urinary problems Flashcards
stress incontinence
urine leaks out at times when your bladder is under pressure
ex) coughing or laughing
stress incontinence causes
- weakening of the bladder neck supports; associated with childbirth
- intrinsic sphincter deficiency
- acquired anatomic damage to the urethral sphincter
- vaginal prolapse from vaginal birth or aging
stress incontinence symptoms
- loss of small amount of urine during physical activity or intraabdominal pressure (coughing, sneezing jumping, lifting, exercises)
- normal voiding habits
- postvoid residual usually less than or equal to 50ml
- pelvic exam= hypermobility or urethra or bladder neck with Valsalva maneuvers
urge incontinence
when urine leaks as you feel a sudden urge to pee, or soon afterwards
urge incontinence causes
- idiopathic
- neurological disorders
- benign prostatic hypertrophy
- bladder irritants (artiical sweetners, caffeine, alcohol, citric, drugs, nicotine)
- bladder cancer
- medications that cause increased bladder contractibility
urge incontinence symptoms
- loss of urine preceded by a sudden and severe desire to pass urine
- nocturia
- may have loss of large amounts of urine with occurrence
mixed incontinence causes
associated with stress and urge incontinence
mixed incontinence symtoms
- associated with stress and urge incontinence
overflow incontinence (reflex incontinence)
when your unable to fully empty your bladder which causes frequent leaking
overflow incontinence (reflex incontinence)causes
- urethral obstruction
- diabetic neuropahy
- some neurologic disorders
- medications side effects
overflow incontinence (reflex incontinence) symptoms
- bladder distension, constant dribbling of urine
- sense of incomplete emptying of the bladder
- pelvic discomfort
- palpable bladder
functional incontinence
leakage of urine caused by factors other then disease of the lower urinary tract
functional incontinence causes
decreased cognition such as with dementia
- impaired mobility
functional incontinence symptoms
- quantity and timing or urine leakage vary
- patterns difficult to discern
urinary incontinence focused assessment
- risk factors
- symtoms of urinary incontinence
- assessment of mobility, self care ability, cognitive ability, communication patterns
- assess the environment for barriers to toileting such as a privacy, restrictive clothing and access to the toilet
urinary incontinence physical assessment/ s/s
- assess abdomen- feeling for distention
- inspect females for uterine prolapse- uterine muscles weakened
- digital rectal exam- both men and women check nerve integrity
- assess for prostate enlargement in men
- lab assessment- urinalysis
- imaging assessment
imaging assements
- bladder scan
- ct of kidneys and ureters
- voiding cystourethrogram
- urodynamic testing
- electromyography or pelvic muscules
urinary incontinence nursing diagnoses
- altered urinary elimination related to incontinence
- potential for altered tissue integrity related to incontinence
urinary incontinence planning and integrating (nonsurgical management )
nonsurgical management
- nutrition therapy
- devices
- electrical stimulation
- magnetic resonance therapy
- pelvic muscle therapy
- vaginal cone therapy
- behavioral interventions
urinary incontinence planning and integrating (maintaining tissue integrity)
- reduce the risk for skin breakdown
- reduce the risk of pt. developing incontinece- associate dermatits
- educate the pt. on the possibility of using an external device
- discuss the possibility of absorbent pads and breifs with the pt.
- options for functional incontinence include intermittent or long dwelling catheter
urinary incontinence care coordination and transit management
home care management- bedside comode, clear path
- self-management education- keeping on schedule
- health care resources- estrogen cream, anticholergenics, the importance of diet, drinking lots of fluids, different exercise, legal exercises
urinary incontinence evaulating outcomes
- maintain optimal urinary elmination through a reduction in the number of urinary incont. ep.
