CHAPTER 59, Chapter 55: Management of Patients with Urinary Disorders, PrepU Chapter 55: Urinary, Ch 59: Caring for Clients with Disorders of the Bladder and Urethra, Chapter 59: Caring for Clients with Disorders of the Bladder and Urethra, Timby Ch.…

Catherization (Permanent)

poses high risk; can cause bladder stones, renal disease, bladder infection, and urosepsis which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream

Ultrasound

postvoid residuals to determine if the client is emptying the bladder completely with strictures

Urethritis in women

May not only accompany cystitis but may also be secondary to vaginal infections

Symptoms of chronic urinary retention

May not produce symptoms because the bladder has stretched over time and accommodates large volumes without producing discomfort. The overstretched bladder doesn't contract effectively, and the client is unaware that the bladder isn't emptying completely.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Urinary retention Urgency Incomplete bladder emptying

Incontinence

acute urinary retention signs and symptoms

sudden inability to void with an urgent need to void, distended bladder, and severe abdominal pain,

urethroplasty

surgery to repair structures damaged by trauma

The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? A)Anticholinergic B)Diuretics C)Anticonvulsant D)Cholinergic

A

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? A)Urinary frequency B)Urinary urgency C)Urinary incontinence D)Urinary stasis

B

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?

Smoking cessation

Cause of cystitis

Fecal contamination

A client being treated in the hospital has been experiencing occasional urinary retention. What is the best nursing action?

Provide privacy for the client.

Urinary diversion

Urine is diverted to another collecting system

Can client with acute urinary retention void?

Usually they cannot void at all

neurogenic bladder

a bladder that does not receive adequate nerve stimulation

Dimethyl Sulfoxide (DMSO)

bladder installation for Interstitial Cystitis

24 hours urine in bladder stones

calcium and uric acid

Bethanechol (Urecholine)

helps to increase contraction of the detrusor muscle, which assists with emptying the bladder.

Bladder cancer

most common cancer of urinary system and occurs more in men after 55 years

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? "This medication will relieve your pain." "This medication should be taken at bedtime." "This medication will prevent re-infection." "This will kill the organism causing the infection."

"This medication will relieve your pain."

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? "Have you had a fever and chills?" "How much fluid are you drinking?" "Do you get up at night to urinate?" "When did you last urinate?"

"When did you last urinate?"

Catheter Associated Urinary Tract Infections

*Hospitals and facilities are committed to reducing the number of CAUTI* Recommended Catheter Uses: 1. Urologic surgery, urinary retention, or urinary outlet obstruction. 2. Perioperative management for clients undergoing select procedure (GI or colorectal). 3. Accurate measurement of urine output (critically ill). 4. Promotion of wound healing (peritoneal). 5. Need for intraoperative monitoring during surgery. 6. Prolonged immobilization (pelvic fractures). 7. End of life comfort.

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective? -"I will not need to worry about being incontinent of urine." -"My urine will be eliminated through a stoma." -"My urine will be eliminated with my feces." -"A catheter will drain urine directly from my kidney."

-"My urine will be eliminated through a stoma." An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? -"This medication will relieve your pain." -"This medication should be taken at bedtime." -"This medication will prevent re-infection." -"This will kill the organism causing the infection."

-"This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

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? -Acute pain -Risk for infection -Impaired urinary elimination -Imbalanced nutrition: Less than body requirements

-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.

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? -Application of an ostomy pouch -Intermittent catheterizations -Exercises to promote sphincter control -Irrigating the urinary diversion

-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.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? -Establishing a predetermined fluid intake pattern for the client -Encouraging the client to increase the time between voidings -Restricting fluid intake to reduce the need to void -Assessing present voiding patterns

-Assessing present voiding patterns The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

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 -Prompted voiding -Interval 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.

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? -Through the bloodstream (hematogenous spread) -By ascending infection (transurethral) -Due to a fistula (direct extension) -The result of urethra abrasion (sexual intercourse)

-By ascending infection (transurethral) The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.

Which information is important when teaching a client how to perform self-catheterization? -Peroxide is recommended for cleaning the urinary catheter. -Catheterization should occur every 4 to 6 hours and before bedtime. -The nurse uses nonsterile technique in the hospital setting. -The catheter is rinsed with sterile normal saline after being soaked in a cleaning solution.

-Catheterization should occur every 4 to 6 hours and before bedtime. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after being soaked in a cleaning solution. Either antibacterial soap or povidone-iodine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.

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.

Patients with urolithiasis need to be encouraged to: -Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. -Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. -Supplement their diet with calcium needed to replace losses to renal calculi. -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.

-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.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? -Increased urine production due to metabolic conditions -Decreased pelvic muscle tone due to multiple pregnancies -Bladder irritation related to urinary tract infections -Obstruction due to fecal impaction or enlarged prostate

-Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. -Urinary retention -Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity -Chronic pain

-Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client problems.

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? -Use tub baths as opposed to showers. -Drink coffee or tea to increase diuresis. -Drink liberal amount of fluids. -Void every 4 to 6 hours.

-Drink liberal amount of fluids. Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathe in a tub because bacteria in the bathwater may enter the urethra.

Which instruction would be included in a teaching plan for a client diagnosed with a UTI? -Take tub baths as opposed to showers. -Drink coffee or tea to increase diuresis. -Drink liberal amount of fluids. -Void every 4 to 6 hours.

-Drink liberal amount of fluids. Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? -Encouraging intake of at least 2 L of fluid daily -Giving the client a glass of soda before bedtime -Taking the client to the bathroom twice per day -Consulting with a dietitian

-Encouraging intake of at least 2 L of fluid daily Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

Which of the following is a cause of a calcium renal stone? -Excessive intake of vitamin D -Gout -Neurogenic bladder -Foreign bodies

-Excessive intake of vitamin D Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

Which metabolic defects are associated with stone formation? -Hyperparathyroidism -Hypoparathyroidism -Hypouricemia -Hyperthyroidism

-Hyperparathyroidism Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation. Hypoparathyroidism, hyperthyroidism, and hypouricemia are not associated with stone formation.

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? -Ileal conduit -Kock Pouch -Ureterosigmoidostomy -Indiana Pouch

-Ileal conduit When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cetaceous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.

Which factor contributes to UTI in older adults? -Low incidence of chronic illness -Immunocompromise -Sporadic use of antimicrobial agents -Active lifestyle

-Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, frequent use of antimicrobial agents, incomplete emptying of the bladder, and obstructed urine flow.

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.

The nurse advises the patient with chronic pyelonephritis that he should: -Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. -Decrease his sodium intake to prevent fluid retention. -Increase fluids to 3 to 4 L/24 hours to dilute the urine. -Decrease his intake of calcium rich foods to prevent kidney stones.

-Increase fluids to 3 to 4 L/24 hours to dilute the urine. Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.

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? A)Application of an ostomy pouch B)Intermittent catheterizations C)Exercises to promote sphincter control D)Irrigating the urinary diversion

A

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? -Kidney -Ureter -Bladder -Urethra

-Kidney The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. -Leukocytosis -Abdominal distention -Hyperactive bowel sounds -Muscle flaccidity

-Leukocytosis -Abdominal distention The nurse should monitor the client for the following signs and symptoms of peritonitis: leukocytosis, abdominal pain and distention, absence of bowel sounds (paralytic ileus), fever, muscle rigidity, guarding, and nausea and vomiting.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? -Abnormalities in urine -Location of discomfort -Elevated calcium levels -Structural defects in the kidneys

-Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

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 oxalate -Low purine -High protein -High sodium

-Low purine 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 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-calcium diet -High-protein diet -Low-phosphorus diet -Low-purine diet

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

-Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.

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 wear underwear made from synthetic material -Importance of urinating every 4 to 6 hours while awake -Suggestion to take tub baths instead of showers -Need to urinate after engaging in sexual intercourse

-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.

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? -Diagnostic studies reporting bladder stones -Crusted drainage around the cystoscopy tube -A white blood count of 12,000 cells/mm3 -New diagnosis of urosepsis

-New diagnosis of urosepsis All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.

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? -Urinary retention -Fever -Frequency -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.

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. -For those patients who are incontinent, insert indwelling catheters. -Perform hand hygiene prior to patient care. -Assist the patients with frequent toileting. -Provide careful perineal care. -Encourage patients to wear briefs.

-Perform hand hygiene prior to patient care. -Assist the patients with frequent toileting. -Provide careful perineal care. 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.

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? A)Ileal conduit B)Kock Pouch C)Ureterosigmoidostomy D)Indiana Pouch

A

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

-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.

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

-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.

The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following? -Stoma ischemia -Postoperative pneumonia -Stoma retraction -Peritonitis

-Peritonitis Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.

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

-Phenazopyridine Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? -Nitrofurantoin -Phenazopyridine -Ciprofloxacin -Levofloxacin

-Phenazopyridine Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

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

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

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

-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.

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? -Determine the stone type. -Relieve any obstruction. -Relieve the pain. -Prevent nephron destruction.

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

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

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

Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? -Overflow -Urge -Reflex -Stress

-Stress Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.

A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing? -Urge incontinence -Functional incontinence -Stress incontinence -Iatrogenic incontinence

-Stress incontinence Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position (Meiner, 2011; Miller, 2012).

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do? -Take the antibiotic as well as an antifungal for the yeast infection she will probably have. -Take the antibiotic for 3 days as prescribed. -Understand that if the infection reoccurs, the dose will be higher next time. -Be sure to take the medication with grapefruit juice.

-Take the antibiotic for 3 days as prescribed. The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? -Straight catheterize the client every 4 to 6 hours. -Administer acetaminophen (Tylenol). -Teach client to increase fluid intake up to 3 liters per day. -Restrict fluid intake to 1 liter per day.

-Teach client to increase fluid intake up to 3 liters per day. The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction? -The nursing assistant keeps the catheter and drainage bag together when moving the client. -The nursing assistant places the drainage bag on the client's abdomen for transport. -The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. -The nursing assistant holds the drainage bag while the client moves to the wheelchair.

-The nursing assistant places the drainage bag on the client's abdomen for transport. The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.

A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? Select all that apply. -The suprapubic catheter can be kept in longer than a urethral catheter. -The patient can void sooner than with a urethral catheter. -The suprapubic catheter allows for more mobility. -The patient is not at risk for a UTI with a suprapubic catheter. -The suprapubic catheter permits measurement of residual urine without urethral instrumentation.

-The patient can void sooner than with a urethral catheter. -The suprapubic catheter allows for more mobility. -The suprapubic catheter permits measurement of residual urine without urethral instrumentation. Suprapubic drainage offers certain advantages. Patients can usually void sooner after surgery than those with urethral catheters, and they may be more comfortable. The catheter allows greater mobility, permits measurement of residual urine without urethral instrumentation, and presents less risk of bladder infection.

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude? -The skin wasn't lubricated before the pouch was applied. -The pouch faceplate doesn't fit the stoma. -A skin barrier was applied properly. -Stoma dilation wasn't performed.

-The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? -The urethra -The bladder -The rectum -The ureters

-The urethra Because the urethra is short in women, ascending infections or microorganisms carried from the vagina or rectum are common. Males have a longer urethra, causing the organisms travel farther to the bladder. Although structures of the urinary system, the other options are where the client has bacteria and microorganisms located. The ureters connect the bladder to kidney thus do not obtain bacteria, just transmit when available.

Which is the procedure of choice for men with recurrent or complicated UTIs? -Transrectal ultrasonography -IV urogram -CT -MRI

-Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

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 -Urge -Overflow -Functional

-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 advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances? -Calcium -Uric acid -Struvite -Cystine

-Uric acid Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.

