Nursing Care of Patients with Disorders of the Urinary System

Nursing Care of Patients with Disorders of the Urinary System

Instructor: Cynthia Reihmann MSN, RN

Learning Outcomes

• List tests performed for the diagnosis of urologic system diseases.

• Identify laboratory tests performed to diagnose urologic system diseases.

• Identify the causes, signs and symptoms, and therapeutic measures for patients with urinary disorders.

• Plan nursing care and teaching for patients with urinary disorders.

Patient Assessment

• Patient History:

  • Collection of a comprehensive patient history, vital for identifying urinary disorders.

  • Focus on history of present illness and any previous urinary issues.

• Physical Assessment:

  • Thorough physical examination to assess urinary function.

• Voiding Patterns:

  • Examination of patient’s normal voiding patterns to identify abnormalities.

• Risk Factors:

  • Identification of risk factors that may contribute to urinary disorders.

  • Refer to Table 57-1 for detailed risk factors.

Gerontological Considerations

• Physiological Changes in the Elderly:

  • Decreased ability to concentrate urine leading to dehydration or electrolyte imbalance.

  • Decreased bladder function impacting storage and emptying.

  • Double Voiding:

  • Involves urinating, waiting a few moments, then attempting to void again.

  • Night Voiding:

  • Frequent urination during the night, affecting sleep quality.

• Medications:

  • Older adults may experience incontinence linked to pharmacological side effects.

• Cognitive and Physical Ability:

  • Assess cognitive and physical abilities that can affect bladder function.

• Changes Due to UTI:

  • Infections may present with atypical symptoms, including confusion.

  • Evidence-based practice reference: 4-1.

Diagnostic Tests

• X-ray:

  • Imaging used to visualize urinary system anatomy.

• Bladder Ultrasonography:

  • Non-invasive test to assess bladder volume and urinary retention.

• Cystoscopy:

  • Procedure for direct visualization of the bladder and urethra.

• Laboratory Tests:

  • Urinalysis (refer to Table 57-5):

  • Provides information on the chemical composition of urine and detects abnormalities.

  • Culture and Sensitivity:

  • Tests for bacterial presence and sensitivity to antibiotics.

  • 24-Hour Urine Collection:

  • Measures total urine output and concentrations of certain substances.

  • Specific Gravity:

    • Assesses urine concentration.

  • Osmolality:

    • Evaluates urine concentration more accurately.

  • Protein:

    • Elevated levels may indicate kidney disorder.

  • Creatinine Clearance:

    • Calculates GFR, indicating kidney function.

Voiding Disorder: Urinary Retention

• Definition:

  • Inability to void completely, categorized into acute or chronic.

• Neurogenic Bladder:

  • Condition where bladder dysfunction occurs due to nerve damage.

• Assessment Findings:

  • Symptoms include inability to void, distended bladder, severe pain.

  • Presence of residual urine, dribbling, signs of infection.

• Diagnostic Findings:

  • Elevated WBCs indicating infection, postvoid residual measures.

  • Investigations for obstructions: structures, urine flow, stones, tumors, cysts.

Voiding Disorder: Urinary Retention - Medical and Surgical Management

• Acute Retention (>100mL):

  • Immediate catheterization and urethral dilation necessary to relieve pressure.

• Chronic Retention:

  • Management options include:

  • Indwelling urethral catheter.

  • Suprapubic cystostomy tube.

  • Clean intermittent catheterization (preferred method).

  • Crede maneuver and manual voiding techniques.

  • Valsalva maneuver to aid voiding.

Voiding Disorder: Urinary Retention - Nursing Management

• Monitoring:

  • Record intake and output, palpate bladder, monitor voiding patterns.

• Intermittent catheterization:

  • Maintain a schedule; assess for use of coude catheterization if indicated.

• Chronic Retention Management:

  • Emphasis on catheter care to prevent infections.

• Complications:

  • Urosepsis and Catheter-Associated Urinary Tract Infections (CAUTI).

Voiding Disorder: Urinary Incontinence

• Definition:

  • The involuntary loss of urine leading to social or hygienic problems.

• Overactive Bladder:

  • Symptoms include urgency and potential incontinence.

• Psychosocial Factors:

  • Consider psychological impacts that may influence incontinence.

• Types of Incontinence:

  • Refer to Table 59-1 for classification.

• Risk Factors:

  • Include age, neurological disorders, medications, and pelvic floor weakness (refer to Box 59-2).

• Etiologies:

  • Bladder dysfunction, urethral/sphincter dysfunction, neurological conditions, obstructions, trauma, hormonal influences, medications, stimulating drinks, or foods.

Voiding Disorder: Urinary Incontinence - Medical and Surgical Management

• Correction of Underlying Cause:

  • Important to identify and treat the cause of incontinence.

• Medications:

  • Anticholinergics:

  • E.g., Oxybutynin.

  • Alpha Blockers:

  • E.g., Tamsulosin.

  • Tricyclic Antidepressants:

  • E.g., Amitriptyline.

• Devices:

  • Use of various assistive devices to aid bladder control.

• Surgery and Procedures:

  • Consider surgical options to correct structural problems affecting urinary function.

Voiding Disorder: Urinary Incontinence - Nursing Management

• Assessment:

  • Detection of skin breakdown, assessing functional causes, evaluating current medications.

• Bladder Training:

  • Program to retrain the bladder for improved control.

