Chapter 55- Urinary Disorders

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

A client 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

- "Increase your fluid intake to 2 to 3 L per day." The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? - "Take your temperature every 4 hours." - "Increase your fluid intake to 2 to 3 L per day." - "Apply an antibacterial dressing to the incision daily." - "Be aware that your urine will be cherry-red for 5 to 7 days."

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

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

- 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.

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

- Anticholinergic Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine.

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

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

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.

- The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. With interstitial cystitis, the bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. A common cause of urethritis in men is infection with Chlamydia trachomatis. Cystitis is usually caused by bacterial infection. The surface of the bladder becomes edematous and reddened, and ulcerations may develop. With urinary incontinence, the bladder can contract without warning, fail to accommodate adequate volumes of urine, or fail to empty completely.

A client has been admitted for an outpatient cystoscopy because of a suspected interstitial cystitis. Which statement best describes the pathology of this disorder? - The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. - It is caused by infection with Chlamydia trachomatis. - It is caused by bacterial infection. The surface of the bladder becomes edematous and reddened, and ulcerations may develop. - The bladder can contract without warning, fail to accommodate adequate volumes of urine, or fail to empty completely.

- urinary tract infection

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

- "I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? - "I should wipe from back to front." - "I should take a tub bath at least 3 times per week." - "I should take at least 1,000 mg of vitamin C each day." - "I should limit my fluid intake to limit my trips to the bathroom."

- 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.

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

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

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