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52 Cards in this Set
- Front
- Back
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What type of catheter is generally used for a client with urianary retention?
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straight catheter
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Who is affected most by urinary incontinence/
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older women
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What are they types of urinary incontinence?
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Stress, Urge, Overflow, reflex, functional
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What are the implications (life effects) that UI has on a patient?
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-decreased quality of life
-stigma -fear of embarassment -decreased socialization -perception that UI is a normal part of aging -other health problems |
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What are some behavioral strategies for the treatment of UI?
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-scheduled/prompted voiding
-pelvic muscle rehab -relaxation techniques -urge suppression technique -eliminate reversible factors -hydration managemnt -bowel regularity -bladder training |
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What medications can be prescribed for an overactive bladder?
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Tolterodine (Detrol LA)
Oxybutinin (Ditropan XL) |
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What is stress incontinence?
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This is related to pregnancy, multiparas, obesity, surgery, exercise, and medications. It can be triggered by laughing, sneezing, coughing, or straining of the abdominal muscles. There are small amounts of urine lost, and the episodes are occasional or continual.
Treatment: Biofeedback, Kegels |
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What is urge incontinence?
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This is related to birth defects, spine or nerve damage, immobility, prostate problems, or cancer. This is when the patient experiences a sudden, unexpected need to void. There are moderate to large amounts of urine lost, and the episodes are situational or occaisonal.
Treatment: Kegels |
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What is overflow incontinence?
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This is related to birth defects, spine or nerve damage, MS, loss of bladder muscle tone, surgery, and medications. There is NO warning prior to the incontinent episode, and a small to moderage amount of urine is lost. This is frequent/continual.
Treatment: treat the cause, intermittent catheterization, bladder scans for post-void residuals |
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What is reflex incontinence?
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This is related to birth defects, spine or nerve damage, developmental disability, senility, or pelvic trauma. There is no warning prior to the incontinent episode, and a large amount of urine is lost. This can be episodic or continual. The treatment involves determining the cause, the patient may need intermittent catheterization, and timed voiding.
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What is functional incontinence?
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This is related t an inability to get to bathroom facilities in time. It could be caused by obesity, clutter, or immobiltiy. It may be associated with urge incontinence (known as mixed incontinence).
Treatment: modify the environment, modfiy the lifestyle |
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What is the most common pathogen in UTIs?
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e.coli
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What are risk factors for a UTI?
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Decline of immune funciton
Obstruction- BPH, tumor, constipation urinary catheters diabetes mellitus |
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What are classic signs of a UTI in an older adult?
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They are different from youngings.
-Non localized abdominal pain, cognitive impariment. A patient over 80 may actually have a decline in body temp. -fatigue, anorexia |
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Who is more likely to have bladder cancer?
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older men
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What are risk factors for bladder cancer?
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chronic bladder irrigation
cigarette smoking |
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What is the classic sign of bladder cancer?
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painless hematuria
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How do you classify ESRD?
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based on the GFR. Kidney failure is defined as a GFR under 15ml/min
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What are the two types of symptoms of BPH?
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obstructive and irritative
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What are the obstructive symptoms of BPH?
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-decrease in caliber and force of urinary stream, difficulty initiating voiding, intermittency, and dribbling
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What are the irritiative factors for BPH?
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urinary frequency
urgency dysuria bladder pain nocturia incontinence |
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What is acute urinary retention?
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Acute retention caused by complete anuria is a medical emergency, as the bladder may distend (stretch) to enormous sizes and possibly tear if not dealt with quickly. If the bladder distends enough it will begin to become painful. The increase in pressure in the bladder can also prevent urine entering from the ureters or even cause urine to pass back up the ureters and get into the kidneys, causing hydronephrosis, and possibly pyonephrosis, kidney failure and sepsis. A person should go straight to an emergency department as soon as possible if unable to urinate when having a painfully full bladder.
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What is involved in conservative treatment for BPH?
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dietary changes
avoid decongestants and anticholinergics 5-alpha-reductase-inhibitors Alpha adrenergic receptor blockers Herbals: saw palmetto |
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What are the 5-aplpha reductase inhibitors and their side effects?
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Finasteride (proscar) and Dutasteride (avodart)
SE: decreased libido, decreased volume of ejaculate, and ED |
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What are the alpha-adrenergic receptor blockers and their side effects?
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Flomax
SE: orthostatic HTN, dizziness, retrograde ejaculation, nasal congestion |
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What is saw palmetto and what are its side effects?
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it can improve urinary symptoms and urinary flow measures.
It does cause and an increased risk of bleeding though! so dont us in pts with a GI diagnosis, d/c before surgery, also it may increase BP and GI side effects |
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What are nursing considerations regarding catheterization of a client with BPH?
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Use a Coude or curved tip catheter. If the obstruction is sizable, a urologist may be needed to place the catheter (use a filiform catheter)
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What are complications of post op care for a client undergoing surgery for BPH?
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hemorrhage, bladder spasms, UI and infection.
