Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Risk factors for urinary problems Health promotion techniques Teaching plan

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Inflammation of bladder Most commonly caused by bacteria moving up urinary tract from external urethra to bladder Catheters: high risk factor in developing nosocomial cystitis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Frequent urge to urinate Dysuria Urgency Urinalysis needed when testing for leukocyte esterase Organism type confirmed by urine culture Other diagnostic assessments

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Inflammation of urethra causing symptoms similar to UTI Role of estrogen in treating estrogen-depletion urethritis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Narrowed areas of urethra Most common symptom—obstruction of urine flow Surgical treatment by urethroplasty—best chance of long-term cure Dilation of urethra (temporary measure) Urethroplasty

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Assessment questions Plans of care vary; based upon incontinence type

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Interventions: Journaling, behavioral interventions, diet modification, pelvic floor (Kegel) exercises Diet therapy Drug therapy—estrogen Surgery Vaginal cone therapy

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Interventions: Drugs—anticholinergics, antihistamines, others Diet therapy—avoid caffeine and alcohol Behavioral interventions—exercises, bladder training, habit training, electrical stimulation

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Also known as reflex incontinence Interventions: Surgery to relieve obstruction Intermittent catheterization Bladder compression, intermittent self-catheterization Drug therapy Behavioral interventions

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Interventions: Treatment of reversible causes Urinary habit training (if incontinence not reversible) Final strategy—containment of urine, protection of patient’s skin Applied devices Urinary catheterization

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Presence of calculi (stones) in urinary tract Assessment Pain-relief measures: Drug therapy CAM therapies Lithotripsy Surgical management Minimally invasive surgery Open surgical procedures

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Uses sound, laser, or dry shock wave energy to break stones into small fragments Patient undergoes conscious sedation Topical anesthetic cream applied to skin site Continuous monitoring by ECG

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Malignant tumors of urothelium, lining of transitional cells in kidney, renal pelvis, ureters, urinary bladder, and urethra Physical assessment Clinical manifestations Psychosocial assessment Diagnostic assessment Postsurgical nursing care interventions Teaching plan upon discharge

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Causes may be from injury to lower abdomen or stabbing/gunshot wounds Surgical intervention required Fractures should be stabilized before bladder repair Nursing interventions prior to surgical intervention

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 78-year-old woman is at her annual checkup with her health care provider. She seems very embarrassed about asking if it’s normal to “leak” urine when coughing or laughing, especially at her age. She has given birth to five children. What is the nurse’s best response to this question? A. “Involuntary loss of urine or incontinence is not a normal consequence of childbirth or aging.” B. “As we get older, our bodies do not function as well as when we were younger.” C. “The unintentional loss of urine can be temporary or permanent depending on the cause.” D. “The most likely cause of your urine leakage is obstruction of the urethra with a kidney stone.”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Later in the visit, the patient asks what could have caused her stress incontinence. What is the nurse’s most accurate reply? A. “It could be due to a loss of awareness that urination is about to occur.” B. “It most likely is related to drinking too many caffeinated beverages.” C. “Do you take any diuretics for your blood pressure?” D. “It may be due to weakening of the bladder neck support that is associated with childbirth.”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Before going home, the patient asks what can be done to fix her problem with urine leaking. Which teaching points should the nurse be sure to include? (Select all that apply.) A. First, keep a diary of episodes of incontinence. B. Collection devices can be used during treatment. C. Kegel exercises can help strengthen the muscles that prevent urine leakage. D. You may want to avoid caffeine and other bladder irritants. E. Be sure to drink less than 2 L of fluids every day, especially in the evening.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient says that she vaguely recalls advice from her OB/GYN about Kegel exercises, but does not recall how to perform them. 1. How should the nurse describe this procedure? 2. How many repetitions of this exercise should be recommended that she perform?

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient says that a friend mentioned taking antidepressant drugs when she had a similar problem, and asks if this could help herself. What is the nurse’s best response? A. “Estrogen may be helpful because it can improve vaginal and urethral blood flow.” B. “Tricyclic antidepressants such as imipramine have been helpful in relieving urinary incontinence.” C. “An antispasmodic drug such as oxybutynin would probably be better.” D. “Your problem may be different from your friend’s, requiring a different solution.”

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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 21-year-old male reports burning and difficulty with urination. What priority question would obtain information about the patient’s chief complaint? A. “How long have you had these symptoms?” B. “Do you have low back pain?” C. “Are you sexually active?” D. “Have you had a fever in the past 24 hours?”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Which patient is at greatest risk of developing a kidney stone? A. African-American female with family history of kidney stones B. Overweight Caucasian male C. Female with history of frequent urinary tract infections D. Hispanic/Latino female who eats animal protein at every meal

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Once an indwelling urinary catheter is placed, how long before bacterial colonization begins? A. 12 hours B. 24 hours C. 48 hours D. 72 hours