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Medical & Surgical management of Urinary retention. pg. 940
- Medical: Chronic retention is manged by permanent drainage with urethral catheter, suprapubic cystostomy tube; clean intermittent catheter (CIC); use of Crede's maneuver or manual voinding or abdominal strain (vasalva maneuver voiding)
- Surgical: chronic retention is manged by permanent drainage with a urethral catheter, suprapubic cystostomy tube (a catheter inseerted through the abdominal wall directly itno the bladder)
- Catheterization of the bladder carries the risk of bladder stones, renal disease, bladder infetion, and urosepsis, a serious systemic infection from microorgansims in the urinary tract invading the bloodstream.
Nursing management of urinary incontinence. pg. 944
- Anticholinergic Drugs: reduces bladder spasiticity & involuntary bladder contractions
- *oxybutynin chloride (Ditropan)
- *tolterodine tartrate (Detrol)
- *phenoxybenzamine hydrochloride (Dibenzaline); which may be useful in treating problems with sphincter control.
- *bethanechol (Urecholine); helps to increase contraction of the detrusor muscle, which assists with emptying of the bladder.
Nursing management of urinary incontinence. pg. 944
- Tricyclic Antidepressant medications: are useful in treating incontinence beacuse they decrease bladder contractions and increase bladder neck resistance
- *amitriptyline (Elavil)
- *nortriptyline (Pamelos)
- *amoxapine (Asendin)
What is Functinal Incontinence?
client has intact function of the lower urinary tract but cannot identify the need to void or ambulate
What is Overflow Incontinence?
involuntary loss of urine related to overdistended bladder; clients void small amounts frequently; dribbling
What is Reflex Incontinence?
bladder has uninhibited contradictions; involuntary reflexes produce spontaneous voiding, with partial or complete loss of sensation of bladder fullness or urge to void.
What is Stress Incontinence?
- client has involuntary loss of urine from intact urethra, which results from sudden increases in intra-abdominal pressure such as with sneezing or coughing.
- RX: pseudoephedrine (Sudafed); may help stress incontinence
What is Urge incontinence?
client experiences urge to void but cannot control voiding in time to reach a toilet.
Nursing management of client after urethral dilatation.
Sitz baths and non-narocotic analgesics may relieve discomfort.
Pathophysiology of urinary bladder malignancy pg. 952
- Most common tumors in the bladder is transitional cell carcinoma.
- Thought to be caused by:
- -cigarette smoking and second-hand smoke
- -recurrent or chronic bacterial infections of the urinary tract
- -bladder stones
- The tumors are classified as papillary or nonpapillary.
- Papillary lesions are superficial and estend outward from the mucosal layer. Nonpaillary tumors are solid growths that grow inward, deep into the bladder wall.
S/SX of urinary bladder malignant tumor?
- common first symptom is painless hematuria, than
Medical management on urinary bladder malignant tumor
small, superficial tumors may be rmoved by cutting (resection) or coagulation (fulguration) with a transurethral resectoscope (the same instrument used in a transurethral resection of the prostate.) Bladder tumors removed in this manner have a high incidence of recurrence: consequently, a cystoscopic examination is performed every 2 to 3 months. Clients having no recurrence of the tumor for at least 1 year require cystoscopicc examinations every 6 months for the rest of their lives so that recurrence of the tumor or a new malignant growth can be detected early.
Surgical Management of urinary bladder malignant tumor
(surgical removal of the bladder) and a urinary diversion procedure often are necessary when the tumor has penetrated the muscle wall.
Nursing management Pre-op of Cystectomy
the nurse obtains a complete medical, drug, and allergy hx on admission and ask the client or family member to describe all symptoms.
Urinary diversion; Ileal Conduit how do you take care of it?
The nurse uses gauze pads to clean mucus away from the stoma. Because the intestinal anastomosis can leak fecal material or the ileal conduit may leak urine itn the peritoneal cavity, he/she observes for and promply reports symptoms of peritonitis (e.g., abdominal tenderness or distention, fever, severe pain)
Urinary diversion; Ureterosigmidostomy how do you take care of it?
