chapter 63 pdf

Overview of Urinary Disorders

Learning Outcomes

• Epidemiology of Urinary Disorders: Understand prevalence and demographics.

• Clinical Manifestations: Correlation with pathophysiological processes.

• Conditions:

  • Urinary tract infections (UTIs)

  • Urolithiasis (kidney stones)

  • Incontinence

  • Bladder cancer

• Diagnosis: Understanding diagnostic results to confirm urinary disorders.

• Interprofessional Management: Discuss approaches for managing the conditions listed above.

• Nursing Care: Develop comprehensive nursing care plans.

• Patient Education: Design practical teaching plans that include pharmacological considerations, dietary changes, and lifestyle modifications.

Key Concepts

• Caring

• Cellular Regulation

• Comfort

• Elimination

• Fluid and Electrolytes

• Infection

• Medication

• Perioperative Care

• Safety

Essential Terms

• Adjuvant: A substance that enhances the effect of a drug.

• Calculus: A stone or crystal formed in the urinary system.

• Clean Intermittent Catheterization (CIC): A procedure to empty the bladder using a catheter at regular intervals.

• Cystitis: Inflammation of the bladder, often due to infection.

• Detrusor Muscle: The smooth muscle of the bladder wall.

• Dysuria: Pain or discomfort during urination.

• External Urethral Sphincter: A muscle that controls urination by relaxing or contracting.

• Functional Incontinence: The inability to reach the toilet due to physical or cognitive impairments.

• Hematogenous: Relating to blood; can refer to infections spreading through the bloodstream.

• Hematuria: Presence of blood in urine.

• Immunotherapy: A type of medical treatment that stimulates or suppresses the immune system to help treat diseases, including some cancers.

Urinary Tract Infections (UTIs)

Case Study - Heather Tomlinson

• Patient Profile: 24-year-old female with urinary frequency, dysuria, and urgency. Mild suprapubic tenderness noted upon physical examination. Urinalysis indicates cloudy yellow urine with white blood cells, nitrites, and bacteria.

Epidemiology of UTIs

• Most common bacterial infections worldwide with approximately 10 million healthcare visits and 100,000 hospitalizations annually in the U.S. The annual treatment cost is estimated between $1.6 billion and $2.14 billion. Risk factors include gender (more prevalent in females), age (increases in males with prostatic enlargement), and behaviors (sexual activity, diabetes, hygiene practices, estrogen deficiency, catheterization). Approximately 40% of hospital-acquired infections (HAIs) are catheter-associated urinary tract infections (CAUTIs).

Evidence-Based Practice

• Care bundle focused on preventing CAUTIs includes nurse-driven catheter removal algorithms, staff education on the indications for catheter use, and daily interprofessional huddles resulting in a 79% reduction in CAUTI rates.

Pathophysiology and Clinical Manifestations of UTIs

• Mechanism: Bacteria, predominantly E. coli (80% of uncomplicated UTIs), enter a sterile bladder causing inflammation. The short female urethra facilitates easier bacterial access. Types include cystitis (bladder infection) and pyelonephritis (kidney infection).

• Symptoms: Dysuria, urgency, frequency, potential hematuria, and suprapubic pain. Systemic symptoms may indicate pyelonephritis, such as fever and flank pain.

Diagnosis of UTIs

• Based on clinical presentation and urinalysis findings. A urine culture may reveal >100,000 bacteria in active infections.

Treatment of UTIs

• Medical Management:

  • First-Line Treatment: 3-day antibiotic course for uncomplicated UTIs (e.g., Bactrim DS, Cipro, Macrobid); 7-10 days for complicated UTIs based on sensitivity results. Urine culture is necessary in complicated cases. Bladder analgesics like phenazopyridine (Pyridium) may alleviate discomfort.

  • Complications: Can include drug resistance, pyelonephritis, renal abscess, and urosepsis if untreated.

• Surgical Management: Indicated for patients with anatomical problems or stones.

Nursing Management for UTIs

• Assessment and Analysis: Vital signs, looking for fever, dysuria, and malaise; physical exam may indicate suprapubic or costovertebral tenderness.

• Nursing Diagnoses: Altered urinary elimination due to irritation; knowledge deficit regarding infection; acute pain linked to bladder irritation.

• Nursing Interventions: Monitor vital signs and urinary symptoms, administer antibiotics based on cultures, provide pain relief, promote increased fluid intake and hygiene practices, and ensure completion of antibiotic regimens.

Patient Education

• Emphasize the importance of fluid intake to reduce infection risks and signs to report.

Case Study Conclusion

• Heather diagnosed with UTI and prescribed appropriate antibiotics.

Urolithiasis

• Affects approximately 8% of the U.S. population, more common in men and certain racial groups.

Pathophysiology and Clinical Signs

• Formation of stones occurs when urine becomes concentrated, causing crystals to aggregate (predominantly calcium). Symptoms include severe pain, nausea, and hematuria depending on stone location.

Management of Urolithiasis

• Medical Management: Diagnosis often involves a CT scan for a non-contrast stone survey, ultrasound, or KUB (kidneys, ureters, bladder) X-ray. Treatment typically includes trial of passage for small stones and narcotics for pain relief.

Nursing Management for Urolithiasis

• Assessment: Monitor vital signs, evaluate pain to indicate stone location.

• Actions: Administer analgesics and fluids, facilitate collection of urine strain to monitor for stone passage.

Incontinence Overview

• Affects about 13.1% of women and 5.4% of men. Defined as involuntary loss of urine, classified based on various factors including stress and urge.

Clinical Management of Incontinence

• Understanding that incontinence is not normal and often treatable is key to patient management.

Nursing Evaluation and Interventions

• Assessment: Diagnostics include urinalysis and voiding diaries for patterns, along with a comprehensive history.

• Actions: Administer medications and perform assessments of urinary systems.

Bladder Cancer Overview

• Over 80,000 cases were diagnosed in the U.S. in 2019, with smoking as a significant risk factor.

Pathophysiology

• Tumor formation linked to genetic changes in target cells.

Management of Bladder Cancer

• Medical Management: Early detection improves survival rates; thorough patient history and regular assessments are essential.

• Surgical Management: Options depend on tumor size and stage, including various excision techniques, with reconstructions needed for invasive cases.

Complications and Support Strategies

• Potential nutritional declines and emotional challenges like depression may occur after surgery.

Evaluation and Patient Outcomes

• Evaluate goals include assessing the patient’s pain management, infection control, and understanding of treatment. Reinforce patient education on adherence, seeking help, and lifestyle adjustments to support recovery and health maintenance.