Professional Documents
Culture Documents
and Urethra
Chapter 59
Spring 2020
Voiding Dysfunction
Urinary retention
◦ The inability to urinate or effectively empty the
bladder
◦ May be acute or chronic
Acute – urethral obstruction, after general anesthesia,
of with certain drugs i.e. atropine or phenothiazine –
client cannot void at all
Chronic – prostatic enlargement, neurologic disorders
(neurogenic bladder) – cannot completely empty
bladder – large residual volume
Urinary Retention
Assessment
◦ Acute - Sudden inability to void, distended bladder,
abd pain, feeling of fullness
◦ Chronic
May not produce symptoms
May experience difficulty starting urination
May void frequently in small amounts
S/S of bladder infection (fever, chills, dysuria)
◦ Urinalysis
◦ Catheterization for residual volume
◦ Ultrasound bladder scanning
Urinary Retention Medical
Management
Acute requires immediate catheterization
◦ If catheter cannot be inserted may require
instrument to dilate urethra or ureteral stents
Chronic is managed by permanent drainage
via
◦ Indwelling urethral catheter
◦ Suprapubic cystostomy tube
◦ Clean intermittent catheterization (preferred)
◦ Crede’s maneuver – manual voiding by pressing on
bladder
Crede’s and Valsalva Maneuver
Crede’s Maneuver
◦ Apply gentle downward pressure to the bladder during voiding.
◦ May be done by client or family member
◦ May be done while sitting on the toilet and rocking back and forth gently
Valsalva Maneuver
◦ Instruct client to bear down as with defecation
◦ Do not teach to client with cardiac problems or who may be adversely affected
by a vagal response (causes the heart rate to slow)
Intermittent Catheterization
Sterile procedure in the hospital using straight
catheter kits
At home this is a clean rather than sterile
procedure
◦ May be single-use or reusable
◦ Prescription from provider required
◦ Usually performed 3-4 times a day based in residual
volume
Indwelling Catheters
A cystostomy tube or suprapubic catheter is
inserted through an abdominal incision into
the bladder.
◦ Maintain a closed system at all times using
preconnected catheter and drainage systems
◦ Properly anchor the tube to avoid tension and
promote drainage
◦ Drainage bag must be below the level of the
bladder (not on the floor)
◦ Meticulous handwashing and strict aseptic
techniques for catheter insertion
Nursing Management
Acute Urinary Retention
◦Resolves quickly with intermittent catheterization
◦Measure the volume in the bladder with bedside scanner
◦Select the smallest catheter in order to avoid trauma to the urethra and bladder
neck
Chronic Urinary Retention
◦Ask all clients during initial health assessment about voiding frequency, amount,
pain, or difficulty starting urinary stream
◦Ultimate goals are to safely empty bladder and prevent infection to the urinary
tract
CAUTI
Catheter Associated Urinary Tract Infections
◦ Organizations must be committed to reducing the
number of CAUTI
◦ Recommended use limited to
Urologic surgery, urinary retention, or urinary outlet
obstruction
Perioperative/Intraoperative
Promotion of wound healing if open sacral or perineal
wounds
Prolonged immobilization
Urinary Incontinence
Major health concern
OAB (overactive bladder) involves urgency,
◦ Skin breakdown
◦ Urinary Tract Infections
Urinary Incontinence
Pathophysiology and Etiology
◦ Neurologic disease, bladder outlet obstruction,
or trauma
◦ Bladder prolapse, low estrogen levels, prostatic
enlargement
◦ Aging or pregnancy and post partum
◦ Failure of urethral sphincters to hold urine in
bladder
◦ Neurogenic bladder due to tumors of the spinal
cord, herniated disk, or spinal cord injuries
Risk Factors for Urinary Incontinence
Pregnancy, vaginal delivery, episiotomy
Menopause
Genitourinary surgery
Pelvic muscle weakness
Incompetent urethra as a result of trauma
Immobility
High impact exercise
Diabetes Mellitus
Age related changes
Obesity
Chronic cough
Neurologic conditions
Medications
Urinary Incontinence
Dietary/Supplement Causes
Alcohol
Caffeine
Decaffeinated tea and coffee
Carbonated drinks
Artificial sweeteners
Corn syrup
Foods that are high in spice sugar or acid
Heart and blood pressure medications
Large doses of Vitamins B or C
Assessment of Urinary Incontinence
coughing or sneezing
Complete inability to control urine
Tests
◦ Bladder augmentation
◦ Injection of Botox into bladder muscle
◦ Retropubic suspension, anterior repair,
transvaginal suspension, sling
◦ Sacral nerve stimulator
Nursing Management
Maintaining continence as much as possible
Prevent skin breakdown
Reduce anxiety
Initiate bladder training program
Pelvic floor muscle exercises (Kegel exercises)
Scheduled voiding at 2-4 hour intervals
Bladder Training
For the client with an indwelling catheter
clamp and unclamp the catheter to
reestablish normal bladder function and
capacity
Once catheter is removed or if they have no
Antimicrobial therapy
◦ Ciprofloxacin, Fosfomycin, levofloxacin,
nitrofurantoin, sulfonamide-
sulfamethoxazole/trimethoprim
◦ Phenazopyridine (reduces bladder discomfort)
orange urine
Correction of contributing factors
Anecdotal – cranberry juice
Nursing Management
Cystitis
Have client drink extra fluids
Cranberry juice may provide a less favorable
◦ Increase fluids
◦ Avoid coffee, tea, colas, alcohol
◦ Shower rather than bathe
◦ Cotton underwear
◦ Void after sex
Interstitial Cystitis/Painful Bladder
Syndrome
Chronic inflammation of the bladder mucosa
which causes pain in the bladder and
surrounding pelvic region.
