Management of Patients With

Urinary Disorders
 Urinary Tract Infections

• The second most common reason persons seek health care

• A common site of health acquired infection
• Lower UTI
– Cystitis
– Prostatitis
– Urethritis
• Upper UTI
– Pyelonephritis: acute and chronic
– Interstitial nephritis
– Renal abscess and perirenal abscess
 Factors Contributing to UTI

• Function of glycosaminoglycan (GAG)

• Urethrovesical reflux
• Uretherovescal reflux
• Uropathogenic bacteria
• Shorter urethra in women
• Risk factors
Urethrovesical Reflux and
Uretherovesical Reflux
Bladder Infection with Long-Term
Catherization
 Nursing Process: The Care of the
Patient with a UTI—Assessment

• Symptoms may include pain and burning upon

urination; frequency; nocturia; incontinence;
suprapubic, pelvic, or back pain; hematuria; and
change in urine or urinary pattern
• About half are asymptomatic
• Assess voiding patterns, association of symptoms
with sexual intercourse, contraceptive practices,
and personal hygiene
• Gerontologic considerations
• Assessment of urine, urinalysis, and urine cultures
• Other diagnostic tests
 Nursing Process: The Care of the
Patient with a UTI—Diagnoses

• Acute pain
• Deficient knowledge
 Collaborative Problems/Potential
Complications

• Sepsis
• Renal failure
 Nursing Process: The Care of the
Patient with a UTI—Planning

• Major goals may include relief of pain and

discomfort, increased knowledge of
preventive measures and treatment
modalities, and absence of complications.
 Interventions

• Prevention: avoid indwelling catheters, care of

catheters
• Personal hygiene
• Medications as prescribed: antibiotics, analgesics, and
antispasmodics
• Application of heat to the perineum to relieve pan and
spasm
• Increased fluid intake
• Avoidance of urinary tract irritants such as coffee, tea,
citrus, spices, cola, and alcohol
• Frequent voiding
• Patient education
 Urinary Incontinence

• An underdiagnosed and underreported

problem that can have significant impact on
the quality of life and decrease independence,
and which may lead to compromise of the
upper urinary system
• Urinary incontinence is not a normal
consequence of aging
• Risk factors
 Types of Urinary Incontinence

• Stress
• Urge
• Reflex
• Overflow
• Functional
• Iatrogenic
• Mixed incontince
 Patient Teaching

• Urinary incontinence is not inevitable and is

treatable
• Management takes time (provide encouragement
and support)
• Develop and use a voiding log or diary
• Behavioral interventions
• Medication teaching related to pharmacologic
therapy
• Strategies for promoting continence
 Urinary Retention

• Inability of the bladder to empty completely

• Residual urine: amount of urine left in the
bladder after voiding
• Causes include age (50–100 mL in adults older
than age 60 due to decreased detrusor muscle
activity), diabetes, prostate enlargement,
pregnancy, neurologic disorders, medications
• Assessment
• Nursing measures to promote voiding
 Urolithiasis and Nephrolithiasis

• Calculi (stones) in the urinary tract or kidney

• Pathophysiology
• Causes; may be unknown
• Manifestations
– Depend upon location and presence of obstruction or
infection
– Pain and hematuria
• Diagnosis: x-ray, blood chemistries, and stone
analysis; strain all urine and save stones
Potential Sites of Urinary Calculi
Methods of Treating Renal Stones
Methods of Treating Renal Stones
Methods of Treating Renal Stones
 Patient Teaching

• Signs and symptoms to report

• Follow-up care
• Urine pH monitoring
• Measures to prevent recurrent stones
• Importance of fluid intake
• Dietary teaching
• Medication teaching as needed
 Urinary Diversion

• Reasons: bladder cancer or other pelvic

malignancies, birth defects, trauma, strictures,
neurogenic bladder, chronic infection or intractable
cystitis; used as a last resort for incontinence
• Types:
– Cutaneous urinary diversion: ileal conduit, cutaneous
ureterostomy, vesicostomy, nephrostomy
– Continent urinary diversion: Indiana pouch, Kock pouch,
uretherosigmoidostomy
 Cutaneous Urinary Diversions

Cutaneous Urinary Diversions

Continent Urinary Diversions

Continent Urinary Diversions

 Nursing Diagnoses: Preoperative

• Anxiety
• Imbalanced nutrition
• Deficient knowledge
 Nursing Diagnoses: Postoperative

• Risk for impaired skin integrity

• Acute pain
• Disturbed body image
• Potential for sexual dysfunction
• Deficient knowledge
 Question

Is the following statement True or False?

Elderly patients often lack the typical symptoms

of UTI and sepsis.
 Answer

True

Elderly patients often lack the typical symptoms

of UTI and sepsis.
 Question

Is the following statement True or False?

Urinary incontinence is inevitable and is not

treatable.
 Answer

False

Urinary incontinence is NOT inevitable and IS

treatable.