Interventions for Interventions for Clients with Urinary Clients with Urinary ProblemsProblems

CystitisCystitis

Inflammation of the bladderInflammation of the bladder Most commonly caused by bacteria Most commonly caused by bacteria

that move up the urinary tract from the that move up the urinary tract from the external urethra to the bladder, external urethra to the bladder, viruses, fungi, or parasitesviruses, fungi, or parasites

Catheter-related infections common Catheter-related infections common during hospital stayduring hospital stay

Incidence and Prevalence of Incidence and Prevalence of CystitisCystitis Frequenct urge to urinateFrequenct urge to urinate Dysuria Dysuria Urgency Urgency Urinalysis needed when testing for Urinalysis needed when testing for

leukocyte esteraseleukocyte esterase Type of organism confirmed by urine Type of organism confirmed by urine

cultureculture Other diagnostic assessmentsOther diagnostic assessments

Drug TherapyDrug Therapy

Urinary antisepticsUrinary antiseptics AntibioticsAntibiotics AnalgesicsAnalgesics AntispasmodicsAntispasmodics Antifungal agentsAntifungal agents Long-term antibiotic therapy for Long-term antibiotic therapy for

chronic, recurring infectionschronic, recurring infections

Nonsurgical Nonsurgical ManagementManagement

Urinary eliminationUrinary elimination Diet therapy includes all food groups, Diet therapy includes all food groups,

calorie increase due to increase in calorie increase due to increase in metabolism caused by the infection, metabolism caused by the infection, fluids, possible intake of cranberry fluids, possible intake of cranberry juice preventivelyjuice preventively

Other pain relief measures, such as Other pain relief measures, such as warm sitz bathswarm sitz baths

CatheterCatheter

UrethritisUrethritis

Inflammation of the urethra that Inflammation of the urethra that causes symptoms similar to urinary causes symptoms similar to urinary tract infectiontract infection

Caused by sexually transmitted Caused by sexually transmitted infections; treat with antibiotic therapyinfections; treat with antibiotic therapy

Estrogen vaginal cream for Estrogen vaginal cream for postmenopausal womenpostmenopausal women

Urethrala StricturesUrethrala Strictures Narrowing of the urethraNarrowing of the urethra Most common symptom—obstruction Most common symptom—obstruction

of urine flowof urine flow Surgical treatment by urethroplasty—Surgical treatment by urethroplasty—

best chance of long-term curebest chance of long-term cure Dilation of the urethra—a temporary Dilation of the urethra—a temporary

measuremeasure UrethroplastyUrethroplasty

Urinary IncontinenceUrinary Incontinence

Five types of incontinence include:Five types of incontinence include: StressStress UrgeUrge Mixed Mixed Overflow Overflow FunctionalFunctional

Collaborative ManagementCollaborative Management

Assessment includes a thorough Assessment includes a thorough client history.client history.

Clinical manifestations for urethral or Clinical manifestations for urethral or uterine prolapseuterine prolapse

Laboratory assessment by urinalysisLaboratory assessment by urinalysis Radiographic assessment, especially Radiographic assessment, especially

before surgerybefore surgery Other diagnostic assessmentsOther diagnostic assessments

Stress Urinary IncontinenceStress Urinary Incontinence

Interventions include:Interventions include: Keeping a diary, behavioral interventions, Keeping a diary, behavioral interventions,

diet modification, and pelvic floor diet modification, and pelvic floor exercisesexercises

Drug therapy: estrogen Drug therapy: estrogen SurgerySurgery Collection devices and vaginal cone Collection devices and vaginal cone

weightsweights

Surgical ManagementSurgical Management

Preoperative carePreoperative care Operative procedureOperative procedure Postoperative carePostoperative care

Assess for and intervene to prevent or Assess for and intervene to prevent or detect complications.detect complications.

Secure urethral catheter.Secure urethral catheter.

Urge Urinary IncontinenceUrge Urinary Incontinence Interventions include:Interventions include:

Drugs: anticholinergics, possibly Drugs: anticholinergics, possibly antihistamines, othersantihistamines, others

Diet therapy: avoid caffeine and alcoholDiet therapy: avoid caffeine and alcohol Behavioral interventions: exercises, Behavioral interventions: exercises,

bladder training, habit training, electrical bladder training, habit training, electrical stimulationstimulation

Reflux Urinary IncontinenceReflux Urinary Incontinence

Interventions include:Interventions include: Surgery to relieve the obstructionSurgery to relieve the obstruction Intermittent catheterizationIntermittent catheterization Bladder compression and intermittent Bladder compression and intermittent

self-catheterizationself-catheterization Drug therapyDrug therapy Behavioral interventionsBehavioral interventions

Functional Urinary Functional Urinary IncontinenceIncontinence Interventions include:Interventions include:

Treatment of reversible causesTreatment of reversible causes If incontinence is not reversible, urinary If incontinence is not reversible, urinary

habit traininghabit training Final strategy—containment of urine and Final strategy—containment of urine and

protection of the client’s skinprotection of the client’s skin Applied devicesApplied devices Urinary catheterization Urinary catheterization

UrolithiasisUrolithiasis

Presence of calculi (stones) in the Presence of calculi (stones) in the urinary tracturinary tract