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 -Urinary calculi -Renal cell carcinoma

-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. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

clean intermittent catheterization (CIC) guideline

1. Perform catherization every 4-8 hours. 2. Bladder should not distend past 350 mL to avoid loss of bladder tone with overdistention, decreased blood flow, and reduction in the layer of the mucin (the layer that protects the bladder mucosa). 3. Have the client void, then perform catherization. This is not withheld until postvoid is < 30 mL return. 4. Postoperative urinary retention usually resolves in 24-48 hours. 5. Record the amount voided and the amount returned with catheter.

Which statement describing urinary incontinence in an older adult client is true? -Urinary incontinence is a normal part of aging. -Urinary incontinence isn't a disease. -Urinary incontinence in the elderly population can't be treated. -Urinary incontinence is a disease.

-Urinary incontinence isn't a disease. Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

Which of the following is a strategy to promote urinary continence? -Void regularly, 5 to 8 times a day -Take diuretics after 4 PM -Use caffeine in moderation -Implement a low fiber diet

-Void regularly, 5 to 8 times a day Strategies to promote urinary continence include increasing awareness of the amount and timing of all fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding regularly, 5 to 8 times a day (about every 2 to 3 hours).

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

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

Which risk factors predispose a client to the development of kidney stones? Select all that apply. -immobilization. -gout. -hyperparathyroidism. -hypoparathyroidism.

-immobilization. -gout. -hyperparathyroidism. Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors.

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: -limit oral fluid intake for 1 to 2 weeks. -report the presence of fine, sandlike particles through the nephrostomy tube. -notify the physician about cloudy or foul-smelling urine. -report bright pink urine within 24 hours after the procedure.

-notify the physician about cloudy or foul-smelling urine. The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder? -painless hematuria -fever -dysuria -urgency

-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.

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.

. Perform hand hygiene prior to patient care. c. Assist the patients with frequent toileting. d. Provide careful perineal care.

Older Adults Assessment of Urinary System

1. A diary over at least 3 days that records time, amount and type of medications. 2. Time and amount of fluid intake. 3. Time and amount of voiding, involuntary urine loss, and/or involuntary loss of stool. 4. Review for medications that may affect bladder emptying or cause constipation. 5. Amount and type of alcohol of illicit drugs. 6. Constipation or fecal impaction. 7. Mobility. 8. Fatigue. 9. Muscle strength. 10. Balance. 11. Falls. 12. Cognition. 13. History of atherosclerosis. 14. History of parkinsonian symptoms. 15. Environmental conditions. 16. Caregiver ability, availability, and stress.

What can contribute to urinary incontinence?

1. Alcohol. 2. Caffeine. 3. Decaffeinated tea and coffee. 4. Carbonated drinks. 5. Artificial sweeteners. 6. Corn syrup. 7. Foods that are high in spice, sugar or acid; especially citrus. 8. Heart and blood pressure medications, sedatives, muscle relaxants. 9. Large doses of vitamin B and C.

urinary incontinence client teaching

1. Be aware if the amount and timing of fluid intake. 2. No diuretics after 4pm. 3. Avoid caffeine, alcohol, and aspartame (bladder irritants). 4. Avoid constipation. 5. Void every 2-3 hours (first thing in AM, before each mean, before going to bed, during the night as needed). 6. Perform pelvic flood muscle exercises. 7. Stop smoking. 8. Control odors by proper peri-care, changing soiled clothing. 9. Do not use perfume, powders, lotions, or sprays in peri area. 10. Wash garment as soon as possible. 11. Use plastic to cover beds, chairs. 12. Place a sheet over the plastic. 13. Follow the recommendations from the physician about training with clamping and unclamping. 14. Keep a record of fluid intake; drink plenty of fluids; and avoid in late afternoon. 15. Contact doctor if increased discomfort, rash, pain in lower abdomen, fever, chills, or cloudy urine present.

Preoperative Nursing Actions Before Bladder Cancer Surgery

1. Complete medical record. 2. Drug and allergy history. 3. Vital signs, general health, weight. 4. Help reduce anxiety by proper education and listening.

How does the nurse determine Chronic Urinary Retention?

1. How often the client urinates. 2. The amount urinated each time. 3. Any pain with urination? 4. Difficult to start the urinary stream? 5. Palpate/Percuss the bladder for bladder distention. 6. Have the client void, then use a bladder scanner to determine the residual volume. 7. Obtain Complete medical, drug, and allergy history. 8. If suspected, report findings to the physician.

Postoperative Nursing Actions After Bladder Cancer Removal

1. Observe for leakage of urine or stool. 2. Maintain renal function. 3. Assess for signs and symptoms of peritonitis. 4. Maintain skin integrity and stoma integrity. 5. Teach client how to manage diversion. 6. Promote positive body image. 7. Monitor intake and output. 8. Monitor urine color, amount, clarity, and for presence of blood. 9. Nasogastric tube is used on low suction setting to prevent distention and pressure on the suture line owing to collection of gas in the bowel. This is removed when peristalsis returns and diet can be advanced.

Risk Factors for urinary incontinence

1. Pregnancy, vaginal delivery, episiotomy. 2. Menopause. 3. Genitourinary surgery. 4. Pelvic flood weakness. 5. Incompetent urethra as a result of trauma or sphincter relaxation. 6. Immobility. 7. High-impact exercise. 8. Diabetes mellitus. 9. Age-related changed in the urinary tract. 10. Obesity. 11. Chronic cough from chronic lung disease such as asthma and smoking. 12. Neurologic conditions such as stroke, Parkinson's, Alzheimer's, spinal cord injury, multiple sclerosis. 13. Diuretics', sedatives, antidepressants, hypnotics, opioids. 14. Caregiver or toilet not available.

Tumors in bladder cancer

1. Removed by cutting/resection or coagulation/fulguration with a transurethral resection of a bladder tumor. When removed this way, they may come back so cystoscopy is performed every 2-3 months. If the tumor returns, clients need cystoscopy every 6 months for rest of their lives. 2. May use antineoplastic drugs after the procedure instilled into the bladder by a catheter. 3. Limit fluids before and after the procedure to keep drug in bladder for 2 hours after. 4. After two hours, the client increases fluids and voids to get drug out.

Bladder cancer risk factors

1. Smoking 2. Exposure to carcinogens 3. Hairdressers (exposure to hair dye), machinists (exposure to chemicals and fumes), truck drivers (exposure to diesel fumes) 4. Recurrent UTI 5. Arsenic in water 6. Bladder stones 7. not drinking enough water 8. bladder birth defects 9. family history 10. high urinary pH 11. high cholesterol intake 12. pelvic radiation or chemo 13. cancers from prostate, colon, and rectum

urinary retention diagnostic findings

1. UA: increased WBCs (infection). 2. Catherization and Ultrasound: determines post residual volume. 3. Bedside ultrasound bladder scanning: volumes over 100 mL shows urinary retention after just voiding. 4. Urodynamic Testing: radiography with contrast instilled in bladder and pressures measured during filling and voiding 5. Uroflowmetry: measures the urine flow and the speed of bladder emptying. 6. Pressure Flow study: measures the bladder pressure required to urinate and the flow rate pressure generates. 7. Electromyography: determine the activity if the external sphincter during voiding. 8. CT scan: determine if kidney stone; cysts, or injury. 9. X-rays: shows anatomy and if any problems. 10. Cystoscopy and Ureteroscopy: examines the bladder and urethra.

cystitis client teaching

1. drink extra fluids; 2-3 litters per day 2. cranberry juice may provide a less favorable environment for bacteria. 3. finish all antibiotics. 4. Avoid coffee, teas, colas, and alcohol. 5. Shower rather than bathe. 6. Cleanse peritoneum after each bowel movement from front to back. 7. Avoid bubble baths, bath salts, peritoneal lotions, vaginal sprays, nylon underwear, and scented TP. 8. Wear cotton underwear. 9. Void every 2-3 hours. 10. Empty bladder completely with each voiding. 11. Void after intercourse. 12. Notify physician of urgency, frequency, burning, difficulty, or blood in urine.

Urinary Diversion Management

1. monitor for fluid and electrolyte imbalances. 2. keep closed collection containers below the level of the stoma. 3. keep tubing that connects the catheter or collection appliance straight to prevent urine from collecting ina curve of the tube. 4. Avoid kinks in the tubing. 5. Drink adequate fluids. 6. Take medications as prescribed. 7. Control odors with cranberry juice, yogurt, buttermilk. 8. Avoid asparagus, cheese, or eggs. 9. Keep skin clean. 10. Drain the continent urinary collection bag four times per day. 11. Wash the urinary collection pouch thoroughly after changing. Rinse with vinegar. 12. If fever, chills, blood in urine, failure of stoma to drain, skin problems around stoma, weight loss > 5 pounds, loss of appetite, pain the flank, inability to insert catheter, signs of fluid and electrolyte imbalance call your provider.

Urethral strictures assessment findings

1. slow or decreased force of stream of urine 2. urine leakage or dribbling after urinating 3. spraying of urine when voiding 4. dysuria 5. urgency 6. hesitancy 7. burning 8. frequency 9. hematuria 10. nocturia 11. lower abdominal or pelvic pain 12. retention of urine after voiding

bladder stones patient teaching

1. strain urine and send any stones found to the lab. 2. Follow the dietary orders. 3. Take prescribed meds as directed. 4. Drink 10 glasses of water per day. 5. exercise regularly. 6. If hematuria, burning, chills, fever, or pain occurs contact doctor.

A client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is instructed to consume ______ mg of calcium per day, or less, as part of dietary treatment.

1000

A client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is instructed to consume ______ mg of calcium per day, or less, as part of dietary treatment. 1000 1250 1500 2000

1000

catheter sizes

14-24 French; select the smallest possible size to prevent trauma; coude is used for obstructions due to curved tip; if the volume of output is > 700 mL, clamp the catheter to prevent bladder spasms or loss of bladder tone

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day?

2,000 mL

A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what? 30 mL 50 mL 100 mL 125 mL

30 mL

A client who was involved in an MVA which resulted in paraplegia is working toward living at home. The client is currently developing an individualized CIC schedule, preferring not to wear a leg bag. What is the maximum amount of urine the client should allow to collect before catheterization? 350 mL 500 mL 100 mL 600 mL

350 mL

A client is a victim of an MVA and is unconscious. In compliance with a physician's order to insert an indwelling catheter, the nurse places the catheter and notes the drainage of a large amount of yellow urine with normal odor. How much urine will the nurse allow to drain before clamping the tube? 700 mL 250 mL 500 mL 1000 mL

700 mL

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? A)Client's manual dexterity and vision B)History of allergy to iodine and seafood C)Dietary habits involving cholesterol-laden food D)Menstrual history

A

The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a litholapaxy. Which nursing action is most important to complete prior to the procedure? A)Strain all urine B)Maintain the intake and output C)Maintain 12 hours of nothing by mouth D)Make sure that the nurse has the consent signed

A

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? A)The urethra B)The bladder C)The rectum D)The ureters

A

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? A)Coffee in the morning B)Fruit juice midmorning C)Milk at lunch D)Ginger ale at dinner time

A

Suprapubic cystostomy tube

A catheter inserted through the abdominal wall directly into the bladder

Interstitial cystitis (painful bladder syndrome)

A chronic inflammation of the bladder mucosa

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A client whose diagnosis of chronic kidney disease requires a fluid restriction A client who has Alzheimer disease and who is acutely agitated A client who is on bed rest following a recent episode of venous thromboembolism A client who has decreased mobility following a transmetatarsal amputation

A client who has Alzheimer disease and who is acutely agitated

Urosepsis

A serious systemic infection from microorganisms in the urinary tract invading the bloodstream

Phenazopyridine (Pyridium)

A urinary tract analgesic, can cause orange or orange-red urine

12. A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what?

A) 30 mL (A urine output below 30 mL/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.)