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What is the post op care for a client undergoing surgery for BPH?
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Bladder irrigation (use a triple lumen foley)
OR Continuous bladder irrigation (CBI)- it removes clotted blood from the bladder and ensures drainage of urine. Use sterile normal saline solution or prescribed solution. |
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What does the nurse need to do with CBI?
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1. Document the drainage color, and the number and size of any clots
2. use aseptic technique with catheter care and CBI 3. tape catheter to leg 4. maintain a closed drainage system 5. dont allow the irrigant to go dry, this can casue bleeding 6. d/c when the bleeding stops- urine should be light pink with no clots. 7. document how much fluid is used, make sure outlow equals inflow |
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Post op considerations for bleeding after CBI
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blood clots are expected 24-36 hours after post op. Large bright red blood however indicates hemorrhage
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Post op considerations for avoidng increased abdominal pressure after CBI
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no straining to have a bowel movement, valsalva.
no sitting or walking long periods |
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post op considerations for bladder spasm after CBI
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check for clots, avoid urinating around the foley, apply antispasmodics, such as belladonna or opium suppositiories
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Post op consdierations for sphincter tone after CBI
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-decreased sphincter tone after cathter removal
-UI or dribbling -perform kegels |
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Patient teaching needs after CBI
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1. care of catheter
2. manage UI 3. maintain oral fluids 2-3 L per day 4. observe for s/sx of UTI or wound infection 5. refrain from driving or intercourse until you see your MD 6. Retrograde ejaculation- anxiety and sexual counseling 7. it will take 2 months for bladder capacity to return to normal, so urinate q2-3hr and avoid bladder irritants |
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What are risk factors for prostate cancer?
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age, ethnicity, family history, and a high fat diet
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What is involved in screening for prostate cancer?
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Because prostate cancer may be asymptomatic, screening is your best bed.
1. digital rectal examination 2. monitor BPH (may be associated with CA) 3. PSA levels- PSA (0-4) normal in 60-69 (7) normal in 70-79 Over 10 is indicative of CA 4. often metastasizes |
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What are signs of prostate cancer
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It is asymptomatic in the early stage. Later stages show signs similar to BPH, like dysuria, hesitancy, dribbling, frequency, urgency, heamturia, nocturia, retention, interupption of urinary stream, and inability to urinate.
Pain: lumbosacral area that radiates to hips or legs with urinary symptoms indicates metastatic dx |
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What are the stages of prostate cancer?
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A: clinically unrecognized
B: clinically intracapsular C: clinically extracapsular, localized to periprostatic area D: metastatic disease- pelvic lymph nodes, bones, bladder, lungs, liver. Control the pain. Bone pain is very severe, especially in the back and legs due to compression of the spinal cord with destruction of bone |
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What are some interventions for prostate cancer?
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1. Health promotion- prostate screening
2. Care after radical prostatectomy is similar for post op care after BPH 3. teaching if the pt is d/cd with an indwelling catheter- clean the meatus once a day with soap and water, high fluid intake, keep collection bag lower than bladder, and secure the catheter to the inner thigh |
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What are signs of a bladder infection?
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bladder spasm, fever, hematuria
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What are the rules for Prostate cancer screening?
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Level 1 Recommendation
-there is insufficient evidence to recommend screening based on inconclusive evidence that screening with DRE and PSA improves health outcomes. Men with a life expectancy of less than 10 years are unlikely to benefit from prostate screening. |
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What is impotence?
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it is defined as the inability to attain and maintain erection long enough for intercourse. 10-20 million american men are affected. ED does increase with age, but it is not inevitable and it is treatable.
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What are risk factors for ED?
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diabetes, HTN, MS, thyroid disorders, renal failure, medications, psychological factors, alcoholism
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What are nursing strategies for ED?
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1. check the medication history. the patient is often on a medication causing the ED.
anticholinergics, digoxin, antihypertensives, sedatives, hypnotics, tranquilizers, antidepressents, sleeping medications |
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What is involved in treatment of ED?
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Sildenafil Citrate (viagra)
-a rare side effect is blindness! vacuum pumps, penile implants, and drugs injected into the penis |
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What is involved in the treatment of ED?
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medical treatments, avoidance of risk factors, devices, reassurance, working with the partner
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What is vaginitis?
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The vaginal canal is more fragile due to atrophy, less lubrication, a more alkaline pH due to lower estrogen levels. The woman may have symptoms similar to a UTI or yeast infection and also itching, foul smelling discharge.
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What is the treatment for vaginitis?
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topical estrogen creams and estrogen replacement therapy
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What is nurinsg teaching for vaginitis?
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avoid douches, avoid perfumes and sprays, cotton undergarments, use lubricant for intercourse
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What is the triphasic human sexual response?
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Desire, excitement, orgasm
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How do vaginal dryness and erectile dysfunction affeect intimacy?
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lubrication is decreased in the female
female changes can lead to dyparenuina lengthened arousal and refractory period in men may not have an orgasm with each experience ED is a common problem for men |
