Nursing Management: Renal and Urologic Problems Chapter 46 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Infectious and Inflammatory Disorders of Urinary System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Urinary Tract Infection ClassificationClassification Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3

Urinary Tract Infection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Fig Sites of infectious processes in the upper and lower urinary tracts.

Urinary Tract Infection Etiology and PathophysiologyEtiology and Pathophysiology Clinical ManifestationsClinical Manifestations Diagnostic StudiesDiagnostic Studies Collaborative Care and Drug TherapyCollaborative Care and Drug Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

Nursing Management: Urinary Tract Infection Nursing AssessmentNursing Assessment Nursing DiagnosesNursing Diagnoses PlanningPlanning Nursing ImplementationNursing Implementation  Health promotion  Acute intervention  Ambulatory and home care EvaluationEvaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6

Acute Pyelonephritis Etiology and PathophysiologyEtiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

Acute Pyelonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Fig Acute pyelonephritis. Cortical surface shows grayish white areas of inflammation and abscessformation (arrow).

Acute Pyelonephritis Clinical Manifestations and Diagnostic StudiesClinical Manifestations and Diagnostic Studies Collaborative Care and Drug TherapyCollaborative Care and Drug Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

Nursing Management: Acute Pyelonephritis Nursing AssessmentNursing Assessment Nursing DiagnosesNursing Diagnoses PlanningPlanning Nursing ImplementationNursing Implementation  Health promotion  Acute intervention and home and ambulatory care EvaluationEvaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10

Chronic Pyelonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11

Urethritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12

Urethral Diverticula Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13

Interstitial Cystitis/Painful Bladder Syndrome Collaborative Care and Drug TherapyCollaborative Care and Drug Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

Nursing Management: Interstitial Cystitis/Painful Bladder Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15

Renal Tuberculosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16

Immunologic Disorders of Kidney Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17

Glomerulonephritis Etiology and PathophysiologyEtiology and Pathophysiology Clinical ManifestationsClinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18

Acute Poststreptococcal Glomerulonephritis Clinical Manifestations and ComplicationsClinical Manifestations and Complications Diagnostic StudiesDiagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

Nursing and Collaborative Management: Acute Poststreptococcal Glomerulonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

Goodpasture Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

Nursing and Collaborative Management: Goodpasture Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

Rapidly Progressive Glomerulonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23

Chronic Glomerulonephritis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24

Nephrotic Syndrome Etiology and Clinical ManifestationsEtiology and Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25

Nursing and Collaborative Management: Nephrotic Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26

Obstructive Uropathies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Fig Sites and causes of upper and lower urinary tract obstruction.

Obstructive Uropathies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Fig Hydronephrosis of the kidney. Note the marked dilation of the pelvis and calyces and thinning of the renal parenchyma.

Urinary Tract Calculi Etiology and PathophysiologyEtiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29

Urinary Tract Calculi Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Fig A, Renal staghorn calculus. The renal pelvis is filled with a large calculus that is shaped to its contours, resembling the horns of a stag (S). B, Imbedded staghorn calculus (yellow arrow) in hydronephrotic, infected, nonfunctioning kidney.

Urinary Tract Calculi TypesTypes Clinical ManifestationsClinical Manifestations Diagnostic StudiesDiagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31

Urinary Tract Calculi Collaborative CareCollaborative Care  Endourologic procedures Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32

Urinary Tract Calculi Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Fig A, Calcium oxalate stones. B, Plain abdominal x-ray showing large bladder calculus.

Urinary Tract Calculi Collaborative Care, continuedCollaborative Care, continued  Lithotripsy  Surgical therapy  Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34

Nursing Management: Urinary Tract Calculi Nursing AssessmentNursing Assessment Nursing DiagnosesNursing Diagnoses PlanningPlanning Nursing ImplementationNursing Implementation EvaluationEvaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35

Strictures Ureteral StricturesUreteral Strictures Urethral StrictureUrethral Stricture Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36

Renal Trauma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37

Renal Vascular Problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38

Nephrosclerosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39

Renal Artery Stenosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40

Renal Vein Thrombosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41

Hereditary Renal Diseases Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 42

Polycystic Kidney Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Fig A, Comparison of polycystic kidney with normal kidney. B, Cysts in the liver.