18. The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?

A) The patient's suprapubic region is dull on percussion. (Dullness on percussion of the suprapubic region is suggestive of urinary retention..)

22. The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply.

A) Dietary history B) Family history of renal stones C) Medication history (Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation.)

21. A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?

A) Hydronephrosis (If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis.)

9. The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patient's bladder?

A) Insertion of a suprapubic catheter (When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.)

39. The nurse has tested the pH of urine from a patient's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding?

A) Obtain an order to increase the patient's dose of ascorbic acid. (Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept BELOW 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase ascorbic acid dosing.)

5. The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide?

A) Restrict protein intake as ordered. (Protein is restricted to 60 grams per day, while sodium is restricted to 3 to 4 grams per day. Low-calcium diets are generally NOT recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate-containing foods and there is NO need to increase potassium intake.)

37. The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?

A) Smoking cessation (People who smoke develop bladder cancer twice as often as those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.)

19. A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patient's post-procedure care?

A) Strain the patient's urine following the procedure. (Following ESWL, the nurse should strain the patient's urine for gravel or sand. There is no need to administer an I.V bolus after the procedure and there is NOT a heightened risk of fluid overload. Catheter insertion is NOT normally indicated following ESWL.)

2. A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?

A) Stress incontinence (Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors [outside the urinary system] make it difficult or impossible for the patient to reach the toilet in time for voiding)

Continent Urinary Diversion (Indiana Pouch) (Kock pouch)

inspect the stoma for bleeding or cyanosis. irrigate the pouch if ordered to prevent blood clots and mucous plugs. teach client how to perform intermittent self catherization every 1-2 hours, then every 4-6 hours.

25. A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic?

A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy (Yeast vaginitis occurs in as many as 25% of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI.)

The nurse is caring for a 13-year-old female client diagnosed with urethritis. Which of the following assessment answers would indicate that further instruction is needed? Select all that apply. A)"I change my sanitary napkin when it is full." B)"My mom buys just regular toilet paper." C)"I take a bubble bath a couple of times per week." D)"I clean my private area with soap and water." E)"I drink fruit drinks because I do not like water."

A,C,D

The nurse is providing instruction in stoma care with temporary bag following an ileal conduit surgery. Which of the following instructions is accurate? Select all that apply. A)Ascorbic acid suppresses urine odors. B)Change temporary ostomy bag when it becomes three-quarters (3/4) full. C)Change the pouch every 4 to 7 days if it is a two-piece pouch. D)Change the pouch daily if it is a one-piece pouch. E)Apply an appliance deodorant to decrease odors.

A,C,E

Transitional cell carcinoma of the bladder

AKA: urothelial cancer; most common type which develops in the bladder's epithelial lining

Nursing Management of urethral strictures

Advise client that urine may be blood tinged after urethral dilatation and it may burn when voiding. Sitz baths and non narcotics may relieve discomfort. Encourage client to drink extra fluids for several days after procedure. Keep follow up appointments. Thank wall antibiotics and contact physician if difficulty voiding or frank bleeding occurs.

When is acute urinary retention seen?

After general anesthesia, or with administration of certain drugs such as atropine or a phenothiazine

Tamsulosin (Flomax)

Alpha Blocker: used for males; relaxes the bladder neck muscles and the muscle fibers of the prostate gland easing the ability to empty the bladder and reducing incontinence

Bladder training for client with an indwelling catheter

Alternately clamp and unclamp the catheters. In the beginning, catheter may be unclamped for 5 minutes every 1 or 2 hours, length of time is usually increased to every 3 or 4 hours, giving the bladder a chance to fill more completely.

The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority? A)The client will decrease fluid intake to 1000 mL/day. B)The client will use the bathroom every 30 minutes while awake. C)The client will maintain perineal skin integrity. D)The client will express feelings of acceptance related to condition.

C

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?

Cipro

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

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? A)Suprapubic cystostomy tube B)Permanent drainage with a urethral catheter C)Clean intermittent catheterization D)Credé voiding procedure

B

Commonly Used Antibiotics for Cystitis

Ciprofloxacin, Fosfomycin, Levofloxacin, Nitrofurantoin, Sulfamethoxazole/Trimethoprim

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action, made by the nursing assistant, would require instruction? A)The nursing assistant keeps the catheter and drainage bag together when moving the client. B)The nursing assistant places the drainage bag on the client's abdomen for transport. C)The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. D)The nursing assistant holds the drainage bag while the client moves to the wheelchair.

B

Oxybutinin (Ditropan)

Anticholinergic: reduces bladder spasticity and involuntary bladder contractions

Tolterodine Tartrate (Detrol)

Anticholinergic: reduces bladder spasticity and involuntary bladder contractions

Drugs that improve bladder retention, emptying, and control

Anticholinergics such as oxybutynin (Ditropan), Detrol, and Dibenzaline

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

Assessing present voiding patterns

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Establishing a predetermined fluid intake pattern for the client Encouraging the client to increase the time between voidings Restricting fluid intake to reduce the need to void Assessing present voiding patterns

Assessing present voiding patterns

The nurse needs to assess the fluid volume status of a client with chronic glomerulonephritis. To accurately assess the client's fluid volume status, the nurse should weigh the client daily: at the same time, on the same scale, with similar clothing. once in the morning, on the same scale, with similar clothing. at the same time, using a different scale every time, with similar clothing. at the same time, on the same scale, with only minimal clothing.

At the same time, on the same scale, with similar clothing.

interstitial cystitis teaching

Avoid spicy foods and acidic foods, omit carbonated beverages, caffeine, citrus products, and foods with high concentrations of vitamin C; refer to a chronic pain center to cope with pain

The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a client how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices? Empty the collection bag when it is between one-half and two-thirds full. Limit fluid intake to prevent production of large volumes of dilute urine. Reinforce the appliance with tape if small leaks are detected. Avoid using moisturizing soaps and body washes when cleaning the peristomal area.

Avoid using moisturizing soaps and body washes when cleaning the peristomal area

The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? Over a bony prominence Away from skin folds At the belt line At the umbilicus

Away from skin folds

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? A)Stress B)Urge C)Overflow D)Functional

B

An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity? A)Avoiding the application of moisture sealant B)Exposing the affected area to air C)Using scented sprays or perfumes D)Avoiding using an electric room deodorizer

B

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? A)Low oxalate B)Low purine C)High protein D)High sodium

B

The nurse is caring for a client with a urinary tract infection and a urethral stricture. Which complication of the condition is the primary cause of infection? A)The bladder mucosa attracts bacteria. B)There is a backflow of urine causing a diverticulum. C)Urine leakage occurs as urine passes through the stricture. D)Urine production is limited due to the urine remaining in the bladder.

B

The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder? A)Douching with a vinegar solution B)Drinking cranberry juice C)Flushing the system with water D)Wiping from the urethra to rectum

B

The nurse is caring for four clients on a urinary medical unit. For which client does the nurse need no further medical interventions? A)The client has pain of 7 out of 10 in the mid-abdomen. B)The client has a residual urine of 90 mL on a bedside ultrasound bladder scan. C)The client has a WBC count of 15,000 on recent lab reports. D)The client is unable to void in the morning hours.

B

The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones? A)The client with frequent urinary tract infections B)The client who is paraplegic C)The client with difficulty ambulating D)The client with abdominal surgery

B

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)A low-sodium diet B)A low-purine diet C)A diet high in fruits and vegetables D)A diet high in calcium

B

11. The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?

B) 2,000 mL (Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have I.V fluids prescribed to keep the urine dilute. A urine output exceeding 2 L a day is advisable.)

32. A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient?

B) A patient who has Alzheimer's disease and who is acutely agitated (Patients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated.)

10. The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding?

B) Avoid further interventions at this time, as this is an acceptable finding. (In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.)

4. A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address?

B) Deficient knowledge related to care of the ileal conduit (The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.)

A client who has just undergone an appendectomy reports the need to urinate but is unable to do so. What is the nurse's response to this client's situation as ordered by the physician?

intermittent catheterization

42. A patient has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of disturbed body image. How can the nurse best address the effects of this urinary diversion on the patient's body image?

B) Encourage the patient to speak openly and frankly about the diversion. (Allowing the patient to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the patient is hesitant.)

38. Resection of a patient's bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?

B) Hold the solution in the bladder for 2 hours before voiding. (The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is NOT consumed orally. There is no need to avoid acidic foods and beverages during treatment.)

35. 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?

B) Increasing fluid intake (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)

23. A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population?

B) Limit the use of indwelling urinary catheters. (When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI.)

30. A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care?

B) Risk for infection related to presence of an indwelling urinary catheter (Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patient's risk for infection is usually prioritized over functional and psychosocial diagnoses.)

8. The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?

B) Teach the patient to perform pelvic floor muscle exercises. (Pelvic floor muscle exercises [sometimes called Kegel exercises] represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach.)

14. The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite?

B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. (The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are NOT more likely to be asymptomatic and are NOT known to be reluctant to report UTIs.)

3. A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice?

B) Using clean technique at home to catheterize (The patient may use a "clean" [nonsterile] technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowler's position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm into the urethra, in a downward and backward direction.)

A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands which of the following reasons that this drug is an effective treatment? A)Increases contraction of the detrusor muscle B)Increases bladder neck resistance C)Reduces bladder spasticity D)Decreases involuntary bladder contractions

B,D

bladder stones prevention

BASED ON TYPE 1. Uric acid stones: low purine diet. 2. Calcium stones: High calcium and low oxylate diet. 3. Limit sodium. 4. Increase fluids

Neurogenic bladder

Bladder that doesn't receive adequate nerve stimulation

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? Through the bloodstream (hematogenous spread) By ascending infection (transurethral) Due to a fistula (direct extension) The result of urethra abrasion (sexual intercourse)

By ascending infection (transurethral)

Management of chronic urinary retention

By permanent drainage with a urethral catheter, suprapubic cystostomy tube, or clean intermittent catheterization (CIC)

As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention? A)Client voided 300 mL without dysuria B)Client voided 550 mL of urine for the daylight shift C)Client voided 300 mL with 250 mL residual volume D)Bladder scanning resulted in 250 mL

C

The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct? A)Continue the same order. B)Obtain an order to decrease the frequency of the catheterizations. C)Obtain an order to increase the frequency of the catheterizations. D)Leave the catheter in if obtaining a urine amount over 500 mL.

C

The nurse is assessing a client brought to the emergency department for systemic complications after a traumatic event. Which assessment finding is most suggestive of an intact urinary tract? A)The nurse notes no abnormalities on abdominal inspection. B)The client states diffuse abdominal pain. C)Urine output is pink and noted at 300 mL. D)The physician notes urine leakage upon palpation.

C

The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in suggesting the disease? A)"Have you noted any unusual vaginal drainage?" B)"Have you experienced hematuria with cramping?" C)"When was your last menstrual period?" D)"Do you drink alcoholic beverages on a frequent basis?"

C

The nurse is caring for a client who is following a treatment plan to decrease urinary tract infections. Which of the following indicates the need to change the treatment plan? A)The client has history of repeated antibiotic therapy. B)The client has improved personal hygiene methods. C)The client exhibits continued symptoms. D)The client has diluted urine.

