8/14/2019 Module EChapter73

1/31

Chapter 73

Interventions for Clients withUrinary Problems

8/14/2019 Module EChapter73

2/31

Cystitis

Inflammation of the bladder Most commonly caused by bacteria thatmove up the urinary tract from theexternal urethra to the bladder, viruses,fungi, or parasitesCatheter-related infections common

during hospital stay

8/14/2019 Module EChapter73

3/31

Incidence and Prevalence

of CystitisFrequenct urge to urinateDysuriaUrgencyUrinalysis needed when testing for leukocyte esteraseType of organism confirmed by urinecultureOther diagnostic assessments

8/14/2019 Module EChapter73

4/31

8/14/2019 Module EChapter73

5/31

Drug Therapy

Urinary antisepticsAntibioticsAnalgesicsAntispasmodicsAntifungal agents

Long-term antibiotic therapy for chronic,recurring infections

8/14/2019 Module EChapter73

6/31

Nonsurgical Management

Urinary eliminationDiet therapy includes all food groups,calorie increase due to increase inmetabolism caused by the infection,fluids, possible intake of cranberry juicepreventively

Other pain relief measures, such as warmsitz baths

8/14/2019 Module EChapter73

7/31

8/14/2019 Module EChapter73

8/31

Urethritis

Inflammation of the urethra that causessymptoms similar to urinary tractinfectionCaused by sexually transmittedinfections; treat with antibiotic therapyEstrogen vaginal cream for

postmenopausal women

8/14/2019 Module EChapter73

9/31

8/14/2019 Module EChapter73

10/31

Urinary Incontinence

Five types of incontinence include:StressUrgeMixedOverflowFunctional

8/14/2019 Module EChapter73

11/31

CollaborativeManagement

Assessment includes a thorough clienthistory.Clinical manifestations for urethral or uterine prolapseLaboratory assessment by urinalysisRadiographic assessment, especiallybefore surgeryOther diagnostic assessments

8/14/2019 Module EChapter73

12/31

8/14/2019 Module EChapter73

13/31

Surgical Management

Preoperative careOperative procedurePostoperative care

Assess for and intervene to prevent or detectcomplications.Secure urethral catheter.

8/14/2019 Module EChapter73

14/31

Urge Urinary Incontinence

Interventions include:Drugs: anticholinergics, possiblyantihistamines, others

Diet therapy: avoid caffeine and alcoholBehavioral interventions: exercises, bladder training, habit training, electrical stimulation

8/14/2019 Module EChapter73

15/31

Reflex UrinaryIncontinence

Interventions include:Surgery to relieve the obstructionIntermittent catheterizationBladder compression and intermittent self-catheterizationDrug therapy

Behavioral interventions

8/14/2019 Module EChapter73

16/31

Functional UrinaryIncontinence

Interventions include:Treatment of reversible causesIf incontinence is not reversible, urinary habittrainingFinal strategycontainment of urine andprotection of the clients skinApplied devicesUrinary catheterization

8/14/2019 Module EChapter73

17/31

8/14/2019 Module EChapter73

18/31

8/14/2019 Module EChapter73

19/31

8/14/2019 Module EChapter73

20/31

Interventions

Drug therapyOpioid analgesicsoften used to controlpainNonsteroidal anti-inflammatory drugsPain medications at regular intervalsConstant delivery systemSpasmolytic drugsimportant for relief of painComplementary and alternative therapy

8/14/2019 Module EChapter73

21/31

Lithotripsy

Extracorporeal shock wave lithotripsyuses sound, laser, or dry shock waveenergy to break the stone into small

fragments.Client undergoes conscious sedationTopical anesthetic cream is applied to

skin site of stone.Continuous monitoring is byelectrocardiography

8/14/2019 Module EChapter73

22/31

Surgical Management

Minimally invasive surgical proceduresStentingRetrograde ureteroscopyPercutaneous ureterolithotomy andnephrolithotomyOpen surgical procedures

Preoperative careOperative procedure

8/14/2019 Module EChapter73

23/31

Postoperative Care

Routine postoperative care procedures for assessment of bleeding, urine, andadequate fluid intake

Strained urineInfection preventionDrug therapyDiet therapyPrevention of obstruction

8/14/2019 Module EChapter73

24/31

Drug Therapy

Drug selection to prevent obstruction depends on what isforming the stone:

CalciumThiazide Diuretics

Oxalate

ZyloprimPyridoxine (B6)Uric acid

ZyloprimPotassium Citrate to alkalinize the urine

CystineCapoten

8/14/2019 Module EChapter73

25/31

Urothelial Cancer

Collaborative managementAssessmentDiagnostic assessment

Bladder washesBladder biopsy

Nonsurgical managementProphylactic immunotherapy

Intravesical instillation with BCGChemotherapy

Multi agent chemotherapy for mets

Radiation therapyFor prolongation of life

8/14/2019 Module EChapter73

26/31

Surgical Management

Preoperative care

8/14/2019 Module EChapter73

27/31

Surgical Management

Operative procedures

8/14/2019 Module EChapter73

28/31

Surgical Urinary Diversion

8/14/2019 Module EChapter73

29/31

Incontinent Urinary Diversion

8/14/2019 Module EChapter73

30/31

Surgical Management

Postoperative care includes:Collaboration with enterostomal therapistKocks pouch

Penrose drainMedena catheter

Neobladder Early post -op drain for irrigation

8/14/2019 Module EChapter73

31/31

Bladder Trauma

Causes may be due to injury to the lower abdomen or stabbing or gunshot wounds.Surgical intervention is required.Fractures should be stabilized beforebladder repair.