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LSC Ch 69 Urinary

LSC Nursing

Cystitis/UTI Most common cause-bacteria others virus, fungi and parasites, non infectious-chemicals/radiation, interstitial- unknown cause
Factors Contributing to UTI Obstruction, Stones, DM, Alkalotic Urine, Female gender, Older, Sexual activity, Antibiotic use
Cause of UTI/Cystitis E-Coli, candida, trichomonas, drug/chemical exposure, rad therapy, SLE, Interstitial cystitis- rare, non-infectious, & chronic
Complications of UTI/Cystitis Pyelonephritis, Urosepsis (spreads to bloodstream), Urinary cath- remove asap,
Older Adults and UTI's Increased rate of UTI in women >80, Lack of estrogen, skin & mucous membrane changes, prostate disease increases the risk for men
Assessment for UTI Physical: Frequency, Urgency, Dysuria, Hesitancy initiating urine stream, low back pain, nocturia, incont, hematuria, pyuria, bacturia, retention, suprapubic tenderness, feeling of incomplete emptying
Rare Symptoms for UTI Fever, Chills, N/V, Malaise, Flank Pain
Symptoms in Eldery for UTI Increased mental confusion, frequent unexplained falls, sudden onset of incontinence, signs of urosepsis-fever, tachycardia, tachypnea, hypotension
Labs U/A & U/C look for esterase & nitrate for positive result, clean catch midstream/straight cath, 10mls, UC done only w/complicated UTI, occasional elevated WBC's (increased # of bands)
Cystoscopy for recurrent/chronic uti'sID's abnormalities bladder calculi, diverticuli, urethral strictures & foreign bodies, & trabeculation-abnormal thickening of the bladder walls due to retention & obstruction
Nursing Diagnosis for Cystitis Acute Pain r/t bladder spasms, Deficient Knowledge, Urge urinary incontinence, Risk or impaired Skin integrity. Collaborative: Risk for Sepsis
Antimicrobials Drug Therapy for UTI Sulfonamides: Septra, Bactrim *3 days-21 days, LT for Chronic UTI, TMP:older pt recurrent UTI's after intercourse, Nitrofurantoin (Macrodantin) urinary antiseptic, Estrogen: intravaginal/urethral horm. post menopausal
Antimicrobials Drug Therapy for UTI QUINOLONES Ciprofloxacin (Cipro)& Levofloxacin (Levaquin) "acins"
Antimicrobials Drug Therapy for UTI: Penicillans Amoxicillin (Amoxil)
Cephalosporins Cefadroxil (Duricef), Cefiximine (Suprax), Foxfomycin (Monurol)
Other Urinary Drugs Antiseptics: Nitrourantoin Macrodantin, Analgesics: Phenazophyridine (Pyridium), Antifungals: Amphotercin B- bladder irrigation, Ketoconazole (Nizoral), Antispasmotic Hyoscyamine (Anaspaz)
Interventions Nutrition Therapy: Drink 2-3L/day, Cranberry products, Avoid caffeine (bladder irritant), Pain Relief: Sitz Bath, Pyridium - changes urine to bright red orange
Teaching UTI's often related to Sexual Intercourse: Urinate before/after intercourse, cotton underwear, no douching
Urethritis symptoms similar to UTI, Male: STD's, Women: Post menopausal-tissue change w/low estrogen, Interventions : Antibiotic Therapy, Estrogen (topical)
Urethral Strictures Causes: Obstruction*, STD's, Childbirth, Catheterization, Recurrent UTI's, Incontinence & Retention, Overflow incontinence: overdistended bladder
Management Urethral Strictures Dilation of urethra stricture: temporary, Urethroplasty: remove affected area w/ or w/o grafting, Larger opening, may need to repeat procedures
Urinary Incontinence INVOLUNTARY loss of urine, Normal bladder needs to contract & Urethra need to relax, Stress incontinene most common
Stress Incontinence Small amounts- unable to tighten urethra enough, common after childbith, Kegel's: vaginal pelvic floor muscles thin and weakened
Urge Incontinence bladder contractions, continence override signal
Drugs that irritate bladder (Urge Incontinence) Caffeine, Artificial Sweetners, ETOH, Citric INtake (juices, fruits), Diuretics, Nicotine
Mixed Incontinence Stress & Urge, Mostly found in older women
Overflow (Reflex) Incontinence Overdistended bladder, Leaking, Underactive bladder, obstructions, neurological impairment
Functional Incontinence Cognitive impairment, Dementia
Nursing Dx Stress Incontinence r/t weak pelvic muscles & structural support
Nursing Dx: Urge Incontinence r/t decreased bladder capacity, bladder spasms, diet, & neuro impairment,
Nursing Dx: Overflow (Reflex) Incontinence r/t Neuro Impairment
Nursing Dx: Functional Incontinence r/t impaired cognition or neuro limitations
Nursing Dx: Mixed/Total Incontinence r/t MANY CAUSES
Additional Nursing Dx for Incontinence Social Isolation, Risk For Impaired Skin Integrity, Disturbed Body Image, Risk For Infection
Interventions: Stress Incontinence Diary, Exercise, Kegels, Nutrition: wt. loss, avoid bladder irritating liquids, fruits, Drug Therapy: Estrogen
Interventions Stress Incontinence continued Cone Therapy: Hold weights in place & walk around, 15 min intervals 2x/day with heaviest wt & progress, Behavior Modification, Psychotherapy, Electrical Stim.
