1. Interventions for Clients with Urinary Problems

2. 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

3. Incidence and Prevalence of Cystitis
Frequenct urge to urinate
Dysuria
Urgency
Urinalysis needed when testing for leukocyte esterase
Type of organism confirmed by urine culture
Other diagnostic assessments

4. Drug Therapy Urinary antiseptics Antibiotics Analgesics Antispasmodics
Antifungal agents
Long-term antibiotic therapy for chronic, recurring infections

5. 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

6. Catheter

7. 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

8. 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

9. Urinary Incontinence Five types of incontinence include: Stress Urge
Mixed
Overflow
Functional

10. 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

11. 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

12. Surgical Management Preoperative care Operative procedure
Postoperative care
Assess for and intervene to prevent or detect complications.
Secure urethral catheter.

13. 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

14. Reflux Urinary Incontinence
Interventions include:
Surgery to relieve the obstruction
Intermittent catheterization
Bladder compression and intermittent self-catheterization
Drug therapy
Behavioral interventions

15. 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

16. Urolithiasis Presence of calculi (stones) in the urinary tract
Collaborative management
History of urologic stones
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic tests

17. IVP (Intravenous Pyelography)

18. 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

19. 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

20. Surgical Management Minimally invasive surgical procedures Stenting
Retrograde ureteroscopy
Percutaneous ureterolithotomy and nephrolithotomy
Open surgical procedures
Preoperative care
Operative procedure

21. 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

22. Drug Therapy
Drug selection to prevent obstruction depends on what is forming the stone:
Calcium
Oxalate
Uric acid
Cystine

23. Urothelial Cancer Collaborative management Assessment
Diagnostic assessment
Nonsurgical management
Prophylactic immunotherapy
Chemotherapy
Radiation therapy

24. Urothelial Cancer

25. Surgical Management Preoperative care Operative procedures
Postoperative care includes:
Collaboration with enterostomal therapist
Kock’s pouch
Neobladder

26. 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.

27. Bladder Trauma

28. 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

29. 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

31. 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

32. 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

33. Peritoneal Dialysis

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