care of pt with urinary problems
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| Cystitis | inflammation of the bladder, caused by irritation or infection, Most common UTI. Noninfectious cys caused by chemicals or radiation. Bacteria most common.bacteriuria can occur. Colonization, asymptomatic bacteriuria is more common in older adults
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| At risk for UTI | women are at higher risk along with middle-aged men with diabetes. immunocompromised are more prone fungal infections. In men > 73 y/o. women increase from 20-50% >80 y/o. post-menopausal from skin & mucous membrane changes, lack of estrogen
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| Etiology and genetic risks of UTI | common organism from intestinal tract. 90% of UTIs caused by Escherichia coli. Fungal inf during long-term antibiotic use from change in flora. Immunosuppressive, diabetes, AIDS at high risk. CANNOT DIE FROM, die from complications
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| Health Promotion | minimum fluid intake by urinating 3L daily unless fluid restriction is needed. Less sugary drinks. Avoid urinary stasis by urinating every 3-4 hours rather than waiting until the bladder is greatly distended.
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| Physical assessment | frequency, urgency, & dysuria are the common manifestations of UTI. Urine may be cloudy, foul, smelling or blood tinged. Ask the pt about risk factors for UTI. Look for confusion, mood swings and unexplained falls in the elderly.
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| Women health considerations | Pregnant women with UTI require promt and aggressive treatment because simple cystitis can lead to acute pyelonephritis during pregnancy, can lead to preterm labor and adversely affect the fetus
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| incontinence. Stress and urge | involuntary loss of urine, NOT a normal sign. Stress: most common, loss of small amounts of urine; coughing, jogging...Urge “unstable”: perception of an urgent need to urinate as a result of bladder contraction regardless of volume of urine in bladder.
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| older adults consideration | decreased mobility from ; hospital or extended-care. Vision & hearing impairments prevent the pt from locating a call light to tell the need to void. Getting out of bed to urinate is common cause of falls. Check meds: diuretics, opioids, anticholinergic.
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| history assessment | ask- do you leak urine or water when coughing, laughing? Use pads in your underwear? Ask about stress/anxiety levels. Look for neurologic diseases, OTC drugs, childbirth, assess mobility, any environmental barriers to toileting,
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| Interventions | urinary bladder training for urge incontinence by inc the bladders ability to hold urine. Determine ability to recognize urge to void. make toileting schedule. Urinary habit train: making a pattern of bladder emptying of person limited cognitive ability
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| Family and pt teaching | maintain normal body weight. Do not limit fluid intake. Do not have sex until after 6-week postop checkup. Do not lift or carry anything over 5lbs post-op. avoid exercise (running, dancing). kegel exercises may be recommended,
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| Urolithiasis | presence of calculi (stones) in the urinary tract. Made by slow urine flow, damage to the lining of the urinary tract and decreased inhibitor substances in the urine that would prevent supersaturation and crystal aggregation
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| Etiology/genetic risks of urolithiasis | cause is unknown, 90% have metabolic risk factors. Hypercalcemia, Hyperoxaluria, Hyperuricemia, Struvite, Cystinuria. Always ask pt with renal stones whether other family members have also had this problem
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| Culture awareness for urolithiasis | the incident is most common is southeastern united states, japan and western Europe. Calcium stone: More common in men than in women & occurs in young adults & early middle adult. Kidney stone: often in younger, more common in white people
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| Dietary treatment for renal stones | Reduction of urinary oxalate content may help prevent calcium oxalate stones. Decrease sodium intake. Ca Phosphate: reduction of protein intake reduces acidic urine. Struvite: reduction of urinary phosphate content. Cystine: Reduce urinary uric acid
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| Psychosocial integrity | allow pt opportunity to express feelings or concerns. nonjudgemental approach in caring for pt with urinary incontinence. Recognize need for pt undergoing cystectomy and urinary diversion to grieve about the body image change. Assess pt level of comfort
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| Physiological integrity | id hospitalized pt at risk for bacteruria & urosepsis. Report any condition that obstructs urine flow. UTI: omplete all prescribed antibiotics even if symptoms are absent. Avoid maintaining indwelling catheters. Teach pt the side effects of medications.
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