Collaborative managementCollaborative management History of urologic stonesHistory of urologic stones Clinical manifestationsClinical manifestations Laboratory assessmentLaboratory assessment Radiographic assessmentRadiographic assessment Other diagnostic testsOther diagnostic tests

IVP (Intravenous IVP (Intravenous Pyelography)Pyelography)

InterventionsInterventions Drug therapyDrug therapy Opioid analgesics—often used to control Opioid analgesics—often used to control

painpain Nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs Pain medications at regular intervalsPain medications at regular intervals Constant delivery systemConstant delivery system Spasmolytic drugs—important for relief of Spasmolytic drugs—important for relief of

painpain Complementary and alternative therapyComplementary and alternative therapy

LithotripsyLithotripsy

Extracorporeal shock wave lithotripsy uses Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to sound, laser, or dry shock wave energy to break the stone into small fragments.break the stone into small fragments.

Client undergoes conscious sedationClient undergoes conscious sedation Topical anesthetic cream is applied to skin Topical anesthetic cream is applied to skin

site of stone.site of stone. Continuous monitoring is by Continuous monitoring is by

electrocardiographyelectrocardiography

Surgical ManagementSurgical Management

Minimally invasive surgical proceduresMinimally invasive surgical procedures StentingStenting Retrograde ureteroscopyRetrograde ureteroscopy Percutaneous ureterolithotomy and Percutaneous ureterolithotomy and

nephrolithotomynephrolithotomy Open surgical proceduresOpen surgical procedures

Preoperative carePreoperative care Operative procedureOperative procedure

Postoperative CarePostoperative Care

Routine postoperative care procedures for Routine postoperative care procedures for assessment of bleeding, urine, and assessment of bleeding, urine, and adequate fluid intakeadequate fluid intake

Strained urineStrained urine Infection preventionInfection prevention Drug therapyDrug therapy Diet therapyDiet therapy Prevention of obstructionPrevention of obstruction

Drug TherapyDrug Therapy

Drug selection to prevent obstruction Drug selection to prevent obstruction depends on what is forming the stone:depends on what is forming the stone: CalciumCalcium OxalateOxalate Uric acidUric acid CystineCystine

Urothelial CancerUrothelial Cancer

Collaborative managementCollaborative management AssessmentAssessment Diagnostic assessmentDiagnostic assessment Nonsurgical managementNonsurgical management

Prophylactic immunotherapyProphylactic immunotherapy ChemotherapyChemotherapy Radiation therapyRadiation therapy

Urothelial CancerUrothelial Cancer

Surgical ManagementSurgical Management

Preoperative carePreoperative care Operative proceduresOperative procedures Postoperative care includes:Postoperative care includes:

Collaboration with enterostomal therapistCollaboration with enterostomal therapist Kock’s pouchKock’s pouch NeobladderNeobladder

Bladder TraumaBladder Trauma

Causes may be due to injury to the Causes may be due to injury to the lower abdomen or stabbing or lower abdomen or stabbing or gunshot wounds.gunshot wounds.

Surgical intervention is required.Surgical intervention is required. Fractures should be stabilized before Fractures should be stabilized before

bladder repair.bladder repair.

Bladder TraumaBladder Trauma

HemodialysisHemodialysis

Hospital, dialysis centerHospital, dialysis center Pt’s blood moves from implanted Pt’s blood moves from implanted

shunt in arm artery shunt in arm artery tube tube machine machine exchange of wastes, fluids, exchange of wastes, fluids, electrolyteselectrolytes Semipermeable membrane Semipermeable membrane

separates pts blood from dialysis separates pts blood from dialysis fluidfluid

HemodialysisHemodialysisConstituents move between the 2 Constituents move between the 2

compartmentscompartmentsEx: wastes in blood Ex: wastes in blood dialysate dialysatebicarbonate in dialysate bicarbonate in dialysate blood bloodBlood cells, proteins remain in Blood cells, proteins remain in

bloodbloodMovement by ultrafiltration, Movement by ultrafiltration,

diffusion, osmosisdiffusion, osmosis Blood to pt veinBlood to pt vein

Peritoneal DialysisPeritoneal Dialysis

Administered in unit or at homeAdministered in unit or at home At night or continuouslyAt night or continuously

CAPD (continuous ambulatory CAPD (continuous ambulatory peritoneal dialysis)peritoneal dialysis)

Peritoneal membrane serves as Peritoneal membrane serves as semipermeable membranesemipermeable membrane

Catheter w/ entry and exit points Catheter w/ entry and exit points implantedimplanted

Dialyzing fluid instilled in catheter into Dialyzing fluid instilled in catheter into cavitycavity

Peritoneal DialysisPeritoneal Dialysis Remains there Remains there Allows exchange of wastes and Allows exchange of wastes and

electrolytes to occurelectrolytes to occur Dialysate drained from by gravity Dialysate drained from by gravity

from cavity into containerfrom cavity into container Requires more time than hemoRequires more time than hemo ComplicationsComplications

Infection in peritoneal cavityInfection in peritoneal cavity

Peritoneal DialysisPeritoneal Dialysis

ESWLESWL..Extracorporeal shock-Extracorporeal shock-wave lithotripsy (ESWL)wave lithotripsy (ESWL)