Ch. 58 Flashcards
urinary incontinence affects
> 13 million people
- major health problem in the US
urinary incontinence is most common in
women and elderly
45% of women over the age of 65 report this condition
pathophysiology of urinary incontinence
- involuntary loss of urine severe enough to cause social or hygienic problems
- not a normal sign if aging
types of incontinence are
- stress
- urge
- overflow
- functional
stress incontinence
inability to retain when laughing, sneezing, jogging, or lifting
urge incontinence
AKA “overactive bladder”
- loss of urine after feeling an urgent need to urinate as a result of bladder contractions regardless of how full the bladder is
overflow incontinence
Occurs when detrusor muscle fails to contract and bladder becomes overdistended and some urine leaks out
functional incontinence
Occurs as a result of loss of cognitive function in patients with dementia as they aren’t aware that they need to urinate
temporary or permanent causes of urinary incontinence
- drugs
- surgery
- spinal cord injury: S2-S4
- brain and nervous system disorders
- factors associated with aging
- disease treatment
urinary incontinence risk factors
Chronic conditions such as :
- Diabetes and Heart failure
- Vaginal deliveries
- Pelvic prolapse
- Prostate problems
- Obesity
collaborative management includes:
patient history
physical assessment
lab assessment/diagnostic tests
most common type of incontinence
stress
stress incontinence interventions
- Keeping a diary
- Nutrition therapy
- Drug therapy—estrogen
- Pelvic muscle (Kegel) exercises
- Bladder training
surgical management of stress incontinence
Insertion of surgical sling or bladder suspension device
- Preoperative and Intra-Op care same as other surgeries
post-op care for post surgical sling or bladder suspension device (stress incont. surgery)
Assess for and intervene to prevent or detect complications
Secure urethral catheter
urge urinary incontinence interventions
Drugs—anticholinergics
Diet therapy—avoid caffeine and alcohol and space fluids throughout the day
Behavioral interventions
- Exercises
- bladder training - patient must be oriented and able to follow directions
- habit training - good for patients with limited cognition
- electrical stimulation
overflow incontinence interventions
- Bladder training
- Drug therapy only if bladder training unsuccessful
- Intermittent self catheterization
functional urinary incontinence interventions
- If incontinence is not reversible, habit training
- Applied devices
- Urinary catheterization
cystitis
inflammation of the bladder from an infection of the bladder
cause of cystitis
- bacteria that move up the urinary tract from the external urethra to the bladder
- UTI- invasion of bacteria anywhere in the urinary tract
risk factors of cystitis
- Urinary Catheters ↑ risk for UTIs in the hospital setting
- More common in women (d/t shorter urethra length 2-3” v male: 7-9”)
- More common in diabetics
cytitis symptoms
- Frequent urge to urinate
- Dysuria: burning on urination
- Urgency: urge to go
- Pelvic pressure
- Urine may be cloudy, foul smell, or blood tinged
3 classic sx: frequency, urgency, burning
cystitis tests/diagnostics
- UA: WBC, bacteria, protein, ketones, bilirubin, RBCs (results quick)
- urine C&S confirms type of organism (24h)
- 80% of UTIs are caused by E. coli
- if organism has “r” = antibiotic resistant
- if organism has “s” = susceptible to antibiotic
dx is confirmed with urine C&S
cystitis interventions
- drug therapy (broad-spectrum ABT at first, then pick ABT that treats bacteria)
- fluid intake (2-3L of fluid)
- comfort measures: warm sitz bath
- diet therapy
- surgery to treat conditions that increase risk for recurrent UTIs: correct a structural abnormality
health promotion and maintenance of cystitis
- sterile technique when inserting catheters
- clean technique when using intermittent catheters at home
- single-use catheter recommended for home settings (use new one every time)
- National Patient Safety Goals – CAUTI prevention; best practice is to not use at all
- liberal intake of water (2-3L of fluid/day unless condition like heart failure with fluid restriction)
drug therapy for cystitis
Urinary antiseptics/Antibiotics (usually 7-10 days)
- sulfa-based med
- penicillin/amoxicillin
- cipro
Analgesics
- tylenol
Antispasmodics
- oxybutanin (urinary spasmodic)
Long-term antibiotic therapy for chronic, recurring infections (6-12 months)
*ask about allergies
cystitis: diet therapy
Diet includes ALL food groups
Increase calories because increase metabolism → infection
