NU 340 > Ch. 58 > Flashcards

Ch. 58 Flashcards

(48 cards)

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1
Q

urinary incontinence affects

A

> 13 million people
- major health problem in the US

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2
Q

urinary incontinence is most common in

A

women and elderly
45% of women over the age of 65 report this condition

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3
Q

pathophysiology of urinary incontinence

A
  • involuntary loss of urine severe enough to cause social or hygienic problems
  • not a normal sign if aging
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4
Q

types of incontinence are

A
  • stress
  • urge
  • overflow
  • functional
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5
Q

stress incontinence

A

inability to retain when laughing, sneezing, jogging, or lifting

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6
Q

urge incontinence

A

AKA “overactive bladder”
- loss of urine after feeling an urgent need to urinate as a result of bladder contractions regardless of how full the bladder is

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7
Q

overflow incontinence

A

Occurs when detrusor muscle fails to contract and bladder becomes overdistended and some urine leaks out

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8
Q

functional incontinence

A

Occurs as a result of loss of cognitive function in patients with dementia as they aren’t aware that they need to urinate

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9
Q

temporary or permanent causes of urinary incontinence

A
  • drugs
  • surgery
  • spinal cord injury: S2-S4
  • brain and nervous system disorders
  • factors associated with aging
  • disease treatment
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10
Q

urinary incontinence risk factors

A

Chronic conditions such as :
- Diabetes and Heart failure
- Vaginal deliveries
- Pelvic prolapse
- Prostate problems
- Obesity

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11
Q

collaborative management includes:

A

patient history
physical assessment
lab assessment/diagnostic tests

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12
Q

most common type of incontinence

A

stress

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13
Q

stress incontinence interventions

A
  • Keeping a diary
  • Nutrition therapy
  • Drug therapy—estrogen
  • Pelvic muscle (Kegel) exercises
  • Bladder training
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14
Q

surgical management of stress incontinence

A

Insertion of surgical sling or bladder suspension device
- Preoperative and Intra-Op care same as other surgeries

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15
Q

post-op care for post surgical sling or bladder suspension device (stress incont. surgery)

A

Assess for and intervene to prevent or detect complications
Secure urethral catheter

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16
Q

urge urinary incontinence interventions

A

Drugs—anticholinergics

Diet therapy—avoid caffeine and alcohol and space fluids throughout the day

Behavioral interventions
- Exercises
- bladder training - patient must be oriented and able to follow directions
- habit training - good for patients with limited cognition
- electrical stimulation

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17
Q

overflow incontinence interventions

A
  • Bladder training
  • Drug therapy only if bladder training unsuccessful
  • Intermittent self catheterization
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18
Q

functional urinary incontinence interventions

A
  • If incontinence is not reversible, habit training
  • Applied devices
  • Urinary catheterization
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19
Q

cystitis

A

inflammation of the bladder from an infection of the bladder

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20
Q

cause of cystitis

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A
  • bacteria that move up the urinary tract from the external urethra to the bladder
  • UTI- invasion of bacteria anywhere in the urinary tract
21
Q

risk factors of cystitis

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A
  • Urinary Catheters ↑ risk for UTIs in the hospital setting
  • More common in women (d/t shorter urethra length 2-3” v male: 7-9”)
  • More common in diabetics
22
Q

cytitis symptoms

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A
  • Frequent urge to urinate
  • Dysuria: burning on urination
  • Urgency: urge to go
  • Pelvic pressure
  • Urine may be cloudy, foul smell, or blood tinged

3 classic sx: frequency, urgency, burning

23
Q

cystitis tests/diagnostics

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A
  • UA: WBC, bacteria, protein, ketones, bilirubin, RBCs (results quick)
  • urine C&S confirms type of organism (24h)
  • 80% of UTIs are caused by E. coli
  • if organism has “r” = antibiotic resistant
  • if organism has “s” = susceptible to antibiotic

