McKenna's Pharmacology for Nursing, 2e

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P A R T 9  Drugs acting on the renal system

Care considerations for people receiving urinary tract antispasmodics

■■ 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 ■ ■ 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. 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 (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). ■ ■ Provide thorough teaching, including drug ■ ■ Monitor the person’s response to the drug KEY POINTS

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 ■ ■ 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. evaluate for possible toxicity. Implementation with rationale