PrepU ch 49 management of patient with urinary disorder
What residual urine volume would be considered abnormal for an elderly client?
150 ml Residual urine volume of more than 50-100 mL is considered normal for an elderly client. Amounts of less than 100 are within a normal range for a middle-aged person.
Which client is at highest risk for developing a hospital-acquired infection?
A client with an i1619 The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk
Renal cell carcinoma s/s
A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.
Bladder cancer
Environmental and occupational health hazards are associated with bladder tumors. Smoking
A risk factor of UTI
Diabetes mellitus
gonorrhea
Urethral strictures
The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do?
patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours
patient with kock pouch has fever
peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.
food high in purines
shellfish, anchovies, asparagus, mushrooms, and organ meats
Bladder retraining following removal of an indwelling catheter begins with
the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.
Which condition or laboratory result supports a diagnosis of pyelonephritis?
the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain.
The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level?
Administration of sodium polystyrene sulfonate [Kayexalate] orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
Which type of medication may be used to inhibit bladder contraction in a client with incontinence?
Anticholinergic agents are considered first-line medications for urge incontinence
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
Ureteral stricture s/s
Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort.
Which is a reversible cause of urinary incontinence in the older adult?
Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in menopausal women. Age is a risk factor for urinary incontinence, not a reversible cause. Decreased fluid intake, rather than increased fluid intake, is a reversible cause of urinary incontinence in the older adult. Decreased estrogen, not progesterone, in the menopausal woman is a reversible cause of urinary incontinence.
Estrogen
Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra.
EXWL
Extracorporeal Shock Wave Lithotripsy the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted.
a malignant tumor of the bladder
Hematuria The client then has symptoms of incontinence (a later sign), dysuria and frequency.
The nurse advises the patient with chronic pyelonephritis that he should:
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.
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.
To prevent UTI
Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow.
The treatment of choice for a spinal cord-injured patient with impaired bladder emptying would include which of the following?
Intermittent self-catheterization Explanation:
To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?
Milk b/c it is alkaline.
Reflex incontinence
Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.
female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following?
Reflux of urine from the urethra into the bladder With urethrovesical reflux, coughing, sneezing, or straining causes the bladder pressure to increase, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra.
pseudoephedrine and phynylpropanolamine
Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
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?
Stress incontinence may occur with sneezing, coughing, or changing position
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent 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.
kidney urethral stones s/s
Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women..
A female client who suffers from urethral strictures undergoes a dilation procedure and experiences a burning sensation while voiding. Which nursing instruction would be most helpful?
Taking warm sitz baths and non-narcotic analgesics can relieve the client's discomfort while voiding. A client may be advised to visit a local stoma support group following a urinary diversion procedure. The application of moisture sealants is useful with ostomy appliances. The encouragement of frequent cleaning and washing of the perineum will protect the skin, but may not relieve the client's discomfort.
urinary 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.
The nurse understands that the most common route of UTI is which of the following?
The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.
planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located?
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.
tricyclic antidepressants
Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance.
STDs
Urethritis
urinary retention. What question should the nurse ask to obtain additional information about the client's report?
When did you last urinate?
acute glomerulonephritis s/s
acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension.
When a client with urinary calculi complains of excruciating pain, the client should be encouraged to
ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis.
Nephrolithiasis s/s
hematuria, suprapubic pain, difficulty starting the urinary stream, symptoms of a bladder infection, and a feeling that the bladder is not completely empty
Bladder inflammation
interstitial cystitis
an ileal conduit is created after a radical cystectomy.
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
Peritonitis s/s
leukocytosis, abdominal pain and distention, absence of bowel sounds (paralytic ileus), fever, muscle rigidity, guarding, and nausea and vomiting.
