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NU 340 > Ch. 58 > Flashcards

Ch. 58 Flashcards

1
Q

urinary incontinence affects

A

> 13 million people
- major health problem in the US

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2
Q

urinary incontinence is most common in

A

women and elderly
45% of women over the age of 65 report this condition

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3
Q

pathophysiology of urinary incontinence

A
  • involuntary loss of urine severe enough to cause social or hygienic problems
  • not a normal sign if aging
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4
Q

types of incontinence are

A
  • stress
  • urge
  • overflow
  • functional
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5
Q

stress incontinence

A

inability to retain when laughing, sneezing, jogging, or lifting

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6
Q

urge incontinence

A

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

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7
Q

overflow incontinence

A

Occurs when detrusor muscle fails to contract and bladder becomes overdistended and some urine leaks out

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8
Q

functional incontinence

A

Occurs as a result of loss of cognitive function in patients with dementia as they aren’t aware that they need to urinate

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9
Q

temporary or permanent causes of urinary incontinence

A
  • drugs
  • surgery
  • spinal cord injury: S2-S4
  • brain and nervous system disorders
  • factors associated with aging
  • disease treatment
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10
Q

urinary incontinence risk factors

A

Chronic conditions such as :
- Diabetes and Heart failure
- Vaginal deliveries
- Pelvic prolapse
- Prostate problems
- Obesity

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11
Q

collaborative management includes:

A

patient history
physical assessment
lab assessment/diagnostic tests

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12
Q

most common type of incontinence

A

stress

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13
Q

stress incontinence interventions

A
  • Keeping a diary
  • Nutrition therapy
  • Drug therapy—estrogen
  • Pelvic muscle (Kegel) exercises
  • Bladder training
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14
Q

surgical management of stress incontinence

A

Insertion of surgical sling or bladder suspension device
- Preoperative and Intra-Op care same as other surgeries

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15
Q

post-op care for post surgical sling or bladder suspension device (stress incont. surgery)

A

Assess for and intervene to prevent or detect complications
Secure urethral catheter

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16
Q

urge urinary incontinence interventions

A

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

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17
Q

overflow incontinence interventions

A
  • Bladder training
  • Drug therapy only if bladder training unsuccessful
  • Intermittent self catheterization
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18
Q

functional urinary incontinence interventions

A
  • If incontinence is not reversible, habit training
  • Applied devices
  • Urinary catheterization
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19
Q

cystitis

A

inflammation of the bladder from an infection of the bladder

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20
Q

cause of cystitis

A
  • bacteria that move up the urinary tract from the external urethra to the bladder
  • UTI- invasion of bacteria anywhere in the urinary tract
21
Q

risk factors of cystitis

A
  • 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
22
Q

cytitis symptoms

A
  • 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

23
Q

cystitis tests/diagnostics

A
  • 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

24
Q

cystitis interventions

A
  • 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
25
Q

health promotion and maintenance of cystitis

A
  • 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)
26
Q

drug therapy for cystitis

A

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

27
Q

cystitis: diet therapy

A

Diet includes ALL food groups
Increase calories because increase metabolism → infection
Fluids to maintain diluted urine
Cranberry juice preventively, cranberry pills OTC outpatient

28
Q

urolithiasis

A
  • 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
29
Q

urolithiasis is also called

A

kidney stones

30
Q

urolithiasis: stones are formed from 1 of 3 substances:

A
  1. Calcium (75% of kidney stones)
  2. Struvite
  3. Uric acid
31
Q

urolithiasis risk factors

A
  • 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)
32
Q

calcium stones

A
  • 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

33
Q

Examples of Food Sources of Oxalates (calcium) // foods to avoid

A
  • 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
34
Q

struvite stones

A
  • 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
35
Q

uric acid stone intervention

A

follow a low purine diet
- avoid seafood, red meats, red wine

36
Q

kidney stones sx

A

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

37
Q

kidney stones dx labs

A

UA
- hematuria
- WBC, RBC (should not have WBC in urine)
- bacteria

dx tests:
- CT scan- standard test to confirm stones, KUB- also shows stones

38
Q

kidney stones priority intervention

A

PAIN- relief

39
Q

kidney stones interventions

A

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

40
Q

nutrition therapy for calcium stones

A
  • 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
41
Q

nutrition therapy: uric acid stones

A

Low-purine diet

Avoid:
- organ meats (red meats)
- poultry
- fish
- gravies
- red wines
- sardines

42
Q

lithotripsy

A
  • Use of sound or laser waves to break stone into small fragments
  • Done outpatient for 30-45min under Conscious sedation
43
Q

lithotripsy monitoring

A
  • monitor VS, pulse ox, cardiac monitor
  • once VS are stable can be d/c home
44
Q

lithotripsy d/c teaching

A
  • 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)
45
Q

what age group of patients are hospitalized with positive UTI?

A
  • elderly due to confusion, altered level of consciousness
  • IVF, IV ABT
46
Q

1st line treatment of UTIs

A

bactrim
- sulfa-med
- ask about sulfur allergy
- take with full glass of water
- monitor for skin rash (steven-johnson syndrome)

47
Q

teaching to prevent UTIs

A
  • 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
48
Q

lithotripsy pre-op teaching (hint: r/t type of anesthesia)

A

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)

NU 340 (26 decks)

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