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Impaired Urinary Elimination and Risk for Infection r/t Urethral Stricture

Urethral stricture is more common in men than women, especially because of the difference in length of the urethra. (C. Long, Barbara; 1996 case 338)

Urethral stricture causing disturbances in micturition, urinary flow ranging from shrinking until completely unable to drain urine out of the body. Urine can not get out of the body can lead to many complications, with the heaviest complication is kidney failure.

Urethral stricture may occur:

1. Congenital
Urethral stricture may occur separately or in conjunction with other urinary tract anomalies.

2. Learned.
Urethral injury (due to the insertion of surgical equipment for transuretral surgery, indwelling catheters, or cystoscopy procedure).
Injuries due to stretching.
Injuries due to accidents.
Urethritis gonorheal untreated.
Muscle spasm.
External pressure eg tumor growth.
(C. Smeltzer, Suzanne;2002 hal 1468 dan C. Long , Barbara;1996 hal 338)

3. Postoperative
Some operations on the urinary tract can cause urethral strictures, such as prostate surgery, surgery with endoscopic instruments.

4. Infection
Infection is the most frequent factors that cause urethral strictures, such as infection by gonococcal bacteria that cause gonorrhea urethritis or non urethral gonorrhea has infected several years earlier, but now it is rare due to the use of antibiotics, most of these strictures located in the pars membranacea, although also found in places other; chlamydia infection is now a major cause but can be prevented by avoiding contact with infected individuals or using condoms.

Clinical manifestations

Beam strength and decreased urine output.
Symptoms of infection.
Urinary retention.
The presence of back flow and trigger cystitis, prostatitis, and pyelonephritis.
(C. Smeltzer, Suzanne; 2002 case 1468)

Nursing Care Plan for Urethral Stricture

Nursing Diagnosis for Urethral Stricture : Impaired Urinary Elimination related to Post-Op Cystotomy.

Nursing Interventions:

1. Monitoring of urine output and characteristics.
Rationale: Detecting interference elimination pattern: urination early.

2. Maintaining a constant bladder irrigation for 24 hours.
Rationale: Preventing blood clots block the flow of urine.

3. Maintaining patency of foley catheter with irrigation.
Rationale: Preventing blood clots clogging the catheter.

4. Ensuring fluid intake (2500-3000).
Rationale: To smoothen the flow of urine.

5. Once the catheter is removed, continue to monitor the symptoms of bladder elimination disorders.
Rationale: Detecting early bladder elimination disorders.

Nursing Diagnosis for Urethral Stricture : Risk for Infection

Nursing Interventions :

1. Monitoring of vital signs, reported symptoms of shock and fever.
Rationale: Prevent before the shock.

2. Monitoring urine color of fresh red blood, not dark red, a few hours after the new surgery.
Rationale: Urine color change from dark red to red fresh on day 2 and 3 after surgery.

3. Counseling to patients in order to prevent the Valsalva maneuver.
Rationale: Can irritate, prostate bleeding in the early postoperative period due to pressure.

4. Preventing the use of a rectal thermometer, rectal examination at least 1 week.
Rational: It can cause bleeding.

5. Maintaining aseptic techniques of urinary drainage system, irrigation if necessary alone.
Rationale: Minimizing the risk of entry of germs that can cause infection.

6. Ensuring intake that much.
Rational: It can lower the risk of infection.