Fluids to maintain diluted urine
Cranberry juice preventively, cranberry pills OTC outpatient
urolithiasis
- Presence of calculi (stones) in urinary tract
- Most common associated condition is dehydration
- Factors relating to urine or urinary tract environment contribute to formation
- Present in 9% of U.S. women and 19% of U.S. men
urolithiasis is also called
kidney stones
urolithiasis: stones are formed from 1 of 3 substances:
- Calcium (75% of kidney stones)
- Struvite
- Uric acid
urolithiasis risk factors
- male 2.5x more likely than woman
- age: 30-50 years
- family hx (45% cases)
- diet: high animal protein and low in fiber and fluids or other dietary patterns causing -prolonged imbalances in acidity of urine
- weight: overweight or severely underweight
- lifestyle: high stress
- medical conditions: HTN, gout, DM, bedridden stratus
- meds: drugs for AIDS, thyroid hormones, chemotherapy, long-term antacid use (tums)
calcium stones
- 70% to 80% of kidney stones are composed of calcium oxalate
- Almost half result from genetic predisposition
Other causes
- Excess calcium in blood (hypercalcemia) or urine (hypercalciuria)
- Excess oxalate in urine (hyperoxaluria)
- Low levels of citrate in urine (hypocitraturia)
- Infection
Examples of Food Sources of Oxalates (calcium) // foods to avoid
- Fruits: Berries, Concord grapes, currants, figs, fruit cocktail, plums, rhubarb, tangerines
- Vegetables: Baked/green/wax beans, beet/collard greens, beets, celery, Swiss chard, chives, eggplant, endive, kale, okra, green peppers, spinach, sweet potatoes, tomatoes
- Nuts: Almonds, cashews, peanuts/peanut butter
- Beverages: Cocoa, draft beer, tea
- Other: Grits, tofu, wheat germ
struvite stones
- Composed of magnesium ammonium phosphate
- Mainly caused by urinary tract infections but can be specific nutrient (mg, al, ph)
- Diet- limit high phosphate foods
- Usually removed surgically bc bigger stones
uric acid stone intervention
follow a low purine diet
- avoid seafood, red meats, red wine
kidney stones sx
Clinical symptoms: Severe pain in flank and lower back, other urinary symptoms, general weakness,
N and V, fever
Pt may be pale and diaphoretic
Temperature and HR ↑ if infection present
if temperature and WBC in urine- think pyelonephritis
kidney stones dx labs
UA
- hematuria
- WBC, RBC (should not have WBC in urine)
- bacteria
dx tests:
- CT scan- standard test to confirm stones, KUB- also shows stones
kidney stones priority intervention
PAIN- relief
kidney stones interventions
Drug therapy: acute treatment for existing stone
1. Opioids
2. NSAIDS
3. Antispasmotics
4. Tamsulosin
- no meds once stone is gone bc pain should be done
get rid of stone with: do CT first
- Lithotripsy: breaks up stones so that it can be passed naturally
- natural passage in urine
- Minimally invasive surgery (smaller stone)
- Open surgical procedures (big stones)
- Preventing Infection
- Preventing obstruction
nutrition therapy for calcium stones
- Low-calcium diet (~400 mg/day) recommended for those with supersaturation of calcium in the urine and who are not at risk for bone loss
- If stone is calcium phosphate, sources of phosphorus (e.g., meats, legumes, nuts) are controlled
- Fluid intake increased
- Sodium intake decreased
nutrition therapy: uric acid stones
Low-purine diet
Avoid:
- organ meats (red meats)
- poultry
- fish
- gravies
- red wines
- sardines
lithotripsy
- Use of sound or laser waves to break stone into small fragments
- Done outpatient for 30-45min under Conscious sedation
lithotripsy monitoring
- monitor VS, pulse ox, cardiac monitor
- once VS are stable can be d/c home
lithotripsy d/c teaching
- ultrasound waves
- increase fluid intake (2-3L)
- filter to place over the toilet to determine if the stones are passed when they urinate (monitor for stones)
what age group of patients are hospitalized with positive UTI?
- elderly due to confusion, altered level of consciousness
- IVF, IV ABT
1st line treatment of UTIs
bactrim
- sulfa-med
- ask about sulfur allergy
- take with full glass of water
- monitor for skin rash (steven-johnson syndrome)
teaching to prevent UTIs
- wipe front to back
- cotton underwear, no thongs
- no bubble baths
- wash hands
- urinate in regular basis- longer urine sits in bladder, more time organisms have to grow
- go to bathroom after sexual activity
lithotripsy pre-op teaching (hint: r/t type of anesthesia)
conscious sedation
- arrange for someone to drive them home
- sleepy, kind of awake, but can’t really feel anything
- NPO 4-6h before surgery (vomit risk)