dx is confirmed with urine C&S

24
Q

cystitis interventions

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A
  • drug therapy (broad-spectrum ABT at first, then pick ABT that treats bacteria)
  • fluid intake (2-3L of fluid)
  • comfort measures: warm sitz bath
  • diet therapy
  • surgery to treat conditions that increase risk for recurrent UTIs: correct a structural abnormality
25
health promotion and maintenance of cystitis
- sterile technique when inserting catheters - clean technique when using intermittent catheters at home - single-use catheter recommended for home settings (use new one every time) - National Patient Safety Goals -- CAUTI prevention; best practice is to not use at all - liberal intake of water (2-3L of fluid/day unless condition like heart failure with fluid restriction)
26
drug therapy for cystitis
Urinary antiseptics/Antibiotics (usually 7-10 days) - sulfa-based med - penicillin/amoxicillin - cipro Analgesics - tylenol Antispasmodics - oxybutanin (urinary spasmodic) Long-term antibiotic therapy for chronic, recurring infections (6-12 months) *ask about allergies
27
cystitis: diet therapy
Diet includes ALL food groups Increase calories because increase metabolism → infection Fluids to maintain diluted urine Cranberry juice preventively, cranberry pills OTC outpatient
28
urolithiasis
- Presence of calculi (stones) in urinary tract - Most common associated condition is dehydration - Factors relating to urine or urinary tract environment contribute to formation - Present in 9% of U.S. women and 19% of U.S. men
29
urolithiasis is also called
kidney stones
30
urolithiasis: stones are formed from 1 of 3 substances:
1. Calcium (75% of kidney stones) 2. Struvite 3. Uric acid
31
urolithiasis risk factors
- male 2.5x more likely than woman - age: 30-50 years - family hx (45% cases) - diet: high animal protein and low in fiber and fluids or other dietary patterns causing -prolonged imbalances in acidity of urine - weight: overweight or severely underweight - lifestyle: high stress - medical conditions: HTN, gout, DM, bedridden stratus - meds: drugs for AIDS, thyroid hormones, chemotherapy, long-term antacid use (tums)
32
calcium stones
- 70% to 80% of kidney stones are composed of calcium oxalate - Almost half result from genetic predisposition Other causes - Excess calcium in blood (hypercalcemia) or urine (hypercalciuria) - Excess oxalate in urine (hyperoxaluria) - Low levels of citrate in urine (hypocitraturia) - Infection
33
Examples of Food Sources of Oxalates (calcium) // foods to avoid
- Fruits: Berries, Concord grapes, currants, figs, fruit cocktail, plums, rhubarb, tangerines - Vegetables: Baked/green/wax beans, beet/collard greens, beets, celery, Swiss chard, chives, eggplant, endive, kale, okra, green peppers, spinach, sweet potatoes, tomatoes - Nuts: Almonds, cashews, peanuts/peanut butter - Beverages: Cocoa, draft beer, tea - Other: Grits, tofu, wheat germ
34
struvite stones
- Composed of magnesium ammonium phosphate - Mainly caused by urinary tract infections but can be specific nutrient (mg, al, ph) - Diet- limit high phosphate foods - Usually removed surgically bc bigger stones
35
uric acid stone intervention
follow a low purine diet - avoid seafood, red meats, red wine
36
kidney stones sx
Clinical symptoms: Severe pain in flank and lower back, other urinary symptoms, general weakness, N and V, fever Pt may be pale and diaphoretic Temperature and HR ↑ if infection present if temperature and WBC in urine- think pyelonephritis
37
kidney stones dx labs
UA - hematuria - WBC, RBC (should not have WBC in urine) - bacteria dx tests: - CT scan- standard test to confirm stones, KUB- also shows stones
38
kidney stones priority intervention
PAIN- relief
39
kidney stones interventions
Drug therapy: acute treatment for existing stone 1. Opioids 2. NSAIDS 3. Antispasmotics 4. Tamsulosin - no meds once stone is gone bc pain should be done get rid of stone with: do CT first - Lithotripsy: breaks up stones so that it can be passed naturally - natural passage in urine - Minimally invasive surgery (smaller stone) - Open surgical procedures (big stones) - Preventing Infection - Preventing obstruction
40
nutrition therapy for calcium stones
- Low-calcium diet (~400 mg/day) recommended for those with supersaturation of calcium in the urine and who are not at risk for bone loss - If stone is calcium phosphate, sources of phosphorus (e.g., meats, legumes, nuts) are controlled - Fluid intake increased - Sodium intake decreased
41
nutrition therapy: uric acid stones
Low-purine diet Avoid: - organ meats (red meats) - poultry - fish - gravies - red wines - sardines
42
lithotripsy
- Use of sound or laser waves to break stone into small fragments - Done outpatient for 30-45min under Conscious sedation
43
lithotripsy monitoring
- monitor VS, pulse ox, cardiac monitor - once VS are stable can be d/c home
44
lithotripsy d/c teaching
- ultrasound waves - increase fluid intake (2-3L) - filter to place over the toilet to determine if the stones are passed when they urinate (monitor for stones)
45
what age group of patients are hospitalized with positive UTI?
- elderly due to confusion, altered level of consciousness - IVF, IV ABT
46
1st line treatment of UTIs
bactrim - sulfa-med - ask about sulfur allergy - take with full glass of water - monitor for skin rash (steven-johnson syndrome)
47
teaching to prevent UTIs
- wipe front to back - cotton underwear, no thongs - no bubble baths - wash hands - urinate in regular basis- longer urine sits in bladder, more time organisms have to grow - go to bathroom after sexual activity
48
lithotripsy pre-op teaching (hint: r/t type of anesthesia)
conscious sedation - arrange for someone to drive them home - sleepy, kind of awake, but can't really feel anything - NPO 4-6h before surgery (vomit risk)
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