Patho Chp 55: Management of Patients With Urinary Disorders

A client presents at the clinic with reports of urinary retention. What question should the nurse ask to obtain additional information about the client's report? "How much fluid are you drinking?" "Do you get up at night to urinate?" "Have you had a fever and chills?" "When did you last urinate?"

"When did you last urinate?" The nurse needs to determine the last time the client voided.

The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include? Encourage voiding immediately after catheter removal Avoid drinking fluids for 6 hours Perform straight catheterization every 4 hours Implement a 2- to 3-hour voiding schedule

Implement a 2- to 3-hour voiding schedule Immediately after the removal of the indwelling catheter, the client is placed on a voiding schedule, usually 2 to 3 hours. At the given time, the client is instructed to void. Immediate voiding is not usually encouraged.

Which statement by the client who is performing self-catheterization indicates a need for further teaching? "I should perform self-catheterization every 4 to 6 hours." "I should lubricate the catheter before insertion." "I will need a sterile catheter kit each time I self-catheterize." "I will wash my catheter will hot soapy water."

"I will need a sterile catheter kit each time I self-catheterize." Clients who self-catheterize use clean technique in the home setting.

The nurse recognizes that test results that most likely indicate a urinary tract infection include: glucose trace RBC 3 WBC 50 proteinuria

WBC 50 ↑ white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount on two separate occasions (morning and evening)? 30 mL 50 mL 100 mL 400 mL

100 mL If the client complains of discomfort or pain, the suprapubic catheter is usually left in place until the client can void successfully. Residual urine must be less than 100 mL to be able to discontinue the suprapubic catheter. Residual urine may be greater than 30 mL and still allow use of a suprapubic catheter to be discontinued.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? Impaired urinary elimination Imbalanced nutrition: Less than body requirements Risk for infection Acute pain

Acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Anticonvulsant Anticholinergic Diuretics Cholinergic

Anticholinergic Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.

Which type of medication may be used to inhibit bladder contraction in a client with incontinence? Estrogen hormone Anticholinergic agent Tricyclic antidepressants Over-the-counter decongestant

Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? Voiding at given intervals Interval voiding Prompted voiding Bladder retraining

Bladder retraining Bladder retraining includes a timed voiding schedule and urinary urge inhibition exercises. These exercises involve delaying voiding to help the patient stay dry for a set period of time. When one time interval is reached, another is set. The time is usually increased by 10 to 15 minutes, until an acceptable voiding interval is achieved.

leaking small amounts of urine. What is the appropriate nursing intervention? Secure or patch it with barrier paste. Change the wafer and pouch. Empty the pouch. Secure or patch it with tape.

Change the wafer and pouch. Whenever a leaking pouching system is noted, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste can trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? Bactrim Cipro Macrodantin Septra

Cipro Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? Dietary habits involving cholesterol-laden food History of allergy to iodine and seafood Client's manual dexterity and vision Menstrual history

Client's manual dexterity and vision It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure.

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? Detects calculi, cysts, or tumors If risk for chronic pyelonephritis is likely Reveals causative microorganisms Shows damage to the kidneys

Detects calculi, cysts, or tumors Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

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

Discouraging caffeine intake

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Iatrogenic Reflex Overflow Urge

Iatrogenic Iatrogenic incontinence refers to the involuntary loss of urine due to extrinsic medical factors, predominantly medications. One such example is the use of alpha-adrenergic agents to decrease blood pressure. In some people with an intact urinary system, these agents adversely affect the alpha receptors responsible for bladder neck closing pressure; the bladder neck relaxes to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence. As soon as the medication is discontinued, the apparent incontinence resolves

The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? Morphine sulfate Meperidine (Demerol) Ketoralac (Toradol) Aspirin

Ketoralac (Toradol) Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketorolac (Toradol), are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to: Uninhibited detrusor contractions. Loss of motor control of the detrusor muscle. Compromised ligament and pelvic floor support of the urethra. A stricture or tumor in the bladder.

Loss of motor control of the detrusor muscle. Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation? Need to urinate after engaging in sexual intercourse Importance of urinating every 4 to 6 hours while awake Suggestion to take tub baths instead of showers Need to wear underwear made from synthetic material

Need to urinate after engaging in sexual intercourse Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? Risk for altered urinary elimination Risk for infection Risk for deficient knowledge: self-catherization Risk for fluid volume excess

Risk for infection Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

Which medication may be ordered to relieve discomfort associated with a UTI? Phenazopyridine Nitrofurantoin Levofloxacin Ciprofloxacin

Phenazopyridine (Pyridium) Pyridium is urinary analgesic ordered to relieve discomfort associated with a UTI. Furadantin, Cipro, and Levaquin are antibiotics.