C

The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder? A)A cystoscopy B)A voiding cystourethrogram C)A bladder biopsy D)A potassium sensitivity test

C

The nurse is caring for a male client who has a significant urinary narrowing secondary to an enlarged prostate. Which nursing action is best to relieve his urinary retention? A)Use a 22 French catheter to remove urine from bladder. B)Teach the Credé's maneuver to remove urine from the bladder. C)Insert a coudé catheter to remove urine from the bladder. D)Use a straight-tipped catheter to remove urine from the bladder.

C

As a result of trauma, a client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. What is the initial step to begin bladder training for a client with an indwelling catheter?

Clamp the catheter.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? A)Incontinence B)Dysuria C)Hematuria D)Frequency

C

28. A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment?

C) Arrange for biofeedback when the patient is learning to perform the exercises. (Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise [PME] uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME.)

1. A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?

C) Drink liberal amounts of fluids. (The patient is encouraged to drink liberal amounts of fluids [water is the best choice] to increase urine production and flow, which flushes the bacteria from the urinary tract. •Frequent voiding [every 2 to 3 hours] is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. •The patient should be encouraged to shower rather than bathe.)

13. The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter?

C) Empty the drainage bag at least every 8 hours. (To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine.)

33. A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patient's admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply.

C) Hematuria D) Urinary frequency E) Acute pain (Stones lodged in the ureter [ureteral obstruction] cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic.)

31. A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response?

C) Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void. (Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would NOT be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is NOT an expected finding after catheter removal.)

20. The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response?

C) Inform the primary care provider that the vascular supply may be compromised. (A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.)

Periurethral bulking

placement of small amounts of collagen in urethral walls to aid the closing pressure

6. The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?

C) Notify the physician about cloudy or foul-smelling urine. (The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.)

34. A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patient's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

C) Pain management (The patient with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the patient's need for I.V fluids or for catheterization.)

36. A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the patient?

C) Tell the patient to report to the ED for further assessment. (Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.)

15. A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed?

C) The widest part of the stoma (The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be NO more than 1.6 mm [1/8 inch] larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.)

bladder cancer other studies

CT scan with guided needed biopsy, MRI, X-ray of the pelvis may show a tumor shadow or bony metastases

Permanent catheterization of the bladder

Carries the risk of bladder stones, renal disease, bladder infection, and urosepsis

Strictures of the urethra

Caused by infections such as gonorrhea or chronic nongonococcal urethritis

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia?

Change in cognitive functioning

Which objective symptom of a UTI is most common in older adults, especially those with dementia? Incontinence Change in cognitive functioning Hematuria Back pain

Change in cognitive functioning

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention? Secure or patch it with tape. Empty the pouch. Change the wafer and pouch. Secure or patch it with barrier paste.

Change the wafer and pouch

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention?

Change the wafer and pouch.

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? Rebound tenderness at McBurney's point An output of 200mL with each voiding Cloudy urine Urine with a specific gravity of 1.005-1.022

Cloudy urine

Chlamydia trachomatis or ureaplasma urealyticum

Common cause of urethritis in men which also causes sexually transmitted infections.

Diet for calcium oxalate stones

Consume adequate calcium. Foods high in oxalate should be avoided: leafy green vegetables, berries, rhubarb, tea, nuts, chocolate, beans, tofu, sweet potatoes, wheat bran, draft beer. Avoid excess protein intake

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? A)Need to wear underwear made from synthetic material B)Importance of urinating every 4 to 6 hours while awake C)Suggestion to take tub baths instead of showers D)Need to urinate after engaging in sexual intercourse

D

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? A)Urinary retention B)Fever C)Frequency D)Painless hematuria

D

The nurse is caring for a client who has chronic urinary retention and discussing the options. When discussing care, which intervention is considered first? A)Completing clean intermittent catheterization B)Inserting a cystostomy tube C)Applying a condom catheter D)Using the Credé's maneuver

D

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? A)Diagnostic studies reporting bladder stones B)Crusted drainage around the cystoscopy tube C)A white blood count of 12,000 cells/mm3 D)New diagnosis of urosepsis

D

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? A)Set up a routine schedule of every 4 hours to check for residual urine. B)Check for residual after the client reports the urge to void. C)Record the volume of urine obtained. D)Catheterize the client immediately after the client voids

D

41. The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a patient how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices?

D) Avoid using moisturizing soaps and body washes when cleaning the peristomal area. (The patient is instructed to avoid moisturizing soaps and body washes when cleaning the area because they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids should be encouraged, not limited, and the collection bag should NOT be allowed to become more than 1/3 full.)

29. A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patient's high risk for urinary retention and should implement what intervention in the patient's plan of care?

D) Double voiding (To enhance emptying of a flaccid bladder, the patient may be taught to double void. After each voiding, the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective.)

26. An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding?

D) Encourage the patient to continue this pattern of fluid intake. (Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or sodium.)

16. A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?

D) Provide privacy for the patient. (Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.)

40. A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response?

D) Reassure the patient that this is an expected phenomenon. (Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or pH is not required.)

27. An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment?

D) Reviewing the patient's medication administration record for recent changes (Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patient's continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals.)

24. A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply.

D) Uncharacteristic fatigue E) New onset of confusion (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.)

17. A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults?

D) Urinary incontinence is not considered a normal consequence of aging. (Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.)

7. A female patient's most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurse's data analysis should be informed by what principle?

D) Urine samples are frequently contaminated by bacteria normally present in the urethral area. (Because urine samples [especially in women] are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies per mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does NOT require three consecutive positive results and urine does NOT contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.)

A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the most plausible nursing diagnosis that the nurse should address? Impaired mobility related to limitations posed by the ileal conduit Deficient knowledge related to care of the ileal conduit Risk for deficient fluid volume related to urinary diversion Risk for autonomic dysreflexia related to disruption of the sacral plexus

Deficient knowledge related to care of the ileal conduit

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply. Difficulty starting a urine stream Suprapubic pain Elevated temperature Hematuria Constipation

Difficulty starting a urine stream Elevated temperature Hematuria Suprapubic pain

Urethral strictures may be caused by infections such as untreated gonorrhea or chronic nongonococcal urethritis, or by trauma to the lower urinary tract or pelvis. They may also be congenital. What are possible modes of medical or surgical management for urethral strictures? Select all that apply. dilatation urethroplasty fulguration antibiotic treatment

Dilatation Urethroplasty

Nursing management of the client with a urinary tract infection should include:

Discouraging caffeine intake

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection?

Drink liberal amount of fluids.

A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client?

Drink liberal amounts of fluid

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? Use tub baths as opposed to showers. Drink coffee or tea to increase diuresis. Drink liberal amount of fluids. Void every 4 to 6 hours.

Drink liberal amounts of fluids

An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? Supplement the client's fluid intake with a high-calorie diet. Emphasize the need to limit intake to 2 L of fluid daily. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. Encourage the client to continue this pattern of fluid intake.

Encourage the client to continue this pattern of fluid intake

An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding?

Encourage the client to continue this pattern of fluid intake.

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? Emphasize that the diversion is an integral part of successful cancer treatment. Encourage the client to speak openly and frankly about the diversion. Allow the client to initiate the process of providing care for the diversion. Provide the client with detailed written materials about the diversion at the time of discharge.

Encourage the client to speak openly and frankly about the diversion

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image?

Encourage the patient to speak openly and frankly about the diversion.

A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. Food cravings Upper abdominal pain Insatiable thirst Fever New onset of confusion

Fever New onset of confusion

urinary incontinence nursing management

Goals: maintaining continence, prevent skin breakdown, reduce anxiety, initiate a bladder training program. Assess for skin breakdown; determine cause or if medications are contributing to incontinence. Use scheduled voiding every 2-4 hours. Use prompted voiding which provides scheduled voiding with prompting and praising used for clients who require encouragement and clients with neuro impairment.

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 whether the client is a good candidate for surgery. help the client cope with the anxiety associated with changes in body image. assess suicidal risk postoperatively. evaluate the client's need for mental health intervention.

Help the client cope with the anxiety associated with changes in body image.

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following? Remain NPO for 12 hours prior to the treatment. Hold the solution in the bladder for 2 hours before voiding. Drink the intravesical solution quickly and on an empty stomach. Avoid acidic foods and beverages until the full cycle of treatment is complete.

Hold the solution in the bladder for 2 hours before voiding

Which factor contributes to UTI in older adults?

Immunocompromise

Which factor contributes to UTI in older adults? Low incidence of chronic illness Immunocompromise Sporadic use of antimicrobial agents Active lifestyle

Immunocompromise

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?

Implement a 2- to 3-hour voiding schedule

When is chronic urinary retention seen?

In client's with Disorders such as prostatic enlargement or neurologic disorders that result in a neurogenic bladder

Urethritis diagnostic studies

In men: urethral smear for culture and sensitivity. In women: a clean catch urine culture to identify bacteria.

Urinary incontinence

Inability to control the voiding of urine

Urinary retention

Inability to urinate or effectively empty the bladder

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Add calcium supplements to the diet to replace losses to renal calculi. 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.

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.

Guidelines for preventing cystitis

Increase fluid intake to 2-3L/day; avoid coffee, teas, colas, and alcohol; shower rather than bathe in a tub; cleanse perineum after each bowel movement with front to back motion; avoid irritating substances like bubble bath; wear cotton underwear; void every 2-3 hours while awake; empty bladder completely with each voiding; void after sexual intercourse; take medication as prescribed; notify physician if you have urgency, frequency, nursing with urination; difficulty urinating, or blood in the urine

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care?

Increasing fluid intake

A client has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What contributes to the likelihood of developing urinary tract or bladder infections? Select all that apply. indwelling catheter decreased fluid intake frequent catheter hygiene increased ingestion of Vitamin C

Indwelling catheter decreased fluid intake

A client has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What contributes to the likelihood of developing urinary tract or bladder infections? Select all that apply.

Indwelling catheter • Decreased fluid intake

Urethritis

Inflammation of the urethra. Seen more in men than in women. Caused by microorganisms other than nongonococcal urethritis.

Cystitis

Inflammation of the urinary bladder

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? Document the presence of a healthy stoma. Assess the client for further signs and symptoms of infection. Inform the primary provider that the vascular supply may be compromised. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.

Inform the primary provider that the vascular supply may be compromised

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response?

Inform the primary provider that the vascular supply may be compromised.

Kegel Exercises Teaching

Initial Instruction: 1. Sit or stand with legs slightly apart. 2. Draw in peri-vaginal muscles and anal sphincter as when controlling voiding or defecating. 3. Hold this contraction for 5 seconds. 4. Relax contraction for 10 seconds. 5. Repeat exercises for 5-6 times, increasing slowly to 25 times. 6. Repeat the sequence of exercises 3-4 times a day. 7. Gradually do the exercises for a total of 200 repetitions. Advanced Instruction: 1. Sit on the toilet and begin to urinate. 2. Stop the flow of urine by doing a Kegel exercise. 3. Hold this position for 5 seconds. 4. Relax and begin voiding. 5. Repeat the sequence 5 times with each voiding.

The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider to use to drain the client's bladder? Insertion of a suprapubic catheter Scheduling the client immediately for a prostatectomy Application of warm compresses to the perineum to assist with relaxation Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours

Insertion of a suprapubic catheter

Stress incontinence

Involuntary loss of urine, which results from sudden increase in intra-abdominal pressure, such as coughing or sneezing

Overflow incontinence

Involuntary loss of urine. Void small amounts frequently, dribbling

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 Aspirin Ketoralac (Toradol) Meperidine (Demerol)

Ketoralac (Toradol)

Use of tobacco products

Leading cause of bladder cancer

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-calcium diet High-protein diet Low-phosphorus diet Low-purine diet

Low-purine diet

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

Maintain skin and stomal integrity

A client undergoes surgery to remove a malignant tumor followed by a urinary diversion procedure. Which postoperative procedure is the most important for the nurse to perform?

