Care of Patients with urinary problems ch 69

Question 1

reason UTI risk increases with age

pg 1492

Answer 1

Skin and mucous membrane changes from a lack of estrogen for women

prostate disease increases risk for UTIs in men

Question 2

major preventative strategy used in health care to reduce cystitis

Answer 2

reducing use of indwelling urinary catheters

use strict sterile technique during insertion

discontinue as soon as possible

Question 3

minimum fluid intake to prevent cystitis, if there are no other health concerns

Answer 3

1.5 to 2.5 Liters

Question 4

common clinical manifestations of UTI

pg 1493

Answer 4

frequency
urgency
dysuria
hesitancy or difficult in initiating urine
low back pain
nocturia
incontinence
hematuria
pyuria
bacteriuria
retention
suprapubic tenderness or fullness
feeling of incomplete bladder emptying

Question 5

rare clinical manifestations of UTI

pg 1493

Answer 5

fever
chills
n/v
malaise
flank pain

Question 6

clinical manifestations that may occur in older adult with UTI

Answer 6

increasing mental confusion or frequent unexplained falls
sudden onset of incontinence or a worsening of incontinence
fever
increased HR
increased RR
hypotension
loss of appetite, nocturia, dysuria

Question 7

“kind of know” drugs for UTIs

pg 1495

Answer 7

Bactrim (trimethoprim/sulfamethoxazole)
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
amoxicillin (Amoxil)
Augmentin (amoxicillin/clavulante)
cefadroxil (Duricef)

Question 8

nursing interventions for sulfonamides

Bactrim (trimethoprim/sulfamethoxazole)

Answer 8

ask about drug allergies, especially sulfa drugs (allergies to sulfa drugs are common and may require chaining drug therapy)

drink full glass of water with each dose and drink at lease 3L daily (sulfamethoxazole can form crystals in kidney tubules)

keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)

Question 9

nursing interventions for fluroquinolones

ex: cipro, levaquin

Answer 9

do not take within 2 hrs of antacid (can interfere with drug absorption)

teach pt how to take pulse, monitor it twice daily (drug can induce cardiac dysrhythmias)

keep out of sun or wear protective clothing and use sunscreen (increases skin sensitivity to sun and can cause sunburns)

Question 10

nursing interventions for penicillins

Answer 10

ask about drug allergies
take with food (can cause GI upset)
call provider if watery diarrhea develops (can cause colitis)
use additional birth control (reduces effectiveness)

Question 11

nursing interventions for cephalosporins

Answer 11

ask about drug allergies to penicillin (structurally similar to penicillin)
call provider if watery diarrhea develops

Question 12

fosftomycin (Monurol)

nursing interventions

Answer 12

mix contents of package with 1/2 cup cold water (granules must be dissolved)
avoid taking with metoclopramide or other drugs that increase GI motility (reduce absorption)

Question 13

nitrofurantoin (Furadantin, Macrobid)

nursing interventions

Answer 13

type of urinary antiseptic

shake bottle well (drug is in suspension)
drink with full glass of water and drink 3L daily (drug precipitates in the kidney tubules and damage the kidneys)

Question 14

bladder analgesic examples

Answer 14

phenazopyridine (Pyridium, Prodium, Pyridiate)

Question 15

bladder analgesic nursing interventions

Answer 15

drug will not treat infection, just symptoms
take with food or following meal to reduce GI disturbances
urine will turn red or orange

Question 16

antispasmodics used with UTIs

examples

Answer 16

hyoscyamine (Anaspaz, Cystospaz)

Question 17

antispasmodics used with UTIs

nursing interventions

Answer 17

notify PCP if blurred vision or other eye problems, confusion, dizziness, fainting, fast HR, fever, difficulty passing urine occurs (these are manifestations of drug toxicity)
wear dark glasses in sunlight (drug dilates the pupil and increases sensitivity)

Question 18

stress incontinence

Answer 18

most common type
loss of small amounts of urine during coughing, sneezing, jogging, lifting
its can’t tighten the urethra enough to overcome the increased bladder pressure caused by contraction of detrusor muscle
common after childbirth
low estrogen levels after menopause also contributes

