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Interventions for Clients with Urinary Problems

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... into container Requires more time than hemo Complications Infection in peritoneal cavity Peritoneal Dialysis ESWL.Extracorporeal shock-wave lithotripsy ... – PowerPoint PPT presentation

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Title: Interventions for Clients with Urinary Problems


1
Interventions for Clients with Urinary Problems
2
Cystitis
  • Inflammation of the bladder
  • Most commonly caused by bacteria that move up the
    urinary tract from the external urethra to the
    bladder, viruses, fungi, or parasites
  • Catheter-related infections common during
    hospital stay

3
Incidence and Prevalence of Cystitis
  • Frequenct urge to urinate
  • Dysuria
  • Urgency
  • Urinalysis needed when testing for leukocyte
    esterase
  • Type of organism confirmed by urine culture
  • Other diagnostic assessments

4
Drug Therapy
  • Urinary antiseptics
  • Antibiotics
  • Analgesics
  • Antispasmodics
  • Antifungal agents
  • Long-term antibiotic therapy for chronic,
    recurring infections

5
Nonsurgical Management
  • Urinary elimination
  • Diet therapy includes all food groups, calorie
    increase due to increase in metabolism caused by
    the infection, fluids, possible intake of
    cranberry juice preventively
  • Other pain relief measures, such as warm sitz
    baths

6
Catheter
7
Urethritis
  • Inflammation of the urethra that causes symptoms
    similar to urinary tract infection
  • Caused by sexually transmitted infections treat
    with antibiotic therapy
  • Estrogen vaginal cream for postmenopausal women

8
Urethrala Strictures
  • Narrowing of the urethra
  • Most common symptomobstruction of urine flow
  • Surgical treatment by urethroplastybest chance
    of long-term cure
  • Dilation of the urethraa temporary measure
  • Urethroplasty

9
Urinary Incontinence
  • Five types of incontinence include
  • Stress
  • Urge
  • Mixed
  • Overflow
  • Functional

10
Collaborative Management
  • Assessment includes a thorough client history.
  • Clinical manifestations for urethral or uterine
    prolapse
  • Laboratory assessment by urinalysis
  • Radiographic assessment, especially before
    surgery
  • Other diagnostic assessments

11
Stress Urinary Incontinence
  • Interventions include
  • Keeping a diary, behavioral interventions, diet
    modification, and pelvic floor exercises
  • Drug therapy estrogen
  • Surgery
  • Collection devices and vaginal cone weights

12
Surgical Management
  • Preoperative care
  • Operative procedure
  • Postoperative care
  • Assess for and intervene to prevent or detect
    complications.
  • Secure urethral catheter.

13
Urge Urinary Incontinence
  • Interventions include
  • Drugs anticholinergics, possibly antihistamines,
    others
  • Diet therapy avoid caffeine and alcohol
  • Behavioral interventions exercises, bladder
    training, habit training, electrical stimulation

14
Reflux Urinary Incontinence
  • Interventions include
  • Surgery to relieve the obstruction
  • Intermittent catheterization
  • Bladder compression and intermittent
    self-catheterization
  • Drug therapy
  • Behavioral interventions

15
Functional Urinary Incontinence
  • Interventions include
  • Treatment of reversible causes
  • If incontinence is not reversible, urinary habit
    training
  • Final strategycontainment of urine and
    protection of the clients skin
  • Applied devices
  • Urinary catheterization

16
Urolithiasis
  • Presence of calculi (stones) in the urinary tract
  • Collaborative management
  • History of urologic stones
  • Clinical manifestations
  • Laboratory assessment
  • Radiographic assessment
  • Other diagnostic tests

17
IVP (Intravenous Pyelography)
18
Interventions
  • Drug therapy
  • Opioid analgesicsoften used to control pain
  • Nonsteroidal anti-inflammatory drugs
  • Pain medications at regular intervals
  • Constant delivery system
  • Spasmolytic drugsimportant for relief of pain
  • Complementary and alternative therapy

19
Lithotripsy
  • Extracorporeal shock wave lithotripsy uses
    sound, laser, or dry shock wave energy to break
    the stone into small fragments.
  • Client undergoes conscious sedation
  • Topical anesthetic cream is applied to skin site
    of stone.
  • Continuous monitoring is by electrocardiography

20
Surgical Management
  • Minimally invasive surgical procedures
  • Stenting
  • Retrograde ureteroscopy
  • Percutaneous ureterolithotomy and nephrolithotomy
  • Open surgical procedures
  • Preoperative care
  • Operative procedure

21
Postoperative Care
  • Routine postoperative care procedures for
    assessment of bleeding, urine, and adequate fluid
    intake
  • Strained urine
  • Infection prevention
  • Drug therapy
  • Diet therapy
  • Prevention of obstruction

22
Drug Therapy
  • Drug selection to prevent obstruction depends on
    what is forming the stone
  • Calcium
  • Oxalate
  • Uric acid
  • Cystine

23
Urothelial Cancer
  • Collaborative management
  • Assessment
  • Diagnostic assessment
  • Nonsurgical management
  • Prophylactic immunotherapy
  • Chemotherapy
  • Radiation therapy

24
Surgical Management
  • Preoperative care
  • Operative procedures
  • Postoperative care includes
  • Collaboration with enterostomal therapist
  • Kocks pouch
  • Neobladder

25
Bladder Trauma
  • Causes may be due to injury to the lower abdomen
    or stabbing or gunshot wounds.
  • Surgical intervention is required.
  • Fractures should be stabilized before bladder
    repair.

26
Hemodialysis
  • Hospital, dialysis center
  • Pts blood moves from implanted shunt in arm
    artery ? tube ? machine ? exchange of wastes,
    fluids, electrolytes
  • Semipermeable membrane separates pts blood from
    dialysis fluid

27
Hemodialysis
  • Constituents move between the 2 compartments
  • Ex wastes in blood ? dialysate
  • bicarbonate in dialysate ? blood
  • Blood cells, proteins remain in blood
  • Movement by ultrafiltration, diffusion, osmosis
  • ? Blood to pt vein

28
(No Transcript)
29
Peritoneal Dialysis
  • Administered in unit or at home
  • At night or continuously
  • CAPD (continuous ambulatory peritoneal dialysis)
  • Peritoneal membrane serves as semipermeable
    membrane
  • Catheter w/ entry and exit points implanted
  • Dialyzing fluid instilled in catheter into cavity

30
Peritoneal Dialysis
  • Remains there
  • Allows exchange of wastes and electrolytes to
    occur
  • Dialysate drained from by gravity from cavity
    into container
  • Requires more time than hemo
  • Complications
  • Infection in peritoneal cavity

31
Peritoneal Dialysis
32
ESWL.Extracorporeal shock-wave lithotripsy (ESWL)
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