Maintain skin and stomal integrity.

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?

Maintain skin and stomal integrity.

A nurse is preparing a care plan for a client with Alzheimer's disease. The client is unable to communicate or feel the pain and discomfort associated with acute urinary retention. Which nursing measures should be taken while caring for such a client? Select all that apply. Measure fluid intake and output. Palpate the abdomen to check for distended bladder. Promote catheterization. Instruct the client on how to minimize urinary odor.

Measure fluid intake and output Palpate the abdomen to check for distended bladder

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program?

Medication usage

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?

Monitor urine output hourly and report output less than 30 mL/hr.

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective?

My urine will be eliminated through a stoma."

Treatment of cystitis with a partial urethral obstruction

No treatment is fully effective until adequate drainage of urine is restored by the removal of the obstruction

The nurse is caring for a client who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the client? Limit oral fluid intake for 1 to 2 days. Report the presence of fine, sand like particles through the nephrostomy tube. Notify the health care provider about cloudy or foul-smelling urine. Report any pink-tinged urine within 24 hours after the procedure.

Notify the health care provider about cloudy or foul-smelling urine.

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

Transient urinary incontinence

Occurs suddenly, temporary, lasts less than 6 months

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

Pain management

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? IV fluid administration Insertion of an indwelling urinary catheter Pain management Assisting with aspiration of the stone

Pain management

Which of the following is the most common symptom of bladder cancer?

Painless gross hematuria

Which finding is an early indicator of bladder cancer?

Painless hematuria

Which finding is an early indicator of bladder cancer? Painless hematuria Occasional polyuria Nocturia Dysuria

Painless hematuria

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?

Painless, gross hematuria

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?

Perform meticulous perineal care daily with soap and water

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

Perform meticulous perineal care daily with soap and water

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

Phenazopyridine

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? Physical and environmental conditions History of allergies Occupational history Smoking habits

Physical and environmental conditions

A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training? Immediately after voiding, perform a bladder scan. Instruct the client to drink more fluids at night for a full bladder in the morning. Place client on a timed voiding schedule. Perform straight catheterizations at specific times each day.

Place client on a timed voiding schedule

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? Smoking cessation Reduction of alcohol intake Maintenance of a diet high in vitamins and nutrients Vitamin D supplementation

Smoking cessation

A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is: placement of small amounts of collagen in urethral walls to aid the closing pressure. a procedure that increases storage capacity of the bladder. implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination. a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

Placement of small amounts of collagen in urethral walls to aid the closing pressure

A client being treated in the hospital has been experiencing occasional urinary retention. What is the best nursing action? Use a slipper bedpan. Apply a cold compress to the perineum. Have the client lie in a supine position. Provide privacy for the client.

Provide privacy for the client

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

Pyridium

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

Pyridium

One of the potential problems for a client with a urinary diversion is disturbed body image related to change in appearance and function. The expected outcome is that the client will accept the altered appearance and perform self-care. Which activities would help in achieving that expected outcome? Select all that apply. Reassure the client that nursing staff will provide care until he or she is ready. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice. Begin exposure to the stoma immediately to help the client adapt properly.

Reassure the client that nursing staff will provide care until he or she is ready. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice.

Cranberry juice or vitamin C

Recommended to keep the bacteria from adhering to the wall of the bladder and promoting their excretion and enhancing the effectiveness of drug therapy.

A client has been admitted to the renal unit with acute pyelonephritis, and is undergoing parenteral antibiotic treatment. What would be a significant aspect of this client's discharge education? recurring infection prevention anti-inflammatory incompatibilities needed dietary changes No option is correct.

Recurring infection prevention

Ditropan

Reduced bladder spasticity and involuntary bladder contractions

Litholapaxy

Removal of bladder stones through the transurethral route using a stone crushing instrument

Fulguration

Removal of small, superficial tumor's with a transurethral resectoscope

Cystoscopy

Reveals a markedly inflamed bladder mucosa with pinpoint hemorrhages and a bladder capacity that's smaller than normal

An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the client for factors that may have contributed to incontinence, the nurse should prioritize what assessment? Reviewing the client's 24-hour food recall for changes in diet Assessing for recent contact with individuals who have UTIs Assessing for changes in the client's level of psychosocial stress Reviewing the client's medication administration record for recent changes

Reviewing the client's medication administration record for recent changes

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids? Significantly increase fluid intake. Increase caffeinated beverages. Significantly decrease fluid intake. No change in fluids needed.

Significantly increase fluid intake

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids?

Significantly increase fluid intake.

A nurse is teaching a client how to do Kegel exercises. Place in order from first to last the correct steps in performing these exercises.

Sit or stand with legs slightly apart. Draw in perivaginal muscles and anal sphincter as when controlling voiding or defecating. Hold position of contraction for 5 seconds (count or time with a watch). Relax contraction for at least 10 seconds. Repeat exercises 5 to 6 times, increasing slowly to 25 times.

Teaching to perform kegel exercises

Sit/stand with legs slightly apart; draw in perivaginal muscles and anal sphincter as when controlling voiding or defecating; hold the position of contraction for 5 seconds; relax for at least 10 seconds; repeat exercises 5-6 times, increase slowly to 25 times; repeat 3-4 times per day; gradually repeat sequence for a total of 200 repetitions

Symptoms of urethral strictures

Slow or decreased force of stream of urine; hesitancy; burning; frequency; nocturnal; retention of residual urine in the bladder that may lead to bladder distention and infection

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? Strain the client's urine following the procedure. Administer a bolus of 500 mL normal saline following the procedure. Monitor the client for fluid overload following the procedure. Insert a urinary catheter for 24 to 48 hours after the procedure.

Strain the client;s urine following the procedure

Which of the following nursing actions is most important in caring for the client following lithotripsy? Monitor the continuous bladder irrigation. Administer allopurinol (Zyloprim). Strain the urine carefully for stone fragments. Notify the physician of hematuria.

Strain the urine carefully for stone fragments

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments.

Client teaching for bladder stones

Strain urine and send any stones to lab; follow diet recommendations; take prescribed medications as prescribed; contact doctor if symptoms return; drink plenty of fluids and exercise regularly; contact physician if hematuria, burning, chills, fever, or pain occurs

Signs of obstructed urine flow

Straining to empty the bladder; feeling that the bladder doesn't empty completely; hesitancy; weak stream; frequency; overflow incontinence; bladder distention

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing?

Stress

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? Reflex Urge Stress Overflow

Stress

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? Stress incontinence Reflex incontinence Overflow incontinence Functional incontinence

Stress incontinence

Symptoms of acute urinary retention

Sudden inability to void, distended bladder, and severe lower abdominal pain and discomfort

Hunner's ulcer

Superficial erosion of the bladder mucosa

Indiana pouch

Surgeon introduces the ureters into a segment of the ileum and cecum and urine is drained by inserting a catheter into the stoma

Ureterosigmoidostomy

Surgeon introduces the ureters into the sigmoid colon, allowing urine to flow through the colon and out the rectum. Nurse checks amount and color of drainage from rectal catheter every 1 or 2 hours and inspects the anal and gluteal areas for signs of early skin breakdown. The catheter is removed when peristalsis returns and client's must never have enemas; suppositories, or laxatives

Continent ileal urinary diversions (Kock pouch)

Surgeon transplants ureters to an isolated segment of the small bowel. Urine is drained by inserting a catheter into the stoma

Cystectomy

Surgical removal of the bladder that's necessary when the tumor has penetrated the muscle wall

Bladder Training

THE CLAMPING AND UNCLAMPING OF THE CATHETER BEGINS TO ESTABLISH NORMAL BLADDER FUNCTION AND CAPACITY. 1. Alternating clamp and unclamp the catheter for 5 mins every 1-2 hours. 2. Gradually increase clamping time every 3-4 hours. 3. The nurse may teach the client to clamp own catheter. 4. Have the client void every hour. 5. Then gradually every 2, 3, and 4 hours. AT FIRST MANY TIMES CLIENTS DO NOT FULLY EMPTY THEIR OWN BLADDER AND MUST BE CATHERIZED AFTER VOIDING

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do? Take the antibiotic as well as an antifungal for the yeast infection she will probably have. Take the antibiotic for 3 days as prescribed. Understand that if the infection reoccurs, the dose will be higher next time. Be sure to take the medication with grapefruit juice.

Take the antibiotic for 3 days as prescribed

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?

Take the antibiotic for 3 days as prescribed.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day.

A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Remind the client that occasional febrile episodes are expected following ESWL. Tell the client to report to the ED for further assessment. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.

Tell the client to report to the ED for further assessment

The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? The client's suprapubic region is dull on percussion. The client is uncharacteristically drowsy. The client claims to void large amounts of urine two to three times daily. The client takes a beta adrenergic blocker for the treatment of hypertension.

The client's suprarubic region is dull on percussion

Clean intermittent catheterization (CIC)

The preferred treatment for chronic urinary retention

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic?

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy The need to expect a heavy menstrual period following the course of antibiotics The risk of developing antibiotic resistance after the course of antibiotics The need to undergo a series of three urine cultures after the antibiotics have been completed

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy

Can client with chronic urinary retention void?

They may be able to void, but they do not completely empty the bladder and they have a large residual volume

Symptoms of interstitial cystitis

They mimic other disorders such as cystitis, bladder cancer, or a sexually transmitted infection

Amtriptyline (Elavil)

Tricyclic Antidepressant: decreases bladder contractions and increases bladder neck resistance

Nortriptyline (Pamelor)

Tricyclic Antidepressant: decreases bladder contractions and increases bladder neck resistance

amoxapine (Asendin)

Tricyclic Antidepressant: decreases bladder contractions and increases bladder neck resistance

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? type and size of the catheter to be used administration of cleansing enemas procedure for insertion of the catheter placement of the catheter

Type and size of the catheter to be used

A client regularly recognizes the sensation of needing to void but cannot control voiding in time to reach a toilet. How would the nurse document this type of incontinence?

Urge

Overactive bladder

Urge Urinary Incontinence: Client experiences sudden urge to urinate, but cannot control voiding in time to reach toilet; either the brain signals the bladder to empty when it is not full or the bladder muscles contract. Caused my bladder irritation from UTI, diabetes, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction.

Urge incontinence

Urge to void, but cannot control voiding in time to reach the toilet

Methenamine

Urinary Tract Antiseptics; used for reoccurring infections

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults?

Urinary incontinence is not considered a normal consequence of aging.

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? Diuretics should be promptly discontinued when an older adult experiences incontinence. Restricting fluid intake is recommended for older adults experiencing incontinence. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. Urinary incontinence is not considered a normal consequence of aging.

Urinary incontinence is not considered a normal consequence of aging.

Which statement describing urinary incontinence in an older adult client is true? Urinary incontinence is a normal part of aging. Urinary incontinence isn't a disease. Urinary incontinence in the elderly population can't be treated. Urinary incontinence is a disease.

