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70 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Factors influencing urination
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Disease Conditions
Prerenal Renal Postrenal Sociocultural Factors Privacy Communal Psychological Factors Anxiety Stress Muscle Tone Weakness |
Fluid Balance
Polyuria- frequency Oliguria- scantily Medications Diuretics Surgical Procedures Diagnostic Examination Intravenous pyelogram (IVP) Cystoscopy |
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How many cc indicate good Kidney function?
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30 cc per hour
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Alterations of the Urinary function- ASSESSMENT
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Assessment
History Pattern of urination Symptoms of urinary alterations Factors affecting urination |
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Alterations in urinary function- Physical Assessment
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Physical Assessment
Skin & Mucosal Membranes Kidneys Bladder Urethral Meatus |
I&O- clarity, deposits, color
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Assessment of Urine
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Assessment of Urine
Intake & Output Characteristics of Urine Color Clarity Odor |
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Common Urine Tests
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Common Urine tests
Urinalysis pH Protein Glucose Blood -specific gravity -Urine Culture &Sensitivity |
Microscopic exams-
WBC Bacteria Casts RBC’s Leukocyte esterase |
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Restoring Care to Urinary Problems
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Strengthening pelvic floor muscles- kegel muscle exercises
Bladder retraining- making sure pt goes to the bathroom at certain times. Habit training Self-catheterization training/teaching Maintenance of skin integrity- urine becomes more acidic as it breaks down. Promotion of comfort |
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Urine Collection Methods
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Catheterization:
Intermittent- better option Indwelling- damages flora= infection Routine catheter care Perineal hygiene Catheter care Fluid intake Prevention infection |
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How to collect Urine
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-Midstream
-Clean-voided -Female: spread labia and cleanse moving front to back -Men: cleanse end of penis in circular motion, retract foreskin -Have patient initiate urine stream, stop urine stream then collect specimen in container |
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UTI facts- *******
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Most common infections treated by primary care providers
Women > Men Rarely in men younger than 50 years old Increased incidence as men age Nosocomial infection |
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Cystitis
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Inflammation of the bladder wall
Most common cause of UTI Caused by ascending bacteria or obstructive voiding patterns |
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Urethritis
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Inflammation of the urethra
May cause same manifestations as cystitis |
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Etiology of UTI
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Bacteria
Escherichia coli Klebsiella Enterobacter & Proteus Sexually transmitted infections Indwelling urethral catheters |
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Clinical Manifestations of UTI
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Dysuria
Frequency Urgency Voiding small amounts Inability to void Incomplete emptying of the bladder Cloudy urine Hematuria |
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Diagnostic studies for UTI
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Dipstick- seen less and less
Leukocyte esterase Nitrite activity Urine C&S CBC Vaginal culture/wet mount |
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Lower UTI
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Cystitis
Urethritis Prostatitis |
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Upper UTI
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Pyelonephritis
Nephritis Renal or Perirenal abscess (these will be covered in Care 2) |
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Treatment of UTI
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Broad-spectrum antibiotics
Antispasmodics Diet modifications Increase fluid intake |
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Patient Education for UTI
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Symptom management
Medication usage Follow-up care Cotton underwear, avoid tight clothes Proper cleansing Void every 2-4 hours Complete emptying of bladder |
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Nursing Diagnosis for UTI
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Impaired Urinary Elimination
Acute pain |
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Modification of UTI for Older Pt.
