Interventions for Clients with Urinary Problems

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Interventions for Clients with Urinary Problems
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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

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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

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Drug Therapy

• Urinary antiseptics
• Antibiotics
• Analgesics
• Antispasmodics
• Antifungal agents
• Long-term antibiotic therapy for chronic,
  recurring infections

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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

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Catheter
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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

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Urethrala Strictures

• Narrowing of the urethra
• Most common symptomobstruction of urine flow
• Surgical treatment by urethroplastybest chance
  of long-term cure
• Dilation of the urethraa temporary measure
• Urethroplasty

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Urinary Incontinence

• Five types of incontinence include
• Stress
• Urge
• Mixed
• Overflow
• Functional

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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

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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

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Surgical Management

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

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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

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Reflux Urinary Incontinence

• Interventions include
• Surgery to relieve the obstruction
• Intermittent catheterization
• Bladder compression and intermittent
  self-catheterization
• Drug therapy
• Behavioral interventions

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Functional Urinary Incontinence

• Interventions include
• Treatment of reversible causes
• If incontinence is not reversible, urinary habit
  training
• Final strategycontainment of urine and
  protection of the clients skin
• Applied devices
• Urinary catheterization

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Urolithiasis

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

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IVP (Intravenous Pyelography)
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Interventions

• Drug therapy
• Opioid analgesicsoften used to control pain
• Nonsteroidal anti-inflammatory drugs
• Pain medications at regular intervals
• Constant delivery system
• Spasmolytic drugsimportant for relief of pain
• Complementary and alternative therapy

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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

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Surgical Management

• Minimally invasive surgical procedures
• Stenting
• Retrograde ureteroscopy
• Percutaneous ureterolithotomy and nephrolithotomy
• Open surgical procedures
• Preoperative care
• Operative procedure

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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

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Drug Therapy

• Drug selection to prevent obstruction depends on
  what is forming the stone
• Calcium
• Oxalate
• Uric acid
• Cystine

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Urothelial Cancer

• Collaborative management
• Assessment
• Diagnostic assessment
• Nonsurgical management
• Prophylactic immunotherapy
• Chemotherapy
• Radiation therapy

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Surgical Management

• Preoperative care
• Operative procedures
• Postoperative care includes
• Collaboration with enterostomal therapist
• Kocks pouch
• Neobladder

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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.

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Hemodialysis

• Hospital, dialysis center
• Pts blood moves from implanted shunt in arm
  artery ? tube ? machine ? exchange of wastes,
  fluids, electrolytes
• Semipermeable membrane separates pts blood from
  dialysis fluid

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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

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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

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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

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Peritoneal Dialysis
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ESWL.Extracorporeal shock-wave lithotripsy (ESWL)