Urinary incontinence isn't a disease

A client who has a history of neurogenic bladder presents with fever, burning, and suprapubic pain. What would the nurse suspect is the problem? urinary tract infection urinary incontinence urinary retention urethral strictures

Urinary tract infection

Residual urine

Urine retained in the bladder after the client voids. The amount may vary from 30mL to several hindered millimeters

functional incontinence

intact function of the lower urinary tract, but cannot identify the need to void or ambulate to the toilet. Caused by cognitive impairment such as brain injury or Alzheimer's; or physical limitations such as RA or musculoskeletal injury.

A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. A diagnosis of bacteriuria requires three consecutive positive results. Urine contains varying levels of healthy bacterial flora. Urine samples are frequently contaminated by bacteria normally present in the urethral area.

Urine samples are frequently contaminated by bacteria normally present in the urethral area

Self Intermittent catheterization at home

Use a red, rubber catheter than can be washed and reused for 2-3 months before replacing. Gloves aren't required, but must wash hands thoroughly before and after procedure. Drain urine into a clean container or directly into the toilet. Schedule is usually 3-4 times daily, although frequency can be increased depending on residual volume. If more than 400mL is returned, the client should be catheterized more often

Low purine diet

Used for Uric acid stones although benefits are unknown. It limits meats, game meat, gravies, anchovies, herring, mackerel, sardines, and scallops. All meats, fish, and poultry should be avoided.

A nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client about self-catheterization, the nurse should encourage what practice? Assuming a supine position for self-catheterization Using clean technique at home to catheterize Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra Self-catheterizing every 2 hours at home

Using clean technique at home to catheterize

The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply. Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink caffeinated beverages twice a day to increase urination. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder Bathe in warm water to soak the affected area.

Void ever 2-3 hours to prevent overdistention of the baldder Cleanse around the preineum and urethral meatus after each bowel movement to reduce pathogens Drink liberal amounts of fluid to flush out bacteria

Diagnostic of urinary retention

Volumes over 100mL

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

WBC 50

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids? a. Significantly increase fluid intake. b. Increase caffeinated beverages. c. Significantly decrease fluid intake. d. No change in fluids needed.

a If not contraindicated, a liberal daily fluid intake of approximately 3000 to 4000 mL is recommended to flush infectious microorganisms from the urinary tract.

Which of the following is the most effective intravesical agent for recurrent bladder cancer? a. Bacillus Calmette-Guérin (BCG) b. Methotrexate c. Cisplatin d. Vinblastine

a BCG is now considered the most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body's immune response to cancer. Chemotherapy with a combination of methotrexate, 5-FU, vinblastine, doxorubicin (Adriamycin), and cisplatin has been effective in producing partial remission of transitional cell carcinoma of the bladder in some patients.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? a. Incontinence b. Urinary retention c. Urgency d. Incomplete bladder emptying

a Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.

Which finding is an early indicator of bladder cancer? a. Painless hematuria b. Occasional polyuria c. Nocturia d. Dysuria

a Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? a. Physical and environmental conditions b. History of allergies c. Occupational history d. Smoking habits

a It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the patient may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a. "This medication will relieve your pain." b. "This medication should be taken at bedtime." c. "This medication will prevent re-infection." d. "This will kill the organism causing the infection."

a Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

A client who has a history of neurogenic bladder presents with fever, burning, and suprapubic pain. What would the nurse suspect is the problem? a. urinary tract infection b. urinary incontinence c. urinary retention d. urethral strictures

a Signs of a bladder infection include fever, chills, and suprapubic pain.

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. Perform hand hygiene prior to patient care. c. Assist the patients with frequent toileting. d. Provide careful perineal care. e. Encourage patients to wear briefs.

b, c, d 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 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? a. Stress incontinence b. Reflex incontinence c. Overflow incontinence d. Functional incontinence

a Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the client to reach the toilet in time for voiding.

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? a. type and size of the catheter to be used b. administration of cleansing enemas c. procedure for insertion of the catheter d. placement of the catheter

a 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 client has been admitted to the renal unit with acute pyelonephritis, and is undergoing parenteral antibiotic treatment. What would be a significant aspect of this client's discharge education? a. recurring infection prevention b. anti-inflammatory incompatibilities c. needed dietary changes d. No option is correct.

a Chronic pyelonephritis can develop after recurrent episodes of acute pyelonephritis. Anti-inflammatory compatibilities are not a factor in acute pyelonephritis. No dietary changes are required. The client is encouraged to drink a large volume of oral fluids daily.

The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? a. The client's suprapubic region is dull on percussion. b. The client is uncharacteristically drowsy. c. The client claims to void large amounts of urine two to three times daily. d. The client takes a beta adrenergic blocker for the treatment of hypertension.

a Dullness on percussion of the suprapubic region is suggestive of urinary retention. Clients retaining urine are typically restless, not drowsy. A client experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? a. Strain the client's urine following the procedure. b. Administer a bolus of 500 mL normal saline following the procedure. c. Monitor the client for fluid overload following the procedure. d. Insert a urinary catheter for 24 to 48 hours after the procedure.

a Following ESWL, the nurse should strain the client's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.

A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function? a. Monitor the client's intake and output. b. Palpate for a thrill over the vascular access. c. Inspect the skin over the fistula or graft for signs of infection. d. Note the nailbeds and mobility of the fingers.

a Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis.

As a result of trauma, a client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. What is the initial step to begin bladder training for a client with an indwelling catheter? a. Clamp the catheter. b. Unclamp the catheter. c. Remove the catheter. d. Perform catheter care.

a One method of bladder training for the client with an indwelling urethral catheter is to alternately clamp and unclamp the catheter. The clamping and unclamping of the catheter begins to reestablish normal bladder function and capacity. In the beginning, the catheter may be unclamped for 5 minutes every 1 or 2 hours. Clamping is the initial step. Removing the catheter is not correct. Catheter care should be done routinely on all patients.

A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is: a. placement of small amounts of collagen in urethral walls to aid the closing pressure. b. a procedure that increases storage capacity of the bladder. c. implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination. d. a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

a Periurethral bulking is the placement of small amounts of collagen in urethral walls to aid the closing pressure. Bladder augmentation is a procedure that increases storage capacity of the bladder. Implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination is one type of surgery done to improve urinary control. Anterior repair is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

A client who was involved in an MVA which resulted in paraplegia is working toward living at home. The client is currently developing an individualized CIC schedule, preferring not to wear a leg bag. What is the maximum amount of urine the client should allow to collect before catheterization? a. 350 mL b. 500 mL c. 100 mL d. 600 mL

a The bladder should not be allowed to get distended beyond 350 mL because bladder overdistention results in loss of bladder tone.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder? a. painless hematuria b. fever c. dysuria d. urgency

a 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.

A client is a victim of an MVA and is unconscious. In compliance with a physician's order to insert an indwelling catheter, the nurse places the catheter and notes the drainage of a large amount of yellow urine with normal odor. How much urine will the nurse allow to drain before clamping the tube? a. 700 mL b. 250 mL c. 500 mL d. 1000 mL

a The nurse selects the appropriate catheter and inserts it under sterile conditions, noting the characteristics and volume of urine returned. If the volume of urine is large (>700 mL), it may be necessary to clamp the catheter.

The nurse needs to assess the fluid volume status of a client with chronic glomerulonephritis. To accurately assess the client's fluid volume status, the nurse should weigh the client daily: a. at the same time, on the same scale, with similar clothing. b. once in the morning, on the same scale, with similar clothing. c. at the same time, using a different scale every time, with similar clothing. d. at the same time, on the same scale, with only minimal clothing.

a Weighing the client daily, at the same time, on the same scale, with similar clothing each time, is important because changes in body weight reflect changes in fluid volume status. Weighing the patient once in the morning, with any scale, or wearing minimal clothing may not reflect the accurate changes. They may cause incorrect assessment of the variation in fluid volume status.

suprapubic cystotomy tube

a catheter is inserted through the abdominal wall directly into the bladder

Transvaginal needle suspension

a procedure in which the bladder and urethra are attached to the pubic bone or fibrous tissue of the rectum through two vaginal incisions and a midline suprapubic incision

Anterior repair

a procedure that increases support to the bladder by tightening the vaginal wall under the urethra

Bladder augmentation

a procedure that increases the storage capacity of the bladder; transplants a section of the intestine or stomach into the top of the bladder

sacral nerve stimulation implantation

a small device is implanted similar to a pacemaker that acts on the nerves that control the bladder and pelvic floor contractions; it is implanted under the skin in the abdomen; a wire connected to the sacral nerve emits electrical pulses to stimulate the nerve and help control the bladder; the client is does not experience pain and is relieved from heavy leaking in many cases

Sling procedures

a small vaginal incision is used to place a piece of synthetic or natural (from self inner thigh or abdomen) material under the bladder neck and is secured to the abdominal wall or pelvic bone to create a hammock-type lifting of the urethra

Pessary

a stiff ring that a healthcare provider places in the vagina to prevent urine leakage; commonly used for prolapse

A client has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What contributes to the likelihood of developing urinary tract or bladder infections? Select all that apply. a. indwelling catheter b. decreased fluid intake c. frequent catheter hygiene d. increased ingestion of Vitamin C

a, b Decreased fluid intake results in decreased urine production. The urinary tract can contain pathogenic microbes which are washed away with sufficient urine production - which required adequate fluid intake (1.5L to 3L per day).

The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. a. Leukocytosis b. Abdominal distention c. Hyperactive bowel sounds d. Muscle flaccidity

a, b The nurse should monitor the client for the following signs and symptoms of peritonitis: leukocytosis, abdominal pain and distention, absence of bowel sounds (paralytic ileus), fever, muscle rigidity, guarding, and nausea and vomiting.

A client postoperatively reports to the nurse the need to urinate, but is unable to void. What should the nurse expect the healthcare provider to order? Select all that apply. a. Complete a straight catheterization. b. Place an indwelling catheterization. c. Schedule a suprapubic catheter insertion. d. Perform a bladder scan. e. Ambulate the client.

a, d Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by bladder scanning and straight catheterization. An indwelling catheter is not recommended for short-term relief. Suprapubic catheters are used for obstructions and in situations in which it is not possible to insert catheters into the urethra. Ambulating the client will not help the client to void.

Valsalva maneuver

abdominal strain; instruct the client to bear down as with defecation; do not teach this method to the client with cardiac problems; used for chronic urinary retention; can be combined with Crede's Maneuver

Retropubic suspension

an open abdominal procedure that involves lifting and anchoring the bladder and urethra to the pelvic wall through the vagina and pubis ligaments; usually done during a hysterectomy

Urethritis treatment

antibiotics, increase fluid intake, warm sitz baths, good diet, plenty of rest, treatment of STI. FAILURE TO SEEK TREATMENT FOR GONOCOCCAL URETHRITIS CAN RESULT IN URETHRAL STRICTURES IN MEN

trauma to urinary system signs and symptoms

anuria, hematuria, pain in the abdomen, pain in the bladder and kidney, symptoms of shock, an indwelling catheter may need to be placed

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

b Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

Which objective symptom of a UTI is most common in older adults, especially those with dementia? a. Incontinence b. Change in cognitive functioning c. Hematuria d. Back pain

b The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? a. Administer prophylactic antibiotics as prescribed. b. Limit the use of indwelling urinary catheters. c. Encourage frequent mobility and repositioning. d. Toilet residents who are immobile on a scheduled basis.

b When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk.

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? a. Emphasize that the diversion is an integral part of successful cancer treatment. b. Encourage the client to speak openly and frankly about the diversion. c. Allow the client to initiate the process of providing care for the diversion. d. Provide the client with detailed written materials about the diversion at the time of discharge.

b Allowing the client to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the client is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the client's body image.