Mimics other disorders with dysuria, and
protectant
Tricyclic antidepressants may relieve pain and
◦ Bladder distention
◦ Transcutaneous electrical nerve stimulation (TENS)
◦ Urinary diversion procedures
Nursing Management
Teach client to avoid spicy foods because they may
contribute to pain
Omitting carbonated beverages, caffeine, citrus
products and foods with high Vitamin C content
Psychological support
Some clients may have difficulty holding a job
because of severity of symptoms
Some clients may avoid sexual activity straining
their relationships
Referral to chronic pain centers or IC support
groups
Urethritis
Inflammation of the urethra
More common in men than women
In women may accompany cystitis or vaginal
infections
◦ May be caused by soaps, bubble baths, sanitary
napkins, or scented toilet paper
In men a common cause is Chlamydia or STI
May also be caused in men by irritation during
vigorous intercourse, rectal intercourse, or
intercourse with a woman who has a vaginal
infection.
Assessment of Urethritis
Dysuria
Fever
Urethral discharge and itching
Diagnosis
◦ Men – urethral smear is obtained for C&S
◦ Women – urinalysis (Clean catch mid stream)
Medical Management
Appropriate antibiotic therapy
Liberal fluid intake
Analgesics
Warm sitz baths
Good diet and plenty of rest
If STI
stones
Clients who are immobile may have a tendency
component of stone
◦ Low purine diet for uric acid stones
Limit organ meats
◦ Calcium oxalate stones require a diet adequate in
calcium and low in oxalate
3 cups of milk daily
Avoid excessive protein
Limit sodium
Nursing Management
Obtain history and monitor vital signs
Document I&O and color of urine
Report evidence of gross hematuria
Encourage client to drink fluids
Filter urine – if solid material is found send
to lab
Administer analgesics as ordered
Client teaching
may form
Infection often occurs
Urinary retention (acute or chronic) may
occur
Urethral Stricture
May be caused by infections such as
untreated gonorrhea or chronic
nongonococcal urethritis
Trauma to the lower urinary tract –
accidents, childbirth, intercourse, surgical
procedures
Prolonged use of intermittent catheters
Urethral Stricture Assessment
Slow or decreased force of stream of
urine
Urine leakage or dribbling after urinating
Spraying of urine when voiding
Dysuria, urgency, hesitancy, burning,
and anemia
Medical Management
Varies according to grade and stage of tumor
Resection or coagulation of the tumor
Topical application of an antineoplastic drug
Photodynamic therapy
Partial or segmental removal of part of the
bladder (cystectomy)
Radical cystectomy including ureters, uterus,
after changing
Contact MD if
◦ Fever
◦ Chills
◦ Blood in urine
◦ Failure to drain urine
◦ Skin problems around stoma
◦ Weight loss
◦ Loss of appetite
◦ Inability to insert catheter
Trauma
Gunshot, stab wounds, crushing injuries, forceful blows
Result in tears, hemorrhage, of penetration of one or more parts
of the urinary system
Signs and symptoms
◦ Anuria, hematuria, pain in abdomen, pain in bladder or kidney area, shock
Diagnostic Findings
◦ Abdominal x-rays, cystoscopy, IVP, exploratory surgery
Surgical management
◦ Depends on type, location and extent of injury
◦ Cystostomy, nephrectomy, nephrostomy tube, repair (reanastomosis) of
ureter, cystectomy
◦ May insert and maintain catheter until urine is clear