Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Chapter 69

Care of Patients with Urinary Problems

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4

Drug Therapy

Urinary antiseptics Antibiotics Analgesics Antispasmodics Antifungal agents Long-term antibiotic therapy for chronic,

recurring infections

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6

Urethritis Inflammation of the urethra that causes

symptoms similar to urinary tract infection Patient-centered collaborative care

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8

Urinary Incontinence

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10

Stress Urinary Incontinence

Interventions include: Keeping a diary, behavioral interventions, diet

modification, and pelvic floor (Kegel) exercises Diet therapy Drug therapy—estrogen Surgery Vaginal cone therapy

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11

Surgical Management Preoperative care Operative procedure Postoperative care:

Assess for and intervene to prevent or detect complications.

Secure urethral catheter.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13

Reflux Urinary Incontinence

Interventions include: Surgery to relieve the obstruction Intermittent catheterization Bladder compression and intermittent self-

catheterization Drug therapy Behavioral interventions

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15

Community-Based Care

Home care management Health teaching Health care resources

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17

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.

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18

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

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19

Surgical Management

Preoperative care Operative procedures Postoperative care includes:

Collaboration with enterostomal therapist Kock’s pouch Neobladder

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20

Community-Based Care

Health teaching Health care resources

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21

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.