Exam 2 Urinary Disorders

Question 1

Post-Void Residual

Answer 1

When someone urinates, but then we check the bladder to see how much is left. It’s ok to have some left in the bladder.

Question 2

Want patients to drink water! Why?

Answer 2

Dehydration can lead to incontinence which can lead to a UTI

Question 3

Manifestations of UTI?

Answer 3

Smell/straw colored

Question 4

Prevent?

Answer 4

Wipe front to back
Evacuate bowels regularly
Try not to get constipated
Void after intercourse
Cloudy/Stinky urine
Hesitant urination
Fever if it gets really bad

Question 5

Catheter Care

Answer 5

PER SHIFT (qshift)
Bag hanging below bladder
No loops in tubing
Red seal closed 
Stat lock on leg
Confused older adults = s/sx may not be present
No lotions/powders down there.

Question 6

**Red seal on bag?

Answer 6

Don’t want to disconnect this d/t sterility. If flushing for the sake of a clog, this requires an order.

Question 7

Pylonephritis

Answer 7

Kidney infection assoc. with bladder.

Req. outpatient but sometime inpatient.

Question 8

Stones

Answer 8

SO painful.
Fevers
Vomiting

Risk:
Dehydration/warm climate
Certain medications
Diuretics

Prevention:
Drink water/drink water

IF stone is too big; lithotripsy: ultrasound waves which break up stones.

Question 9

Stones

Answer 9

SO painful.
Fevers
Vomiting

Risk: 
Dehydration/warm climate
Certain medications
Diuretics
Having had them before

Prevention:
Drink water/drink water

IF stone is too big; lithotripsy: ultrasound waves which break up stones.

Question 10

Bladder retraining program

Answer 10

q2-3 hrs (also with incontinent patients)

-help retrain bladder

Question 11

Incontinence

Answer 11

Not a natural consequence of aging.

Question 12

Incontinence Effects

Answer 12

Don’t want to go places…

Question 13

Incontinence Etiology

Answer 13

-Pressure exceeds closure of sphincter

Question 14

Diagnosis of incontinence?

Answer 14

DRIP!

D-delirium/dehydration/depression
R-restricted mobility and impaction
I-Infection/inflame/impaction
P=polyuria/polypharmacy

Ability to get to bathroom?
Cognitive malfunction
Feel urges?
Assess pelvic floor muscles by doing internal exam...
Urinalysis
Post Void Residual (PVR)
Imaging of upper urinary tract.

Question 15

Nursing Management of Incontinence

Answer 15

Make sure they're drinking enough fluids!
Take pt. to bathroom every two hours.
Encourage cessation of smoking.
Stool softeners/fiber!
Pelvic Floor Muscle training
Use absorbant purchased products.

Question 16

UTIs Etiology

Answer 16

Both complicated and uncomplicated.
Uncomplicated - only bladder
Complicated - goes up past bladder.

• Not urinating frequently
• Peristalsis (urethra peristalsis activity)
• Intercourse can cause infection
• Blood Borne infection
• PH in bladder
• High urea in bladder

Who @ Risk for:
Antibiotic resistance
Repeated infections.

Question 17

UTI Manifestations

Answer 17

-Pain when urinating
-Frequency urinating
-Intermittency
-Post Void Dribbling
-Urinary Retention
-Nocturia
-Urgency
-Cloudy
(Fatigue/Anorexia)

BUT… older adults don’t have these manifestations. They are lethargic/confused!

Question 18

UTI Diagnose

Answer 18

• dipstick
• culture
• clean catch
• catheterize if can’t do clean catch

Question 19

UTI planning

Answer 19

• Drinking fluid
• Urinate often
• 150lb person… 60oz per day
• Wiping from front to back
• Incontinent people need to be cleaned well!
• No harsh soaps down there
• Report!! S/Sx of UTI
• Fluid flushes out bacteria and calms bladder down.
• Avoid caffeine/alcohol/citrus juices

Question 20

Difference between Upper and Lower UTI??

Answer 20

• Upper = systemic sx/fever/chills
• Lower = local to urinary system and issues with urination and retention.

What is unique to some patient populations? Older adults present with cognitive impairment!!