Chapter 45
Management of Patients With
Urinary Disorders
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Urinary Tract Infections (UTIs)
• The second most common reason for seeking health
care
• A common site of nosocomial infection
• Lower UTIs
– Cystitis
– Prostatitis
– Urethritis
• Upper UTIs
– Pyelonephritis: acute and chronic
– Interstitial nephritis
– Renal abscess and perirenal abscess
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Factors Contributing to UTI
• Function of glycosaminoglycan (GAG)
• Urethrovesical reflux
• Ureterovesical reflux
• Uropathogenic bacteria
• Shorter urethra in women
• Risk factors: see Charts 45-2 and 45-3
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Urethrovesical Reflux and
Ureterovesical Reflux
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Bladder Infection With
Long-Term Catherization
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Nursing Process—Assessment of the
Patient With a UTI
• Symptoms include pain and burning upon urination;
frequency; nocturia; incontinence; suprapubic, pelvic, or
back pain; hematuria; or change in urine or urinary
pattern
• About half of patients are asymptomatic
• Assess voiding patterns, association of symptoms with
sexual intercourse, contraceptive practices, and personal
hygiene
• Gerontologic considerations
• Assess urine, urinalysis, and urine cultures
• Other diagnostic tests
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Nursing Process—Diagnosis of the
Patient With a UTI
• Acute pain
• Deficient knowledge
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Collaborative Problems/Potential
Complications
• Sepsis
• Renal failure
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Nursing Process—Planning the Care of the
Patient With a UTI
• Major goals include relief of pain and discomfort,
increased knowledge of preventive measures
and treatment modalities, and absence of
complications
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Interventions
• Prevention: avoid indwelling catheters; exercise proper
care of catheters
• Exercise correct personal hygiene
• Take medications as prescribed: antibiotics, analgesics,
and antispasmodics
• Apply heat to the perineum to relieve pan and spasm
• Increase fluid intake
• Avoid urinary tract irritants such as coffee, tea, citrus,
spices, cola, and alcohol
• Frequent voiding
• Patient education: see Chart 45-4
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Urinary Incontinence
• An underdiagnosed and underreported problem
that can significantly impact the quality of life
and decrease independence and may lead to
compromise of the upper urinary system
• Urinary incontinence is not a normal
consequence of aging
• Risk factors: see Chart 45-5
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Types of Urinary Incontinence
• Stress
• Urge
• Reflex
• Overflow
• Functional
• Iatrogenic
• Mixed incontinence
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Patient Teaching
• 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: see Chart 45-7
• Medication teaching related to pharmacologic
therapy
• Strategies for promoting continence: see Chart 45-8
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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 age (50 to 100 mL in adults older than
age 60 due to decreased detrusor muscle activity),
diabetes, prostate enlargement, pregnancy, neurologic
disorders, and medications
• Assessment
• Nursing measures to promote voiding
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Urolithiasis and Nephrolithiasis
• Calculi (stones) in the urinary tract or kidney
• Pathophysiology
• Causes: may be unknown
• Manifestations
– Depend upon location and presence of obstruction
or infection
– Pain and hematuria
• Diagnosis: x-ray, 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
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Methods of Treating Renal Stones (cont.)
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Methods of Treating Renal Stones (cont.)
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Patient Teaching
• Signs and symptoms to report
• Follow-up care
• Urine pH monitoring
• Measures to prevent recurrent stones
• Importance of fluid intake
• Dietary teaching
• Medication teaching as needed
• See Chart 45-11
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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
• Types:
– Cutaneous urinary diversion: ileal conduit,
cutaneous ureterostomy, vesicostomy, and
nephrostomy
– Continent urinary diversion: Indiana pouch,
Kock pouch, and ureterosigmoidostomy
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Cutaneous Urinary Diversions
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Continent Urinary Diversions
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Nursing Diagnoses—Preoperative
• Anxiety
• Imbalanced nutrition
• Deficient knowledge
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Nursing Diagnoses—Postoperative
• Risk for impaired skin integrity
• Acute pain
• Disturbed body image
• Potential for sexual dysfunction
• Deficient knowledge
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