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Chapter 69
Care of Patients with Urinary Problems
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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
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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
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Drug Therapy
Urinary antiseptics Antibiotics Analgesics Antispasmodics Antifungal agents Long-term antibiotic therapy for chronic,
recurring infections
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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
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Urethritis Inflammation of the urethra that causes
symptoms similar to urinary tract infection Patient-centered collaborative care
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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
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Urinary Incontinence
Five types of incontinence are: Stress incontinence Urge incontinence Mixed incontinence Overflow incontinence Functional incontinence
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Collaborative Management Patient history Physical assessment Laboratory assessment Imaging assessment Other diagnostic assessment
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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
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Surgical Management Preoperative care Operative procedure Postoperative care:
Assess for and intervene to prevent or detect complications.
Secure urethral catheter.
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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
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Reflux Urinary Incontinence
Interventions include: Surgery to relieve the obstruction Intermittent catheterization Bladder compression and intermittent self-
catheterization Drug therapy Behavioral interventions
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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
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Community-Based Care
Home care management Health teaching Health care resources
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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
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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.
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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
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Surgical Management
Preoperative care Operative procedures Postoperative care includes:
Collaboration with enterostomal therapist Kock’s pouch Neobladder
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Community-Based Care
Health teaching Health care resources
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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.