Transcript Chapter 45
Chapter 45 Management of Patients With Urinary Disorders Copyright © 2008 Lippincott Williams & Wilkins. Urinary Tract Infections (UTIs) • The second most common reason for seeking health care • A common site of nosocomial infection • Lower UTIs – Cystitis – Prostatitis – Urethritis • Upper UTIs – Pyelonephritis: acute and chronic – Interstitial nephritis – Renal abscess and perirenal abscess Copyright © 2008 Lippincott Williams & Wilkins. Factors Contributing to UTI • Function of glycosaminoglycan (GAG) • Urethrovesical reflux • Ureterovesical reflux • Uropathogenic bacteria • Shorter urethra in women • Risk factors: see Charts 45-2 and 45-3 Copyright © 2008 Lippincott Williams & Wilkins. Urethrovesical Reflux and Ureterovesical Reflux Copyright © 2008 Lippincott Williams & Wilkins. Bladder Infection With Long-Term Catherization Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Assessment of the Patient With a UTI • Symptoms include pain and burning upon urination; frequency; nocturia; incontinence; suprapubic, pelvic, or back pain; hematuria; or change in urine or urinary pattern • About half of patients are asymptomatic • Assess voiding patterns, association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene • Gerontologic considerations • Assess urine, urinalysis, and urine cultures • Other diagnostic tests Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Diagnosis of the Patient With a UTI • Acute pain • Deficient knowledge Copyright © 2008 Lippincott Williams & Wilkins. Collaborative Problems/Potential Complications • Sepsis • Renal failure Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Planning the Care of the Patient With a UTI • Major goals include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications Copyright © 2008 Lippincott Williams & Wilkins. Interventions • Prevention: avoid indwelling catheters; exercise proper care of catheters • Exercise correct personal hygiene • Take medications as prescribed: antibiotics, analgesics, and antispasmodics • Apply heat to the perineum to relieve pan and spasm • Increase fluid intake • Avoid urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol • Frequent voiding • Patient education: see Chart 45-4 Copyright © 2008 Lippincott Williams & Wilkins. Urinary Incontinence • An underdiagnosed and underreported problem that can significantly impact the quality of life and decrease independence and may lead to compromise of the upper urinary system • Urinary incontinence is not a normal consequence of aging • Risk factors: see Chart 45-5 Copyright © 2008 Lippincott Williams & Wilkins. Types of Urinary Incontinence • Stress • Urge • Reflex • Overflow • Functional • Iatrogenic • Mixed incontinence Copyright © 2008 Lippincott Williams & Wilkins. Patient Teaching • Urinary incontinence is not inevitable and is treatable • Management takes time (provide encouragement and support) • Develop and use a voiding log or diary • Behavioral interventions: see Chart 45-7 • Medication teaching related to pharmacologic therapy • Strategies for promoting continence: see Chart 45-8 Copyright © 2008 Lippincott Williams & Wilkins. Urinary Retention • Inability of the bladder to empty completely • Residual urine: amount of urine left in the bladder after voiding • Causes include age (50 to 100 mL in adults older than age 60 due to decreased detrusor muscle activity), diabetes, prostate enlargement, pregnancy, neurologic disorders, and medications • Assessment • Nursing measures to promote voiding Copyright © 2008 Lippincott Williams & Wilkins. Urolithiasis and Nephrolithiasis • Calculi (stones) in the urinary tract or kidney • Pathophysiology • Causes: may be unknown • Manifestations – Depend upon location and presence of obstruction or infection – Pain and hematuria • Diagnosis: x-ray, blood chemistries, and stone analysis; strain all urine and save stones Copyright © 2008 Lippincott Williams & Wilkins. Potential Sites of Urinary Calculi Copyright © 2008 Lippincott Williams & Wilkins. Methods of Treating Renal Stones Copyright © 2008 Lippincott Williams & Wilkins. Methods of Treating Renal Stones (cont.) Copyright © 2008 Lippincott Williams & Wilkins. Methods of Treating Renal Stones (cont.) Copyright © 2008 Lippincott Williams & Wilkins. Patient Teaching • Signs and symptoms to report • Follow-up care • Urine pH monitoring • Measures to prevent recurrent stones • Importance of fluid intake • Dietary teaching • Medication teaching as needed • See Chart 45-11 Copyright © 2008 Lippincott Williams & Wilkins. Urinary Diversion • Reasons: bladder cancer or other pelvic malignancies, birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis; used as a last resort for incontinence • Types: – Cutaneous urinary diversion: ileal conduit, cutaneous ureterostomy, vesicostomy, and nephrostomy – Continent urinary diversion: Indiana pouch, Kock pouch, and ureterosigmoidostomy Copyright © 2008 Lippincott Williams & Wilkins. Cutaneous Urinary Diversions Copyright © 2008 Lippincott Williams & Wilkins. Continent Urinary Diversions Copyright © 2008 Lippincott Williams & Wilkins. Nursing Diagnoses—Preoperative • Anxiety • Imbalanced nutrition • Deficient knowledge Copyright © 2008 Lippincott Williams & Wilkins. Nursing Diagnoses—Postoperative • Risk for impaired skin integrity • Acute pain • Disturbed body image • Potential for sexual dysfunction • Deficient knowledge Copyright © 2008 Lippincott Williams & Wilkins.