Please enable JavaScript.
Coggle requires JavaScript to display documents.
DISORDERS OF THE LOWER URINARY TRACT (cancer of the bladder (Risk Factors,…
DISORDERS OF THE LOWER URINARY TRACT
Urethritis
It is the infectionand inflammation of the urethra
Pathophysiology, causes and risk factors are the same as with a nuerogenic bladder
Assessment and Findings
a purulent bladder
dysuria with burning on micturition
history of sexual exposure in past week
Management
Surgical Management
Artificial urinary sphincter implant
Neuroprosthesis
Continent vesicotomy
Nursing Management
Anti-bacterial agents can be prescribed for treatment of bacterial UTI.
Applying measures to stimulate the voiding reflex
teaching and supervising intermittent catheterisation where indicated
increasing fluid intake and monitoring intake and output daily
Obtaining and documenting the hsitory and signs and symptoms of urinary tract infections
Health Educationth
teach the patient about the importance of increasing fluid intake
the nurse should encourage the patient to maintain good personal hygiene and should suggest showering rather than bathing.
cancer of the bladder
Cuases
lmmune response failure therapy
Cellular transformation and derangement
Risk Factors
high urinary Ph
age and gender
bladder calculi
Recurrent bacterial infections of the urinary tract
Cigarette smoking
Pathophysiology
cancers of the colon metastasise to the bladder and cause cancers there
cancers of the bladder metastasise to the lungs and bones and cause cancers there.
tumours that arise from the base of the bladder and involve the bladder neck and urethral orrifices
Assessment and Findings
weight loss and weakness
anaemia due to haematuria
Alterations in voiding
Haematuria
possible back or pelvic pain once metastasis has occured
Surgical Management
Partial or radical cystectomy for invasive carcinoma
Renal artery embolism to kill the tumour by cutting it's blood supply
Cystoscopy and transurethral resection of the bladder tumour
urinary diversion
It is a procedure done whereby urinary flow has to bypass the urinary bladder or the bladder is removed
When is it done?
cancer of the prostate, urethra and of the vagina
chronic infection causing stricturesin the urethra
neurogenic bladder
vesical fistula which include vesicocutaneous fistula, ileo-vesical fistula and vesico-vaginal fistula
following radical cystectomy in case of urinary bladder cancer
The flow of urine may be diverted to various points:
intestinal or ileal conduit
vesicotomy at the bladder
ureterotomy at ureters
Pyelostomy or nephrostomy at renal pelvis
Health Education
instruct on self catheterisation if possible
instruct the patient on freely expressing their emotions thus helping them to accept their state.
instruct on how to engage in pain relief activities such as deep breathing exercises and support of the stoma area during movement and cough.
strategies to promote skin integrity
the nurse should instruct the patient on correct bathing procedures
Neurogenic bladder
This is a disruption of nerve impulse transmission from the bladder to the brain
Risk Factors
age and gender
instrumentation of the bladder
obstruction of urinary flow
micro-organisms
inability of the bladder to empty resulting in urinary stasis
Pathophysiology
bacteria from perineum gain access to the urethra into the bladder
this bacteria attaches and colonises the urethra and bladder mucosa
Accumulation of bacteria causes inflammation and obstruction to free flow of urine and a back flow known as a reflux
causes
tumours
diseases such as multiple sclerosis and CVA and spinal lesions above the level of T12 leading to inhibited bladder control
injuries
Clinical assessments and Findings
urinary retention
recurrent urinary tract infections
urinary incontinence
loss of sensation of the urge to void and loss of micturition reflexx
Surgical Management
Bladder training is important and may be through the means of voiding schedule.( Ginsberg, 2013)
Intermittent catheterisation can be used for people with completed portal urinary retention.
Nursing management
a diet low in calcium to prevent calculi
Encouragement of mobility and ambulation
Use of an external condom-type catheter
A liberal fluid intake is encouraged to reduce the urinary bacterial count, reduce stasis, decrease concentration of calcium in the urine, and minimise the precipitation of urinary crystals and subsequent stone formation.
Continuous, internittent and self-catheterisation
Bladder Trauma
It can be secondary to pelvic fractures or from a blow in the lower abdomen, especially when the bladder is full.
Assessment and Findings
Inability to void
Distended bladder
Painful micturition
haematuria
Blunt trauma may present with echymosis
urethral trauma may present with blood at the urinary meatus
medical management
maintain urinary drainage
urine is taken to the lab for analysis to detect RBC's and to evaluate the cause of bleeding
control haemorrhage, pain and infection to persevere and restore renal function.
haematocrit and haemoglobin levels are monitored closely
nursing management
the nurse should frequently assess the patient during the first few days after injury to detect flank and abdominal pain, muscle spasm and swellig over the flank
follow-up nursing care includes monitoring the blood pressure to detect hypertension
the nurse must advise the patient to restrict activities for about 1 month after trauma to minimise the incidence of secondary bleeding.
Health educatio
Go to the bathroom at specific times
lt should take between 6-12 weeks to accomplish completely retrained bladder
Teach patient to empty bladder every morning after waking up
:
