826
P A R T 9
Drugs acting on the renal system
■■
Smooth muscle spasms affecting the urinary tract
may be caused by inflammation and irritation; effects
of the spasms include dysuria, urinary urgency,
incontinence, nocturia and suprapubic pain.
■■
Antispasmodics block parasympathetic activity,
thereby relaxing detrusor and other urinary tract
muscles.
BLADDER PROTECTANT AGENT
Another type of drug frequently used to alleviate
problems in the urinary tract and bladder is the bladder
protectant pentosan used to prevent irritation to the
KEY POINTS
Care considerations for people receiving
urinary tract antispasmodics
Assessment: History and examination
■
■
Assess for
contraindications or cautions
: any
history of allergy to these drugs
to prevent
hypersensitivity reactions
; pyloric or duodenal
obstruction or other GI lesions or obstructions
or obstructions of the lower urinary tract,
which
could be dangerously exacerbated by these drugs
;
glaucoma,
which could increase intraocular
pressure due to blockage of the parasympathetic
nervous system
; and current status of pregnancy or
breastfeeding,
which would require cautious use.
■
■
Perform a physical assessment before therapy
to establish baseline data
and during therapy
to
determine the effectiveness of the drug and the
occurrence of any adverse effects associated with
drug therapy.
■
■
Inspect the skin
to evaluate for the development
of rash or hypersensitivity reactions.
■
■
Assess level of consciousness, orientation and
reflexes
to evaluate for any CNS effects of the
drug.
■
■
Assess urinary elimination pattern, including
amount and frequency of episodes, and for any
complaints of frequency, urgency, pain or difficulty
voiding
to monitor for excessive parasympathetic
blockade or development of underlying UTI.
■
■
Arrange for ophthalmological examination,
including intraocular pressure,
to assess for any
developing glaucoma.
■
■
Assess vital signs, including pulse,
to establish
a baseline for evaluating the extent of
parasympathetic blockade.
■
■
Monitor the results of laboratory tests such as
urinalysis and urine culture and sensitivity
to
evaluate the effectiveness if UTI is the problem
and renal and hepatic function tests
to determine
the need for possible dose adjustment and to
evaluate for possible toxicity.
Implementation with rationale
■
■
Arrange for the appropriate treatment of any
underlying UTI,
which may be causing the spasm.
■
■
Arrange for an ophthalmological examination at
the beginning of therapy and periodically during
long-term treatment
to evaluate drug effects
on intraocular pressure so that the drug can be
stopped if intraocular pressure increases.
■
■
Administer the drug with food if GI upset occurs
to alleviate GI discomfort.
■
■
Encourage fluid intake
to maintain urinary flow,
flush the bladder and prevent urinary stasis.
■
■
Offer frequent sips of water or use of sugarless
hard lollies
to alleviate dry mouth.
■
■
Monitor urinary output
to ensure adequate renal
function and bladder emptying.
■
■
Institute safety precautions if the person
experiences CNS effects
to prevent injury.
■
■
Encourage the person to continue treatment for the
underlying cause of the spasm
to treat the cause
and prevent the return of the signs and symptoms.
■
■
Offer support and encouragement
to help the person
deal with the discomfort of the drug therapy.
■
■
Provide thorough teaching, including drug
name, dosage, rationale for use and schedule for
administration; signs and symptoms of adverse
effects; measures to alleviate or prevent adverse
effects; use of fluids and sugarless hard lollies
to
combat dry mouth
; danger signs and symptoms to
report immediately; appropriate perineal hygiene
measures
to reduce the risk of infection if that
is the underlying cause
; and the importance of
periodic monitoring, including laboratory testing
and evaluation,
to enhance knowledge about drug
therapy and to promote compliance.
Evaluation
■
■
Monitor the person’s response to the drug
(resolution of urinary tract spasms and relief of
signs and symptoms); repeat culture and sensitivity
tests as recommended for evaluation of the
effectiveness of all of these drugs.
■
■
Monitor for adverse effects (skin evaluation,
orientation and reflexes, intraocular pressure).
■
■
Monitor the effectiveness of comfort and safety
measures and compliance with the regimen.
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
