Chapter 55
Management of Patients With
Urinary Disorders
Urinary Tract Infections
Most common reason Upper UTI
health care o Pyelonephritis: acute
Common site of and chronic
acquired infection o Interstitial nephritis
Lower UTI
o Renal abscess and
o Cystitis perirenal abscess
o Prostatitis
o Urethritis
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Factors Contributing to UTI
Bacterial invasion of the urinary tract
Urethrovesical reflux, ureterovesical reflux
Uropathogenic bacteria
Shorter urethra in women
Risk factors
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Urethrovesical and Uretherovesical Reflux
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Nursing Process: The Care of the Patient
With a UTI—Assessment
Pain, burning upon urination, frequency, nocturia,
incontinence, hematuria
About half are asymptomatic
Association of symptoms with sexual intercourse,
contraceptive practices, and personal hygiene
Gerontologic considerations
Assessment of urine, urinalysis, and urine cultures
Other diagnostic tests
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Nursing Process: The Care of the Patient
With a UTI—Diagnoses
Acute pain related to infection
Deficient knowledge about:
o Factors predisposing patient to infection and
recurrence
o Detection and prevention of recurrence
o Pharmacologic therapy
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Collaborative Problems and Potential
Complications
Sepsis (urosepsis)
Acute kidney injury
Chronic kidney disease
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Nursing Process: The Care of the Patient
With a UTI—Planning
Major goals may include:
o Relief of pain and discomfort
o Increased knowledge of preventive measures and
treatment modalities
o Absence of complications
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Interventions
Relieving pain
Medications as prescribed: antibiotics, analgesics, and
antispasmodics
Application of heat to the perineum to relieve pain and
spasm
Increased fluid intake
Avoidance of urinary tract irritants such as coffee, tea,
citrus, spices, cola, and alcohol
Frequent voiding
Patient education
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Question #1
Is the following statement true or false?
Older adult patients often lack the typical symptoms
of UTI and sepsis
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Answer to Question #1
True
Older adult patients often lack the typical symptoms
of UTI and sepsis
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Urinary Incontinence
Affects more than 25 million adults in the United States
Underdiagnosed and underreported
Affects women and men
Risk factors: refer to chart 55-6
Symptom of many possible disorders
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Types of Urinary Incontinence
Stress
Urge
Functional
Iatrogenic
Mixed incontinence
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Patient Education #1
Urinary incontinence is not inevitable and is treatable
Management takes time (provide encouragement and
support)
Develop and use a voiding log or diary
Behavioral interventions
Medication education related to pharmacologic therapy
Strategies for promoting continence
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Question #2
Is the following statement true or false?
Urinary incontinence is inevitable and is not treatable
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Answer to Question #2
False
Urinary incontinence is not inevitable and is treatable
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Urinary Retention
Inability of the bladder to empty completely
Residual urine: amount of urine left in the bladder after
voiding
Causes include:
o Adults 60 years and older may have 50 to 100 mL of
residual urine remaining in the bladder after voiding
o Postoperative spasms
o Diabetes, prostatic enlargement, urethral pathology,
trauma, pregnancy, neurologic disorder
o Medications
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Urolithiasis and Nephrolithiasis
Calculi (stones) in the urinary tract or kidney
Pathophysiology
Causes: may be unknown
Depends on location and presence of obstruction or
infection
Pain and hematuria
Diagnosis: radiography, blood chemistries, and stone
analysis; strain all urine and save stones
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Potential Sites of Urinary Calculi
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Methods of Treating Renal Stones #1
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Methods of Treating Renal Stones #2
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Methods of Treating Renal Stones #3
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Patient Education #2
Signs and symptoms to report
Follow-up care
Urine pH monitoring
Measures to prevent recurrent stones
Importance of fluid intake
Dietary education
Medication education as needed
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Urinary Tract Cancers
Bladder, kidney and renal pelvis, ureters, other structures
such as prostrate
Cancer of bladder:
o More common after age 55 years
o Leading cause of death
o Smoking increases risk 50%; refer to Chart 55-13
S/S: visible painless hematuria; pelvic or back pain may
indicate metastasis
Diagnosis: ureteroscopy, excretory urography, CT, MRI,
ultrasonography
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Bladder Cancer Management
Medical management: depends on the grade and stage of
the tumor
o Chemotherapy
o Radiation
Surgical management:
o Transurethral resection or fulguration
o Followed by bacille Calmette–Guérin (BCG) treatment
o Cystectomy
o Urinary diversion
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Nursing Management of Bladder Cancer
Immediate postop: monitor urine volume hourly
Provide stoma and skin care
Test urine and care for ostomy
Encourage fluids and relieve anxiety
Patient education about self-care: managing ostomy
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Urinary Diversion
Reasons: bladder cancer or other pelvic malignancies,
birth defects, trauma, strictures, neurogenic bladder,
chronic infection or intractable cystitis; used as a last
resort for incontinence
Cutaneous urinary diversion: ileal conduit, cutaneous
ureterostomy, vesicostomy, nephrostomy
Continent urinary diversion: Indiana pouch, Kock pouch,
uretherosigmoidostomy
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Cutaneous Urinary Diversions
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Continent Urinary Diversions
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Nursing Diagnosis: Preoperative
Anxiety
Imbalanced nutrition
Deficient knowledge
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Nursing Diagnosis: Postoperative
Risk for impaired skin integrity
Acute pain
Disturbed body image
Potential for sexual dysfunction
Deficient knowledge
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