medsurg ch 61 Concepts of Care for Patients With Urinary Problems
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for post procedure home care?
"Do not share your toilet with family members for the next 24 hours." The nurse tells the client who is being treated for bladder cancer and had a live virus compound instilled into his bladder not to share his toilet with family members for the next 24 hours. The toilet must not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup (236 mL) of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach.The client must sit while urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation must be washed separately from other clothing in a solution of 10% liquid bleach. It does not need to be discarded.
The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows understanding of the teaching?
"I need to be drinking at least 1.5 to 2.5 L of fluids every day." The client who shows a correct understanding of avoiding UTIs says, "I need to be drinking at least 1.5 to 2.5 L of fluids every day." To reduce the number of UTIs, clients need to be drinking a minimum of 1.5 to 2.5 L of fluid (mostly water) each day.Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output needs to be at least 1.5 L daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.
The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client statement indicates that the teaching was effective?
"I need to drink 2½ L of fluid every day." Teaching an older female about interventions to decrease the risk for cystitis is effective when the client says, "I need to drink 2½ L of fluid every day." Drinking this much fluid each day flushes out the urinary system and helps reduce the risk for cystitis.Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.
The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which client statement requires further teaching?
"I take my medication when I have symptoms." Further teaching is need for a female client with a UTI taking an antibiotic drug regimen when the client says, "I take my medication only when I have symptoms." clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent.Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 L of fluid a day help prevent UTIs.
A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the primary health care provider before the ESWL procedure begins?
"I take over-the-counter naproxen twice a day for joint pain." For a client admitted for ESWL, it is most critical for the nurse to report to the primary health care provider that the client takes over-the-counter naproxen twice a day for joint pain. Because a high risk for bleeding during ESWL has been noted, clients would not take nonsteroidal anti-inflammatory drugs before this procedure. The ESWL will have to be rescheduled for this client.Blood in the client's urine would be reported to the primary health care provider but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures would be reported, but will not require rescheduling of the procedure.
The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures?
"I will have to drain my pouch with a catheter." The client who is scheduled for a neobladder and Kock pouch correctly understands the procedure when the client says, "I will have to drain my pouch with a catheter." A neobladder is a type of continent reservoir created from an intestinal graft to store urine and replace the surgically removed bladder. A Kock pouch is also a continent reservoir with a Penrose drain and a plastic Medena catheter in the stoma. The drain removes lymphatic fluid or other secretions. The catheter ensures urine drainage so that incisions can heal. For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.Urine is not excreted through the anus. Fluids would not be restricted. A neobladder does not require the use of an ostomy bag.
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which client statement indicates that teaching was effective?
"I will no longer be able to have red wine with my dinner." Teaching about low purine diets to a client with urolithiasis consisting of uric acid is effective when the client says, "I will no longer be able to have red wine with my dinner." Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client needs to decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming.Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.
The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification?
"I will use a new, sterile catheter each time I do the procedure." The client with a neurogenic bladder who needs to self-catheterize for bladder emptying requires further clarification when the client says, "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating.The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that must be stressed.
An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond?
"That is tough. What do you think might help?" When an older women says to the nurse, "I am so embarrassed about buying adult diapers for myself," the nurse says "That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem.Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client. Rather, it suggests to the client that telling untruths is acceptable.
The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include?
"You are exercising correct muscles if you can stop urine flow in midstream." The nurse is telling the client about pelvic muscle exercises and says, "You are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.Pelvic muscle exercises can be performed anywhere and would be performed at least 10 times daily to improve and maintain pelvic muscle strength. Noticeable results in pelvic muscle strength take several weeks.
A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.)
"You will need to take all of these drugs to get the benefits." "Drink at least 3 L of fluids every day." "Be certain to wear sunscreen and protective clothing." "Take this drug with 8 ounces (236 mL) of water." The nurse tells the client with a UTI who is taking trimethoprim/sulfamethoxazole to be certain to wear sunscreen protection clothing, drink at least 3 L of fluid every day, take the drug with 8 ounces (236 mL) of water, and take all of these drugs to get the benefits. Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole, because increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules, so fluid intake prevents this complication. Clients must be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon, to prevent bacterial resistance and infection recurrence.Emptying the bladder is important, but not keeping it empty. The client would be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.