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective? a. "I will not need to worry about being incontinent of urine." b. "My urine will be eliminated through a stoma." c. "My urine will be eliminated with my feces." d. "A catheter will drain urine directly from my kidney."

b An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? a. A client whose diagnosis of chronic kidney disease requires a fluid restriction b. A client who has Alzheimer disease and who is acutely agitated c. A client who is on bed rest following a recent episode of venous thromboembolism d. A client who has decreased mobility following a transmetatarsal amputation

b Clients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.

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

b Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

The nurse is teaching a client how to perform self-catheterization. Which direction should the nurse include? a. Peroxide is recommended for cleaning the urinary catheter. b. Catheterization should occur every 4 to 6 hours and before bedtime. c. The nurse uses nonsterile technique in the hospital setting. d. The catheter is rinsed with sterile normal saline after soaking in a cleaning solution.

b The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after soaking in a cleaning solution. Either antibacterial soap or povidone-iodine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following? a. Remain NPO for 12 hours prior to the treatment. b. Hold the solution in the bladder for 2 hours before voiding. c. Drink the intravesical solution quickly and on an empty stomach. d. Avoid acidic foods and beverages until the full cycle of treatment is complete.

b The client is allowed to eat and drink before the instillation procedure. Once the bladder is full, the client must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.

A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the most plausible nursing diagnosis that the nurse should address? a. Impaired mobility related to limitations posed by the ileal conduit b. Deficient knowledge related to care of the ileal conduit c. Risk for deficient fluid volume related to urinary diversion d. Risk for autonomic dysreflexia related to disruption of the sacral plexus

b The client will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.

The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? a. Over a bony prominence b. Away from skin folds c. At the belt line d. At the umbilicus

b The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do? a. Take the antibiotic as well as an antifungal for the yeast infection she will probably have. b. Take the antibiotic for 3 days as prescribed. c. Understand that if the infection reoccurs, the dose will be higher next time. d. Be sure to take the medication with grapefruit juice.

b The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? a. 1,250 mL b. 2,000 mL c. 2,750 mL d. 3,500 mL

b Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable.

radical cystectomy

bladder and lower thirds of both ureters are removed; if the tumor has extended through the bladder wall. In women: removal of bladder, lower third of ureter, uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra. In men: removal of the bladder, lower third or ureter, prostate, and seminal vesicles

reflex incontinence

bladder has uninhibited contractions; involuntary reflexes produce spontaneous voiding with partial or complete loss of sensation of bladder fullness or urge to void; caused by impaired induction of impulse above reflex arc secondary to spinal cord injury; tumor; or infection.

cystitis

bladder infection/inflammation from bacteria (usually E. coli); caused by cystoscopy, catherization, improper peri-care, prostatitis, BPH, pregnancy, sexual intercourse, radiation, feminine hygiene products, spermicides; the bacteria adhere to the mucosal lining in the bladder and multiply; can lead to lesions, redness, inflammation of bladder lining

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? a. Rebound tenderness at McBurney's point b. An output of 200mL with each voiding c. Cloudy urine d. Urine with a specific gravity of 1.005-1.022

c The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise.

A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training? a. Immediately after voiding, perform a bladder scan. b. Instruct the client to drink more fluids at night for a full bladder in the morning. c. Place client on a timed voiding schedule. d. Perform straight catheterizations at specific times each day.

c Placing the client on a timed voiding schedule after a catheter removal will promote bladder muscle retraining. The nurse should do a bladder scan immediately after voiding, but this is not the initial action. The nurse does not need to complete urinary catheterization at specific intervals for initial bladder training. The client needs to limit fluids at night.

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. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs. d. Wear only nylon underwear to reduce the chance of irritation.

c 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.

Which instruction would be included in a teaching plan for a client diagnosed with a UTI? a. Take tub baths as opposed to showers. b. Drink coffee or tea to increase diuresis. c. Drink liberal amount of fluids. d. Void every 4 to 6 hours.

c Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? a. Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. b. Remind the client that occasional febrile episodes are expected following ESWL. c. Tell the client to report to the ED for further assessment. d. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.

c Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.

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? a. Morphine sulfate b. Aspirin c. Ketoralac (Toradol) d. Meperidine (Demerol)

c 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.

The nurse is caring for a client who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the client? a. Limit oral fluid intake for 1 to 2 days. b. Report the presence of fine, sand like particles through the nephrostomy tube. c. Notify the health care provider about cloudy or foul-smelling urine. d. Report any pink-tinged urine within 24 hours after the procedure.

c The client should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? a. IV fluid administration b. Insertion of an indwelling urinary catheter c. Pain management d. Assisting with aspiration of the stone

c The client with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the client's need for IV fluids or for catheterization. Kidney stones cannot be aspirated.

Which of the following nursing actions is most important in caring for the client following lithotripsy? a. Monitor the continuous bladder irrigation. b. Administer allopurinol (Zyloprim). c. Strain the urine carefully for stone fragments. d. Notify the physician of hematuria.

c The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a. Straight catheterize the client every 4 to 6 hours. b. Administer acetaminophen (Tylenol). c. Teach client to increase fluid intake up to 3 liters per day. d. Restrict fluid intake to 1 liter per day.

c The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

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

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

The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a client with an indwelling catheter? a. Vigorously clean the meatus area daily. b. Apply powder to the perineal area twice daily. c. Empty the drainage bag at least every 8 hours. d. Irrigate the catheter every 8 hours with normal saline.

c To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention? a. Secure or patch it with tape. b. Empty the pouch. c. Change the wafer and pouch. d. Secure or patch it with barrier paste.

c 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.

Implantation of an artificial sphincter

can be inflated to prevent urine loss and deflated to allow urination

uretosigmoidostomy

catheter is inserted into the rectum to drain urine continuously. check the amount and color of the drainage from the catheter every 1-2 hours. inspect anal and gluteal areas for skin breakdown. monitor for electrolyte losses in urine. teach client to exercise for sphincter control. have client void rectally every 2 hours after sphincter control is obtained to prevent reabsorption by the sigmoid colon of fluid and electrolytes which can result in imbalances. NEVER GIVE CLIENT ENEMAS, SUPPOSITORIES, OR LAXATIVE

urinary incontinence causes

caused by: 1. neurologic diseases 2. bladder outlet obstruction or trauma 3. bladder prolapse or low estrogen levels in women 4. prostatic enlargement in men 5. women whom were incontinent with pregnancy may continue after pregnancy. 6. Failure of the urethral sphincters to hold urine in. 7. Trauma. 8. Prostate surgery. 9. Relaxed pelvic muscles. 10. Impingement of spinal nerves.

Micrococcus ureae

causes the urea in the urine to react with water which creates ammonia and causes odor, skin breakdown, and ammonia dermatitis

Mitimycin

chemotherapeutic agent injected via a catheter into the bladder; when the bladder is heated it works better (electromotive mitomycin therapy) to destroy cancer in bladder

urinary incontinence assessment findings

complains of frequency, leaking small amounts when coughing or sneezing, inability to urinate

cystostomy

creation of an artificial opening into the bladder to allow for drainage of urine

Bladder stones other diagnostic studies

cystoscopy, kidney ureter bladder (KUB) study, IVP, or ultrasound can all detect the presence of bladder stones

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? a. Antispasmodic agents b. Urinary analgesics c. Antibiotics d. Anticholinergic agents

d Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence.

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? a. Diuretics should be promptly discontinued when an older adult experiences incontinence. b. Restricting fluid intake is recommended for older adults experiencing incontinence. c. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. d. Urinary incontinence is not considered a normal consequence of aging.

d Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? a. Establishing a predetermined fluid intake pattern for the client b. Encouraging the client to increase the time between voidings c. Restricting fluid intake to reduce the need to void d. Assessing present voiding patterns

d The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

interferon alpha-2a (Roferon a)

injected IV into the bladder; stimulates the production of lymphocytes and macrophages that may destroy cancer in the bladder

Injection of onabotulinumtoxinA (Botox)

injected into the bladder muscle and is commonly used for overactive bladder (urge incontinence). Helps the bladder relax and increases the storage capacity and reduces incontinence. Treatments can be repeated every 3 months.

A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? a. Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. b. A diagnosis of bacteriuria requires three consecutive positive results. c. Urine contains varying levels of healthy bacterial flora. d. Urine samples are frequently contaminated by bacteria normally present in the urethral area.

d Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.

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

d 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 being treated in the hospital has been experiencing occasional urinary retention. What is the best nursing action? a. Use a slipper bedpan. b. Apply a cold compress to the perineum. c. Have the client lie in a supine position. d. Provide privacy for the client.

d Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the client with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of: a. Anticipatory grieving b. Situational low self esteem c. Deficient knowledge: stoma care d. Disturbed body image

d The client is exhibiting defining characteristics of disturbed body image.

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? a. "Have you had a fever and chills?" b. "How much fluid are you drinking?" c. "Do you get up at night to urinate?" d. "When did you last urinate?"

d The nurse needs to determine the last time the client voided.

Pseudoephedrine (Sudafed)

decongestant: may help stress incontinence

retrograde pyelogram

detects kidney damage if the tumor is obstructing one of the ureters

spiral CT scan

determines presence of stones

Urethritis signs and symptoms

discomfort on urination, fever in men if infection to prostate, testes, and epididymis; urethral discharge and itching

Papillary lesions in bladder

distended; superficial finger-like projections extend outward into mucosae

urethroplasty

done for strictures if dilation is not successful; surgical repair of the ureter using resection method; postop keep urinary splitting catheter in place until healed; performed in two stages: 1. urinary diversion, 2. plastic repair

Suprapubic Surgery

done when stones are too large and must be removed through a surgical incision in the bladder; urethral catheter left in place for a week or more, monitor intake and output. follow postoperative care

Uroflowmetry

done with strictures; demonstrates flow from the bladder

photodynamic therapy (PDT)

experimental: IV injection of photosensitizing agent that is absorbed in concentration over several days by malignant cells; a laser in inserted via a cystoscope which activates the drug to kill malignant cells in the bladder

Nonpapillary lesions in bladder

flat solid growths that grow inward deep into bladder wall and more likely to metastasize to lymph nodes, liver, lungs, and bone

Bladder stones

forms in the bladder or the upper tract and travel to the bladder and stay there; large stones form in people with chronic urinary retention and urinary stasis; caused by prostate enlargement, clients who are immobile, or have paraplegia or quadriplegia

Urethritis nursing actions

frequent peritoneal care, sterile technique with catheters, proper cleaning technique

Urethral Strictures causes

gonnorrhea, chronic gonococcal urethritis, accidents, childbirth, intercourse, surgical procedures, prolonged use of catheters, surgery, enlarged prostate, cancer; more common in men; may need to void twice to expel urine stuck in diverticulum

trauma to urinary system

gunshot, stab wounds, crushing injury, forceful blows can result in tears, hemorrhage, or penetration; injuries to kidney area may result in bruising or tearing of the kidney; blood and urine may leak into the peritoneal

phenoxybenzamine hydrochloride (Dibenzaline)

helps with sphincter control in urinary incontinence

Bladder stones signs and symptoms

hematuria, cloudy or dark urine, suprapubic pain, difficulty starting the urinary stream, symptoms of bladder infection, feeling the bladder is not completely empty, pain with voiding

Cystitis other possible tests

if repeated occurrences of infection, Intravenous Pyelogram (IVP) or Cystoscopy may be done to determine causes such as BPH and bladder diverticulum which is weakened bladder and outpouching of bladder wall which allows bacteria to invade

urine specimen in cystitis

increased RBCs, WBCs; culture and sensitivity to determine type of bacteria

overflow incontinence

involuntary loss of urine associated with overdistention and overflow of the bladder causing dribbling and voiding in small amounts. Can be caused by fecal impaction or enlarged prostate; smooth muscle relaxants; impaired ability of the bladder to contract; neurologic abnormalities such as spinal cord lesions or tumors; obstruction to urinary output.

