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THE ASSESSMENT AND CARE FOR IMPAIRED URINARY ELIMINATION PN 134. ASSESSMENT. Pain on urination Pattern of urination Strength of urine stream Urgency, frequency, incontinence, hematuria, nocturia Intake and output Urine color, clarity, and odor. URINARY RETENTION. Urinary retention
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THE ASSESSMENT AND CARE FOR IMPAIRED URINARY ELIMINATION PN 134
ASSESSMENT • Pain on urination • Pattern of urination • Strength of urine stream • Urgency, frequency, incontinence, hematuria, nocturia • Intake and output • Urine color, clarity, and odor
URINARY RETENTION • Urinary retention • Etiology/pathophysiology • The inability to void despite an urge to void • Clinical manifestations/assessment • Distended bladder • Discomfort in pelvic region • Voiding frequent, small amounts
URINARY RETENTION • Client may experience discomfort and anxiety. • Frequency of urination and voiding small amounts may occur. • Treatment: urinary analgesics and antispasmotics. • Urinary catheter may be used, or surgery if indicated. • When client able to void, check for residual urine-should be less than 50mL.
URINARY RETENTION • Stasis may lead to infection. • Distended bladder may result. • Caused by stress, calculus obstruction, stones, tumor, infection, medications, trauma.
URINARY RETENTION • Medical management/nursing interventions • Warm shower or sitz bath • Natural voiding position if possible • Urinary catheter • Surgical removal of obstruction • Analgesics
URINARY RETENTION • Urinary Analgesics • Pyridium, Pyridate, phenazopyridine: • Uses: relief of pain associated with lower genitourinary tract • Adverse Reactions: headache, rash, pruritis, GI disturbances, discoloration of the urine, sclera and/or skin. • Dosage range: 200 mg TID PO
Urinary Incontinence • Etiology/pathophysiology • Involuntary loss of urine from the bladder • Total incontinence; dribbling; stress incontinence • Secondary • Infection; loss of sphincter control; sudden change in pressure in the abdomen • Permanent or temporary
URINARY INCONTINENCE • Stress: leakage of urine on straining. • Urge: sudden need to urinate. • Overflow: full bladder leads to leakage. • Total: no control of voiding. • Nocturnal enuresis: night time incontinence.
Urinary Incontinence • Clinical manifestations/assessment • Involuntary loss of urine • Leaking with coughing, sneezing, or lifting • Medical management/nursing interventions • Treat underlying cause • Surgical repair of bladder • Temporary or permanent catheter • Bladder training • Kegal exercises
Urinary Tract Infections • Etiology/pathophysiology • UTIs are caused by pathogens that enter the urinary tract – with or without presence of symptoms • Bacteriuria (bacteria in the urine): the most common of all nosocomial infections; often associated with urinary catheters • Common in older people r/t bladder obstruction, insufficient bladder emptying, decreased bactericidal secretions of the prostate, increased perineal soiling in women, sexual intercourse.
Urinary Tract Infections • Immobility, sensory impairment, and multiple organ impairment may increase the probability of infection in the older adult • Females more susceptible because shorter urethra and proximity to vaginal and rectal area.
Urinary Tract Infections • Gram-negative microorganisms from the GI tract (e.g. E. Coli, Klebsiella, Proteus, or Pseudomonas) commonly cause UTIs. They ascend through the urinary meatus. • Body usually keeps infections in check by washing them from the body through voiding. • If there is incomplete emptying of the bladder or reflux of urine, the retained urine supports growth of bacteria.
Urinary Tract Infections • Clinical Manifestations • Urgency, frequency, burning on urination • Microscopic or gross hematuria • Cloudy or blood-tinged urine • Nocturia • Abdominal discomfort, perineal or back pain • Sudden onset incontinence or increased incontinence • Type of infection depends on location: cystitis, urethritis, nephritis, etc.
Urinary Tract Infection • Treatment • Pharmacology: antibiotics • Common ones: • Norflaxin (Noroxin) • Nitrofurantoin (Furadantin) • Sulfisoxazole (Gantrisin) • Trimethoprim-Sulfamethoxazole ( Bactrim, Septra)
Urinary Tract Infection • Diagnostic Tests: UA, C&S
CYSTITIS • Inflammation of the urinary bladder. • Caused by escherichia coli, candida albicans, coitus, prostatitis, diabetes mellitus. • Culture, sensitivity testing, antimicrobial medication, urinary tract analgesic. • Increase fluid intake, record I & O.
CYSTITIS • Encourage fluid intake. Should drink between 3-4 liters of non-caffeinated fluid a day. • Intake of meats and whole grains makes the urine more acidic and may discourage growth of bacteria in the urinary bladder. • Drinking cranberry juice
PYELONEPHRITIS • Bacterial infection of renal pelvis, tubules, interstitial tissue of one or both kidneys. Also known as pyelitis or nephropyelitis. • Usually associated with pregnancy, chronic health problems such as DM, polycystic or hypertensive kidney disease, insult to the urinary tract such as catheterization, infection, obstruction, or trauma
PYELONEPHRITIS • Kidney becomes edematous, inflamed; blood vessels congested • Urine may be cloudy and contain pus, mucous, and blood • Small abscesses may form in the kidney • Symptoms of acute condition: chills, fever, flank pain, prostration
PYELONEPHRITIS • Repeated episodes chronic pyelonephritis and atrophy of the kidney with nephrons being destroyed. • Destruction of nephrons Azotemia: retention in the blood stream of excessive amounts of nitrogenous compounds • Treat to prevent from becoming chronic
PYELONEPHRITIS • Diagnostic tests could be: IVP, UA and C&S, CBC, BUN, serum creatinine. • Collect urine specimens before administering antimicrobials • Pharmacology: sulfonamides (Bactrim,Cipro); antipyretics if with fever, analgesics if in pain.
