Medical Surgical Nursing Care: Urinary Incontinence

MEDICAL SURGICAL
NURSING CARE

 The Urinary System Disorders

 Dr Ibrahim Bashayreh, RN, PhD

22/12/2010
URINARY INCONTINENCE
 Involuntary urination
 Increased bladder pressure
 Lowered urethral resistance
 Pelvic muscle relaxation
 Impaired neural control
 Bladder problems

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 Types
o Stress
o Urge
o Overflow
o Reflex
o Functional
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- MANIFESTATIONS
 Uncontrolled urination
 Several types

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– DIAGNOSTIC TESTS
 Postvoid residual urine

 Ultrasonic bladder scan
 Cystometrography (Measurement of bladder
function, as by a cystometer)
 Uroflowmetry (is a test that measures the
volume of urine released from the body, the
speed with which it is released, and how
long the release takes)

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- TREATMENT
 Medications
o Inhibit detrusor muscle (is a layer of the
urinary bladder wall made of smooth

muscle fibers arranged in spiral,
longitudinal, and
circular bundles contractions)
o Increase bladder capacity
o Estrogen therapy
 Surgery
o Bladder neck suspension
o Prostatectomy
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– NURSING CARE
 Impaired Urinary Elimination

 Toileting Self-Care Deficit
 Social Isolation

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– NURSING CARE
 Evaluating
o Keep voiding diary
o Identify wetting episodes
o Assess willingness to participate in
social activities
 Teaching
o Home environment
o Voiding diary
o Therapies
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URINARY RETENTION
 Occurs when bladder cannot empty

 May be caused by obstructive or functional
problem
o Benign prostatic hypertrophy
o Surgery
o Drugs
o Neurologic diseases
o Trauma

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URINARY RETENTION -
MANIFESTATIONS
 Manifestations
o Overflow voiding
o Incontinence
o Firm, distended bladder
 May be displaced

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URINARY RETENTION
 Complications
o Hydronephrosis
o Acute renal failure
o Urinary tract infection
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URINARY RETENTION –
INTERDISCIPLINARY
CARE
 Diagnostic tests
o Portable bladder scan
 Treatment depends on cause

o Surgery
o Medications
o Stimulation techniques
o Catheterization
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URINARY RETENTION -
SURGERY
 Surgery (removal of obstuction, resection of

prostate)
 Catheterization after surgery helps prevent
overdistention

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URINARY RETENTION –
NURSING CARE
 Identify clients
 Take measures to promote urination

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URINARY TRACT
INFECTIONS
 Affect up to 20% of women

 Incidence increases with aging
 Healthcare-associated infections common
(catheter)
 Classified according to region and primary
site affected
 Cystitis is most common

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URINARY TRACT
INFECTIONS
 Bacteria from intestines can infect area

 Changes in urinary tract with aging can
increase risk

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CYSTITIS -
MANIFESTATIONS
 Bladder mucosa inflamed and congested

with blood
 Dysuria
 Frequency, urgency
 Hematuria
 Pyuria

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UTIS – DIAGNOSTIC
TESTS
 Urinalysis
 Urine culture & sensitivity
 CBC with differential
 IVP
 Voiding cystourethrography
 Cystoscopy

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UTIS - MEDICATIONS
 Antibiotics
o 3 or 7 day treatment

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UTIS – NURSING CARE
 Assessment
 Impaired Urinary Elimination
 Readiness for Enhanced Self Health
Management
 Teaching

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PYELONEPHRITIS
 Inflammatory disorder of renal pelvis and

parenchyma
o Acute
 E. coli
o Chronic
 Other disorders

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PYELONEPHRITIS -
MANIFESTATIONS
 Acute
o Rapid onset
o Chills, fever
o Malaise, vomiting
 Flank pain, costovertebral tenderness (the
angle formed by the lower border of the12th,
or bottom, rib and the spine)
o Cystitis
 Chronic
o Fibrosis, scarring, renal failure
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GLOMERULONEPHRITIS
 Inflammatory condition of glomerulus

