Chapter 73

Interventions for Clients with

Urinary Problems
Cystitis

 Inflammation of the bladder

 Most commonly caused by bacteria that
move up the urinary tract from the
external urethra to the bladder, viruses,
fungi, or parasites
 Catheter-related infections common
during hospital stay
Incidence and Prevalence
of Cystitis
 Frequenct urge to urinate
 Dysuria
 Urgency
 Urinalysis needed when testing for
leukocyte esterase
 Type of organism confirmed by urine
culture
 Other diagnostic assessments
Drug Therapy

 Urinary antiseptics
 Antibiotics
 Analgesics
 Antispasmodics
 Antifungal agents
 Long-term antibiotic therapy for chronic,
recurring infections
Nonsurgical Management

 Urinary elimination
 Diet therapy includes all food groups,
calorie increase due to increase in
metabolism caused by the infection,
fluids, possible intake of cranberry juice
preventively
 Other pain relief measures, such as warm
sitz baths
Urethritis

 Inflammation of the urethra that causes

symptoms similar to urinary tract
infection
 Caused by sexually transmitted
infections; treat with antibiotic therapy
 Estrogen vaginal cream for
postmenopausal women
Urethral Strictures

 Narrowing of the urethra

 Most common symptom—obstruction of
urine flow
 Surgical treatment by urethroplasty—best
chance of long-term cure
 Dilation of the urethra—a temporary
measure
 Urethroplasty
Urinary Incontinence

 Five types of incontinence include:

 Stress
 Urge
 Mixed
 Overflow
 Functional
Collaborative
Management
 Assessment includes a thorough client
history.
 Clinical manifestations for urethral or
uterine prolapse
 Laboratory assessment by urinalysis
 Radiographic assessment, especially
before surgery
 Other diagnostic assessments
Stress Urinary
Incontinence
 Interventions include:
 Keeping a diary, behavioral interventions, diet
modification, and pelvic floor exercises
 Drug therapy: estrogen
 Surgery
 Collection devices and vaginal cone weights
Surgical Management

 Preoperative care
 Operative procedure
 Postoperative care
 Assess for and intervene to prevent or detect
complications.
 Secure urethral catheter.
Urge Urinary Incontinence

 Interventions include:
 Drugs: anticholinergics, possibly
antihistamines, others
 Diet therapy: avoid caffeine and alcohol
 Behavioral interventions: exercises, bladder
training, habit training, electrical stimulation
Reflex Urinary
Incontinence
 Interventions include:
 Surgery to relieve the obstruction
 Intermittent catheterization
 Bladder compression and intermittent self-
catheterization
 Drug therapy
 Behavioral interventions
Functional Urinary
Incontinence
 Interventions include:
 Treatment of reversible causes
 If incontinence is not reversible, urinary habit
training
 Final strategy—containment of urine and
protection of the client’s skin
 Applied devices
 Urinary catheterization
Urolithiasis

 Presence of calculi (stones) in the urinary

tract
 Collaborative management
 History of urologic stones
 Clinical manifestations
 Laboratory assessment
 Radiographic assessment
 Other diagnostic tests
Interventions
 Drug therapy
 Opioid analgesics—often used to control
pain
 Nonsteroidal anti-inflammatory drugs
 Pain medications at regular intervals
 Constant delivery system
 Spasmolytic drugs—important for relief of
pain
 Complementary and alternative therapy
Lithotripsy

 Extracorporeal shock wave lithotripsy

uses sound, laser, or dry shock wave
energy to break the stone into small
fragments.
 Client undergoes conscious sedation
 Topical anesthetic cream is applied to
skin site of stone.
 Continuous monitoring is by
electrocardiography
Surgical Management

 Minimally invasive surgical procedures

 Stenting
 Retrograde ureteroscopy
 Percutaneous ureterolithotomy and
nephrolithotomy
 Open surgical procedures
 Preoperative care
 Operative procedure
Postoperative Care

 Routine postoperative care procedures for

assessment of bleeding, urine, and
adequate fluid intake
 Strained urine
 Infection prevention
 Drug therapy
 Diet therapy
 Prevention of obstruction
Drug Therapy
 Drug selection to prevent obstruction depends on what is
forming the stone:
 Calcium
 Thiazide Diuretics
 Oxalate
 Zyloprim
 Pyridoxine (B6)
 Uric acid
 Zyloprim
 Potassium Citrate to alkalinize the urine
 Cystine
 Capoten
Urothelial Cancer
 Collaborative management
 Assessment
 Diagnostic assessment
 Bladder washes

 Bladder biopsy

 Nonsurgical management
 Prophylactic immunotherapy
 Intravesical instillation with BCG
 Chemotherapy
 Multi agent chemotherapy for mets
 Radiation therapy
 For prolongation of life
Surgical Management

 Preoperative care
Surgical Management

 Operative procedures
Surgical Urinary Diversion
Incontinent Urinary Diversion
Surgical Management

 Postoperative care includes:

 Collaboration with enterostomal therapist
 Kock’s pouch
 Penrose drain
 Medena catheter
 Neobladder
 Early post -op drain for irrigation
Bladder Trauma

 Causes may be due to injury to the lower

abdomen or stabbing or gunshot wounds.
 Surgical intervention is required.
 Fractures should be stabilized before
bladder repair.