Urinary Slides NURS G170

UTI Classifications?

• Uncomplicated

-Acute Cystitis and Acute Pyelonephritis

• Asymptomatic Bacteriuria

• Health care-associated

UTI Psychosocial Effects?

Client may feel embarrassed and experience anxiety if a bathroom is not near them or if there is odor when using bathrooms

UTI age related effects?

• Adults over 55 years of age may have limited ability to perform activities of daily living such as wiping

front to back due to issues with range of motion.

• more common among post-menopausal females

• elderly clients may present as new onset confusion, new onset urinary incontinence, lack of

appetite, lethargy, and low grade or no fever

• Elderly clients are at an increased risk of developing urosepsis

UTI Clinical Presentation?

• Increased urination urgency and frequency, dysuria, hematuria, and suprapubic pain.

• If kidneys are affected: flank or back pain, nausea and vomiting, chills, and a high fever.

• If bladder is affected: bloody urine, lower abdominal pain with or without pelvic pressure, and frequency and dysuria

UTI Labs and Diagnostic Studies?

• Urine dipstick test pH for presence of hematuria, leukocyte esterase and nitrites

• Urine culture for specific causative agent

UIT Nursing Role?

• Assessment, monitoring response to treatment

• ADL assistance as needed

• Fall risk due to urgency

UTI Nursing Education?

• Use of antibiotics including importance of completing the entire antibiotic regime even if starting to feel

better as the bacteria are not yet fully gone and can reoccur

• Hydration: instructed to drink 2 to 3L of water or other fluids per day.

• females wiping after urination from front to back and urinating after sexual activity, showering rather than

baths, and emptying the bladder often

UTI Antibiotics?

• First line treatment: Trimethoprim/sulfamethoxazole is of the classification sulfonamides

• Nitrofurantoin

• Fluoroquinolones

UTI Nonopiod analgesic?

Phenazopyridine treats the discomfort, burning, and dysuria

Incontinence Pathophysiology?

Weakness of urethral sphincter or pelvic floor muscles

resulting in involuntary urinary leakage

urge incontinence?

detrusor muscle overactivity that causes bladder contraction and may also be caused by the loss of neurologic control or by irritation of the bladder

Overflow Incontinence?

Bladder cannot empty sufficiently and leakage occurs.

Other causes of Incontinence?

Pelvic organ prolapse, Pelvic mass, BPH

Incontinence Risk Factors?

• Food and drink such as alcohol, chili peppers, caffeine

• Medications such as diuretics (such as furosemide)or antihypertensive (alpha blockers such as doxazosin)

Incontinence Comorbidities?

COPD/asthma, neurological conditions

Incontinence Health Impact?

• Psychosocial: feelings of embarrassment/humiliation, appears to affect mental well-being

• Age-Related Considerations: fall risks

Incontinence Presentation?

UA, bladder scan

Incontinence Nursing Role?

• Develop client care based on primary need of client.

• Environmental Factors such as lack of toileting facilities, limited opportunity to void

• Safety Considerations - strongly correlated with increased risk for falls.

• Individual Factors includes consideration of impact on individual lifestyle and self esteem

example use of pads/briefs or bed wetting.

•advocate and communicator

• Use of nursing process based on assessment and maintaining client dignity, sociocultural

and environmental factors

Incontinence Pharmacology?

• Urinary Antispasmodics: Ditropan (oxybutynin,) - contraindicated with bowel obstruction or renal/liver impairment

• Bladder Relaxants: Mirabegron (myrbetriq) - contraindicated with hepatic or renal impairment

Incontinence Bladder Training?

- Set times for urination, such as every 4 hours. The goal is to increase this time duration by 30 min at a time

Pelvic Floor Muscle Training?

Kegel exercises - instruct the client to squeeze their pelvic muscles and hold for 3 seconds, then release. This should be repeated 10 times per session.

Retention Causes/Pathophysiology?

• Obstructive Causes: pelvic organ prolapse, Benign prostate hypertrophy (BPH), stones (renal)

• Infectious Causes: prostatitis, urethritis, UTI

• Other Causes: complications from childbirth, neurological disorders

Retention Risk Factors?

- constipation, BPH, and pelvic organ prolapse (such as a uterine prolapse),

Retention Co-Morbidites?

Neuro Disorders or Injury - Guillain-Barré syndrome, spinal cord infarction or demyelination, tumors or abscesses in the epidural area, and trauma to the spinal cord

Retention Epidemiology?

• Affects more males than females

Retention Clinical Presentation?

Painful urination, complaint of urgency, bladder

fullness after voiding, hematuria or foul-smelling urine

• Acute: lower abdominal pain/discomfort

• Chronic: may be asymptomatic or slow urine stream or reduced urge to void

Retention Lab Testing/Diagnostic Studies?

• Urine culture may need catheterization

• Bladder Scan: ultrasound for post-void residual measure.

- 200 mL = inadequate emptying, 400 mL = urinary retention

• Cystoscopy

- medical procedure that lets a doctor look inside your bladder and urethra using a thin, lighted tube called a cystoscope

Retention Treatment & Therapies?

Medications example for urinary retention related to enlarged prostrate such as 5- alpha reductase inhibitors to reduce prostate growth or alpha-blockers to relax muscle of bladder

BPH Pathophysiology?

non-cancerous growth of prostate tissue that

compresses urethra and may result in retention or blockage of urine flow

BPH Risk Factors?

Male over 50 years of age, history of first degree relative of BPH, obesity, and metabolic syndrome

BPH Co-Morbidities?

metabolic syndrome and obesity

BPH Presentation?

difficulty urinating, dysuria, nocturia, retention, increased frequency, etc

BPH Labs and Diagnostics?

Digital Rectal Exam or PSA test

BPH Lifestyle Modifications?

Diet such as decreased saturated fats, exercise, reduce

caffeine intake, smoking cessation

BPH Pharmacology?

• Alpha-blockers; Doxazosin (Cardura) & Tamsulosin (Flomax) to relax smooth muscles in prostate and bladder neck so urine passes.

• 5-alpha reductase inhibitors; Finasteride (Proscar) & Dutasteride (Avodart) for inhibit hormones that increase prostate enlargement

Transurethral Needle Ablation (TUNA)?

uses a cystoscope with curved needles delivering

radiofrequency energies creating thermal necrosis in the prostate tissues which decreases the size of the prostate

Transurethral Incision (TUIP)?

Incisions are made in the bladder neck to widen the

channel to allow for more urine to pass through the constricted area.

Photoselective vaporization of the prostate (PVP)?

uses a tissue specific laser to vaporize and destroy prostate tissue to decrease the size.

Transurethral Resection of Prostate (TURP)?

Most common surgical treatment removes pieces of prostrate through use of resectoscope is guided through tip of penis

Client Education with TURP Surgery?

- Drink 2 to 3 L of water per day to flush out the bladder and to eat high-fiber foods to decrease the risk of constipation and straining.

-Avoid heavy lifting and strenuous activities until cleared by the provider in approximately 4 to 6 weeks.

-Refrain from sexual activity for 4 to 6 weeks

- Contact the provider if a fever develops, the client is unable to urinate, or there is bright red blood or more clots in the urine

CBI Care?

Maintain intake and output by measuring the

amount of saline put into the bladder and

subtracting that amount from the output in the

catheter drainage bag to determine the amount of

urine output