 Acute or chronic
 Primary kidney disorder or secondary to
systemic disease

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GLOMERULONEPHRITIS
 Affects structure and function of glomerulus
 Damages capillary membrane
o Blood cells and proteins escape into
filtrate
o Hematuria, proteinuria, azotemia
(increase BUN & Creatinin)

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ACUTE
GLOMERULONEPHRITIS -
MANIFESTATIONS
 Usually follows infection of group A beta-

hemolytic Streptococcus
 Manifestations develop abruptly
o Hematuria, proteinuria, edema,
hypertension, fatigue,
o Anorexia, nausea, vomiting, headache
o Elevated BUN and serum creatinine

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ACUTE
MANIFESTATIONS
 Older adults may show less characteristic

manifestations
 Symptoms may subside spontaneously
 Some may develop chronic
glomerulonephritis

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CHRONIC
MANIFESTATIONS
 Symptoms develop slowly caused by
progressive destruction of glomeruli and
loss of nephrons
 Signs of renal failure may be reason to seek
diagnosis

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GLOMERULONEPHRITIS
–
DIAGNOSTIC TESTS
 ASO titer (anti streptolysine O)

 ESR
 BUN
 Serum creatinine

 Serum electrolytes
 Urinalysis
 KUB x-ray
 Kidney scan or biopsy

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GLOMERULONEPHRITIS –
INTERDISCIPLINARY
CARE
 Focus is on identifying and treating

underlying disease process and preserving
kidney function
 Often no specific treatment

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TREATMENT
 Medications
 Plasma exchange therapy
 Dietary management

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NURSING CARE
 Assessment
 Diagnosing, Planning, and Implementing
o Excess Fluid Volume
o Fatigue
o Risk for Infection
o Ineffective Role Performance
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NEPHROTIC SYNDROME -
MANIFESTATIONS
 Significant proteinuria
 Low serum albumin levels
 High blood lipids
 Edema
 Thromboemboli
 Usually resolves without long-term effects

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HYDRONEPHROSIS
 Abnormal dilation of renal pelvis and

calyces
 Results from urinary tract obstructions or
backflow of urine
 Manifestations depend on how rapidly it
develops

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HYDRONEPHROSIS -
MANIFESTATIONS
 Acute (colicky flank pain, hematuria, pyuria,

fever, nausea and vomiting, abdominal pain
 Chronic (intermittent dull flank pain,
hematuria, pyuria, fever, palpable mass)

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HYDRONEPHROSIS –
INTERDISCIPLINARY
CARE
 Diagnosis
o Ultrasound
o CT scan
o Cystoscopy
 Treatment
o Stents
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HYDRONEPHROSIS -
SURGERY
 Stents positioned during suergery or

cystoscopy
o Pig-tail or J-shaped
o Temporary or long-term
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HYDRONEPHROSIS –
NURSING CARE
 Focuses on ensuring urinary drainage

 Monitor I&O
 Irrigate tubes only as ordered

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POLYCYSTIC KIDNEY
DISEASE
 Hereditary
 Cyst formation and massive kidney
enlargement
 Relatively common

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POLYCYSTIC KIDNEY
DISEASE
 Renal cysts develop in nephron

 Cysts fill, enlarge and multiply
o Causes kidneys to enlarge
 Gradual destruction of functional kidney
tissue
 Slowly progressive
 Flank pain, hematuria, proteinuria, polyuria,
nocturia

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A POLYCYSTIC KIDNEY AND A NORMAL KIDNEY FOR COMPARISON.

