NURS 1067 Week 11 Final Exam Review.

NURS 1067 Week 11 Final Exam Review. Impaired urinary elimination - a general diagnosis; diagnosis allow nurses to support clients until a more specific nursing diagnosis or medical diagnosis can be made, stress incontinence, urge incontinence. urinary incontinence - uncontrolled loss of urine that is of sufficient magnitude to be a problem; can affect anyone across the lifespan, however higher prevalence among older adults; among younger adults, affects more women than men; affects the quality of life and may have serious health consequences; UI is a symptom due to various causes. urinary retention - inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of an inability to urinate. chronic (urinary retention) - -Chronic: incomplete bladder emptying despite urination acute (urinary retention) - -Acute: total inability to pass urine Medical emergency (causes) Urinary Retention - Deficient detrusor muscle strength, Detrusor muscle does not contract with enough force to empty bladder, Neurological diseases, over distension of bladder, alcoholism, medications(anticholinergics) (causes) Urinary Retention - Bladder outlet obstruction, Bladder cant empty due to an obstruction (causes) urinary retention - Additional causes,Surgical or childbirth trauma, fecal impaction Urinary Retention - Clinical Manifestations - Feelings of:pressure, discomfort, tenderness of suprapubic area, restlessness;Diaphoresis; Overflow incontinence Voiding small amounts frequently, no relief or comfort post void; Post-residual void > 150ml Health History - Past medical health history (related comorbidities); Infectious status, diabetes, cognitive impairment, Parkinsonism, arthritis, back problems, sensory impairment, visual & hearing impairments Health History - Lifestyle factors (smoking, obesity);Medications diuretics, morphine, sedatives;Environment, cognitive, functional status Physical Assessment - Signs and symptoms of dehydration;Inspect perineal area;Assess skin integrity, rash, discharge? ;Kidneys and bladder Distention → Retention Post-void residual → Retention (use of bladder scan);Flank pain;Assess urine ACCO Related Nursing Diagnoses - -Toileting self care deficit -Risk for impaired skin integrity -Risk for infection -Diagnoses related to stress, self-esteem, personal identity, social isolation, disturbed body image -Impaired comfort -Pain Nursing Interventions - Keep a bladder log Promote and maintain regular voiding patterns,Be available, answer call bells, give patient time to void completely,Bladder/Habit training Nursing Interventions - Modify environment so that it meets functional needs of client;Maintain skin integrity and prevent infection;Incontinence briefs and pads provided, but are a last resort since they do not solve the problem,Change frequently teaching( Nursing interventions) - Teaching;Infection prevention;Proper hygiene Promote skin integrity; Importance of hydration; Avoiding triggers (food/fluids);See Nutritional; Management slides Nursing Interventions - Pelvic Muscle Exercise (Kegel Exercises) Effective for stress incontinence Nursing Interventions - Promote complete bladder emptying, Effective for the client with urinaryretention,Scheduled toileting,Every 3-4hrs Don't rush patient Double voiding Void, sit on toilet for 3-4 minutes, void again Medical Management - UI - Pharmaceutical options -Urge or reflex UI ,Antimuscarinic (antispasmodic, anticholinergic), Relax bladder muscled and inhibit overactive detrusor muscle Ex. Oxybutynin chronic(Medical Management - Retention) - Post-void residuals of > 100ml should do intermittent catheterizations (take catheter out immediately after urine is evacuated) acute(Medical Management - Retention) - Immediate indwelling or intermittent catheterization required ;Indwelling: Catheter remains in bladder for long periods of time;Option if there is an obstruction or if client unwilling or unable to do intermittent catheterizations pharmaceutical options(medical management-retention) - ⍺-adrenergic antagonists: Reduce urethral sphincter resistance to urinary outflow Ex. Doxasozin for patients with enlarged prostate 5 ⍺-reducatse inhibitors: Reduces size of prostate Ex. Finasteride surgical option( medical management-retention) - Useful to manage retention caused by obstructions Ex. Transurethral resection of the prostate (TURP) Nutrition Management(avoid excessive consumption of) - Citrus juices,Carbonated beverages,Tobacco ,Tomatoes or tomato based products,Alcohol ,Caffeine,Greasy/spicy foods,Drinking large amounts of fluid late in the evening UTI's - "Second most common bacterial disease the human body is subject to" (Lewis et. al., 2014, p.1289) UTI's - Women are more susceptible than men, More than 50% of women will have had a UTI in their lifetime UTI's - Accounts for 40% of hospital acquired infections (Potter, Perry, Stockert & Hall, 2014, p.1117),Due to instrumentation (catheterization) -Bacteria is inevitable within 2 days -100% colonization within 30 days UTI's - Urinary tract above the urethra is usually sterile UTI's - Natural defenses to prevent UTIs include: Normal voiding, complete emptying of bladder, antibacterial capability of the bladder mucosa, function of the ureterovesical junction, peristaltic movement propelling urine, acidic PH of urine and Alteration of these can lead to infections UTI's - Most infections are caused by gram-negative bacteria, E-coli most common Comorbidities:(UTI's Risk Factors) - Diabetes, immunocompromised clients, urinary retention, obstructions, instrumentation, older adults, patients using antibiotics, underlying disease Risk for women ( UTI's Risk Factors) - At greater risk due to shortened urethra and proximity to anal orifice, and Sexual activity, pregnancy, diaphragm and spermicide use, pelvic organ prolapse Risk for men ( UTI's Risk Factors) - Instrumentation, congenital abnormalities UTIs classification:Lower urinary tract symptoms (LUTS) - Dysuria, frequency >2qh, urgency, suprapubic discomfort or pressure, Urine characteristics: -May have blood (hematuria),Sediment, appear cloudy, presence of WBCs or bacteria Foul smelling UTIs classification: Upper urinary tract symptoms - Flank pain, tenderness, chills, fever UTIs classification:Initial infection - First or isolated infection, no reoccurrence or separated by years UTI's classification:Recurrent infection- Unresolved - Caused by second pathogen, or because initial was not eradicated: Unresolved: Bacteria are resistant to antibiotic, or Antibiotic is discontinued before bacterium are eradicated, or Antibiotic does not achieve proper concentrations in bloodstream to be effective UTI's classification:Recurrent infection-Bacterial Persistence - Bacteria develop resistance to antibiotic agent often due to a foreign body in urinary system which allows bacteria to survive Clinical Manifestations: Developmental Considerations of UTI's - Older adults may not present with 'typical' symptoms; May present with: Non-localized abdominal pain, cognitive impairment, less likely to have a fever, may even have slight decrease in temperature, fatigue, anorexia How to Diagnose UTI's - Dipstick urinalysis Presence of nitrates (indicates presence of bacteria), WBCs (pyuria), leukocytes, blood (hematuria),Microscopic urinalysis How to Diagnose UTI's - Urine culture and sensitivity,Needs to be a 'sterile' sample, often store in fridge, Mid-stream urine 'clean catch'Catheterization ,Developmental considerations; Imaging: CT scan or Intravenous Pyelogram (IVP) Nursing Assessment for UTI's( health history) - Previous UTI? ;Past health history