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
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
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