Its a catheter inserted in the rectum to drain urine continuously. The nurse teaches the client exercises to improve sphincter control. Once good control is achieved, th nurse instructs the client to void (rectally) every 2 hr.s to prevent reabsorption of fluid and electrolytes. Clients must NEVER HAVE ENEMAS, suppositories, or laxatives.
Risk for ineffective sexuality patterns related to erectile dysfunction (male) or dyspareunia (female)?
Discuss alternatives to sexual intercourse such as closeness nad giving pleasure to the partner.
What is Residual urine?
urine remained in a bladder at the end of the urination. More than 50 mL is abnormal. It can cause cystitis because of bacteria form residual urine.
What are voiding disfunctions?
urinary retention and urinary incontinence
Nursing guidelines 59-1 applying a condom catheter pg. 940
- *Assess the penis for swelling or skin breakdown.
- *Wrap the adhesive strip in an upward spiral about the penis, taking care not to wrap it tightly.
- *Secure the upper end of the unrolled sheath to the skin wiht a second strip of adhesive or a Velcro strap, but not so tightly as to interfere with circulation.
- *Connect the catheter drainage tip to a drainage bag. *Remove or chage the condom catheter daily, or more often as needed, to check skin integrity.
- *Wash the catheter and colleciton bag with mild soap and water and rinse with a 1:7 vinegar-and water solution.
How to increase muscle tone and voluntary control.
- With Kegel exercise.
- Initial instruction: sit or stand with legs slightly apart
- Hold this position of contraction for 5 secons.
- Repeat exercises 5 to 6 times, increasing slowly to 25 times
Client and family teaching 59-2 Managing urinary incontinence
control odors by frequent cleansing of the perineum, changing clothes and incontinence briefs (e.g., attends, depends) when they become wet, and using an electric room deodorizer.
Assessment findings and medical & nursing management of cystitis.
- Cystitis: imflammation of the urinary bladder; usually caused by bacterial infection.
- S/SX: urgency to void
- Medical Manag: antimicrobial Therapy; trimethroprim-sulfamethoxale (Beactrim, septra)
- Nsg. Manag: advise to drink extra fluids
DX confirmation on cystitis (IC).
A biopsy of the bladder mucosa reveals an inflammatory process with scarring and hemorrhagic areas, and confirms the diagnosis.
How to avoid cystitis?
Void after sexual intercouse
What is the purpose of a midstream catch & how do we work with someone with it?
- Purpose:To obtain a meaningful report on a urine sample, it is importantthat the urine specimen be collected properly. While a regularlyvoided specimen is acceptable for routine urinalysis, a midstreamcollection is preferred. For collection of a urine culture, amidstream collection must be performed. The following procedure can ensure that the results are accurate.
- *Spread labia with one hand and wipe inner fold from front toback. Discard towelette and repeat with second and third.
ATB's for UTI's
- nalidixic acid
Box 59-3 Signs of abstructed urine flow. pg 949
- Straining to empty bladder
- feeling that the bladder does not empty completely
- weak stream
- overflow incontinence
- bladder distention
Nutrition notes 59-1the client with bladder stones
- Encourage clients with bladder stones to drink 8 oz of fluid hourly during waking hr.s, or at least 2 L of fluid daily
- A low purine diet, used for uric acid stones
- Clients with calcium oxalate stones should consume adequate calcium (e.g., 3 cups of milk daily) Reduce sodium intake can lower calcium intake
S/Sx of urinary bladder malignancy
- Common 1st symptom is painless hematuria
- next UTI=fever, dysuria, urgency, and frequency
Pathophysiology and etiology of prostate cancer. pg 874
The cause is unknown but there seems to be a relationship with increased testosterone levesl and diet that is high in fat.
Assessment findings in prostate cancer.
- DRE detects a prostatic nodule.
- A PSA > than 4 ng/mL =is the basis for performing more definitive diagnostic procedures, and a PSA >