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Cystitis increased-
Immobility, constipation, fecal and urinary incontinence, urinary retention Women Atrophic changes (hormonal) Men Benign prostatic hypertrophy Medications- they may be taking BP meds that can have HTZ (diuretic) |
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Urethritis
Def Diagnosis Tx |
Inflammation of the urethra
Commonly associated with STI Associated manifestations of cystitis |
Diagnosed
History and clinical manifestations Treatment Remove etiologic mechanism Sitz baths, increased fluid intake |
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Urethritis
Def Dx Tx |
Gram-negative bacteremia
Indwelling catheter or untreated UTI |
Prevent septic shock
Signs / Symptoms of Shock Medications IV antibiotics Oral antibiotics |
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Interstitial Cystitis
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Also called painful bladder disease
Underdiagnosed Mainly in young women |
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CM of Interstitial Cystitis
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Clinical Manifestations
Bladder tenderness Lower abdominal pain or pelvic pain Urgency & frequency Nocturia Painful intercourse (dyspareunia) |
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Tx for Interstitial Cystitis
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Treatments
Controversial Reduce pain Improve patient coping- by teaching |
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Urinary Incontinence
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A condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrable
13 – 56 % noninstitutionalized adults >60 y/o ½ nursing home residents Annual cost >15 million |
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major types of incontinence
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Stress
Urge Overflow Functional Iatrogenic (medications- alpha receptors antagonist for example) Mixed (of any of the above) |
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Etiology of Stress Urinary Incontinence
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Obstetric or surgical trauma
Loss of estrogen Repeated straining Urogenital prolapse Surgery |
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Etiology of Urge Urinary Incontinence
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Occurs randomly when involuntary urination is preceded by the warning of a few seconds to a few minutes
Etiology Uncontrolled contraction or overactivity of detrusor muscle seen with CNS disorders Alzheimer’s disease, brain tumor, Parkinson’s disease, MS |
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Etiology of Overflow Urinary Incontinence
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Overflow Urinary Incontinence
An involuntary urine loss associated with overdistention of the bladder Etiology Physical causes Psychosocial causes Medications |
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Tx for Urinary Incontinence
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Kegel Exercises
Electrical stimulation Bladder and behavioral training Medications Fluid intake & dietary changes Urodynamic evaluation Electromyographic (EMG) Cystoscopy Surgery- Bladder Neck Suspensions Implantation of artificial Urinary Sphincter |
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Urinary Incontinence- modification for older clients
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Incontinence is NOT a normal part of the aging process, but is common
Previous treatments Medications |
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5 Types of Neurogenic Bladder
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- accidents, insults to spinal cord, etc.
1.Uninhibited- Infantile or uninhabited Voiding. Also, urge to void causes urine flow 2.Sensory paralytic- interruption in the lateral spinal tracts 3.Motor paralytic- Most common 4.Autonomous- Cant perceive fullness or start/maintain urination 5.Reflex-transection of spine cord above sacral segments |
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Upper vs. Lower Motor Neuron in Neurogenic Bladder
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Upper motor neuron
Above the sacral segments of the spinal cord Lower motor neuron At or below the sacral vertebrae |
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CM of Neurogenic Bladder
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Retention with or without incontinence
may or may not feel a need to void or feel a sense of bladder distention Diagnosis is made from the location of neurological dysfunction |
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Bladder Trauma
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Blunt or penetrating injury to the bladder that may cause bladder to rupture
Hematuria & low abdomen pain or pain referred to a shoulder |
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Urethral Trauma
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Complications include development of urethral strictures & risk of impotence in men
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Ureteral Trauma
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Accidentally during surgery
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Renal or Ureteral Calculi (stones)- CM
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Sharp, severe pain of sudden onset
Renal colic or ureteral colic Nausea Vomiting Pallor Hyperthermia Elevated WBC |
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Tx of Renal or Ureteral Calculi
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Reduce pain
Increase fluids Prevent recurrence Dietary changes |
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Nursing Diagnosis for Calculi
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Nursing Diagnosis
Acute Pain Effective therapeutic regimen management |
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Surgical Procedures for Calculi
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Endourolgic Procedures
Lithotripsy Extracoporeal Shock Wave Lithotripsy Percutaneous Lithtripsy |
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Urinary Calculi-
Def |
Urolithiasis
Nephrolithiasis Usually asymptomatic 4% or population Pass spontaneously |
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Urinary Calculi Etiology and Types
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Urinary statis
Supersaturation of urine with poorly soluble crystalloids |
Types
Calcium Oxalate Struvite Uric Acid Cystine Xanthine |
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Etiology of Urinary Reflux
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Congenital abnormaility