Question 19

urge incontinence

Answer 19

perception of an urgent need to urinate as a result of bladder contractions regardless of volume of urine in bladder
can’t suppress signal to urinate and have sudden strong urge to void and often leak large amounts of urine at this time
aka overactive bladder
can be related to stroke, neurologic problems, other urinary tract problems, irritation from concentrated urine or artificial sweeteners, caffeine, alcohol, citric intake
diuretics and nicotine can also irritate the bladder

Question 20

mixed incontinence

Answer 20

presence of more than one type
urine loss related to both stress and urge incontinence
more common in older women

Question 21

overflow incontinence

Answer 21

occurs when detrusor muscle fails to contract and bladder becomes distended
aka reflex incontinence
occurs when bladder has reached max capacity and some urine must leak out to prevent bladder rupture
urethra may be obstructed and fail to relax enough to urinate
incomplete bladder emptying or urinary retention from urethral obstruction results in overflow incontinence

Question 22

functional incontinence

Answer 22

occurs as a result of factors other than abnormal function of bladder and urethra
common factor is loss of cognitive function in patients with dementia

Question 23

definition/description of stress incontinence

pg 1498

Answer 23

involuntary loss of urine during activities that increase abd and detrusor pressure
patients can’t tighten the urethra sufficiently to overcome the increased detrusor pressure
leakage of urine results

Question 24

cause of stress incontinence

pg 1498

Answer 24

weakening of bladder neck supports; associated with childbirth.
intrinsic sphincter deficiency caused by such congenital condition like epispadias and myelomeningocele
acquired anatomic damage to the urethral sphincter (from repeated incontinence surgeries, prostectomy, radiation therapy, trauma)

Question 25

clinical manifestations of stress incontinence pg 1498

Answer 25

urine loss with physical exertion, cough, sneeze exercise usually only small amounts of urine post-void residual usually

Question 26

definition/description of urge incontinence pg 1498

Answer 26

involuntary loss of urine associated with a strong desire to urinate patients can't suppress signal from bladder muscle to brain that it s time to urinate

Question 27

causes of overflow incontinence pg 1498

Answer 27

``` diabetic neuropathy side effects of medications after radical pelvic surgery spinal cord damage enlarged prostate large genital prolapse multiple sclerosis ```

Question 28

estrogen (Cenestin, Enjuvia) purpose/action pg 1502

Answer 28

reduces incontinence, possibly by improving vaginal and urethral blood flow and tone

Question 29

estrogen (Cenestin, Enjuva) nursing interventions pg 1502

Answer 29

report unusual vaginal bleeding (estrogen increases risk for endometrial cancer) avoid smoking and report calf pain or swelling (estrogen increase risk for thrombophlebitis, especially among women who smoke)

Question 30

what is classification and purpose of following drugs ``` oxybutynin (Ditropan) tolterodine (Detrol) propantheline (Pro-Banthine) dicyclomine (Barmine, Bentyl) trospium (Sanctrual) ```

Answer 30

anticholinergics/antispasmodics reduce incontinence by causing bladder muscle relaxation and surpassing urge to void

Question 31

anticholinergics/antispasmodics - used to treat incontinence nursing interventions pg 1502

Answer 31

ask if pt has glaucoma (can increase intraocular pressure) increase fluid intake and use hard candy (dry mouth common side effect) increase fluid intake and dietary fiber (constipation is common side effect) monitor urine output and report significantly lower than intake (can cause urinary retention)

Question 32

tricyclic antidepressants - purpose/action | pg 1502

Answer 32

have some anticholinergic actions and also block acetylcholine receptors. both actions can relieve urinary incontinence

Question 33

tricyclic antidepressants - nursing interventions pg 1502

Answer 33

do not take with other tricyclic antidepressants or MAO inhibitors (drugs prolong effects of catecholamines and lead to hypertensive crisis) change positions slowly, especially in the morning (cause dizziness and orthostatic hypotension) use same interventions as anticholinergic drugs (these produce anticholinergic activities and side effects)

Question 34

nutrition therapy to help avoid incontinence pg 1504

Answer 34

avoid foods that like caffeine and alcohol space fluids at regular intervals limit fluids after dinner hour

Question 35

behavioral interventions for incontinence (vague ones) pg 1504

Answer 35

bladder training habit training exercise therapy electrical stimulation

Question 36

bladder training

Answer 36

patient learns to control bladder start a voiding schedule can start with 30 minute interval (then void every 30 minutes) avoid urge to void between set times increase intervals by 15-30 minutes follow schedule till achieve success as interval increases, bladder gradually tolerates more volume

Question 37

habit training

Answer 37

scheduled toileting helpful in cognitively impaired patients caregivers assist at specific times (like q2hr)

Question 38

urinary incontinence - self management education pg 1507

Answer 38

maintain normal body weight to reduce pressure do not limit fluid intake maintain sterile drainage system with catheter following surgery: do not put anything in your vagina do not have sex for 6 weeks following surgery do not lift or carry anything heavier than 5 lbs until clearance has been given (up to 3 months)

Question 39

one major manifestations of renal stone

Answer 39

severe pain flank pain suggest stone in kidney or upper ureter pain that extends to abd or scrotum suggests stone in ureters or bladder

Question 40

s/s of urolithiasis (stone)

Answer 40

