra causing symptoms similar to urinary tract infection (UTI)  Role of estrogen in treating estrogen- depletion urethritis 5

6. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Narrowed areas of urethra  Most common symptom: Obstruction of urine flow  Surgical treatment by urethroplasty: Best chance of long-term cure  Dilation of urethra (temporary measure)  Urethroplasty 6

7. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Interventions ◦ Journaling, behavioral interventions, diet modification, pelvic floor (Kegel) exercises ◦ Diet therapy ◦ Drug therapy: Estrogen ◦ Surgery ◦ Vaginal cone therapy 7

8. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Interventions ◦ Drugs: Anticholinergics, antihistamines, others ◦ Diet therapy: Avoid caffeine and alcohol ◦ Behavioral interventions: Exercises, bladder training, habit training, electrical stimulation 8

9. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Also known as reflex incontinence  Interventions ◦ Surgery to relieve obstruction ◦ Intermittent catheterization ◦ Bladder compression, intermittent self- catheterization ◦ Drug therapy ◦ Behavioral interventions 9

10. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Interventions ◦ Treatment of reversible causes ◦ Urinary habit training (if incontinence not reversible) ◦ Final strategy: Containment of urine, protection of patient’s skin ◦ Applied devices ◦ Urinary catheterization 10

11. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Presence of calculi (stones) in urinary tract  Assessment  Pain-relief measures ◦ Drug therapy ◦ CAM therapies ◦ Lithotripsy  Surgical management  Minimally invasive surgery  Open surgical procedures 11

12. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Uses sound, laser, or dry shock wave energy to break stones into small fragments  Patient undergoes conscious sedation  Topical anesthetic cream applied to skin site  Continuous ECG monitoring 12

13. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Problems of urine outflow obstruction 13

14. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Bacterial infection in kidney and renal pelvis (upper urinary tract)  Acute symptoms: ◦ Fever, chills, tachycardia, tachypnea ◦ Flank, back, or loin pain ◦ Abdominal discomfort ◦ Turning, nausea and vomiting, urgency, frequency, nocturia ◦ General malaise or fatigue 14

15. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Hypertension  Inability to conserve sodium  Decreased ability to concentrate urine  Development of hyperkalemia and acidosis 15

16. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Manifestations  Preventive measures  Treatment  Priority collaboration  Assessment of treatment efficacy  Teaching needs 16

17. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Microvascular complication of type 1 or type 2 diabetes  First manifestation: Persistent albuminuria  Priority goals in prevention of ESKD 17

18. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Tract Infections (UTIs)  Upper UTI ◦ Acute pyelonephritis  Usually female clients  Symptoms  Chills, fever, flank pain, nausea with vomiting  Painful urination, frequency, urgency, pyuria, hematuria

19. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Tract Infections (cont’d)  Lower UTI ◦ Acute cystitis  Frequently in females  E. coli, Staph, Klebsiella, Pseudomonas  Symptoms  Pain and burning on urination, frequency, urgency, ◦ Urethritis, prostatitis  Same symptoms  In men, this is most commonly related to STI’s/STD’s

20. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Antiseptics/Antiinfectives  Bacteriostatic, bactericidal ◦ Urinary antiinfectives  Nitrofurantoin (Furadantin, Macrodantin) ◦ Sulfonamides  Trimethoprim-sulfamethoxazole (Bactrim) ◦ Fluoroquinolones  Ciprofloxacin (Cipro) ◦ Penicillins  Amoxicillin/clavulanic acid (Augmentin)

21. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Antiseptics/Antiinfectives (cont’d)  Nitrofurantoin ◦ Treats gram + and gram – ◦ Inhibits bacterial enzymes and metabolism ◦ Side effects/adverse reactions  Dizziness, HA, drowsiness  Rust-colored or brown urine  Rash, pruritus  GI distress  Superinfection, peripheral neuropathy, hepatotoxicity, Stevens-Johnson syndrome, blood dyscrasias

22. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Antiseptics/Antiinfectives (cont’d)  Nitrofurantoin ◦ Nursing interventions  Take with food to decrease GI distress.  Avoid antacids.  Do not crush or open capsules.  Shake liquid suspension well.  Rinse mouth after taking drug.  Do not drive or operate dangerous equipment.  Increase fluid intake, consume cranberry juice, plums, proteins, vitamin C.

23. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Analgesics  Phenazopyridine (Pyridium) ◦ Action  Relieves pain, burning sensation, frequency, urgency  ◦ Side effects/adverse reactions  GI upset  Red-orange urine  Blood dyscrasia  Nephrotoxicity, hepatotoxicity

24. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Antispasmodics  Oxybutynin (Ditropan) ◦ Action  Direct action on smooth muscles to relieve spasms ◦ Side effects/adverse reactions  Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation ◦ Caution  Avoid in narrow-angle glaucoma, cardiac, renal, hepatic, prostate problems

25. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Urinary Antimuscarinics  Tolterodine tartrate (Detrol) ◦ Action:  Control overactive bladder by decreasing nerve impulse and stimulation ◦ Side effects  Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation ◦ Caution  To be avoided if client has narrow-angle glaucoma or cardiac, renal, hepatic, prostate problems