Ectopic ureter Chronic bladder infection Outlet obstruction Frequency as a result of another condition |
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CM and Surgical Tx of Urinary Reflux
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CM-
Pyelonephritis Flank Pain CVA tenderness |
Surgical Tx-
reimplantation of ureter |
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Etiology of Urinary Retention
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Detrusor failure in women
Obstructive voiding in men Neuropathies DM CVA Spinal cord injury |
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CM of Urinary Retention
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Distended bladder
Inability to empty the bladder completely Postvoid residual >100ml after an attempt to void |
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Tx, Nursing Diagnosis and Interventions for Urinary Retention
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Tx-
Medications Urethral Dilations Diagnosis- Urinary Retention |
Interventions-
Assess urine output patterns Implement measure to stimulate independent voiding Catheterize patient Prevent infection Prevent tissue injury |
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Alternatives to Catheterization
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Suprapubic catheterization-
Surgical placement of a catheter through the abdominal wall above the symphysis pubis and into the urinary bladder Condom catheter- Incontinent or comatose men Soft, pliable rubber sheath that slips over the penis |
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Ureteral Tumors- facts**
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Men 50-60 year old
Rarely Women Extend from renal or bladder neoplasms or from tumors originating in the bowel, uterus or ovary Found in lower 1/3 of ureter |
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CM of Ureteral Tumors
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Gross hematuria
Painlessly until obstruction occurs Flank pain- associated with tumors |
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Tx of Ureteral Tumors
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Surgical excision and resection
Radiation Surgery Palliative care Neo-adjuvant chemotherapy |
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Bladder Cancer- facts
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Most frequent neoplasm of the urinary tract
Older adults Caucasian > African-American |
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Etiology and CM of Bladder Cancer
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Cigarette smoking
Industrial exposure Artificial sweeteners Coffee |
Clinical Manifestations
Painless hematuria |
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Tx of Bladder Cancer
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Alkylating intravesical chemotherapy
Bacille Calmette-Guerin (BCG) Surgery Tx side effects Radical Cystectomy Radiation therapy |
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Nursing Diagnosis for Bladder Cancer (preoperative vs. Postoperative)
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Preoperative-
Knowledge Deficit Risk for disturbed body image Postoperative- Risk for injury Risk for impaired skin integrity Risk for sexual dysfunction |
Powerlessness
Risk for injury Impaired Urinary Elimination Knowledge deficit Risk for Sexual Dysfunction |
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Surgical Procedures for Bladder Cancer
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-Cutaneous Urinary Diversion
-Ileal Conduit -Cutaneous Ureterostomy -Vesicostomy -Nephrostomy -Cutaneous Ureterostomy -Indiana Pouch -Kock Pouch -Ureterosigmoidostomy -Various Revisional Diversions |
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Ureterostomy
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Done in Bladder Cancer-
If ureters are obstructed by a tumor Attaches ureter to the abdomen then to drainage appliance |
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Postoperative Assessment in Bladder Cancer
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Hematuria
Stenosis Check Stoma |
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Palliative Procedures in Bladder Cancer
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Percutaneous Nephrostomy or Pyelostomy
Inoperable bladder cancer Catheter inserted into the renal pelvis Catheter is connected to an external drainage system |
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Modification for older patients with Bladder Cancer
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Self-Care
Dexterity Arthritis Decreased visual acuity |
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The Indiana Pouch
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The Surgeon introduces the ureters into a segment of ileum and cecum. Urine is drained periodically by inserting a catheter into the stoma
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Kock Pouch (Continent ileal Urinary Diversion)
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The surgeon transplants ureters to an isolated segment of small bowel, ascending colon, or ileocolonic segment and develops an effective continence mechanism or valve. Urine is drained by inserting a catheter into the stoma.
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In Males- the kock pouch can be modified by attaching one end of the pouch to the urethra, allowing more normal void. The female is too short for this.
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Ureterosigmoidostomy
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The Surgeon introduces the ureters into the sigmoid colon, thereby allowing urine to flow through the colon and out of the rectum.
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Conventional ileal Conduit
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The Surgeon transplants the ureters to an isolated section of the terminal ileum, bringing one end to the abdominal wall.
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Cutaneous Ureterostomy
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The surgeon brings the detached ureter through the abdominal wall and attaches it to an opening in the skin.
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Vesicostomy
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The surgeon sutures the bladder to the abdominal wall and creates an opening (stoma) through the abdominal and bladder walls for urinary drainage
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Nephrostomy
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The surgery inserts a catheter into the renal pelvis via an incision in the flank or by percutaneous catheter placement into the kidney.
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