• Use of Barrier Garments and External Collection Devices:

  • To manage incontinence and maintain hygiene.

• Client and Family Teaching:

  • Reference materials: 59-1 and 59-2 for detailed educational content.

Infectious and Inflammatory Disorder: Cystitis

• Definition:

  • Inflammation of the urinary bladder, occurring more frequently in women than men.

• Etiology:

  • Causes include local intrusion, instrumentation, fecal contamination, benign prostatic hyperplasia (BPH), indwelling catheters, pregnancy, and sexual activity.

• Signs and Symptoms:

  • Urgency, frequency, dysuria, low back pain, cloudy or strong-smelling urine.

  • Significant atypical presentation in elderly with confusion.

• Diagnostic Tests:

  • Urinalysis:

  • To detect abnormalities and infection.

  • Culture and Sensitivity:

  • Identification of pathogens and appropriate treatments.

  • IV Pyelogram:

  • Imaging to assess the upper urinary tract.

  • Cystoscopy:

  • Visualization for clearer diagnostics.

Infectious and Inflammatory Disorder: Cystitis - Medical Management

• Antimicrobial Therapy:

  • Usage of antibiotics to treat urinary infection.

• Correction of Contributing Factors:

  • Address any underlying causes leading to cystitis.

• Remove Obstruction:

  • Surgical or procedural measures taken to alleviate urinary flow obstruction.

Infectious and Inflammatory Disorder: Cystitis - Nursing Management

• Patient and Family Teaching:

  • Encourage increased fluid intake, specifically cranberry juice for its benefits.

  • Importance of completing the full course of medication.

  • Advise avoiding caffeinated beverages and alcohol.

  • Promote healthy voiding practices to minimize recurrences.

Infectious and Inflammatory Disorder: Urethritis

• Definition:

  • Inflammation of the urethra, more common in men than in women.

• Etiology:

  • Caused by various microorganisms, including gonococci, soaps, bubble baths, sanitary napkins, sexually transmitted infections (STIs) such as Chlamydia, and trauma.

• Signs and Symptoms:

  • Discomfort, fever, discharge, and itching in the urethral area.

Infectious and Inflammatory Disorder: Urethritis - Medical Management

• Antibiotics:

  • Administration of appropriate antibiotics to resolve infection.

• Fluids and Analgesics:

  • Adequate hydration and pain relief as symptomatic treatment.

• Sitz Baths:

  • Recommended for comfort and symptom relief.

Infectious and Inflammatory Disorder: Urethritis - Nursing Management

• Reinforce Medical Management:

  • Ensure adherence to the treatment plan.

• Sterile Technique:

  • Emphasize the importance of sterile techniques during any procedures.

• Frequent Perineal Care:

  • Encourage regular cleansing to prevent infection and promote healing.

Obstructive Disorder: Bladder Stones

• Definition:

  • Stones formed within the bladder or arriving from the upper urinary tract.

• Etiology:

  • Chronic urinary retention and stasis lead to stone formation.

• Signs and Symptoms:

  • Some may be asymptomatic. Symptoms can include pain, hematuria, cloudy or dark urine, difficulty initiating urination, and feeling a residual sensation after voiding.

• Diagnostic Tests:

  • Urinalysis:

  • To check for blood and infection indicators.

  • Blood Chemistry and 24-Hour Urine:

  • Assess for stone-forming substances.

  • CT Scan, KUB (Kidneys, Ureters, Bladder):

  • Imaging studies to locate stones.

  • Ultrasound and Cystoscopy:

  • Further evaluation of bladder stones.

Obstructive Disorder: Bladder Stones - Medical and Surgical Management

• Procedure Options:

  • Cystolitholapaxy or suprapubic incision to remove the stones.

• Dietary Changes:

  • Recommended adjustments to prevent further stone formation.

Obstructive Disorder: Bladder Stones - Nursing Management

• Assessment:

  • Regular monitoring for hematuria, presence of stones, and pain levels.

• Patient Education:

  • Importance of hydration and dietary adherence to prevent recurrence.

Bladder Cancer

• Pathophysiology and Etiology:

  • First signs may include hematuria; bladder cancer is most common in individuals with a history of tobacco use, environmental exposures, bacterial infections, family history, and those with high urinary pH or high cholesterol intake.

• Signs and Symptoms:

  • Urine changes, early signs related to UTIs, and later signs may suggest metastasis.

• Diagnostics:

  • Cystoscopy:

  • Used for direct visualization and biopsy of tumors.

  • Biopsy:

  • Confirms diagnosis and tumor characteristics.

Bladder Cancer - Medical and Surgical Management

• Management Approaches:

  • Determined by the grade and stage of the cancer, including resection, cystoscopy, use of antineoplastic drugs, photodynamic therapy, and radiation therapy.

• Cystectomy:

  • Surgical removal of the bladder may be required in advanced cases.

• Urinary Diversions:

  • Surgical procedures creating a new pathway for urine excretion.

Bladder Cancer - Nursing Management

• Presurgical Care:

  • Comprehensive history collection, provision of emotional support, and education about the procedure.

• Post-surgical Urinary Diversion Care:

  • Monitor for urine or stool leakage, assess renal function, observe for signs of peritonitis, and ensure skin and stoma integrity.

  • Monitoring:

  • Close observation of NG tube function if present and care guidelines for stoma management.

• Client and Family Teaching:

  • Reference material: 59-4 for post-operative education.