UNIT 9 Urinary Incontinence, Cystitis, Urethritis, Urolithiasis/ Kidney Stones CHAPTER 61

Question 1

What is urinary Incontiene?

Answer 1

Urinary incontinence (UI) is an involuntary loss of urine severe enough to cause social or hygienic problems. It is not a normal consequence of aging or childbirth and often is a stigmatizing and an underreported health problem. Many adults suffer in silence, are socially isolated, and may be unaware that treatment is available. In addition, the cost of incontinence can be enormous

Question 2

Name 3 of the different categories of Urinary Incontinence?

Answer 2

Stress, Mixed, Urge

Question 3

Urinary Issues

Answer 3

Polyuria-
* Oliguria- less than 30ml per hr or urine output
* Anuria- no urinataion
* Frequency-
* Nocturia- voiding more to 2-3 times at night
* Urgency
* Enuresis- bed wetting - common in children
* Incontinence- not being able to contain urine(involuntary)
* Retention- bladder cannot empty urine
* Urinary tract infection(most common in women)
* Dysuria(pINFUL URRINATION, BURING ETC)
* Neurogenic bladder

Question 4

Stress Incontinence

Answer 4

is loss of urine control during activities that increase intraabdominal pressure, such as coughing, sneezing, laughing, or exercise.

Question 5

Urge incontinence

Answer 5

involves a sudden strong urge to void, followed by rapid bladder contraction. The affected person does not have enough time for toileting between recognition of the urge to urinate and the onset of voiding.

Question 6

Mixed incontinence

Answer 6

is a combination of both stress and urge incontinence.

Question 7

What do elevated BUN and Creatine levels indicate?
A. Kidneys are functioning Properly
B. Dehydration, Kidney functional filters, reabsorbs and secretes urine.
C. Kidney damage, kidney does not functionally filter, reabsorb, and secrete Urine
D.Hydration

Answer 7

C. Kidney damage, kidney does not functionally filter, reabsorb, and secrete Urine

Extra Info- Elevated Bun may also indicate

Elevated levels may indicate kidney injury or disease as well as conditions such as diabetes, high blood pressure, blockage of the urinary tract, a high-protein diet, severe burns, gastrointestinal bleeding, or problems such as dehydration or heart failure, which affect blood flow.

Question 8

What is the normal range of Specific Gravity of the Urine?
A. 1050-1035
B. 1.005- 1.030
C. 25000-45000
D. 2.5-3.5

Answer 8

B. 1.005- 1.030

Question 9

What does an Elevated Specific Gravity Indicate? What number is associated with an Elevated Specific Gravity?
A. Dehydration, concentrated urine, Dark Amber in color. Specific Gravity Number- 2.000
B. Hydrated, Pale clear urine. Specific Gravity Number-1.003
C. Blue color of the urine, Specific Gravity Number- 1.005
D. Green color of the urine, Specific Gravity Number- 1.030

Answer 9

Answer Choice A is the correct answer.
A. Dehydration, concentrated urine, Dark Amber in color. Specific Gravity Number- 2.000

Question 10

What is Urinary Retention?

Answer 10

Urinary retention is the inability of the bladder to empty. It is caused by an obstruction in the urinary tract or by a neurologic disorder.

Question 11

Does a Urine Collection (Culture Sensitivity Urine test need the pt to perform Midstream and clean catch Method?
A. Yes
B.No

Answer 11

A. Yes

For culture and sensitivity testing, urine is collected by the clean-catch, or midstream, method, using a sterile specimen cup. It is crucially important for the pt to perform the clean catch method so the collection of the urine is free from any bacteria.

Question 12

Who is more at risk for Nocturia?
A. 77 year old male
B. 15 year old girl
C. 45 year old yoga instructor
D. 23 year old male

Answer 12

The correct answer is A. 77 year old male

Question 13

What are the benefits of Kegal Exercises for females?
A. Strengthen the quads muscles
B. Recommended helping keep the female pelvic floor toned, which reduces the risk for incontinence.
C. To decrease pelvic floor muscle to decrease the risk for incontinence.
D.Increases the risk for incontinence

Answer 13

The correct answer choice B. Recommended to help keep the female pelvic floor toned, which reduces the risk for incontinence.

Question 14

A nurse reviews the results of a client’s urinalysis. Which constituent found in urine indicates the presence of an abnormality that should be reported to the primary health-care provider?
1. Electrolytes
2. Protein
3. Water
4. Urea

Answer 14

2. Protein

Question 15

What is the normal range of Blood Urea Nitrogen and what does it indicate?