The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first?
A 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. After change-of-shift report, the nurse decides to first assess a 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention.The 26 year old admitted with urosepsis and slight fever, the 32 year old scheduled for cystoscopy, and the 40 year old with noninfectious urethritis are not at immediate risk for complications or deterioration.
Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN?
A 55 year old with incontinence who has intermittent catheterization prescribed. The nurse manager assigns a 55-year-old client with incontinence who has intermittent catheterization prescribed to the experienced LPN/LVN.Admission assessments and intravesical chemotherapy would be done by an RN. Preoperative preparation for cystectomy and stoma site selection would be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.
A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first?
Administer morphine sulfate as prescribed. The intervention the nurse implements first for a client admitted with urolithiasis who reports "spasms of intense flank pain, nausea, and severe dizziness" is to administer morphine sulfate 4 mg IV. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.An infusion of metoclopramide (Reglan) 10 mg IV would be begun after the client's pain is controlled. A urine specimen for urinalysis would be obtained and an infusion of 0.9% normal saline at 100 mL/hr would be started after the client's pain is controlled.
The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). What teaching will the nurse include? (Select all that apply.)
Dysuria Frequency Urgency Nocturia The signs and symptoms of UTI include: dysuria (pain or burning with urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly).Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI
A client with cognitive impairment has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan?
Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.
An older adult client diagnosed with urge incontinence is prescribed oxybutynin. Which side effects will the nurse tell the client to expect? (Select all that apply.)
Increased intraocular pressure Dry mouth Constipation Urge incontinence is the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. Side effects of oxybutynin prescribed for urge incontinence include: dry mouth, constipation, and increased intraocular pressure with the potential to make glaucoma worse. Oxybutynin is an anticholinergic/antispasmodic medication.Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.
The nurse is performing catheter care. Which nursing action demonstrates proper aseptic technique?
Positioning the collection bag below the height of the bladder Proper aseptic technique during catheter care involves positioning the collection bag below the height of the bladder. Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract.Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation would be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.
Which nursing intervention or practice is effective in helping to prevent urinary tract infection (UTI) in hospitalized clients?
Reevaluating the need for indwelling catheters The nursing intervention that is effective in helping to prevent UTIs in hospitalized clients is reevaluating the need for indwelling catheters. Studies have shown that this intervention is the best way to prevent UTIs in the hospital setting.Encouraging fluids, although it is a valuable practice for clients with catheters, will not prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with heart failure and kidney failure. Irrigating catheters daily is contraindicated, because any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.
A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action will the nurse take with this client?
Refers the client to the clinic nurse practitioner for immediate follow-up. When a client who is 6 months pregnant comes to the prenatal clinic with a suspected UTI, the nurse needs to refer the client to the clinic nurse practitioner for immediate follow-up. Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus.It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a primary health care provider.
The nurse is teaching a class about cancer prevention. Which interventions will the nurse include that can prevent bladder cancer? (Select all that apply.)
Stopping the use of tobacco Wearing gloves and a mask when working around chemicals and fumes Showering after working with or around chemicals The interventions that are helpful in preventing bladder cancer are: showering after working with or around chemicals, stopping the use of tobacco, and wearing gloves and a mask when working around chemical and fumes. Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer.Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions must be taken when working with chemicals. However, lead aprons are used to protect from radiation.
A client diagnosed with urge incontinence is started on tolterodine. What interventions will the nurse suggest to alleviate the side effects of this drug? (Select all that apply.)
Use hard candy for dry mouth. Encourage increased fluids. Increase fiber intake. Interventions the nurse suggests to alleviate the side effects of tolterodineinclude: encouraging increased fluids, increasing fiber intake, and using hard candy for dry mouth. Anticholinergics cause constipation. Increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth.Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.
A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (assistive personnel [AP])?
Using a bladder scanner to check residual bladder volume after the client voids The home health RN delegates the task of using a bladder scanner to check residual bladder volume after the client voids, to the UAP. Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (AP) who has been trained and evaluated in this skill.Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.
