Managing Urinary Elimination Issues

Oct 9, 2024

Mindmap

Urinary Elimination Problems and Management

Common Urinary Elimination Problems

  • Urinary Retention: Inability to partially or completely empty the bladder.
    • Symptoms: Pressure, discomfort, pain.
    • Post Void Residual (PVR): Amount of urine left in bladder after voiding.
  • Urinary Incontinence: Involuntary loss of urine.
    • Types:
      • Urge Incontinence: Involuntary leakage with urgency.
      • Stress Incontinence: Leakage due to exertion or sneezing/coughing.

Urinary Tract Infections (UTIs)

  • Common in hospitals; often caused by E. coli.
  • Foley catheters increase UTI risk; CMS does not reimburse for catheter-associated UTIs.
  • Symptoms can include fever, altered vital signs, confusion (especially in elderly).
  • Pyelonephritis: Serious UTIs can lead to bloodstream infections.
  • Treatment: Antibiotics; prompt intervention is crucial.

Urinary Diversions

  • Cystectomy: Removal of bladder due to cancer or dysfunction.
  • Types:
    • Ureterostomy: Stoma created with ureter.
    • Nephrostomy Tubes: Drain renal pelvis when ureter is obstructed.

Growth and Development

  • Children associate urination sensation around ages 2-3.
  • Nocturnal Enuresis: Bedwetting at night.
  • Pregnancy increases urinary frequency.
  • Aging increases risk of urinary issues.

Psychosocial Implications

  • Incontinence affects self-image and self-esteem.
  • Cultural considerations important in care assessments.

Nursing History and Assessment

  • Assess elimination patterns, symptoms, factors affecting urination.
  • Physical assessment includes kidneys, bladder, genitalia, skin.
  • Intake and Output: Indicator of kidney and bladder function.

Characteristics of Urine

  • Color: Ranges from pale straw to amber.
    • Hematuria: Dark red if from kidneys, bright red if from bladder/urethra.
  • Clarity: Cloudy urine may indicate infection or protein presence.
  • Odor: Strong ammonia smell may indicate UTI.

Laboratory and Diagnostic Testing

  • Proper labeling and collection of urine specimens is crucial.

Promoting Normal Micturition

  • Ensure privacy, adequate fluid intake.
  • Encourage complete bladder emptying.

Preventing Infection

  • Proper hygiene, wiping front-to-back for women.
  • Catheterization: Risk for Catheter-Associated UTIs (CAUTIs).

Types of Catheters

  • Different sizes and types based on patient needs.
  • Routine catheter care and closed drainage systems to prevent CAUTI.

Catheter Irrigations

  • Necessary for catheter patency but carries UTI risk.

Catheter Removal

  • Prompt removal reduces hospital-acquired UTIs.

Medications

  • Antimuscarinics (e.g., Oxybutynin) for urgency.
  • Flomax for prostate issues.
  • Antibiotics for UTIs.

Restorative Care

  • Lifestyle changes to avoid bladder irritants.
  • Pelvic Floor Muscle Training: Improves bladder control.
  • Bladder Retraining: Behavioral therapy to control voiding schedule.

Catheterization and Skin Care

  • Intermittent Catheterization: Aimed at periodic bladder drainage.
  • Incontinence-Associated Dermatitis: Skin care crucial to prevent damage.

Ensure adherence to infection control practices, patient hygiene, and monitoring for any complications related to urinary elimination and catheter use.