Obstructive uropathies

• Subjective data collection for urinary system:

  • health history
  • medication
  • surgery
  • nutritional assessment
  • elimination assessment
  • pain assessment
  • sexual history
• Inspection

  • urinary meatus for inflammation or discharge
  • bladder distention and masses
  • external genitalia for redness, swelling and drainage
• Palpation

  • abdomen for bladder distention, masses or tenderness
• Percuss

  • costovertebral angle for tenderness and pain, kidney infection, polycystic kidney disease
  • bladder if it contains more than 150ml of urine
• UTIs are the most common bacterial infection in women. It is usually caused by E-coli or other bacteria
• Cystitis: inflammatory condition of the urinary bladder, pain, urgency and frequency of urination, hematuria
• Urethritis is the inflammation of the urethra
• Predisposing factors for UTI:

  • increasing urinary stasis due to obstruction or urinary retention
  • anatomical due to congenital defects, fistula or a shorter female urethra
  • function disorders like constipation or voiding dysfunction
  • compromised immune response due to diabetes or an immunodeficiency virus infection
  • foreign bodies like indwelling catheter
• Emptying symptoms for UTI:

  • dysuria
  • difficulty starting the urine stream
  • intermittency
  • pain
  • urine loss after completion of voiding
  • urinary retention or incomplete emptying
  • weak urinary stream
  • hematuria
• Storage symptoms of UTI

  • incontinence
  • nocturia
  • nocturnal enuresis (night incontinence)
  • urgency
  • urinary frequency
• Manifestation of UTI in older adults:

  • non-localized abdominal discomfort
  • cognitive impairment or delirum (unaware of their symptoms)
  • less likely to develop a fever
  • non specific symptoms such as fatigue or anorexia
• Diagnostic tests for UTI

  • dipstick urinalysis
  • urine culture and sensitivity by voiding midtsream, catheterization and sample of an indwelling catheter
• Protein in urine is a sign of nephritis (kidney inflammation)
• Glucose in urine is a sign of diabetes
• Ketones in urine is a sign of high blood sugar
• Nitrite in urine can be a sign of bacterial infection like a UTI
• RBC in urine can signify dammage to glomeruli or tubules VS WBC in high number may indicate a UTI
• Treatment of UTI is with antibiotics, infection control nd hygiene or indwelling catheter care
• Health promotion of UTI

  • emptying bladder regularly
  • regular bowel movements
  • wiping perineal area from front to back
  • drinking adequate amount of liquid
  • sterile technique during catheter insertion
  • routine perineal hygiene
• Acute intervention for UTI

  • adequate liquid intake
  • avoid bladder irritants such as alcohol, caffeine, citrus juice, chocolate and spicy food
  • application of heat
  • medication teaching
• Benign prostatic hyperplasia is the increase in size of the prostate gland leading to a disruption of urine outflow since it compresses the urethra. It results from hormonal changes associated with the aging process
• Obstructive BPH clinical manifestations

  • decrease in the caliber and force of urine stream
  • difficulty initiating voiding
  • intermittency of urine while voiding
  • dribbling at the end of urination
• Irritative BPH clinical manifestations

  • urinary frequency and urgency
  • dysuria
  • bladder pain
  • nocturia (often first noticed symptom)
  • incontinence due to inflammation or infection
• Potential complications of BPH:

  • acute urinary retention
  • UTI
  • calculi
  • renal failure
  • pyelonephritis (kidney infection)
  • bladder damage
• Diagnostic test for BPH

  • history and physical examination
  • digital rectal examination to check size, symmetry and consistency
  • urinalysis or urine culture
  • prostate specific antigen
  • cysto urethroscopy
  • transrectal ultrasonography
• Treatment for BPH

  • adequate water intake
  • avoiding bladder irritant like caffeine and alcohol
  • avoid retaining urine
  • inserting catheter to relieve retention
  • avoid taking decongestant (reduce bladder contraction)
  • medication
• Medication for BPH are a-adrenergic receptor blockers which promote smooth relaxation in the prostate which facilitate urinary flow and 5-a-reductase inhibitors which decrease the size of the prostate gland
• Indication for a straight catheter

  • collection of sterile urine sample in some situations
  • instillations of medication in the bladder
  • study of anatomical structure
  • urodynamic testing
• Indication for an indwelling catheter

  • accurate measurement of urine output
  • surgical procedure
  • relief of urinary retention
  • palliative care
  • prolonged immobilization
  • stage 3 or 4 pressure injuries urine contaminated
  • collection of urine for testing
• Urinary retention is the inability to empty the bladder despite urination or accumulation of urine in the bladder due to the inability to urinate. It is caused by an obstruction or deficient bladder muscle contraction strength
• Contraindications for catheters

  • urethral trauma or injuries
  • pelvic fractures
  • straddle impacts
  • priapism (constant erection)
  • prostate cancer
  • hematuria
  • acute prostatitis
  • immunocompromised patient
• Possible complications when inserting catheter are tissue damage, false path, hematuria, pain, UTI, obstruction, urinary spasm or leaks
• Complications post catheter removal is urinary retention, pain when voiding, overactive bladder, hematuria, incontinence
• To identify a distended bladder, you need to hear dullness
• Residual urine is urine remaining in the bladder after each miction, up to 100 mL is considered normal
• Functional signs of urine retention

  • distended bladder (globe-like)
  • frequent miction of less than 150 mL
  • suprapubic pain
• Bladder scan is an ultrasound that measures the post voiding residual (PVR) that remains in the bladder after voluntary urination
• Intermittent catheterization

  Men: 16 fr

  Women: 14 fr
• Indwelling catheter

  Women: 10-14 fr

  Men: 12-16 fr

  Suprapubic: 16-20 fr
• Types of drainage bags

  • bag with a urometer
  • bedside bag
  • leg bag