Chapter 69

1. Chapter 69 Care of Patients with Urinary Problems

2. Cystitis • Inflammation of the bladder • Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder • Catheters are the most common factor placing patients at risk for UTIs in the hospital setting

3. Cystitis (Cont’d) • Frequent urge to urinate • Dysuria • Urgency • Urinalysis needed when testing for leukocyte esterase • Type of organism confirmed by urine culture • Other diagnostic assessments

4. Drug Therapy • Urinary antiseptics • Antibiotics • Analgesics • Antispasmodics • Antifungal agents • Long-term antibiotic therapy for chronic, recurring infections

5. Nonsurgical Management • Urinary elimination • Diet therapy includes all food groups, calorie increase because of increase in metabolism caused by the infection, fluids, possible intake of cranberry juice preventively • Other pain-relief measures, such as warm sitz baths

6. Urethritis • Inflammation of the urethra that causes symptoms similar to urinary tract infection • Patient-centered collaborative care

7. Urethral Strictures • Narrowed areas of the urethra • Most common symptom—obstruction of urine flow • Surgical treatment by urethroplasty—best chance of long-term cure • Dilation of the urethra—a temporary measure • Urethroplasty

8. Urinary Incontinence • Five types of incontinence are: • Stress incontinence • Urge incontinence • Mixed incontinence • Overflow incontinence • Functional incontinence

9. Collaborative Management • Patient history • Physical assessment • Laboratory assessment • Imaging assessment • Other diagnostic assessment

10. Stress Urinary Incontinence • Interventions include: • Keeping a diary, behavioral interventions, diet modification, and pelvic floor (Kegel) exercises • Diet therapy • Drug therapy—estrogen • Surgery • Vaginal cone therapy

11. Surgical Management • Preoperative care • Operative procedure • Postoperative care: • Assess for and intervene to prevent or detect complications. • Secure urethral catheter.

12. Urge Urinary Incontinence • Interventions include: • Drugs—anticholinergics, possibly antihistamines, others • Diet therapy—avoid caffeine and alcohol • Behavioral interventions—exercises, bladder training, habit training, electrical stimulation

13. Reflux Urinary Incontinence • Interventions include: • Surgery to relieve the obstruction • Intermittent catheterization • Bladder compression and intermittent self-catheterization • Drug therapy • Behavioral interventions

14. Functional Urinary Incontinence • Interventions include: • Treatment of reversible causes • If incontinence is not reversible, urinary habit training • Final strategy—containment of urine and protection of the patient’s skin • Applied devices • Urinary catheterization

15. Community-Based Care • Home care management • Health teaching • Health care resources

16. Urolithiasis • Presence of calculi (stones) in the urinary tract • Assessment • Pain-relief measures: • Drug therapy • Complementary and alternative therapy • Lithotripsy • Surgical management • Minimally invasive surgery • Open surgical procedures

17. Lithotripsy • Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to break the stone into small fragments. • Patient undergoes conscious sedation. • Topical anesthetic cream is applied to skin site of stone. • Continuous monitoring is by electrocardiography.

18. Urothelial Cancer • Malignant tumors of the urothelium, the lining of the transitional cells in the kidney, renal pelvis, ureters, urinary bladder, and urethra • Physical assessment • Clinical manifestations • Psychosocial assessment • Diagnostic assessment

19. Surgical Management • Preoperative care • Operative procedures • Postoperative care includes: • Collaboration with enterostomal therapist • Kock’s pouch • Neobladder

20. Community-Based Care • Health teaching • Health care resources

21. 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 before bladder repair.