Care of Patients with urinary problems ch 69 Flashcards
reason UTI risk increases with age
pg 1492
Skin and mucous membrane changes from a lack of estrogen for women
prostate disease increases risk for UTIs in men
major preventative strategy used in health care to reduce cystitis
reducing use of indwelling urinary catheters
use strict sterile technique during insertion
discontinue as soon as possible
minimum fluid intake to prevent cystitis, if there are no other health concerns
1.5 to 2.5 Liters
common clinical manifestations of UTI
pg 1493
frequency urgency dysuria hesitancy or difficult in initiating urine low back pain nocturia incontinence hematuria pyuria bacteriuria retention suprapubic tenderness or fullness feeling of incomplete bladder emptying
rare clinical manifestations of UTI
pg 1493
fever chills n/v malaise flank pain
clinical manifestations that may occur in older adult with UTI
increasing mental confusion or frequent unexplained falls
sudden onset of incontinence or a worsening of incontinence
fever
increased HR
increased RR
hypotension
loss of appetite, nocturia, dysuria
“kind of know” drugs for UTIs
pg 1495
Bactrim (trimethoprim/sulfamethoxazole) ciprofloxacin (Cipro) levofloxacin (Levaquin) amoxicillin (Amoxil) Augmentin (amoxicillin/clavulante) cefadroxil (Duricef)
nursing interventions for sulfonamides
Bactrim (trimethoprim/sulfamethoxazole)
ask about drug allergies, especially sulfa drugs (allergies to sulfa drugs are common and may require chaining drug therapy)
drink full glass of water with each dose and drink at lease 3L daily (sulfamethoxazole can form crystals in kidney tubules)
keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)
nursing interventions for fluroquinolones
ex: cipro, levaquin
do not take within 2 hrs of antacid (can interfere with drug absorption)
teach pt how to take pulse, monitor it twice daily (drug can induce cardiac dysrhythmias)
keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)
nursing interventions for penicillins
ask about drug allergies
take with food (can cause GI upset)
call provider if watery diarrhea develops (can cause colitis)
use additional birth control (reduces effectiveness)
nursing interventions for cephalosporins
ask about drug allergies to penicillin (structurally similar to penicillin)
call provider if watery diarrhea develops
fosftomycin (Monurol)
nursing interventions
mix contents of package with 1/2 cup cold water (granules must be dissolved)
avoid taking with metoclopramide or other drugs that increase GI motility (reduce absorption)
nitrofurantoin (Furadantin, Macrobid)
nursing interventions
type of urinary antiseptic
shake bottle well (drug is in suspension)
drink with full glass of water and drink 3L daily (drug precipitates in the kidney tubules and damage the kidneys)
bladder analgesic examples
phenazopyridine (Pyridium, Prodium, Pyridiate)
bladder analgesic nursing interventions
drug will not treat infection, just symptoms
take with food or following meal to reduce GI disturbances
urine will turn red or orange
antispasmodics used with UTIs
examples
hyoscyamine (Anaspaz, Cystospaz)
antispasmodics used with UTIs
nursing interventions
notify PCP if blurred vision or other eye problems, confusion, dizziness, fainting, fast HR, fever, difficulty passing urine occurs (these are manifestations of drug toxicity)
wear dark glasses in sunlight (drug dilates the pupil and increases sensitivity)
stress incontinence
most common type
loss of small amounts of urine during coughing, sneezing, jogging, lifting
its can’t tighten the urethra enough to overcome the increased bladder pressure caused by contraction of detrusor muscle
common after childbirth
low estrogen levels after menopause also contributes
urge incontinence
perception of an urgent need to urinate as a result of bladder contractions regardless of volume of urine in bladder
can’t suppress signal to urinate and have sudden strong urge to void and often leak large amounts of urine at this time
aka overactive bladder
can be related to stroke, neurologic problems, other urinary tract problems, irritation from concentrated urine or artificial sweeteners, caffeine, alcohol, citric intake
diuretics and nicotine can also irritate the bladder
mixed incontinence
presence of more than one type
urine loss related to both stress and urge incontinence
more common in older women
overflow incontinence
occurs when detrusor muscle fails to contract and bladder becomes distended
aka reflex incontinence
occurs when bladder has reached max capacity and some urine must leak out to prevent bladder rupture
urethra may be obstructed and fail to relax enough to urinate
incomplete bladder emptying or urinary retention from urethral obstruction results in overflow incontinence
functional incontinence
occurs as a result of factors other than abnormal function of bladder and urethra
common factor is loss of cognitive function in patients with dementia
definition/description of stress incontinence
pg 1498
involuntary loss of urine during activities that increase abd and detrusor pressure
patients can’t tighten the urethra sufficiently to overcome the increased detrusor pressure
leakage of urine results
cause of stress incontinence
pg 1498
weakening of bladder neck supports; associated with childbirth.
