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Ulcerative colitis


Description


Ulcerative colitis is an autoimmune disorder that, along with Crohn’s disease, is referred to as inflammatory bowel disease (IBD). See Inflammatory Bowel Disease, p. 352, for a discussion of the disorder.


Urethritis


Urethritis is an inflammation of the urethra. Causes of urethritis include a bacterial or viral infection, trichomonal and monilial infection (especially in women), chlamydial infection, and gonorrhea (especially in men).


In men, purulent discharge usually indicates a gonococcal urethritis. A clear discharge typically signifies a nongonococcal urethritis. Urethritis also produces bothersome lower urinary tract symptoms, including dysuria, urgency, and frequent urination, similar to those seen with cystitis.


In women, urethritis is difficult to diagnose. It frequently produces bothersome lower urinary tract symptoms, but urethral discharge may not be present.


Nursing and collaborative management


Treatment is based on identifying and treating the cause and providing symptomatic relief.



Teach patients to avoid using vaginal deodorant sprays, properly cleanse the perineal area after bowel movements and urination, and avoid sexual intercourse until symptoms subside. Teach patients with sexually transmitted urethritis to refer their sex partners for evaluation and testing if they had sexual contact in the 60 days preceding onset of the symptoms or diagnosis.


Urinary incontinence


Description


Urinary incontinence (UI), an involuntary leakage of urine, affects an estimated 17 million people in the United States. Although its prevalence is higher among older women and men, it is not a natural consequence of aging. An estimated 80% of incontinence can be cured or significantly improved.


Pathophysiology


UI can result from anything that interferes with bladder or urethral sphincter control.



Diagnostic studies



■ A focused history, physical assessment, and a voiding record provide information about the onset of UI, factors that provoke urinary leakage, and associated conditions.


■ Pelvic examination assesses for organ prolapse and evaluates pelvic floor muscle strength.


■ Urinalysis identifies possible factors contributing to transient incontinence or urinary retention (e.g., urinary infection, diabetes mellitus).


■ Measure postvoid residual (PVR) urine in the patient undergoing evaluation for UI. The PVR volume is obtained by asking the patient to urinate, followed by catheterization or use of a bladder ultrasound within a relatively brief period (preferably 10 to 20 minutes).


■ Urodynamic testing is indicated in selected cases of UI.


■ Imaging studies of the upper urinary tract (e.g., ultrasound) are obtained when incontinence is associated with urinary tract infections or there is evidence of upper urinary tract involvement.


Collaborative care


Transient, reversible factors are corrected initially, followed by management of the type of UI. In general, less invasive treatments are attempted before more invasive methods (e.g., surgery) are used.


Several behavioral therapies may be used including (1) pelvic floor muscle training (Kegel exercises) to help some patients manage stress, urge, or mixed UI, and (2) biofeedback to assist the patient to identify, isolate, contract, and relax the pelvic muscles.


Drug therapy


Drug therapy varies according to UI type.



■ In stress UI, drugs have a limited role in management. α-Adrenergic agonists can be used to increase bladder sphincter tone and urethral resistance but have limited benefit.


■ In urge and reflex UI, drugs play a key management role. Anticholinergic drugs and muscarinic receptor antagonists relax the bladder muscle and inhibit overactive detrusor contractions. These preparations include immediate- and extended-release tolterodine (Detrol, Detrol LA); immediate, extended, and transdermal oxybutynin (Ditropan, Ditropan XL, Oxytrol TDS); twice-daily trospium chloride (Sanctura); extended-release solifenacin (VESIcare); and darifenacin (Enablex). Botox (onabotulinumtoxinA) can be used in the treatment of UI as a result of detrusor overactivity. Botox is injected into the bladder, resulting in relaxation of the bladder, an increase in its storage capacity, and a decrease in UI.


Surgical therapy


Surgical techniques also vary according to the type of UI.



■ Surgical correction of stress UI may reposition the urethra and/or create a backboard of support or otherwise stabilize the urethra and bladder neck and make them more receptive to changes in intraabdominal pressure.


■ Another technique for stress UI augments the urethral resistance of the intrinsic sphincter unit with a sling or periurethral injectables.


■ Retropubic colposuspension and pubovaginal sling placement appear to be most effective. Typically, both procedures are performed through low transverse incisions.


■ Placement of a suburethral sling, using autologous fascia, cadaveric fascia, or a synthetic material, is also used to correct stress UI in women.


■ An artificial urethral sphincter can be used in men with intrinsic sphincter deficiency and severe stress UI.


■ Alternatively, one of several bulking agents can be injected underneath the mucosa of the urethra to correct stress UI in women or men.


Nursing management


You need to recognize both the physical and the emotional problems associated with incontinence. Maintain and enhance the patient’s dignity, privacy, and feelings of self-worth.



■ This is a two-step approach involving containment devices to manage existing urinary leakage and a definitive plan to reduce or resolve the factors leading to incontinence.



Urinary retention


Description


Urinary retention is the inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of an inability to urinate. In certain cases, it is associated with urinary leakage or postvoid dribbling, called overflow urinary incontinence (UI).



Pathophysiology


Urinary retention is caused by two different dysfunctions of the urinary system: bladder outlet obstruction and deficient detrusor (bladder muscle) contraction strength.



Diagnostic studies


The diagnostic studies for urinary retention are the same as the ones for UI (see Urinary Incontinence, p. 640).


Collaborative care


Behavioral therapies that were described for UI also may be used in the management of urinary retention. Scheduled toileting and double voiding may be effective in chronic urinary retention with moderate postvoid residual volumes.



Drug therapy


Several drugs may be administered to promote bladder evacuation. For patients with obstruction at the level of the bladder neck, an α-adrenergic antagonist may be prescribed. These drugs relax the smooth muscle of the bladder neck, prostatic urethra, and possibly dual-innervated rhabdosphincter, diminishing urethral resistance.


Surgical therapy


Surgical interventions are used to manage urinary retention caused by obstruction. Transurethral or open surgical techniques are used to treat benign or malignant prostatic enlargement, bladder neck contracture, urethral strictures, or dyssynergia of the bladder neck.


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Oct 26, 2016 | Posted by in NURSING | Comments Off on U

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