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Interventions For Clients With Urinary Problems

This document discusses various urinary problems including cystitis, urethritis, urinary incontinence, urolithiasis, and bladder cancer. It covers signs and symptoms, diagnostic assessments, drug and nonsurgical management, and surgical procedures and postoperative care for each condition. Assessment involves patient history, urinalysis, and other tests. Management depends on the specific condition but may include antibiotics, analgesics, behavioral interventions, surgery, stents, catheters, and lifestyle changes.

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104 views31 pages

Interventions For Clients With Urinary Problems

This document discusses various urinary problems including cystitis, urethritis, urinary incontinence, urolithiasis, and bladder cancer. It covers signs and symptoms, diagnostic assessments, drug and nonsurgical management, and surgical procedures and postoperative care for each condition. Assessment involves patient history, urinalysis, and other tests. Management depends on the specific condition but may include antibiotics, analgesics, behavioral interventions, surgery, stents, catheters, and lifestyle changes.

Uploaded by

kimberlyrwarren8817
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Chapter 73

Interventions for Clients with


Urinary Problems
Cystitis

 Inflammation of the bladder


 Most commonly caused by bacteria that
move up the urinary tract from the
external urethra to the bladder, viruses,
fungi, or parasites
 Catheter-related infections common
during hospital stay
Incidence and Prevalence
of Cystitis
 Frequenct urge to urinate
 Dysuria
 Urgency
 Urinalysis needed when testing for
leukocyte esterase
 Type of organism confirmed by urine
culture
 Other diagnostic assessments
Drug Therapy

 Urinary antiseptics
 Antibiotics
 Analgesics
 Antispasmodics
 Antifungal agents
 Long-term antibiotic therapy for chronic,
recurring infections
Nonsurgical Management

 Urinary elimination
 Diet therapy includes all food groups,
calorie increase due to increase in
metabolism caused by the infection,
fluids, possible intake of cranberry juice
preventively
 Other pain relief measures, such as warm
sitz baths
Urethritis

 Inflammation of the urethra that causes


symptoms similar to urinary tract
infection
 Caused by sexually transmitted
infections; treat with antibiotic therapy
 Estrogen vaginal cream for
postmenopausal women
Urethral Strictures

 Narrowing 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
Urinary Incontinence

 Five types of incontinence include:


 Stress
 Urge
 Mixed
 Overflow
 Functional
Collaborative
Management
 Assessment includes a thorough client
history.
 Clinical manifestations for urethral or
uterine prolapse
 Laboratory assessment by urinalysis
 Radiographic assessment, especially
before surgery
 Other diagnostic assessments
Stress Urinary
Incontinence
 Interventions include:
 Keeping a diary, behavioral interventions, diet
modification, and pelvic floor exercises
 Drug therapy: estrogen
 Surgery
 Collection devices and vaginal cone weights
Surgical Management

 Preoperative care
 Operative procedure
 Postoperative care
 Assess for and intervene to prevent or detect
complications.
 Secure urethral catheter.
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
Reflex Urinary
Incontinence
 Interventions include:
 Surgery to relieve the obstruction
 Intermittent catheterization
 Bladder compression and intermittent self-
catheterization
 Drug therapy
 Behavioral interventions
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 client’s skin
 Applied devices
 Urinary catheterization
Urolithiasis

 Presence of calculi (stones) in the urinary


tract
 Collaborative management
 History of urologic stones
 Clinical manifestations
 Laboratory assessment
 Radiographic assessment
 Other diagnostic tests
Interventions
 Drug therapy
 Opioid analgesics—often used to control
pain
 Nonsteroidal anti-inflammatory drugs
 Pain medications at regular intervals
 Constant delivery system
 Spasmolytic drugs—important for relief of
pain
 Complementary and alternative therapy
Lithotripsy

 Extracorporeal shock wave lithotripsy


uses sound, laser, or dry shock wave
energy to break the stone into small
fragments.
 Client undergoes conscious sedation
 Topical anesthetic cream is applied to
skin site of stone.
 Continuous monitoring is by
electrocardiography
Surgical Management

 Minimally invasive surgical procedures


 Stenting
 Retrograde ureteroscopy
 Percutaneous ureterolithotomy and
nephrolithotomy
 Open surgical procedures
 Preoperative care
 Operative procedure
Postoperative Care

 Routine postoperative care procedures for


assessment of bleeding, urine, and
adequate fluid intake
 Strained urine
 Infection prevention
 Drug therapy
 Diet therapy
 Prevention of obstruction
Drug Therapy
 Drug selection to prevent obstruction depends on what is
forming the stone:
 Calcium
 Thiazide Diuretics
 Oxalate
 Zyloprim
 Pyridoxine (B6)
 Uric acid
 Zyloprim
 Potassium Citrate to alkalinize the urine
 Cystine
 Capoten
Urothelial Cancer
 Collaborative management
 Assessment
 Diagnostic assessment
 Bladder washes

 Bladder biopsy

 Nonsurgical management
 Prophylactic immunotherapy
 Intravesical instillation with BCG
 Chemotherapy
 Multi agent chemotherapy for mets
 Radiation therapy
 For prolongation of life
Surgical Management

 Preoperative care
Surgical Management

 Operative procedures
Surgical Urinary Diversion
Incontinent Urinary Diversion
Surgical Management

 Postoperative care includes:


 Collaboration with enterostomal therapist
 Kock’s pouch
 Penrose drain
 Medena catheter
 Neobladder
 Early post -op drain for irrigation
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.

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