BN Ch.89 Urinary Disorders

Question 1

__________ refers to the procedure of
crushing the kidney stones.

Answer 1

Lithotripsy

Question 2

__________ are epithelial, fatty, or waxy
tissue abnormally forced out of the renal
tubules.

Answer 2

Casts

Question 3

A __________is performed to measure
bladder pressure during filling.

Answer 3

Cystometrogram

Question 4

A primary cancer of the kidney is referred to as a/an __________.

Answer 4

Hypernephroma

Question 5

A __________ pouch is a type of continent diversion in which the middle portion of the ileum is folded and opened onto itself to create a pouch.

Answer 5

Kock

Question 6

Almost continuous; commonly caused by prostatectomy

Answer 6

True incontinence

Question 7

A sudden increase in intra-abdominal pressure.

Answer 7

Stress Incontinence

Question 8

Irritation of the bladder wall by urine components.

Answer 8

Urge Incontinence

Question 9

Bladder instability as a result of upper motor lesions

Answer 9

Reflex Incontinence

Question 10

Write the correct sequence of the steps performed during a cystoscopy.

1. Instill Xylocaine jelly into the urethra.
2. Encourage the client to drink fluids.
3. Obtain a urinalysis and a urine culture.
4. Pass the cystoscope into the client’s bladder.

Answer 10

3. Obtain a urinalysis and a urine culture.
4. Instill Xylocaine jelly into the urethra.
5. Pass the cystoscope into the client’s bladder.
6. Encourage the client to drink fluids.

Question 11

What are the specialized imaging studies used to study the urinary tract?

Answer 11

• The specialized imaging studies used to study the urinary tract include the following:
  
  • Intravenous pyelogram
  • Radioactive renogram
  • Bone scan
  • Nephrotomogram
  • Renal Arteriogram
  • Cystogram
  • Voiding cystourethrogram
  • Retrograde pyelogram

Question 12

What are urodynamic tests?

Answer 12

• Urodynamic testing is a series of tests that determine the actual function of the detrusor muscle of the bladder, which pushes the urine out; the external sphincter muscle
• The pelvic (pubococcygeal) muscles.

Question 13

What are the factors that cause transient incontinence?

Answer 13

• Factors that cause transient incontinence include reversible contributing factors such as changes in mental status, infections, medications, fluid intake, mobility problems, and stool impaction.

Question 14

Which factors make a person more susceptible to urinary tract infection (UTI)?

Answer 14

• Factors that may make a person more susceptible to UTI include catheterization, which can advance bacteria into the bladder; systemic diseases, such as diabetes
• Changes in the vaginal pH in women.

Question 15

What is glomerulonephritis?

Answer 15

• Glomerulonephritis is a group of diseases in which the kidneys are damaged and partly destroyed by inflammation of the glomeruli.
• It may be a result of an acute infection, as with poststreptococcal glomerulonephritis.
• This type of inflammation may result in an antigen and antibody reaction.

Question 16

Who is considered a good candidate for kidney donation?

Answer 16

• The client’s living relatives who have compatible tissue matches are considered good candidates as kidney donors.
• The donor must have two well- functioning kidneys and no underlying disease.

Question 17

Nursing care for urinary disorders focuses on maintaining and preserving renal function, decreasing discomfort, preventing infection promoting skin integrity, maintaining fluid balance, restoring and maintaining the client’s self- esteem, and client and family teaching.

1. A client comes to the healthcare facility with complaints of increased urinary frequency, especially during the night, for about the past week. The client also reports a painful, burning sensation felt when passing urine.
   a. Which nursing diagnoses may be established for a client with a urinary disorder?

Answer 17

The following nursing diagnoses may be established for a client with a urinary disorder:

• Risk for infection related to
  
  • Dehydration,
  • Excess wastes in the body tissue breakdown
  • Damage
• Risk for deficient or excess fluid volume related to the kidney’s inability to effectively concentrate urine, fluid restrictions, or electrolyte imbalance.
• Stress urinary incontinence, reflex urinary incontinence, functional urinary incontinence related to sphincter incompetence, neurologic disorders, impaired mental status, medications, fistula, cancer, surgery, trauma, or obstruction.
• Urinary retention related to obstruction, sphincter incompetence, cancer, or trauma.
• Impaired tissue integrity related to dehydration, mucous membrane friability and break- down, or general malaise.
• Social isolation related to incontinence, presence of ureterostomy, or presence of a urinary diversion appliance.
• Ineffective sexuality patterns related to indwelling catheter, dialysis, or urinary diversion.
• Pain related to surgery, invasive diagnostic tests, urinary tract infections, pyelonephritis, or calculi

Question 18

What are the general nursing considerations undertaken when caring for clients with urinary disorders?

Answer 18

The following general nursing considerations are undertaken when caring for clients with urinary disorders:

• Obtaining frequent vital signs, especially blood pressure.
• Managing related symptoms such as
  
  • Diarrhea,
  • Nausea,
  • Vomiting,
  • Headache,
  • Anemia, and
  • Pain.
• Administering prescribed
  
  • Diuretics
  • Mineral supplements
  • Antibiotics
• Providing skin and mouth care.
• Observing and documenting skin:
  
  • Condition
  • Tissue turgor
  • Presence of edema
  • Dehydration.
• Measuring and recording fluid intake and output (I&O), color and clarity of urine, and urine specific gravity.
• Taking daily weights and encouraging fluid intake.
• Assisting with voiding and continence training.
• Providing medications and emotional support for dysuria and painful intercourse.
• Managing and caring for an indwelling catheter or suprapubic Cystocath.
• Giving sitz baths and warm moist packs to offset pain.
• Assisting with movement and activity to prevent disorders of immobility, such as;
  
  • Deep-vein thrombosis
  • Pneumonia
  • Urinary tract infections

Question 19

A client complains of urinary leakage when coughing or sneezing. The client has been experiencing these incidences since childbirth 6 months ago. The client is diagnosed with stress incontinence.

a. Which tips should the nurse provide the client to help empty the bladder completely?

Answer 19

The nurse should provide the following tips to help the client empty the bladder completely:

• Teach the client to take ample time in the bathroom.
• Encourage the client with “shy bladder syndrome” to find a private, quiet bathroom.
• Encourage the client to listen to the sound of running water, which helps the bladder that has difficulty starting to urinate.
• Encourage the client to start a bladder training program.
• Tap above the pubic bone, tap the clitoris, or tickle the base of the bladder to initiate a stream.
• Push on the belly above the pubic bone during the stream to empty the bladder completely.
• Use the double-void technique to empty the bladder completely.

Question 20

Which client education is provided for the management of stress incontinence?

Answer 20

The nurse should provide the following client education for management of stress incontinence:

• Use an incontinent pad on the bed and wheelchair to prevent soiling.
• Teach principles of bladder retraining, including the Credé maneuver, if necessary.
• Self-catheterization may be required for long-term management.
• Wear an appliance, condom catheter, or incontinent briefs or pads.
• Wash appliances regularly.
  Ensure regular skin care to maintain good skin integrity.
  • Wash hands after using the bathroom.