intrinsic sphincter deficiency caused by such congenital condition like epispadias and myelomeningocele
acquired anatomic damage to the urethral sphincter (from repeated incontinence surgeries, prostectomy, radiation therapy, trauma)
clinical manifestations of stress incontinence
pg 1498
urine loss with physical exertion, cough, sneeze exercise
usually only small amounts of urine
post-void residual usually
definition/description of urge incontinence
pg 1498
involuntary loss of urine associated with a strong desire to urinate
patients can’t suppress signal from bladder muscle to brain that it s time to urinate
causes of overflow incontinence
pg 1498
diabetic neuropathy side effects of medications after radical pelvic surgery spinal cord damage enlarged prostate large genital prolapse multiple sclerosis
estrogen (Cenestin, Enjuvia)
purpose/action pg 1502
reduces incontinence, possibly by improving vaginal and urethral blood flow and tone
estrogen (Cenestin, Enjuva)
nursing interventions pg 1502
report unusual vaginal bleeding (estrogen increases risk for endometrial cancer)
avoid smoking and report calf pain or swelling (estrogen increase risk for thrombophlebitis, especially among women who smoke)
what is classification and purpose of following drugs
oxybutynin (Ditropan) tolterodine (Detrol) propantheline (Pro-Banthine) dicyclomine (Barmine, Bentyl) trospium (Sanctrual)
anticholinergics/antispasmodics
reduce incontinence by causing bladder muscle relaxation and surpassing urge to void
anticholinergics/antispasmodics - used to treat incontinence
nursing interventions
pg 1502
ask if pt has glaucoma (can increase intraocular pressure)
increase fluid intake and use hard candy (dry mouth common side effect)
increase fluid intake and dietary fiber (constipation is common side effect)
monitor urine output and report significantly lower than intake (can cause urinary retention)
tricyclic antidepressants - purpose/action
pg 1502
have some anticholinergic actions and also block acetylcholine receptors. both actions can relieve urinary incontinence
tricyclic antidepressants - nursing interventions
pg 1502
do not take with other tricyclic antidepressants or MAO inhibitors (drugs prolong effects of catecholamines and lead to hypertensive crisis)
change positions slowly, especially in the morning (cause dizziness and orthostatic hypotension)
use same interventions as anticholinergic drugs (these produce anticholinergic activities and side effects)
nutrition therapy to help avoid incontinence
pg 1504
avoid foods that like caffeine and alcohol
space fluids at regular intervals
limit fluids after dinner hour
behavioral interventions for incontinence (vague ones)
pg 1504
bladder training
habit training
exercise therapy
electrical stimulation
bladder training
patient learns to control bladder
start a voiding schedule
can start with 30 minute interval (then void every 30 minutes)
avoid urge to void between set times
increase intervals by 15-30 minutes
follow schedule till achieve success
as interval increases, bladder gradually tolerates more volume
habit training
scheduled toileting
helpful in cognitively impaired patients
caregivers assist at specific times (like q2hr)
urinary incontinence - self management education
pg 1507
maintain normal body weight to reduce pressure
do not limit fluid intake
maintain sterile drainage system with catheter
following surgery: do not put anything in your vagina
do not have sex for 6 weeks following surgery
do not lift or carry anything heavier than 5 lbs until clearance has been given (up to 3 months)
one major manifestations of renal stone
severe pain
flank pain suggest stone in kidney or upper ureter
pain that extends to abd or scrotum suggests stone in ureters or bladder
s/s of urolithiasis (stone)
pain n/v pallor diaphoresis frequency dysuria oliguria or anuria (suggest obstruction) bladder distention temp and pulse are elevated with infection BP may decrease if severe pain cause shock
diagnostic tests for kidney stones
easily seen on x-rays
IV urogram or CT
non contrast CT is most sensitive test
when would IV urography not be used for high risk patients
who are these high risk patients
risk for acute kidney injury induced by contrast dye
older adults, DM, multiple myeloma, elevated serum creatinine
what is lithotripsy
uses sound, laser, or dry shock waves to break up stones into small fragments
lithotripsy procedure
cardiac rhythm is monitored by ECG
shock waves delivered in sync with R wave
500-1500 shock waves applied for 30-45 minutes
continuous ECG monitoring for dysrhythmias and fluoroscopic observation for stone destruction are maintained
strain urine following procedure
minimal invasive surgical procedures to treat kidney stones
stenting
retrograde ureteroscopy
percutaneous ureterolithotomy
percutaneous nephrolithotomy
retrograde ureteroscopy
endoscopic procedure
ureteroscope passed through the urethra and bladder into ureter
once stone is seen, it is removed by basket, forceps, or loop
foley can be placed to facilitate passage
percutaneous ureterolithotomy or nephrolithotomy
removal of stone in kidney or ureter through the skin
patient lies prone or on side
under local or general anesthesia
needle passed into collecting system of kidney
endoscope can be attached to grasp stone
often a nephrostomy tube left in place to prevent stone fragments from passing through urinary tract
drug therapy to prevent kidney stone obstruction
depends on stone type
for hypercalciuria - thiazide diuretics, orthophosphate, sodium cellulose phosphate
for hyperoxaluria - allopurinol and vitamin b6
for cystinuria - AMPG, captopril
dietary interventions for calcium oxalate kidney stone
avoid spinach, black tea, rhubarb
decrease sodium intake
dietary interventions for calcium phosphate kidney stones
limit intake of foods high in animal protein to 5-7 servings per week and never more than 2 per day
can reduce calcium, milk, dairy products
decrease sodium intake
dietary interventions for struvite (magnesium ammonium phosphate)
limit daily products, organ meats, whole grains
dietary interventions for uric acid stones
reduce purine sources
organ means, poultry, fish, gravies, red wines, sardines
dietary interventions for cystine kidney stones
limit animal protein
fluid intake of 500 mL every 4 hrs while awake and 750 mL at night
post op following bladder surgery for bladder cancer
external pouch covers ostomy to collect urine
will have penrose drain an medena catheter
pt with neobladder usually requires 2-4 days in ICU
irrigation can be done to ensure patency
no sensation of bladder fullness with neobladder
when drainage collects on the outside, report any decrease in urine amount or leakage
To prevent and treat urolithiasis, patients are encouraged to
drink lots of fluids and eat lots of fruits and vegetables, a low amount of protein, and a balanced intake of calcium, fats, and carbohydrates.
thiazide diuretics for stones
chlorothiazide or hydrochlorothiazide
promote calcium resorption from the kidney tubules back into the body.
reduces urine calcium loads
orthophosphates for stones
alter calcium phosphorus metabolism
results in decreased urine saturation of calcium oxalate
