Chapter 55 Urinary Disorders

All choices are true. Correct Explanation: Symptoms of bladder stone formation include hematuria, suprapubic pain, difficulty starting the urinary stream, symptoms of a bladder infection, and a feeling that the bladder is not completely empty. Some clients may have few or no symptoms. (less)

Mr. Wilson is being seen in your clinic with a suspected diagnosis of bladder stones. Stones may form in the bladder or originate in the upper urinary tract and travel to and remain in the bladder. What are some signs and symptoms that Mr. Wilson may be experiencing? Select all that apply. a) All choices are true. b) Hematuria c) Difficulty starting urinary stream d) Suprapubic pain

Discouraging caffeine intake Explanation: Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen. (less)

Nursing management of the client with a urinary tract infection should include: a) Teaching the client to douche daily b) Instructing the client to limit fluid intake c) Discouraging caffeine intake d) Administering morphine sulfate

A UTI Correct Explanation: The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI.

The nurse is caring for a patient with dementia in the long-term care facility when the patient has a change in cognitive function. What should the nurse suspect this patient may be experiencing? a) A UTI b) A stroke c) An aneurysm d) Fecal impaction

Contact the physician. Correct Explanation: The appropriate nursing intervention when a newly created stoma is dark purple is to notify the physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to determine if it the stoma has superficial ischemia or if it is necrotic.

The nurse, in assessing a patient's newly created stoma, observes that the stoma color is now dark purple. The appropriate nursing intervention is to do which of the following? a) Change the pouching system. b) Remove the urinary stents. c) Apply Karaya powder. d) Contact the physician.

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs. Correct Explanation: Urgency, burning, frequency, and difficulty urinating are all common symptoms of a UTI. The client should notify the physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To prevent UTI recurrence, the full amount of antibiotics ordered must be taken despite the fact that the symptoms may have subsided. Women are told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation. (less)

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include? a) Limit fluid intake to reduce the need to urinate. b) Take medication ordered for a UTI until the symptoms subside. c) Wear only nylon underwear to reduce the chance of irritation. d) Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

Increasing fluid intake Correct Explanation: Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most patients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all patients. Eating small, frequent meals does not influence the risk for recurrence. (less)

A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patient's discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt? a) Increasing intake of protein from plant sources b) Adopting a high-calcium diet c) Increasing fluid intake d) Eating several small meals each day

Cranberry juice Correct Explanation: Cranberry juice or vitamin C may be recommended to keep the bacteria from adhering to the wall of the bladder and thus promoting their excretion and enhancing the effectiveness of drug therapy. (less)

Susan Hopkins, a 32-year-old administrative assistant, is being seen by a physician with the urology practice where you practice nursing. She has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What can Mrs. Hopkins consume to decrease the likelihood of bladder infection? a) Increased protein b) Cranberry juice c) Prune juice d) Red meat

Monitor urine output hourly and report output less than 30 mL/hr. Correct Explanation: In the immediate postoperative period, urine volumes are monitored hourly. Throughout the patient's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately.

A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? a) Clean the stoma with soap and water after the patient voids. b) Monitor urine output hourly and report output less than 30 mL/hr. c) Turn the patient every 2 hours around the clock. d) Administer pain medication every 2 hours.

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Correct Explanation: A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours (Meschi et al., 2011). (less)

The nurse is educating a patient with urolithiasis about preventative measures to avoid another occurrence. What should the patient be encouraged to do? a) Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. b) Add calcium supplements to the diet to replace losses to renal calculi. c) Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. d) Limit voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.