Transcript 13. Interventions for clients with urinary problems

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
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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
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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:
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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
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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:
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Calcium
Oxalate
Uric acid
Cystine
Urothelial Cancer
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Collaborative management
Assessment
Diagnostic assessment
Nonsurgical management
 Prophylactic immunotherapy
 Chemotherapy
 Radiation therapy
Urothelial Cancer
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.
Bladder Trauma
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 shockwave lithotripsy (ESWL)