Immunological Disorders of the Kidney • Nephrotic syndrome • Etiology/pathophysiology • Physiologic changes of the glomeruli interfere with selective permeability • Clinical manifestations/assessment • Proteinuria; hypoalbuminemia • Generalized edema • Anorexia • Fatigue • Oliguria
Nephrotic Sydrome • http://www.youtube.com/watch?v=-ebByDNbTWI
Immunological Disorders of the Kidney • Medical management/nursing interventions • Corticosteroids • Diuretics • Diet • Low sodium • High protein
Immunological Disorders of the Kidney • Nephritis (acute glomerulonephritis) • Etiology/pathophysiology: in taking a health hx., will usually find that an infectious disease process triggers an immune response. • Frequently a beta-hemolytic streptococcus (2-3 weeks prior) • The immune response inflamed glomeruli excretion of RBCs and protein in the urine
Immunological Disorders of the Kidney • Clinical manifestations/assessment • Edema of the face – esp. around eyes • Pallor • Malaise • Anorexia • Dyspnea with exertion • Hematuria – “cola” colored frank bleeding • Changes in voiding patterns • Oliguria; dysuria
Immunological Disorders of the Kidney • Diagnostic Tests: Blood tests will usually show: elevated BUN, serum Creatinine, potassium, ESR, and antistreptolysin-O titer. • Urinalysis will show presence of RBCs, casts, and protein • Treatment includes drug therapy, diet, and rest. • Treat to prevent renal complications, cardiac complications, and complications to cerebral functioning.
Immunological Disorders of the Kidney • Medical management/nursing interventions • Antibiotics • Treat primary symptoms • Diuretics • Antihypertensives • Diet • Protein and sodium restrictions • Increase calories
Immunological Disorders of the Kidney • Pharmacology • Prophylactic antimicrobial therapy possible • Drug of choice is Penicillin • Diuretic and antihypertensive drugs may be ordered • Corticosteroids, chemotherapeutic drugs, and/or immunosuppressive drugs to control inflammatory response.
Immunological Disorders of the Kidney • Nursing Interventions • Focus is on control of symptoms and prevention of complications • Monitor level of consciousness if BUN is elevated • VS , I/O • Bedrest and fluid adjustments are guided by urine output until diuresis is adequate • Level of Activity: depends on the degree of edema, BP, proteinuria, and hematuria – all of which increase with excessive activity
Immunological Disorders of the Kidney • Patient Teaching • Nature of illness • Effect of diet and fluids on fluid balance and sodium retention • Diet: prescribed sodium and fluid restriction • Info on protein restriction/ CHO sources for energy • Medication • Pacing daily activities • Avoiding trauma and infections • S/Sx that require medical attention • Importance of medical follow up
Immunological Disorders of the Kidney • Nephritis /Chronic Glomerulonephritis) • Etiology/pathophysiology • Slow, progressive destruction of glomeruli • Commonly caused by other chronic illnesses • Diabetes mellitus • Systemic lupus erythematosus
Immunological Disorders of the Kidney • Clinical manifestations/assessment • Malaise; morning headaches • Dyspnea with exertion • Visual and digestive disturbances • Generalized edema • Weight loss • Fatigue • Hypertension • Anemia • Proteinuria
Immunological Disorders of the Kidney • Chronic Glomerulonephritis (cont.) • Medical management/nursing interventions • Same as acute glomerulonephritis • Bedrest, dietary modification, medication • Goal: prevent further renal damage; prevent cerebral and cardiac complications • Renal dialysis • Kidney transplant
Immunological Disorders of the Kidneys • Pharmacology • Antimicrobial therapy given prophylactically • Diuretics and antihypertensive drugs ordered
PHARMACOLOGY • Types of diuretics: • Thiazides: hydrochlorothiazide • Loop diuretics • Potassium sparing diuretics • Osmotic diuretics • Carbonic Anhydrase inhibitor diuretics
PHARMACOLOGY • Diuretics: • -drug that increases the secretion of urine. • -kidney disease often causes excess fluid retention • (edema). • -many different types of diuretics used for different • purposes.
PHARMACOLOGY • Antihypertensives • methydopa (Aldomet) • minoxidil ( Loniten) • hydralazine HCL ( Apresoline) • Monitor BP, pulse, postural hypotension, and K, Na,Cl, and CO2 and I&O
PHARMACOLOGY • Phosphate binding antacids: aluminum hydroxide gel ( Amphogel) • Potassium exchange: sodium polystrene • Electrolyte Replacement: calcitrol (Rocaltrol)