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• Risk factors for urinary problems
• Health promotion techniques
• Teaching plan
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Inflammation of bladder
• Most commonly caused by bacteria moving up urinary tract
from external urethra to bladder
• Catheters: high risk factor in developing nosocomial cystitis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Frequent urge to urinate
Dysuria
Urgency
Urinalysis needed when testing for leukocyte esterase
Organism type confirmed by urine culture
Other diagnostic assessments
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Inflammation of urethra causing symptoms similar to UTI
• Role of estrogen in treating estrogen-depletion urethritis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Narrowed areas of urethra
• Most common symptom—obstruction of urine flow
• Surgical treatment by urethroplasty—best chance of long-term
cure
• Dilation of urethra (temporary measure)
• Urethroplasty
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Assessment questions
• Plans of care vary; based upon incontinence type
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Interventions:
• Journaling, behavioral interventions, diet modification, pelvic floor
(Kegel) exercises
• Diet therapy
• Drug therapy—estrogen
• Surgery
• Vaginal cone therapy
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Interventions:
• Drugs—anticholinergics, antihistamines, others
• Diet therapy—avoid caffeine and alcohol
• Behavioral interventions—exercises, bladder training, habit
training, electrical stimulation
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Also known as reflex incontinence
• Interventions:
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Surgery to relieve obstruction
Intermittent catheterization
Bladder compression, intermittent self-catheterization
Drug therapy
Behavioral interventions
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• Interventions:
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Treatment of reversible causes
Urinary habit training (if incontinence not reversible)
Final strategy—containment of urine, protection of patient’s skin
Applied devices
Urinary catheterization
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Presence of calculi (stones) in urinary tract
• Assessment
• Pain-relief measures:
• Drug therapy
• CAM therapies
• Lithotripsy
• Surgical management
• Minimally invasive surgery
• Open surgical procedures
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Uses sound, laser, or dry shock wave energy to break stones
into small fragments
• Patient undergoes conscious sedation
• Topical anesthetic cream applied to skin site
• Continuous monitoring by ECG
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Malignant tumors of urothelium, lining of transitional cells in
kidney, renal pelvis, ureters, urinary bladder, and urethra
• Physical assessment
• Clinical manifestations
• Psychosocial assessment
• Diagnostic assessment
• Postsurgical nursing care interventions
• Teaching plan upon discharge
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Causes may be from injury to lower abdomen or
stabbing/gunshot wounds
• Surgical intervention required
• Fractures should be stabilized before bladder repair
• Nursing interventions prior to surgical intervention
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A 78-year-old woman is at her annual checkup with her health care
provider. She seems very embarrassed about asking if it’s normal to
“leak” urine when coughing or laughing, especially at her age. She has
given birth to five children.
What is the nurse’s best response to this question?
A. “Involuntary loss of urine or incontinence is not a normal
consequence of childbirth or aging.”
B. “As we get older, our bodies do not function as well as when we
were younger.”
C. “The unintentional loss of urine can be temporary or permanent
depending on the cause.”
D. “The most likely cause of your urine leakage is obstruction of the
urethra with a kidney stone.”
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Later in the visit, the patient asks what could have caused
her stress incontinence. What is the nurse’s most accurate
reply?
“It could be due to a loss of awareness that urination is
about to occur.”
B. “It most likely is related to drinking too many caffeinated
beverages.”
C. “Do you take any diuretics for your blood pressure?”
D. “It may be due to weakening of the bladder neck support
that is associated with childbirth.”
A.
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Before going home, the patient asks what can be done to fix her problem
with urine leaking. Which teaching points should the nurse be sure to
include? (Select all that apply.)
A.
B.
C.
D.
E.
First, keep a diary of episodes of incontinence.
Collection devices can be used during treatment.
Kegel exercises can help strengthen the muscles that prevent urine
leakage.
You may want to avoid caffeine and other bladder irritants.
Be sure to drink less than 2 L of fluids every day, especially in the
evening.
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The patient says that she vaguely recalls advice from her OB/GYN
about Kegel exercises, but does not recall how to perform them.
1.
2.
How should the nurse describe this procedure?
How many repetitions of this exercise should be
recommended that she perform?
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The patient says that a friend mentioned taking antidepressant drugs
when she had a similar problem, and asks if this could help herself. What
is the nurse’s best response?
A.
B.
C.
D.
“Estrogen may be helpful because it can improve vaginal and
urethral blood flow.”
“Tricyclic antidepressants such as imipramine have been helpful in
relieving urinary incontinence.”
“An antispasmodic drug such as oxybutynin would probably be
better.”
“Your problem may be different from your friend’s, requiring a
different solution.”
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
21
A 21-year-old male reports burning and difficulty with
urination. What priority question would obtain information
about the patient’s chief complaint?
A.
B.
C.
D.
“How long have you had these symptoms?”
“Do you have low back pain?”
“Are you sexually active?”
“Have you had a fever in the past 24 hours?”
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Which patient is at greatest risk of developing a kidney
stone?
African-American female with family history of kidney
stones
B. Overweight Caucasian male
C. Female with history of frequent urinary tract infections
D. Hispanic/Latino female who eats animal protein at every
meal
A.
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Once an indwelling urinary catheter is placed, how long
before bacterial colonization begins?
12 hours
B. 24 hours
C. 48 hours
D. 72 hours
A.
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