THE ASSESSMENT AND CARE FOR IMPAIRED URINARY ELIMINATION PN 134
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THE ASSESSMENT AND CARE FOR IMPAIRED URINARY ELIMINATION
PN 134
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ASSESSMENT
Pain on urination Pattern of urination Strength of urine stream Urgency, frequency, incontinence,
hematuria, nocturia Intake and output Urine color, clarity, and odor
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URINARY RETENTION
Urinary retention Etiology/pathophysiology
The inability to void despite an urge to void
Clinical manifestations/assessmentDistended bladderDiscomfort in pelvic regionVoiding frequent, small amounts
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URINARY RETENTION
Client may experience discomfort and anxiety.
Frequency of urination and voiding small amounts may occur.
Treatment: urinary analgesics and antispasmotics.
Urinary catheter may be used, or surgery if indicated.
When client able to void, check for residual urine-should be less than 50mL.
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URINARY RETENTION
Stasis may lead to infection. Distended bladder may result. Caused by stress, calculus
obstruction, stones, tumor, infection, medications, trauma.
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URINARY RETENTION
Medical management/nursing interventionsWarm shower or sitz bathNatural voiding position if possibleUrinary catheterSurgical removal of obstructionAnalgesics
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URINARY RETENTION
Urinary Analgesics Pyridium, Pyridate, phenazopyridine: Uses: relief of pain associated with
lower genitourinary tract Adverse Reactions: headache, rash,
pruritis, GI disturbances, discoloration of the urine, sclera and/or skin.
Dosage range: 200 mg TID PO
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Urinary Incontinence
Etiology/pathophysiologyInvoluntary loss of urine from the bladder
Total incontinence; dribbling; stress incontinence
SecondaryInfection; loss of sphincter control; sudden change in pressure in the abdomen
Permanent or temporary
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URINARY INCONTINENCE
Stress: leakage of urine on straining. Urge: sudden need to urinate. Overflow: full bladder leads to
leakage. Total: no control of voiding. Nocturnal enuresis: night time
incontinence.
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Urinary Incontinence
Clinical manifestations/assessmentInvoluntary loss of urine
Leaking with coughing, sneezing, or lifting
Medical management/nursing interventionsTreat underlying causeSurgical repair of bladderTemporary or permanent catheterBladder trainingKegal exercises
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Urinary Tract Infections
Etiology/pathophysiology UTIs are caused by pathogens that enter the
urinary tract – with or without presence of symptoms
Bacteriuria (bacteria in the urine): the most common of all nosocomial infections; often associated with urinary catheters
Common in older people r/t bladder obstruction, insufficient bladder emptying, decreased bactericidal secretions of the prostate, increased perineal soiling in women, sexual intercourse.
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Urinary Tract Infections
Immobility, sensory impairment, and multiple organ impairment may increase the probability of infection in the older adult
Females more susceptible because shorter urethra and proximity to vaginal and rectal area.
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Urinary Tract Infections
Gram-negative microorganisms from the GI tract (e.g. E. Coli, Klebsiella, Proteus, or Pseudomonas) commonly cause UTIs. They ascend through the urinary meatus.
Body usually keeps infections in check by washing them from the body through voiding.
If there is incomplete emptying of the bladder or reflux of urine, the retained urine supports growth of bacteria.
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Urinary Tract Infections
Clinical Manifestations Urgency, frequency, burning on urination Microscopic or gross hematuria Cloudy or blood-tinged urine Nocturia Abdominal discomfort, perineal or back
pain Sudden onset incontinence or increased
incontinence Type of infection depends on location:
cystitis, urethritis, nephritis, etc.
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Urinary Tract Infection
Treatment Pharmacology: antibiotics Common ones:
Norflaxin (Noroxin) Nitrofurantoin (Furadantin) Sulfisoxazole (Gantrisin) Trimethoprim-Sulfamethoxazole
( Bactrim, Septra)
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Urinary Tract Infection
Diagnostic Tests: UA, C&S
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CYSTITIS
Inflammation of the urinary bladder. Caused by escherichia coli, candida
albicans, coitus, prostatitis, diabetes mellitus.
Culture, sensitivity testing, antimicrobial medication, urinary tract analgesic.
Increase fluid intake, record I & O.
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CYSTITIS
Encourage fluid intake. Should drink between 3-4 liters of non-caffeinated fluid a day.
Intake of meats and whole grains makes the urine more acidic and may discourage growth of bacteria in the urinary bladder.
Drinking cranberry juice
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PYELONEPHRITIS
Bacterial infection of renal pelvis, tubules, interstitial tissue of one or both kidneys. Also known as pyelitis or nephropyelitis.
Usually associated with pregnancy, chronic health problems such as DM, polycystic or hypertensive kidney disease, insult to the urinary tract such as catheterization, infection, obstruction, or trauma
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PYELONEPHRITIS
Kidney becomes edematous, inflamed; blood vessels congested
Urine may be cloudy and contain pus, mucous, and blood
Small abscesses may form in the kidney
Symptoms of acute condition: chills, fever, flank pain, prostration
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PYELONEPHRITIS
Repeated episodes chronic pyelonephritis and atrophy of the kidney with nephrons being destroyed.