Surgical Interventions Reposition bladder & urethra, often have a suprapubic cath in place until can urinate w/o residual volume >50ml
Bladder Training vs Habit Training Improve bladder function for those w/URGE incontinence vs Establishing a predictable pattern for those w/FUNCTIONAL incontinence
Interventions for Urge Incontinence To Prevent/manage Urge, Drug Therapy: Anticholinergis- Propantheline (Pro-banthine), oxybutynin (Ditropan), Tolterodine (Detrol), SE Block Stim of bladder contraction, Tricyclic Antidepressants w/ACh Activity Imipramine (Tofranil) Nortriptyline
Interventions for URGE incontinence Cont Avoid foods w/bladder stimulating or diuretic effects, space fluids (q2hrs), Limit 2hrs before bed, Behavioral: Bladder Training- short intervals, gradually increase, Habit Training: scheduled toileting, Exercise- Kegels, Elec. Stim: vag or rec
Interventions for REFLEX (Overflow) Incontinence Expected Outcome: Achieve Continence, Surgery: prostate removal or genital prolapse repair,
Drug Therapy for REFLEX Incontinence Cholinergic (short-term), Bethenechol Chloride: Urecholine, impacts on bladder tone Increases bladder pressure
Behavioral Interventions for Reflex Incontinence Bladder Compression: Crede Method, Valsala, Double Voiding, Splinting, & Intermittent Self Catheterization
Crede Method Tugging pubic hair, Massage
Valsalva Deeper breathes, exhale (pressure toward bladder)
Double-Voiding Void, repeat in 3-5 minutes
Splinting Pushes cycstocele back into vagina
Interventions for Functional Incontinence Remain Dry- Expected Outcome, Treat reversible causes, Applied devieces: Intravaginalpessaries: Support pelvic floor prolapse, Condom Cath, Penile Clamp Dangers: can cause tissue damage or infection
Catheterization Containment of incontinence: Absorbent pads, briefs, Danger: Skin B/D. Intermittent Cath, Indwelling: Skin B/D, Terminal Illness or critically Ill
Interventions for Mixed (Total) Incontinence A combo of 2 or more types of incontinence, ie: Post Menopausal Women have stress & urge. Dementias: Reflex (overflow) & Functional.
Hypercalcemia Primary Absorptive: Increased intestinal Calcium Absorption, Renal: Decreased renal tubular excretion of calcium
Hypercalcemia Secondary Resorptive: hyperparathyroidism, Vit. D Intox, Renal Tubular Acidosis, prolonged immobilization
Hyperoxaluria Primary: Genetic Secondary: diet-excess oxalate foods ie spinach, rhubarb, swiss chard, beets, cocoa, wheat germs pecans, peanuts, okra, chocolate
Hyperuricemia Primary: Gout Secondary: increased production or decreased clearance of purine from myeloproliferative disorders, thiazide diuretics, carcinoma
Struvite Made of magnesium ammonium phosphate and carbonate apatite; formed by urea splitting by bacteria most commonly proteus mirabilis; needs an alkaline urine to form
Cystinuria Autosomal recessive defect of amino acid metabolism that precipitates insoluble cystine crystals in the urine
Assessment of Stones in Urinary Tract History of having stones, SEVERE PAIN, occurs when moving through tracts, sudden, worse than childbirth, N/V, Diaphoresis, pallor, VS Elevated, BP may be low, pain causes shock
What to Avoid for Calcium Oxalate Spinach, Black Tea, & Rhubarb, Decrease Sodium intake
What to Avoid for Calcium Phosphate Limit animal protein to 5-7 servings/wk, never more than 2/day, may benefit from reduced calcium intake, decrease sodium intake
What to Avoid for Struvite (magnesium ammonium phosphate) Limit high phosphate foods ie: dairy products, organ meats, whole grains.
What to avoid for uric acid Decrease intake of purine sources ie: organ meats, poultry, fish, gravies, red wines, and sardines
What to avoid for Cystine Limit animal protein intake, encourage oral fluid intake (500ml q4hrs during the day 750ml at night)
Prevention of stones Drink 3L H20/day, Exercise/walk, nutrition
Bladder CA (Urothelial Cancer) Hx of smoking, exposure to toxic chemicals, parasite infection, LT use of cytoxan, *BLOODY URINE, Painless, Cystoscopy, Chemotherapy, Immunotherapy of BCG
Surgical Procedures Type of surgery dependent on stage of cancer, CYSTECTOMY is the best chance of cure for larger cancers
Ureterostomies divert directly through the skin surface thru a ureteral skin opening (stoma). After ureterostomy, the pt must wear a pouch
Conduits collect urine in a portion of the intestine, which is then opened onto the skin surface as a stoma. Must wear a pouch.
Sigmoidostomies Divert urine to the large intestine, so NO STOMA is required. The pt excretes urine w/bm's, bowel incontinence may occur.
Ileal resevoirs Divert urine into a surgically created pouch or pocket that functions as a bladder. The stoma is continent and the pt removes urine by regular catheterization.
Post Op Care After Ostomy assess condition of stoma, Kock's pouch, penrose drain removes lymphatic fluid or other secretions, may eed to irrigate to ensure patency, No sensation of bladder fullness, need to learn new cues for voiding, prescibed times or neobladder pressure
Teaching Care of Ostomy Drugs, Nutrition, Stoma, Collection Device, Cath, Observe return demo from pt/caregiver, Men:need to sit to urinate (sigmoid) and impotence after surgery, Empty, b4 going out to any function
Bladder Trauma Most common cause: pelvic fx, stabilize b4 surgical repair, Sexual Assault, Penetrating or blunt injury (gunshot or stabbing), Seat belt (if bladder is full), Interventions, Surgical repair, Cystecotomy
Created by: ginabeana