2 Medical Management -Diagnostic Tests: KUB, Renal Ultrasound, blood chemistries, endoscopy -Establish urinary drainage Indwelling catheter Suprapubic Cystostomy Ureterostomy Nephrostomy Stent Insertion Relieve pain- narcotics, anticholinergicsUreterostomy-ilieal conduitNephrostomy-percutaneous puncture, incision in the backStent insertion-cystoscopyAnticholinergics-Atropine to dec. smooth muscle motility, anti-spasmodic effect
3 Nursing Interventions - observe for signs of hematuria - aseptic care of the surgical site -note restoration of urinary function -provide safe environment to prevent injury or infection
4 Etiology/pathophysiology -Causes: Kinks, cysts, tumors, calculi, prostatic hypertrophy -May lead to infection that thrives due to urine stasis -May lead to ischemia due to compression or atrophy of renal tissue -Clinical Manifestations/Assessment -Continuous need to void -Voiding small amounts frequently -Pain -Nausea
5 Etiology/Pathophysiology: HydronephrosisEtiology/Pathophysiology:-Dilation of the renal pelvis-can be congenital ordevelop at any time-Unilateral or bilateral-Due to the obstruction of the urinary tract-The obstruction builds up pressure from theaccumulation of urine that can’t flow past it-The pressure may cause functional and anatomicaldamage to the renal system.-- The renal pelvis and ureters dilate--Pressure causes fibrosis and loss of functionof affected nephrons causing kidneyobstruction_
7 -Dull flank pain (slow onset) A degree of pain will depend on the Clinical Manifestations:-Dull flank pain (slow onset)A degree of pain will depend on thestretching of the urinary tract structures-Severe stabbing pain (sudden onset)-Nausea/Vomiting-Frequency, dribbling, burning and difficultystarting urination
8 Medical Management -Diagnostic Tests: UA, Renal function studies (BUN, Creatinine), cystoscopy, IVP, KUB, CT, US -Surgery to relieve obstruction -Nephrectomy- if kidney is severely damaged -Antibiotics -Narcotics/antispasmodics
9 Nursing interventions -Assessment: Subjective-pain, voiding pattern, history of obstructive disorders -Objective-vomiting, hematuria, edema, urine output, abdominal mass, bladder distention, tenderness over kidneys/bladder -Administer meds as ordered, I & O, observe for signs of infection, vital signs, pain assessment, encourage intake of 2L/day unless restricted, anchor drainage tubes, catheter care -if surgery is done: incision observation, care and dressing changes as ordered -Patient and family teaching
10 Urolithiasis (kidney stone) Etiology/Pathophysiology-Calculi develop from minerals that haveprecipitated out of solution and adhere,forming stones that vary in size andshape-Why do these stones form? Not sure!-Contributing factors: predisposed,diet, meds-Identified according to location:nephrolithiasis, ureterolithiasis,cystolithiasisNutrition and Diet Tx- Box 21-3
13 -Lithotripsy- “ extracorporeal shock wave” -Pt is submerged in a special tank of water -Ultrasonic shock waves are used to pulverize the stone -Urine still must be strained -Pt. may still experience renal colic as the stone fragments pass.
15 Nursing Interventions -Assessment Subjective-pt Nursing Interventions -Assessment Subjective-pt.’s pain description Objective-presence of hematuria, nausea, vomiting, restlessness - Strain all urine and observe characteristics -Daily fluid intake of 2L (unless contraindicated) -Medication: drug therapy will be specific to the stone composition -Administer analgesics -Monitor lab and diagnostic test results, especially BUN and Creatinine -Pt. and family teaching- hydration, dietary modifications, medication administration, exercise, keep follow up appointments with MD and when to contact the MD.
16 Renal tumors Etiology/Pathophysiology -Mostly adenocarcinomas -Usually develop unilaterally-Renal cell carcinomas, as a primarymalignant tumor, arise from cells of theproximal convoluted tubulesRisk factors-Smoking-Family history-Pre-existing renal disorders, such aspolycystic kidney disease and renal cysticdisease secondary to renal failure-Transitional cell tumors of the renal pelviscause hematuria and can be confirmed bycytological study.
18 Clinical manifestations -Early- intermittent painless hematuria -Late- weight loss, dull flank pain, palpable mass in flank area, gross hematuria Medical management -Radical Nephrectomy -Radiation -Chemotherapy
19 Nursing Interventions -Assessment Subjective-Inquire about blood in the urine, pain, weight loss, fatigue Objective-Physical assessment, hematuria -Adequate hydration to reduce the discomfort when voiding -Administer analgesia -Encourage active/ passive ROM exercises -Pt./family teaching: community resources, support groups, home health care, importance of follow-up care
20 Renal Cysts Etiology/Pathophysiology -A single cyst may not matter, butmultiple cysts interfere with kidneyfunction-The most significant problem arise withpolycystic kidney disease (PKD)-Cysts form in the kidney and can causepressure on the kidney structure andcompromise function-A patient with a long standing renalinsufficiency or a dialysis pt. maydevelop PKD
22 Clinical Manifestations -Determined by the degree of kidney structure involved -Abdominal and flank pain -Voiding disturbances - Recurrent UTIs -Hematuria -Hypertension
23 Medical management -Diagnostic Tests: Radiographic imaging, blood work -No specific treatment -Pain relief -Heat (unless bleeding) -Analgesics -Antibiotics -Antihypertensives -Dialysis -Renal transplant
24 Nursing Interventions -Assessment- Subjective: Abdominal/flank pain, headaches, GI complaints, voiding disturbances, history of recurrent UTIs Objective: Monitor BP, check for hematuria, note the pt.’s complaints and response to treatment. -Patient/family information about genetic counseling -Severity of the disease and patient complaints will determine the nursing intervention
25 Tumors of the Urinary Bladder Etiology/Pathophysiology-Most common site of cancer in theurinary tract-Ranges from benign papilloma toinvasive carcinomaClinical Manifestations-Painless intermittent hematuria-Changes in voiding pattern
26 Medial management -Localized tumor: remove by burning (fulguration) -Invasive lesion- partial or total cystectomy (Surgery will include diversion such as an ileal conduit) Nursing Interventions -Assess voiding patterns -Observe characteristics of urine -Importance of follow-up care
27 Conditions affecting the prostate gland BPH- Benign Prostatic HypertrophyEtiology/Pathophysiology-enlargement of the prostate gland whichencircles the urethra at the base of thebladder-pressure on the urethra prevents completeemptying of the bladder-function of the prostate gland is to secretean alkaline fluid that helps to neutralizeseminal fluid and increase sperm motility-common in men over 50 years old
32 Nursing Interventions -Assessment Subjective- inquire about urine stream, difficulty starting, frequency, nocturia Objective-voiding pattern -Insertion of a foley catheter as ordered, avoid a rapid decompression (after 1000 ml is drained, wait 5 minutes before proceeding to drain more) -Post-op TURP: maintain patency of foley catheter and bladder irrigation system, vital signs, close monitoring of urine for signs of hemorrhaging -Medicate for pain and bladder spasms -Patient/family education