Nursing and Collaborative Management: Polycystic Kidney Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 44

Medullary Cystic Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 45

Alport Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 46

Renal Involvement in Metabolic and Connective Tissue Diseases Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 47

Urinary Tract Tumors Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 48

Kidney Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Fig Cross section of kidney with renal cell carcinoma. The carcinoma (blue arrow) is on the pole of the kidney. Note that the renal vein is involved and thrombosed (yellow arrow).

Kidney Cancer Clinical Manifestations and Diagnostic StudiesClinical Manifestations and Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 50

Nursing and Collaborative Management: Kidney Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Table Robson's System of Staging Renal Carcinoma.

Bladder Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Fig A, Papillary transitional cell carcinoma (T) seen arising from the dome of the bladder as a cauliflower-like lesion (blue arrow). B, Opened bladder showing a bladder cancer at an advanced stage. Yellow areas represent ulcerations and necrosis (yellow arrow).

Bladder Cancer Clinical Manifestations and Diagnostic StudiesClinical Manifestations and Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 53

Nursing and Collaborative Management: Bladder Cancer Surgical TherapySurgical Therapy Radiation Therapy and ChemotherapyRadiation Therapy and Chemotherapy Intravesical TherapyIntravesical Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 54

Urinary Incontinence and Retention Diagnostic StudiesDiagnostic Studies Collaborative Care: Urinary IncontinenceCollaborative Care: Urinary Incontinence  Drug Therapy  Surgical Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 55

Nursing Management: Urinary Incontinence Collaborative Care: Urinary RetentionCollaborative Care: Urinary Retention  Drug therapy  Surgical therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 56

Nursing Management: Urinary Retention Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 57

Instrumentation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 58 Fig Types of urinary catheters. A, Simple urethral catheter. B, Mushroom-tip de Pezzer catheter (can be for suprapubic catheterization). C, Wing-tip Malecot catheter. D, Indwelling urethral catheter with inflated balloon. E, Indwelling Tiemann catheter with coudé tip–inflated balloon. F, Three-way indwelling catheter (third lumen can be used for irrigation).

Instrumentation Urethral CatheterizationUrethral Catheterization Ureteral CathetersUreteral Catheters Suprapubic CathetersSuprapubic Catheters Nephrostomy TubesNephrostomy Tubes Intermittent CatheterizationIntermittent Catheterization Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 59

Surgery of the Urinary Tract Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 60

Renal and Ureteral Surgery Preoperative ManagementPreoperative Management Postoperative ManagementPostoperative Management  Urine output  Respiratory status  Abdominal distention Laparoscopic NephrectomyLaparoscopic Nephrectomy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 61

Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 62 Fig Methods of urinary diversion. A, Ureteroileosigmoidostomy. B, Ileal loop (ileal conduit). C, Ureterostomy (transcutaneous ureterostomy and bilateral cutaneous ureterostomies). D, Nephrostomy.

Urinary Diversion Incontinent Urinary DiversionIncontinent Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 63

Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 64 Fig Urinary stoma. Symmetric, no skin breakdown, protrudes about 1.5 cm; mucosa is healthy red. This configuration is flat when the patient is upright or supine.

Urinary Diversion Continent Urinary DiversionsContinent Urinary Diversions Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 65

Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 66 Fig Creation of a Kock pouch with implantation of ureters into one intussuscepted portion of the pouch and creation of a stoma with the other intussuscepted portion.

Urinary Diversion Orthotopic Bladder ReconstructionOrthotopic Bladder Reconstruction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 67

Nursing Management: Urinary Diversion Preoperative ManagementPreoperative Management Postoperative ManagementPostoperative Management Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 68

Nursing Management: Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 69 Fig Ammonia salt encrustation secondary to alkaline urine.

Nursing Management: Urinary Diversion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 70 Fig Retracted urinary stoma with pressure sore from faceplate above stoma (arrow).