Answer 15

10-20
kidney function

Question 16

What are Culture and Sensitive Urine Specimens used to test?

Answer 16

Urine culture and sensitivity testing are performed for diagnosis of a UTI. Urine in the bladder normally is sterile; it does not contain bacteria or organisms. If organisms grow in the culture, sensitivity testing is performed to determine the appropriate antibiotic for treatment.

Question 17

What is the pH of urine

Answer 17

4.6-8

Question 18

What is the minimum urine output?

Answer 18

Normal urine output should equal fluid intake
Approximately 60mL/hr
Minimum 30mL/hr or 0.5mL/Kg per hour

Question 19

Overflow incontinence

Answer 19

As seen in patients who are unable to empty the bladder completely, resulting in a constant dribbling of urine or increased frequency of urination.

drug of choice bethanechol chloride

Question 20

Goals for pt’s with Urinary Incontinenece?

Answer 20

Maintain or restore a normal voiding pattern
* Regain normal urine output
* Prevent associated risks such as infection, skin breakdown,
fluid and electrolyte imbalance, and lowered self-esteem
* Perform toilet activities independently with or without
assistive devices
* Contain urine with the appropriate device, catheter, ostomy
appliance, or absorbent product

Question 21

Patient teaching for Anticholinergic -Fesoterodine

Answer 21

is used to suppress involuntary bladder contraction and increase bladder capacity for urge incontinence and overflow

PATIENT TEACHING
Ask whether the patient has glaucoma before starting any drugs from this class because anticholinergics can increase intraocular pressure and make glaucoma worse.

Suggest that patients increase fluid intake and use hard candy to moisten the mouth to reduce the dry mouth side effect.

Teach patients to increase fluid intake and the amount of dietary fiber to prevent constipation associated with this drug category.

Teach patients to monitor urine output and to report an output significantly lower than intake to the primary health care provider because all of these drugs can cause urinary retention, especially for men with an enlarged prostate.

Instruct patients taking the extended-release forms of these drugs not to chew or crush the tablet/capsule to avoid both ruining the time-release feature and increasing the risk for a bolus dose with more side effects.

Question 22

Nursing Interventions

Answer 22

Promoting fluid intake
* Maintaining normal voiding patterns
* Assisting with toileting
* Preventing urinary tract infections
* Continence (bladder) training
◦ Bladder training
◦ Habit training
◦ Prompted voiding
* Assessing medications
Pelvic muscle exercises
* Maintaining skin integrity
* Performing urinary catheterizations and external draining
devices
* Dietary Alterations for bladder issues
* Community Resources
* Infection control
* Tricks to help start the flow of urine
* Practice Guidelines

Question 23

What is Cystitis?

Answer 23

inflammation of the bladder

Cystitis is an inflammatory condition of the bladder. Commonly, it refers to inflammation from an infection of the bladder. However, cystitis can be caused by inflammation without infection.

Question 24

What can cause Cystitis

Answer 24

For example, drugs, chemicals, or local radiation therapy cause bladder inflammation without an infecting organism. Irritants, such as feminine hygiene spray, spermicidal jellies, or long-term use of a catheter can cause cystitis without infection. Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn’s disease, diverticulitis, lupus, or tuberculosis.

Irritants can cause cystitis without infection
– Can occur in any area of urinary tract and kidney – could
be Urinary Tract Infection
– Can occur due to indwelling catheter

Question 25

What is the drug class of choice to treat inflammatory disorders

Answer 25

glucocortorsteriods or steroid they reduce inflammation

Question 26

Which of the following diagnoses test would be elevated following the recent diagnosis of Cystitis

A. c- reactive protein
B. Urine analysis
C. PTT
D. platelet count

Answer 26

A. c- reactive protein
over 6mg sign of inflammation

Question 27

What are the signs and symptoms of Cystitis

Answer 27

frequency,
urgency
, dysuria
, foul urine,
fever, chills,
nausea and vomiting,
hematuria,
elevated WBC,
confusion- elderly