Destruction of nephrons Azotemia: retention in the blood stream of excessive amounts of nitrogenous compounds
Treat to prevent from becoming chronic
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PYELONEPHRITIS
Diagnostic tests could be: IVP, UA and C&S, CBC, BUN, serum creatinine.
Collect urine specimens before administering antimicrobials
Pharmacology: sulfonamides (Bactrim,Cipro); antipyretics if with fever, analgesics if in pain.
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Immunological Disorders of the Kidney Nephrotic syndrome
Etiology/pathophysiologyPhysiologic changes of the glomeruli
interfere with selective permeability Clinical manifestations/assessment
Proteinuria; hypoalbuminemiaGeneralized edemaAnorexiaFatigueOliguria
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Nephrotic Sydrome
http://www.youtube.com/watch?v=-ebByDNbTWI
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Immunological Disorders of the Kidney
Medical management/nursing interventionsCorticosteroidsDiureticsDiet
Low sodiumHigh protein
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Immunological Disorders of the KidneyImmunological Disorders of the KidneyNephritis (acute glomerulonephritis) Etiology/pathophysiology: in taking a
health hx., will usually find that an infectious disease process triggers an immune response.Frequently a beta-hemolytic streptococcus (2-3 weeks prior)
The immune response inflamed glomeruli excretion of RBCs and protein in the urine
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Immunological Disorders of the KidneyImmunological Disorders of the Kidney
Clinical manifestations/assessmentEdema of the face – esp. around eyesPallorMalaiseAnorexiaDyspnea with exertionHematuria – “cola” colored frank
bleedingChanges in voiding patternsOliguria; dysuria
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Immunological Disorders of the Kidney
Diagnostic Tests: Blood tests will usually show: elevated BUN, serum Creatinine, potassium, ESR, and antistreptolysin-O titer.
Urinalysis will show presence of RBCs, casts, and protein
Treatment includes drug therapy, diet, and rest.
Treat to prevent renal complications, cardiac complications, and complications to cerebral functioning.
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Immunological Disorders of the KidneyImmunological Disorders of the Kidney
Medical management/nursing interventionsAntibioticsTreat primary symptomsDiureticsAntihypertensivesDiet
Protein and sodium restrictionsIncrease calories
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Immunological Disorders of the Kidney Pharmacology
Prophylactic antimicrobial therapy possible
Drug of choice is Penicillin Diuretic and antihypertensive drugs may
be ordered Corticosteroids, chemotherapeutic
drugs, and/or immunosuppressive drugs to control inflammatory response.
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Immunological Disorders of the Kidney
Nursing Interventions Focus is on control of symptoms and prevention
of complications Monitor level of consciousness if BUN is elevated VS , I/O Bedrest and fluid adjustments are guided by
urine output until diuresis is adequate Level of Activity: depends on the degree of
edema, BP, proteinuria, and hematuria – all of which increase with excessive activity
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Immunological Disorders of the Kidney Patient Teaching
Nature of illness Effect of diet and fluids on fluid balance and
sodium retentionDiet: prescribed sodium and fluid restrictionInfo on protein restriction/ CHO sources for
energy Medication Pacing daily activities Avoiding trauma and infections S/Sx that require medical attention Importance of medical follow up
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Immunological Disorders of the KidneyImmunological Disorders of the Kidney
Nephritis /Chronic Glomerulonephritis) Etiology/pathophysiology
Slow, progressive destruction of glomeruli
Commonly caused by other chronic illnesses
Diabetes mellitusSystemic lupus erythematosus
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Immunological Disorders of the KidneyImmunological Disorders of the Kidney
Clinical manifestations/assessment Malaise; morning headaches Dyspnea with exertion Visual and digestive disturbances Generalized edema Weight loss Fatigue Hypertension Anemia Proteinuria
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Immunological Disorders of the KidneyImmunological Disorders of the Kidney
Chronic Glomerulonephritis (cont.) Medical management/nursing
interventions Same as acute glomerulonephritis
Bedrest, dietary modification, medication Goal: prevent further renal damage;
prevent cerebral and cardiac complications
Renal dialysis Kidney transplant
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Immunological Disorders of the Kidneys
PharmacologyAntimicrobial therapy given
prophylacticallyDiuretics and antihypertensive drugs
ordered
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PHARMACOLOGY
Types of diuretics:Thiazides: hydrochlorothiazideLoop diureticsPotassium sparing diureticsOsmotic diureticsCarbonic Anhydrase inhibitor diuretics
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PHARMACOLOGY
Diuretics:
-drug that increases the secretion of urine. -kidney disease often causes excess fluid
retention (edema). -many different types of diuretics used for
different purposes.
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PHARMACOLOGY
Antihypertensives methydopa (Aldomet) minoxidil ( Loniten) hydralazine HCL ( Apresoline) Monitor BP, pulse, postural
hypotension, and K, Na,Cl, and CO2 and I&O
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PHARMACOLOGY
Phosphate binding antacids: aluminum hydroxide gel ( Amphogel)
Potassium exchange: sodium polystrene
Electrolyte Replacement: calcitrol (Rocaltrol)