Which characteristic is seen with a healthy stoma? No bleeding when cleansing the stoma Dry in appearance Pink color Painful

Pink color Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

Which term refers to inflammation of the renal pelvis? Pyelonephritis Urethritis Interstitial nephritis Cystitis

Pyelonephritis Pyelonephritis: upper urinary tract inflammation, which may be acute or chronic. Cystitis: inflammation of the urinary bladder. Urethritis: inflammation of the urethra. Interstitial nephritis: inflammation of the kidney.

Inflammation of the GI areas:

Pyelonephritis: upper urinary tract inflammation, which may be acute or chronic. Cystitis: inflammation of the urinary bladder. Urethritis: inflammation of the urethra. Interstitial nephritis: inflammation of the kidney.

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? Septra Pyridium Levaquin Bactrim

Pyridium The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.

Sympathomimetics have which of the following effects on the body? Decrease of heart rate Constriction of pupils Constriction of bronchioles Relaxation of bladder wall

Relaxation of bladder wall Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

Patients with urolithiasis need to be encouraged to: a. Increase their fluid intake so that they can excrete up to 4 liters every day. b. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. c. Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system. d. Supplement their diet with calcium needed to replace losses to renal calculi.

a. Increase their fluid intake so that they can excrete up to 4 liters every day. Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. Fluids need to be increased up to 4 L/day to help prevent additional stone formation.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? Stress Overflow Functional Urge

Urge Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. a. For those patients who are incontinent, insert indwelling catheters. b. Encourage patients to wear briefs. c. Perform hand hygiene prior to patient care. d. Provide careful perineal care. e. Assist the patients with frequent toileting.

c. Perform hand hygiene prior to patient care. d. Provide careful perineal care. e. Assist the patients with frequent toileting. In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? Reflux of urine from the urethra into the bladder Interruption in the protective effect of glycosaminoglycan Dysfunction of the bladder neck or urethra. Disturbance in the normal bacterial flora of the vagina

Reflux of urine from the urethra into the bladder With coughing, sneezing, or straining, the bladder pressure increases, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra. See Figure 28-1 in the text.

The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A low-purine diet A low-sodium diet A diet high in fruits and vegetables A diet high in calcium

A low-purine diet Purines are chemical compounds in food known to cause gout The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines.

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? Irrigating the urinary diversion Application of an ostomy pouch Intermittent catheterizations Exercises to promote sphincter control

Application of an ostomy pouch An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.

suprapubic catheter

a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization? placement of the catheter procedure for insertion of the catheter administration of cleansing enemas type and size of the catheter to be used

type and size of the catheter to be used Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.

A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? Low-phosphorus diet Low-purine diet Low-calcium diet High-protein diet

Low-purine diet Purines are chemical compounds in food known to cause gout For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited.

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? Frequency Fever Urinary retention Painless hematuria

Painless hematuria The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer? Decreasing kidney function associated with fever and hematuria Muscle spasm and abdominal rigidity over the flank Deep flank and abdominal pain Painless, gross hematuria

Painless, gross hematuria Gross hematuria: there is enough blood present in the urine that it is visible to the naked eye Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? Prevent nephron destruction. Determine the stone type. Relieve any obstruction. Relieve the pain.

Relieve the pain. The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

4 types of incontinence

Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? Low purine High protein Low oxalate High sodium

Low purine Purines are chemical compounds in food known to cause gout A low-purine diet is used for uric acid stones; the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? Acute glomerulonephritis Ureteral stricture Renal cell carcinoma Urinary calculi

Urinary calculi Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women.

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? Maintain skin and stoma integrity Determine the client's ability to manage stoma care Show photographs and drawings of the placement of the stoma Suggest a visit to a local ostomy group

Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor.

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use a clean technique during insertion Perform meticulous perineal care daily with soap and water Place the catheter bag on the client's abdomen when moving the client Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens

Perform meticulous perineal care daily with soap and water Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to: assess suicidal risk postoperatively. help the client cope with the anxiety associated with changes in body image. evaluate the client's need for mental health intervention. assess whether the client is a good candidate for surgery.

help the client cope with the anxiety associated with changes in body image. Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety.

Bladder retraining following removal of an indwelling catheter begins with performing straight catheterization after 4 hours. advising the client to avoid urinating for at least 6 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule. encouraging the client to void immediately.

instructing the client to follow a 2- to 3-hour timed voiding schedule. Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.

The nurse is educating a patient with urolithiasis about preventive 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. 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. c. Add calcium supplements to the diet to replace losses to renal calculi. d. 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. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. 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