Stress Urinary Incontinence

involuntary loss of urine from intact urethra when sneezing or coughing. caused by decreased pelvic floor muscle strength, multiple pregnancies, obesity, menopause.

urinary incontinence

is a symptom that can result from bladder or ureteral dysfunction; the bladder may contract without warning, fail to accommodate volumes of urine, or fail to empty completely and become overstretched resulting in overflow incontinence

Intermittent catherization

is performed in the hospital aseptically or at the client's home using clean technique which includes washing their hands thoroughly with a schedule of 3-4 times per day before and after; kit includes: straight-tip catheter, sterile gloves, lubricant, and a sterile collection container; if a catheter is reused in the home setting, wash with soap and hot water and allow to air dry, can be reused for 2-4 weeks; if greater than 400 mL is returned, the client should catheterize more often; teach the client technique, catheter care, and follow up care

Crede's maneuver

manual voiding; apply gentle downward pressure to the bladder during voiding; can be done while sitting on the toilet and rocking back and forth gently; used with chronic urinary retention

Urine sample in interstitial cystitis

may be normal unless infection is present in which RBCs and WBCs will be elevated; negative urine culture

Neurogenic Bladder

may be spastic causing incontinence. may be flaccid causing retention.

urethral strictures nursing actions

may burn with voiding, may be blood in urine, sitz baths and analgesics for pain, drink extra fluids, keep appointments for follow up dilations, take all your antibiotics, report frank bleeding

chronic urinary retention signs and symptoms

may not produce symptoms because the bladder stretches over time and accommodates larger volumes without producing discomfort, difficulty with emptying the bladder, difficulty starting to urinate, urge to void after they just voided, voiding small amounts frequently if large amount of residual urine, bladder infections, dribbling of urine, continuous discomfort in the lower abdomen and urinary tract

Urinary Diversion Procedure

may offer relief of symptoms with Interstitial Cystitis

interstitial cystitis signs and symptoms

mimic STD, cystitis, and bladder cancer signs. 1. Frequent urination and passing small amounts of urine. 2. Searing or burning pain. 3. Painful intercourse. 4. A need to void immediately even with a small amount of urine in bladder.

indwelling catheters

monitor and maintain the integrity of the closed drainage system, proper anchoring of the tube to avoid tension and promote drainage. *Important* 1. Maintain a closed drainage system at all times by following manufacturers instructions, using preconnected urinary catheter and drainage systems, minimizing irrigation, and using the needleless port system for irrigation if needed. 2.. Maintain the urine flow by always positioning the drainage bag below the level of the bladder (not on the floor). 3. Maintain cleanliness through meticulous handwashing, disinfecting needleless port and letting it dry before use, and using strict aseptic technique for catheter insertion.

trauma to urinary system nursing actions

monitor for lack of urine output, abdominal pain, hematuria, focus on the client's physical and emotional needs related to the trauma

bladder stones nursing actions

monitor intake and output, monitor for fever, monitor vitals every 4 hours, complete medical, drug, and allergy history, type and location of pain, inspect urine color, consistency, and amount, report hematuria, encourage fluids unless heart failure or renal disease, filter the urine with wire mesh to inspect for stones, send stones to the lab

urinary retention nursing actions

monitor intake and output, palpating the abdomen for distention, promoting complete urination, monitor the voiding pattern of clients

Urethritis

more common in men; inflammation of the urethra; can be caused by gonococci, nongonococcal urethritis, gonorrhea. In women: secondary to vaginal infections, soaps, bubble baths, sanitary napkins, scented TP. In men: catherization, cystoscopy, irritation with intercourse, anal intercourse, or intercourse with a woman who has a vaginal infection can all cause bacteria to invade urethra. Chlamydia trachomatis or Ureaplasma urealyticum

Urethral Strictures

narrowed areas of the urethra; may cause extension or ureter and kidney pelvis may become distended with urine back flow, diverticula in bladder may result from overdistention in which urine become trapped in the diverticula and manifests bacteria causing infection

transcient incontinence

occurs suddenly and lasts less than 6 months. Caused by temporary delirium or confusion; infection; increased urinary production from metabolic disorders; diuretics', anticholinergics, or antidepressants.

Purine foods

organ meats, sardines, meats, fish, and poultry

incontinent urinary diversion

ostomy bags to collect urine

interstital cystitis

painful bladder syndrome with chronic inflammation causing disintegration of bladder lining and lost elasticity; the bladder wall contains multiple pinpoint hemorrhages that join and form larger hemorrhages that may turn into fissuring and scarring which shrinks the bladder. Cause in unknown, but may be hormonal before menopause, may be autoimmune or systemic condition from UC, IBS, fibro, CFS, and endometriosis.

Bladder cancer signs and symptoms

painless hematuria, urine color changes, fever, dysuria, urgency, frequency; later stages: back and pelvic pain, urinary retention, urinary frequency, swelling in the feet, anorexia, weight loss, weakness, bone pain, anemia (shortness of breath, fatigue) from blood loss

chronic urinary retention treatment

permanent urinary catheter, suprapubic cystostomy tube, or clean intermittent catherization

clean intermittent catheterization (CIC)

preferred over permanent catherization to reduce risks; clients who lack mobility or cognitive functioning may not be able to do this; males that cannot perform this may undergo surgery to release the ureteral; sphincters which allows urine to drain freely and the client can wear a condom catheter; there are external devices for women but finding a fit is difficult so most women require permanent catherization without being able to correct the cause

Antihistamines

prescribed for Interstitial Cystitis to reduce urinary frequency and urgency

A client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. The catheter would be clamped and unclamped to:

promote normal bladder function.

acute urinary retention medical treatment

requires immediate catherization, if catheter will not fit through urethra, special urologic instruments that dilate the urethra are used; for strictures, urethra dilation using larger and larger catheters to increase the urethra size or a Foley catheter can be ballooned inside the site of the stricture in the urethra to open it and stents may be placed temporarily or permanently (all these can be performed as outpatient, local anesthesia, or sedation may be used)

continent urinary diversions

reservoir created within the body to collect urine created with a piece of intestine that is attached to the ureter and to a stoma on the other end; inserts a catheter through the valve into the reservoir to drain the urine

Estrogen

restores mucosal, vascular, and muscular integrity of the urethra for postmenopausal women with incontinence, but treatment only works for 1 year

Cystoscopy in interstitial cystitis

reveals inflamed bladder mucosa with pinpoint hemorrhages and a smaller bladder capacity.

Biopsy in interstitial cystitis

reveals inflammation with scarring and hemorrhagic conditions and confirms dx

Urinalysis for Bladder Stones

rules out infection

Chronic urinary retention

seen in clients with disorders that result in a neurogenic bladder; more common in men; increased risk after age 70; client can still void but cannot completely empty the bladder (retention with overflow) and has a large residual urine volume from 30 mL to several 100 mL

acute urinary retention

seen in complete urethral obstruction, after general anesthesia, or with the administration of certain drugs such as atropine or a phenothiazine; client may not be able to void at all

voiding cystourethrography

shows the stricture and diverticulum in bladder

Urethral insert

similar to a tampon device that the client inserts into the urethra before engaging in activity that contributes to stress incontinence

Obstructed Urinary Flow Signs

straining to empty bladder, feeling that the bladder does not empty completely, hesitancy, weak stream, frequency, overflow incontinence, bladder distention

Bladder distention

stretching the bladder increases capacity and interferes with pain signals and may be effective in Interstitial Cystitis for about 2-4 weeks after bladder installation using water of gas

neobladder

take a piece of the intestine to form a reservoir; it is connected to the ureters and urethra so the client voids normally; may need to use catheter to drain the reservoir properly; may be incontinent especially at night

Potassium Sensitivity in interstitial cystitis

the examiner instills water into the bladder, the water is removed and potassium is instilled, if there is more pain and urgency with potassium, interstitial cystitis or painful bladder syndrome may be the cause

Urinary incontinence

the inability to control voiding of urine

urinary retention

the inability to urinate or effectively empty the bladder

Elmiron (pentosan polysulfate)

the most effective medication for interstitial cystitis that provides relief of bladder pain

cystectomy

the surgical removal of all or part of the urinary bladder; may be done if the tumor is confined to a small area and not large

Intravesicular injection of a weakened strain of mycobacterium bovis

treatment for bladder cancer, this bacteria destroys the cancer

Amitriptyline (Elavil)

tricyclic antidepressant: used for Interstitial Cystitis to relieve pain and depression associated with the disease

nephostomy

tube entered into the kidneys

Urine sample in bladder cancer

tumor markers present, RBCs cause anemia; looking for BUN or creatinine in serum

Mixed Incontinence

two or more types of incontinence such as stress and overflow combined.

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?

type and size of the catheter to be used

cystitis signs and symptoms

urgency, pressure in bladder, frequency, low back pain, dysuria, perineal and suprapubic pain, cloudy or strong smelling urine, hematuria, chills, fever; chronic cystitis has less severe symptoms

urethral strictures other studies

urinalysis to determine infection, cystoscopy, retrograde pyelogram, and IVP to view stricture

ileal conduit

urinary diversion where transparent ostomy bag is applied over the stoma to make stoma assessment easier. NOTIFY PHYSICIAN IF STOMA COLOR CHANGES TO CYANOTIC COLOR OR BEGINS TO BLEED. OR IF THE STOMA EDGES SEPERATES FROM THE STOMA SKIN REPORT SIGNS OF PERITONITIS: ABDOMINAL TENDERNESS, DISTENTION, FEVER, SEVERE PAIN Use gauze pads to clean mucus away from the stoma. protect the skin around the stoma. change the dressing when wet. inspect the skin around the stoma for signs and symptoms of infection.

total incontinence

urine is continuously and unpredictably lost from the bladder; caused from surgery, trauma, or anatomic malformation.

Urinary diversion

urine is diverted to another collecting system other than the bladder

Biofeedback

used electronic devices or diaries to assist clients to track when the bladder and urethral muscles contract in order to gain more control

Drip collector

used for male clients with problems with dribbling; this is a small pocket of absorbent padding placed over the penis and anchored in place with fitted underwear.

Condom Catheter

used for males clients that are unable to schedule a voiding routine; the tubing is connected to a closed urinary drainage bag or disposable urinary drainage system

bougies

used to dilate the urethra with strictures; also called: dilators, sounds, filiform bougies, and followers; very painful, may cause bleeding and further stricture formation; start with 6-8 F and move up to 24-26 F until tolerated

Blue light fluorescence cystoscopy

uses a photosensitizing drug in combination with blue light cystoscopy which is instilled in the bladder and remains for at least 1 hour; the drug is absorbed by cancer cells which can be visualized by the blue light; abnormal cells are fluorescent red; normal cells appear bluish green

cystolitholapaxy

uses a stone crushing instrument (lithotrite) to crush and remove stones; after procedure, leave a urethral catheter in place for 1-2 days; administer antibiotics as ordered, monitor intake and output, encourage fluids

cystoscopic examination

visualizes the tumor for bladder cancer and is confirmed with microscopic biopsy

transcutaneous electrical nerve stimulation (TENS)

wires applied to lower back and suprapubic area; the electrical stimulation increases blood flow to the bladder, strengthens pelvic muscles, and triggers the release of endorphins to block pain for treatment of Interstitial Cystitis