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Urinary Incontinence
 Affects more than 25 million adults in
the United States
 Underdiagnosed and underreported
 Affects women and men
 Risk factors: refer to chart 49-4
 Symptom of many possible disorders
Types of Urinary Incontinence
 Stress
 Urge
 Functional
 Iatrogenic
 Mixed
 Overflow
Patient Education for Urinary
Incontinence
 Urinary incontinence is not inevitable
and is treatable
 Management takes time (provide
encouragement and support)
 Education verbally and in writing
 Develop and use a voiding log or diary
 Behavioral interventions
 Medication education related to
pharmacologic therapy
 Strategies for promoting continence
Urolithiasis and
Nephrolithiasis
 Calculi (stones) in the urinary tract or kidney
Pathophysiology
 Causes: may be unknown
 Depends on location and presence of
obstruction or infection
 Pain and hematuria
 Diagnosis: radiography, blood chemistries, and
stone analysis; strain all urine and save stones
Potential Sites of Urinary
Calculi
Treatment options
Patient Education for Renal
Calculi
 Signs and symptoms to report
 Follow-up care
 Urine pH monitoring
 Measures to prevent recurrent stones
 Importance of fluid intake
 Dietary education
 Medication education as needed
Urinary Tract Cancers
 Bladder, kidney and renal pelvis,
ureters, other structures such as
prostrate
 Cancer of bladder:
◦ More common after age 65 years
◦ Leading cause of death
◦ Smoking increases risk 50%
 S/S: visible painless hematuria; pelvic
or back pain may indicate metastasis
 Diagnosis: ureteroscopy, excretory
Bladder Cancer Management
 Medical management: depends on the grade
and stage of the tumor
◦ Chemotherapy
◦ Radiation
 Surgical management:
◦ Transurethral resection or fulguration
◦ Followed by bacille Calmette–Guérin (BCG)
treatment
◦ Cystectomy
◦ Urinary diversion
Nursing Management of Bladder
Cancer
 Immediate postop: monitor urine
volume hourly
 Provide stoma and skin care
 Test urine and care for ostomy
 Encourage fluids and relieve anxiety
 Patient education about self-care:
managing ostomy
Urinary Diversion
 Procedure to divert urine from bladder
to new exit site, stoma
 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: ileal conduit, orthotopic
neobladder reconstruction, or
continent urinary diversion (Indiana
Assessment of the Patient
Undergoing Urinary Diversion
Surgery
 Preoperative assessment
◦ Cardiopulmonary function
◦ Nutritional status
◦ Learning needs
 Postoperative assessment
◦ Signs and symptoms of complications
◦ Urine volume, drainage system, color of
drainage
◦ Pain
Nursing Interventions for the
Patient Undergoing Urinary
Diversion Surgery
 Preoperative
◦ Relieving anxiety
◦ Ensuring adequate nutrition
◦ Explaining surgery and its effects
 Postoperative
◦ Maintaining skin integrity
◦ Relieving pain
◦ Improving body image, exploring sexuality issues
◦ Monitoring and managing potential complications
◦ Patient education
Thanks for your attention

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5-part 2-urinary tract disl,;l,';l';orders.ppt

  • 1. Urinary Incontinence  Affects more than 25 million adults in the United States  Underdiagnosed and underreported  Affects women and men  Risk factors: refer to chart 49-4  Symptom of many possible disorders
  • 2. Types of Urinary Incontinence  Stress  Urge  Functional  Iatrogenic  Mixed  Overflow
  • 3. Patient Education for Urinary Incontinence  Urinary incontinence is not inevitable and is treatable  Management takes time (provide encouragement and support)  Education verbally and in writing  Develop and use a voiding log or diary  Behavioral interventions  Medication education related to pharmacologic therapy  Strategies for promoting continence
  • 4. Urolithiasis and Nephrolithiasis  Calculi (stones) in the urinary tract or kidney Pathophysiology  Causes: may be unknown  Depends on location and presence of obstruction or infection  Pain and hematuria  Diagnosis: radiography, blood chemistries, and stone analysis; strain all urine and save stones
  • 5. Potential Sites of Urinary Calculi
  • 7. Patient Education for Renal Calculi  Signs and symptoms to report  Follow-up care  Urine pH monitoring  Measures to prevent recurrent stones  Importance of fluid intake  Dietary education  Medication education as needed
  • 8. Urinary Tract Cancers  Bladder, kidney and renal pelvis, ureters, other structures such as prostrate  Cancer of bladder: ◦ More common after age 65 years ◦ Leading cause of death ◦ Smoking increases risk 50%  S/S: visible painless hematuria; pelvic or back pain may indicate metastasis  Diagnosis: ureteroscopy, excretory
  • 9. Bladder Cancer Management  Medical management: depends on the grade and stage of the tumor ◦ Chemotherapy ◦ Radiation  Surgical management: ◦ Transurethral resection or fulguration ◦ Followed by bacille Calmette–Guérin (BCG) treatment ◦ Cystectomy ◦ Urinary diversion
  • 10. Nursing Management of Bladder Cancer  Immediate postop: monitor urine volume hourly  Provide stoma and skin care  Test urine and care for ostomy  Encourage fluids and relieve anxiety  Patient education about self-care: managing ostomy
  • 11. Urinary Diversion  Procedure to divert urine from bladder to new exit site, stoma  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: ileal conduit, orthotopic neobladder reconstruction, or continent urinary diversion (Indiana
  • 12. Assessment of the Patient Undergoing Urinary Diversion Surgery  Preoperative assessment ◦ Cardiopulmonary function ◦ Nutritional status ◦ Learning needs  Postoperative assessment ◦ Signs and symptoms of complications ◦ Urine volume, drainage system, color of drainage ◦ Pain
  • 13. Nursing Interventions for the Patient Undergoing Urinary Diversion Surgery  Preoperative ◦ Relieving anxiety ◦ Ensuring adequate nutrition ◦ Explaining surgery and its effects  Postoperative ◦ Maintaining skin integrity ◦ Relieving pain ◦ Improving body image, exploring sexuality issues ◦ Monitoring and managing potential complications ◦ Patient education
  • 14. Thanks for your attention