(SOURCE: NMSB, CUSTOM MEDICAL STOCK PHOTOS, INC.)
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POLYCYSTIC KIDNEY
DISEASE -
MANIFESTATIONS
 Enlarged kidneys
 Flank pain, hematuria, proteinuria, polyuria,
nocturia

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POLYCYSTIC KIDNEY
DISEASE –
INTERDISCIPLINARY
CARE
 Management is supportive
 Renal ultrasound to diagnose
 Fluids
 Medications

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POLYCYSTIC KIDNEY
DISEASE –
NURSING CARE

o Excess Fluid Volume
o Grieving
o Ineffective Self Health Management
o Ineffective Coping

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CANCER OF THE URINARY

TRACT
 Bladder cancer
 Kidney tumors

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BLADDER CANCER
 Bladder cancer is 10th leading cause of

cancer deaths
o Major risk factors
 Carcinogens in urine related to a history of
smoking (probably because of the excretion
of carcinogens such as 4-aminobiphenyl),
 which increases the risk about four-fold.
 Chronic inflammation or infection of
bladder mucosa
 Smoking
 Chemicals in environment
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BLADDER CANCER -
MANIFESTATIONS
 Painless hematuria
 Frequency
 Urgency
 Dysuria

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BLADDER CANCER –
INTERDISCIPLINARY
CARE
o Bladder ultrasound
o Urinalysis
o Urine cytology
o Cystoscopy
 Treatment
o Medications
o Surgery
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KIDNEY TUMORS
 Uncommon
 Renal cell carcinoma most common primary
tumor
 Risk factors
o Smoking
o Obesity
o Renal calculi

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KIDNEY TUMORS
 Most arise from tubular epithelium

 Can occur anywhere
 Often metastasize

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KIDNEY TUMORS -
MANIFESTATIONS
 May be silent
 Flank pain
 Palpable mass
 Fever, fatigue
 Weight loss, anemia, polycythemia
 Hypercalcemia, hypertension, or
hyperglycemia

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KIDNEY TUMORS –
INTERDISCIPLINARY
CARE
o Renal ultrasound
o CT scan
o Kidney biopsy
 Treatment
o Radical nephrectomy
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BLADDER AND KIDNEY
CANCER – NURSING
CARE
 Assessment
o Impaired Urinary Elimination
o Risk for Impaired Skin Integrity
o Disturbed Body Image

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BLADDER AND KIDNEY

TUMORS – NURSING
CARE

o Acute Pain
o Ineffective Breathing Pattern

o Disturbed Body Image

22/12/2010

Medical Surgical Nursing Care: Urinary Incontinence

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MEDICAL SURGICAL

 The Urinary System Disorders

 Postvoid residual urine

urinary bladder wall made of smooth

 Impaired Urinary Elimination

o Identify wetting episodes

o Assess willingness to participate in

 Occurs when bladder cannot empty

o Firm, distended bladder

o Acute renal failure

o Urinary tract infection

 Treatment depends on cause

 Surgery (removal of obstuction, resection of

 Affect up to 20% of women

 Bacteria from intestines can infect area

 Bladder mucosa inflamed and congested

UTIS – NURSING CARE

 Inflammatory disorder of renal pelvis and

 Inflammatory condition of glomerulus

(increase BUN & Creatinin)

 Usually follows infection of group A beta-

o Elevated BUN and serum creatinine

 Older adults may show less characteristic

 ASO titer (anti streptolysine O)

 Focus is on identifying and treating

o Risk for Infection

o Ineffective Role Performance

 Abnormal dilation of renal pelvis and

 Acute (colicky flank pain, hematuria, pyuria,

 Stents positioned during suergery or

 Focuses on ensuring urinary drainage

 Renal cysts develop in nephron

A POLYCYSTIC KIDNEY AND A NORMAL KIDNEY FOR COMPARISON.

 Diagnosing, Planning, and Implementing

CANCER OF THE URINARY

 Bladder cancer is 10th leading cause of

 Most arise from tubular epithelium

o Risk for Impaired Skin Integrity

o Disturbed Body Image

BLADDER AND KIDNEY

 Diagnosing, Planning, and Implementing

o Ineffective Breathing Pattern

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