Question 28

Diagnostic test for Cystitis

Answer 28

Dx- clean catch, sterile, pelvic ultrasound or CT

Question 29

treatment for Cystitis

Answer 29

Tx- antibiotics if bacterial, fluids, hygiene, cranberry juice

Question 30

Health promotion for Cystitis

Answer 30

Although infectious cystitis is common, in many cases it is preventable. When catheters must be used in institutional se ings, strict a ention to sterile technique during insertion is essential to reduce the risk for UTIs (see the Best Practice for Patient Safety & Quality Care: Minimizing Catheter-Associated Urinary Tract Infection box). Long-term placement of urinary catheters requires aseptic technique for insertion. When intermi ent catheterization was used in home care se ings, the use of clean technique resulted in a similar rate of UTI compared with sterile technique. Clean technique, using single-use catheters, for catheter insertion is recommended in home se ings where multiple resistant organisms are less likely to be present. Multiuse catheters for home use are no longer recommended. Sterile technique must be used in health care facilities to reduce the risk for infection (Beauchemin et al., 2018).

Question 31

Preventing a Urinary Tract Infection

Answer 31

• Drink fluid liberally, as much as 2 to 3 L daily if not contraindicated by health conditions.
• Be sure to get enough sleep, rest, and nutrition daily to maintain immunologic health.
• If spermicides are used, consider changing to another method of contraception.
• [For women] Clean your perineum (the area between your legs) from front to back.
• [For women] Avoid using or wearing irritating substances such as douches, scented lubricants for intercourse, bubble bath, tight-fi ing underwear, and scented toilet tissue. Wear loose-fi ing co on underwear.
• [For women] Empty your bladder before and after intercourse.
• [For both women and men] Gently wash the perineal area before intercourse.
• Do not routinely delay urination because the flow of urine can help remove bacteria that may be colonizing the urethra or bladder.
• If you experience burning when you urinate, if you have to urinate frequently, or if you find it difficult to begin urinating, notify your primary health care provider right away, especially if you have a chronic medical condition (e.g., diabetes) or are pregnant.

Question 32

Drug treatment for UTI/ Cystitis

Answer 32

Fluconazole is the drug of choice for treatment of Candida (fungal) infections.

Guidelines for uncomplicated cystitis recommend nitrofurantoin, trimethoprim/sulfamethoxazole, or fosfomycin as first-line therapy for those patients at low risk of resistance to antimicrobials (Hooten & Gupta, 2018). Longer antibiotic treatment (7 to 21 days) and sometimes different agents are required for hospitalized patients and those with complicated UTIs (e.g., men, pregnant women, and patients with anatomic, functional or metabolic derangements that affect the urinary tract).

Question 33

caution for Sulfamethoxazole/trimethoprim

Answer 33

Sulfamethoxazole/trimethoprim should be stopped at the first appearance of a skin rash. A rash may indicate the onset of Stevens-Johnson syndrome (aching joints and muscles; bilateral blistering skin) or toxic epidermal necrolysis (redness, blistering, and peeling skin and mucous membranes).
Antibiotics are one of the drug categories most frequently involved in the error of administration to patients who have documented allergies to these drugs.

Question 34

What is Urethritis

Answer 34

Urethritis is an inflammation of the urethra and can result from infectious and noninfectious conditions. The incidence is highest among adults ages 20 to 24 years. The most common cause of infectious urethritis is sexually transmi ed infections (STIs).

Question 35

What is the main cause of Urethritis

A. UTI
B. PPI
C. STI
D. PUD

Answer 35

C. STI

Highest incidence is adults in early 20’s
– Most common cause is STI
– Test for STIs and pregnancy

These include gonorrhea or nonspecific urethritis caused by Ureaplasma (a gram-negative bacterium), Chlamydia (a sexually transmi ed gram-negative bacterium), or Trichomonas vaginalis (a protozoan found in both the male and female genital tract). Urethritis is also known as pyuria-dysuria syndrome, frequency-dysuria syndrome, trigonitis syndrome, and urethral syndrome.

Question 36

Health promotion and pt teaching for Urethritis

Answer 36

-Use cotton underwear, no nylon
– Clean the perineum from front to back
– Urinate before and after intercourse
– Void every 4 hours and as needed
– Advise to take medications
– Drink plenty of water

Urinalysis may show pyuria (white blood cells [WBCs] in the urine)

Question 37

What are the signs and symptoms for Urethritis

Answer 37

Symptoms of urethritis include discharge of mucopurulent or purulent material,
dysuria,
and itching or discomfort of the area (urethral pruritus). The discharge can be any color, depending on the infecting organism or source of irritation. Additional symptoms may include fever (with or without chills) and urgent or frequent urination.

Question 38

Should ALL pt’s with Urethritis be tested for Gonorrhea?

