Management of Patients with Urinary Disorders Urinary Tract Infections

Chapter 49 Management of Patients with Urinary Disorders Urinary Tract Infections Common site of acquired infection Lower UTI o Cystitis o Prostatitis o Urethritis Upper UTI o Pyelonephritis: acute and chronic o Interstitial nephritis o Renal abscess and perirenal abscess Copyright © 2022 Wolters Kluwer · All Rights Reserved Factors Contributing to UTI Bacterial invasion of the urinary tract Urethrovesical reflux, ureterovesical reflux Uropathogenic bacteria Shorter urethra in women Risk factors Copyright © 2022 Wolters Kluwer · All Rights Reserved Urethrovesical and Ureterovesical Reflux Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of the Patient with a UTI Pain, burning upon urination, frequency, nocturia, incontinence, hematuria About half are asymptomatic Association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene Gerontologic considerations Assessment of urine, urinalysis, and urine cultures Other diagnostic tests Copyright © 2022 Wolters Kluwer · All Rights Reserved Collaborative Problems and Potential Complications of the Patient with a UTI Sepsis (urosepsis) Acute kidney injury Chronic kidney disease Copyright © 2022 Wolters Kluwer · All Rights Reserved Planning and Goals for the Patient with a UTI Major goals may include: o Relief of pain and discomfort o Increased knowledge of preventive measures and treatment modalities. (Refer to Chart 49-3) o Absence of complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient with a UTI Relieving pain Medications as prescribed: antibiotics, analgesics, and antispasmodics. (See Table 49-1) Application of heat to the perineum to relieve pain and spasm Increased fluid intake Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol Frequent voiding Patient education Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Older adult patients often lack the typical symptoms of UTI and sepsis. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: Older adult patients often lack the typical symptoms of UTI and sepsis. The incidence of bacteriuria in older adults differs from that in younger adults. Bacteriuria increases with age and disability, and women are affected more frequently than men. UTI is the most common infection of older adults. Early symptoms include malaise, nocturia, urinary incontinence, or a complaint of foul-smelling urine. Copyright © 2022 Wolters Kluwer · All Rights Reserved Urinary Incontinence Affects more than 25 million adults in the United States Underdiagnosed and underreported Affects women and men Risk factors: refer to chart 49-4 Symptom of many possible disorders Copyright © 2022 Wolters Kluwer · All Rights Reserved Types of Urinary Incontinence Stress Urge Functional Iatrogenic Mixed Overflow Copyright © 2022 Wolters Kluwer · All Rights Reserved Patient Education for Urinary Incontinence Urinary incontinence is not inevitable and is treatable Management takes time (provide encouragement and support) Education verbally and in writing Develop and use a voiding log or diary Behavioral interventions Medication education related to pharmacologic therapy Strategies for promoting continence Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Urinary incontinence is a normal consequence of aging. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: Urinary incontinence is not a normal consequence of aging. However, age-related changes in the urinary tract do predispose the older person to incontinence. Nurses must listen to patients and provide teaching on strategies to help manage urinary incontinence in older adults. Copyright © 2022 Wolters Kluwer · All Rights Reserved Urinary Retention  Inability of the bladder to empty completely  Residual urine: amount of urine left in the bladder after voiding  Causes include: o Adults 60 years and older may have 50 to 100 mL of residual urine remaining in the bladder after voiding o Postoperative spasms o Diabetes, prostatic enlargement, urethral pathology, trauma, pregnancy, neurologic disorder o Medications Copyright © 2022 Wolters Kluwer · All Rights Reserved Urolithiasis and Nephrolithiasis Calculi (stones) in the urinary tract or kidney Pathophysiology Causes: may be unknown Depends on location and presence of obstruction or infection Pain and hematuria Diagnosis: radiography, blood chemistries, and stone analysis; strain all urine and save stones Copyright © 2022 Wolters Kluwer · All Rights Reserved Potential Sites of Urinary Calculi Copyright © 2022 Wolters Kluwer · All Rights Reserved Ureteroscopy Copyright © 2022 Wolters Kluwer · All Rights Reserved Extracorporeal Shock Water Lithotripsy Copyright © 2022 Wolters Kluwer · All Rights Reserved Percutaneous Nephrolithotomy Copyright © 2022 Wolters Kluwer · All Rights Reserved Patient Education for Renal Calculi Signs and symptoms to report Follow-up care Urine pH monitoring Measures to prevent recurrent stones Importance of fluid intake Dietary education Medication education as needed Copyright © 2022 Wolters Kluwer · All Rights Reserved