- maintain tissue integtiry of the skin and mucous membranes in the perineal area
- demonstrate knowledge of proper use of drugs and correct procedures for self catheterization, use of artificial sphincter or care of an indwelling urinary catheter
- demonstrate effective use of the selected exercise or bladder training program
- select and use incontinence interventions, devices, and products
cystitis
inflammatory conditon of the bladder
- usually refers to inflammation from infection of bladder
cystitis causes
- irritants without infection
- complication of other disorders (gynecologic cancers, pelvic inflammatory disorders, endometriosis, chrons disease, diverticulitis, lupus, tb)
- infectious cystitis caused by pathogens from bowel or vagina, viruses, mycobacteria, parasites, yeast
cystitis physical assessment and s/s
- frequency, dysuria, urgency
- fever, chills, nausea= infection
- assess catheter
- have pt. void for urine examination
- vital signs, lower abdomen, bladder palpation
cystitis lab assessment
- clean cach urine specimen (urinalysis, culture, and sensitivity)
- serum wbc with differential
cystitis other diagnostic assessment
- pelvic ultrasound or ct
- voiding
- cystourethrography
- cystoscopy
cystitis nonsurgical managment
- drug therapy
- fluid intake
- comfort measures such as pain relief
cystitis surgical managemnt
- treat conditions that increase risk for utis
- removal of obstructions
- removal of vesicoureteral reflux
- removal of calculi
cystitis health promotion and maintenance
- sterile technique when inserting catheters
- clean technique when using intermittent catheters at home
- single-use catheter recommended for home settings
- national pt. safety goal- CAUTI prevention: removal of catheter as soon as possible
- liberal intake of water
cystitis care coordination and transition management
- assess level of clients understanding
- teach to take prescribed drugs
- address concerns associated with intimacy and recurrent utis
urethritis
- inflammation of urethra
- highest incidence is adults aged 20-24
- sit is the most common cause
- symptoms include mucopurulent or purlent discharge, dysuria, discomfort
interpofessional collaborative care
- urinalysis may show pyuria (a urinary condition characterized by an elevated number of white blood cells in urine
- test for sti
- usually resolves spontaneously
urolithiasis
presence of calculi in the urinary tract
nephrolithiasis
formation of calculi in kidney
ureterolithiasis
formation of the calculi in the ureter
urolithiasis causes
- metabolic probelms (hypercalcemia, hyperoxaluria, hyperuricemia, struvite, cystinuria)
- DEHYDRATION IS THE MOST COMMON RISK FACTOR THAT INCREASES CHANCE
- risk factors: family history, obesity, diabetes or gout, diet (high sodium)
urolithiasis s/s
- severe pain
- flank pain
- nausea, vomiting, pallor, diaphoresis
- frequency and dysuria
- oliguria and anuria
urolithiasis assessment criteria
- history of urologic stones
- diet
- past treatment
- recognize urinary tract obstruction
- assess for bladder distension
urinalysis
urolithiasis managing pain (nonsurgical)
- drug therapy
- lithotripsy
urolithiasis managing pain (surgical management)
minimally invasive surgical procedures
- open procedures
urolithiasis preventing infection
- drug therapy- antibiotics
- lab test (urine sample, C&S test, urine cultures)
urolithiasis preventing obstruction
- high fluid intake (3l/day or more)
- accurate measurements of intake and output
- drug therapy
- nutrition therapy/ diet modification
urothelial cancer patho
malignant tumors of urothelium linning of transitional cells in kidney, renal pelvis, ureters, urinary bladder, and urethra
urothelial cancer cause
direct cause unknow
- GREATEST RISK FACTOR IS TABACCO
-exposure to toxins, family history, schistosoma haematobium infection, use of drugs
urothelial cancer physical assessment and s/s
- ask about active and passive exposure to cig smoke
- ask about hobbies and occupation
- ask change in urine habit
- assess skin color, nutrition status abdomen
- examine urine color and clarity
BLOOD IN URINE IS FIRST INDICATION OF BLADDER CANCER
urothelial cancer psychosocial assessment
- assess pt. emotions, including response to possibly having bladder cancer
- assess pt. coping mechanism
- available support groups
urothelial cancer diagnostic assessment
- urinalysis showing gross or microscopic hematuria (blood in urine)
- bladder wash specimens and bladder biopsies
- cytoscopy, cystoureterography, ct scans, ultrasounds, MRI
urothelial cancer intervention/management
prophylatic immunotherapy with BCG
- multiagent chemotherapy; radiation therapy
urothelial cancer surgical managment
- depends on type and stage of cancer
- complete bladder removal
- alternatives for urine elimination
urothelial cancer health promotion maintenance
- smoking cessation
- use ppe around dry, liquid, gaseous chemicals
- shower or bathe, change clothing
urothelial cancer care coordination and trainsition management
- self-management education
- united ostomy assoication
- wound, ostomy, continence nurses society