Answer 38

All patients with urethritis should be tested for N. gonorrhoeae and C. trachoma with an endourethral (in men) or endocervical (women) smear. Testing for Chlamydia may be done with the same sample. STI testing for VDRL serology and HIV is suggested by the Centers for Disease Control and Prevention (Barrow et al., 2020; CDC, 2016 ). A pregnancy test is performed for women who have had unprotected intercourse. In women, a pelvic examination may reveal tissue changes from low estrogen levels in the vagina. Urethroscopy may show low estrogen changes with inflammation of urethral tissues.

Question 39

What drug class is mainly used to treat infectious urethritis?

A. antifungal
B.Antibiotics
C. NSAID
D. antihypertensive

Answer 39

B.Antibiotics

improvement in urethral symptoms with the use of estrogen vaginal cream. Estrogen cream applied locally to the vagina increases the amount of estrogen in the urethra as well, reducing irritating symptoms. Urethritis from STIs is treated with antibiotic therapy.

Question 40

What is Urolithiasis?

Answer 40

Urolithiasis is the presence of calculi (stones) in the urinary tract. Stones often do not cause symptoms until they pass into the lower urinary tract, where they can cause excruciating pain.

Stones in urinary tract
* Common cause – dehydration, urinary stasis
* Result is obstruction in urinary tract
* Genetic
* Infection
* Diet – calcium and Vit D, high vit C intake
* Immobility (breakdown of bones increases circulating Ca which leads to stones

Question 41

What are the risk factors for kidney stones

Answer 41

-immobility
diet high in vitamin calcium
-dehydration
-Diet may be considered a risk for stone formation. Increased sodium intake has been associated with stone formation
-Patients who have a family history of stones, are obese, or have diabetes or gout (hyperuricemia) have increased risk for initial stone formation
-Because a metabolic problem is so strongly associated with stone formation and is a nonmodifiable risk factor, an adult of any age who develops a stone is always at high risk for future stone development.
-hyperparathyroidism
-hyperuricemia

Question 42

Signs and symptoms of Kidney stones

Answer 42

The major symptom of stones is severe pain, commonly called renal colic. Flank pain suggests that the stone is in the kidney or upper ureter. Flank pain that extends toward the abdomen or to the scrotum and testes or the vulva suggests that stones are in the ureters or bladder. Pain is most intense when the stone is moving or the ureter is obstructed.

Renal colic begins suddenly and is often described as “unbearable.” Nausea, vomiting, pallor, and diaphoresis often accompany the pain. However, a large stationary stone in the kidney (staghorn calculus) rarely causes much pain because it is not moving. Frequency and dysuria occur when a stone reaches the bladder. Oliguria (scant urine output) or anuria (absence of urine output) suggests obstruction, possibly at the bladder neck or urethra.

s/s- renal colic,
bladder distention,
hematuria,
flank pain
(CVA),
Nausea, Vomiting,
Pallor, s/s of infection

Urinary tract obstruction is an emergency and must be treated immediately to preserve kidney function.

Question 43

What is the best nursing intervention for a patient with Kidney stones?

Answer 43

Nursing interventions focus on pain relief and preventing infection and urinary obstruction

Other management techniques include avoiding overhydration and underhydration in the acute phase to help make the passage of a stone less painful. Strain the urine and teach the patient to strain it to monitor for stone passage. Send any stone passed to the laboratory for analysis because preventive therapy is based on stone composition.

Question 44

Drug therapy for Urithialisis

Answer 44

Drug therapy is needed in the first 24 to 36 hours when pain is most severe. Opioid analgesics are used to control the severe pain caused by stones in the urinary tract and may be given IV for rapid pain relief. NSAIDs such as ketorolac or ketoprofen in the acute phase may be effective. When NSAIDs are used, there is an increased risk for kidney impairment from reduced perfusion. NSAIDs interfere with renal autoregulation, and the risk for impairment is greater among patients with pre-existing kidney dysfunction. Risk for bleeding is also increased from platelet inhibition when NSAIDs are used. Bleeding risk is particularly concerning when surgical intervention for stones is needed.

Question 45

Diagnoses and treatment for Kidney stones

Answer 45

Dx – urinalysis, urine specific gravity, 24-hour urine, CT, KUB,
IVP
Tx –pain management – ketorolac (Toradol),
-strain urine,
-thiazide diuretic/allopurinol,
-ambulation, I&O,
- Increase fluid
intake
-Lithotripsy, stent

Teaching – avoid the risk factors
Increase fluids
Increase ambulation