``` pain n/v pallor diaphoresis frequency dysuria oliguria or anuria (suggest obstruction) bladder distention temp and pulse are elevated with infection BP may decrease if severe pain cause shock ```

Question 41

diagnostic tests for kidney stones

Answer 41

easily seen on x-rays IV urogram or CT non contrast CT is most sensitive test

Question 42

when would IV urography not be used for high risk patients who are these high risk patients

Answer 42

risk for acute kidney injury induced by contrast dye older adults, DM, multiple myeloma, elevated serum creatinine

Question 43

what is lithotripsy

Answer 43

uses sound, laser, or dry shock waves to break up stones into small fragments

Question 44

lithotripsy procedure

Answer 44

cardiac rhythm is monitored by ECG shock waves delivered in sync with R wave 500-1500 shock waves applied for 30-45 minutes continuous ECG monitoring for dysrhythmias and fluoroscopic observation for stone destruction are maintained strain urine following procedure

Question 45

minimal invasive surgical procedures to treat kidney stones

Answer 45

stenting retrograde ureteroscopy percutaneous ureterolithotomy percutaneous nephrolithotomy

Question 46

retrograde ureteroscopy

Answer 46

endoscopic procedure ureteroscope passed through the urethra and bladder into ureter once stone is seen, it is removed by basket, forceps, or loop foley can be placed to facilitate passage

Question 47

percutaneous ureterolithotomy or nephrolithotomy

Answer 47

removal of stone in kidney or ureter through the skin patient lies prone or on side under local or general anesthesia needle passed into collecting system of kidney endoscope can be attached to grasp stone often a nephrostomy tube left in place to prevent stone fragments from passing through urinary tract

Question 48

drug therapy to prevent kidney stone obstruction

Answer 48

depends on stone type for hypercalciuria - thiazide diuretics, orthophosphate, sodium cellulose phosphate for hyperoxaluria - allopurinol and vitamin b6 for cystinuria - AMPG, captopril

Question 49

dietary interventions for calcium oxalate kidney stone

Answer 49

avoid spinach, black tea, rhubarb | decrease sodium intake

Question 50

dietary interventions for calcium phosphate kidney stones

Answer 50

limit intake of foods high in animal protein to 5-7 servings per week and never more than 2 per day can reduce calcium, milk, dairy products decrease sodium intake

Question 51

dietary interventions for struvite (magnesium ammonium phosphate)

Answer 51

limit daily products, organ meats, whole grains

Question 52

dietary interventions for uric acid stones

Answer 52

reduce purine sources | organ means, poultry, fish, gravies, red wines, sardines

Question 53

dietary interventions for cystine kidney stones

Answer 53

limit animal protein | fluid intake of 500 mL every 4 hrs while awake and 750 mL at night

Question 54

post op following bladder surgery for bladder cancer

Answer 54

external pouch covers ostomy to collect urine will have penrose drain an medena catheter pt with neobladder usually requires 2-4 days in ICU irrigation can be done to ensure patency no sensation of bladder fullness with neobladder when drainage collects on the outside, report any decrease in urine amount or leakage

Question 55

To prevent and treat urolithiasis, patients are encouraged to

Answer 55

drink lots of fluids and eat lots of fruits and vegetables, a low amount of protein, and a balanced intake of calcium, fats, and carbohydrates.

Question 56

thiazide diuretics for stones

Answer 56

chlorothiazide or hydrochlorothiazide promote calcium resorption from the kidney tubules back into the body. reduces urine calcium loads

Question 57

orthophosphates for stones

Answer 57

alter calcium phosphorus metabolism | results in decreased urine saturation of calcium oxalate