1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 37 Nursing Care of Patients with Disorders of the Urinary System

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Tract Infections (UTIs)  Invasion of Urinary Tract by Bacteria  Women Greater Than Men  Aging  Older Men Due to Enlarged Prostate  Women Due to Declining Estrogen

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition UTI Predisposing Factors  Stasis of Urine  Contamination in Perineal/Urethral Area  Instrumentation  Reflux of Urine  Previous UTIs

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition UTI Symptoms  Dysuria  Urgency  Frequency  Cloudy, Foul-smelling Urine

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition UTI  Urethritis: Inflammation of Urethra  Cystitis: Inflammation/Infection of Bladder Wall  Pyelonephritis: Infection of the Kidneys

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition UTI Nursing Data Collection  Dysuria, Flank Pain, Fever, Chills, Malaise  Urine Examined for Cloudiness, Blood, Foul Odor  Predisposing Factors  Urinalysis and Culture Results

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Acute Pain  Impaired Urinary Elimination  Risk for Injury  Deficient Knowledge

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care  Monitor Symptoms  Monitor Intake and Output  Pain Control  Teaching  Medications: Take All Antibiotics  Prevention

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urological Obstructions  Obstruction of Urine Flow is Always Significant  Backup of Urine Destroys Kidney

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urological Obstructions (cont’d)  Urethral Strictures  Urethra Lumen Narrowing Due to Scar Tissue  Renal Calculi  Hard, Generally Small Stones  Kidney Stones  Nephrolithiasis

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Calculi in Urinary Tract

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi  Pathophysiology  Urinary Salts Settle Out  Calcium Oxalate Most Common

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Etiology  Heredity  Chronic Dehydration  Infection  Immobility  Men Greater than Women

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Signs and Symptoms  Flank Pain  Renal Colic  Dysuria  Costovertebral Tenderness  Hematuria Frequency  Urgency  Enuresis  GI Upset

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Diagnosis  Kidney-Ureter-Bladder X-Ray  Intravenous Pyelogram (IVP)  Renal Ultrasound  Urinalysis

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi Therapeutic Interventions  Small Stones Passed  IV Fluids  Pain Control  Thiazide Diuretics  Allopurinol  Lithotripsy

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Extracorpeal Shock Wave Lithotripsy

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi Surgery  Cystoscopy  Cystolitholapaxy  Cystotomy  Ureterolithotomy  Nephrolithotomy  Nephrostomy Tube

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Prevention  Foods  Hydration  Exercise

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Complications  UTIs  Hydronephrosis

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi (cont’d)  Nursing Diagnoses  Acute Pain  Risk for Infection  Deficient Knowledge

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Calculi Nursing Care  Monitor Symptoms  Strain All Urine  Intake and Output  Pain Control  Hydration  Teaching

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hydronephrosis  Obstruction in Urinary Tract  Kidney Enlarges as Urine Collects  Treat Cause

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hydronephrosis (cont’d)

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hydronephrosis (cont’d)  Signs and Symptoms  Frequency  Urgency  Dysuria  Flank and Back Pain  Kidney Disease

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hydronephrosis Therapeutic Interventions  Treat Cause  Urinary Catheter  Stents  Nephrostomy Tube  Intake and Output  No Clamping

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder  Most Common Urinary Tract Cancer  Men Greater than Women  Ages 50 to 70 Years  Etiology  Smoking  Industrial Pollution

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Signs and Symptoms  Early  Painless  Hematuria

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Signs and Symptoms (cont’d)  Late  Pelvic Pain  Lower Back Pain  Dysuria  Inability to Void

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Diagnosis  Urinalysis  Telomerase  Urine for Cytology, Culture  Cystoscopy and Transurethral Biopsy  IVP

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Therapeutic Interventions  Chemotherapy  Bacille Calmette-Guérin Vaccine  Photodynamic Therapy

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Therapeutic Interventions (cont’d)  Surgery  Cystoscopy and Pyelogram with Fulguration  Laser  Robotic Laparoscopic Radical Cystectomy  Urinary Diversion

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Therapeutic Interventions (cont’d)  Incontinent Urinary Diversion  Ileal Conduit

34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Therapeutic Interventions (cont’d)  Continent Urinary Diversion  Kock Pouch  Indiana Pouch  Mainz Pouch  Florida Pouch

35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Therapeutic Interventions (cont’d)  Othotopic Bladder Substitution  Studer Pouch  Hemi-Kock Pouch  Ileal W–Neobladder

36. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Bladder (cont’d)  Nursing Care  WOC Nurse  Monitor Urine Output  Education  Pre-op and Post-op Care

37. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney  Rare  Risk Factors  Smoking  Obesity  Hypertension  Long-term Kidney Dialysis

38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney (cont’d)  Risk Factors (cont’d)  Radiation Exposure  Asbestos  Industrial Pollution

39. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney (cont’d)  Later Signs and Symptoms  Hematuria  Dull Pain in Flank Area  Mass

40. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney Diagnosis  IVP  Cystoscopy and Pyelogram  Ultrasound  CT Scan  MRI  Renal Biopsy

41. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney (cont’d)  Therapeutic Interventions  Radical Nephrectomy  Nephron-sparing Surgery  Radiation Therapy  Immunotherapy  Chemotherapy

42. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Kidney (cont’d)  Nursing Care  Monitor Urine Output  Education  Pre-op and Post-op Care

43. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Trauma  Flank pain  Hematuria  Treat injury

44. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Trauma (cont’d)  Nursing Care  Intake and Output  Vital Signs  IV Fluids  Pain Control

45. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Polycystic Kidney Disease  Multiple Cysts in the Kidney  Signs and Symptoms  Dull Heaviness in Flank/Back  Hematuria  Hypertension  UTI

46. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Polycystic Kidney Disease (cont’d)  Progressive  No Treatment

47. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diabetic Nephropathy  Long-term Complication of Diabetes  Most Common Cause of Chronic Kidney Disease  Atherosclerotic Changes Decrease Blood to Kidney  Smaller Doses of Insulin as Progresses  Chronic Kidney Disease Develops

48. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diabetic Nephropathy Therapeutic Interventions  Early  Control Blood Glucose and Blood Pressure  Restricted-protein Diet  Later  Dialysis  Kidney Transplant

49. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diabetic Nephropathy (cont’d)  Nursing Care  Education on Glucose and Blood Pressure Control

50. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nephrotic Syndrome  Large Amounts of Protein Lost in Urine  Increased Glomerular Membrane Permeability

51. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nephrosclerosis  Hypertension Damages Kidneys by Sclerotic Changes  Therapeutic Interventions  Antihypertensives  Nursing diagnosis  Impaired Health Maintenance

52. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis  Inflammatory Disease of the Glomerulus  Glomerulus More Porous  Proteins, WBCs, RBCs Leak into Urine

53. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis (cont’d)  Causes  Acute Post-streptococcal  Goodpasture’s Syndrome  Chronic Glomerulonephritis

54. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis (cont’d)  Signs and Symptoms  Oliguria  Hypertension  Electrolyte Imbalances  Edema  Flank Pain

55. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis (cont’d)  Diagnosis  Urinalysis  Ultrasound  X-Ray  Biopsy

56. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis (cont’d)  Therapeutic Interventions  Resolves  Kidney Disease Treatment

57. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerulonephritis Nursing Care  Vital Signs  Symptom Support  Rest  Fluid, Sodium, Protein Restrictions  Education

58. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury  Sudden Loss of Kidney Function  Azotemia  Waste Products Accumulate  Oliguric  May Recover

59. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury Causes  Prerenal Failure  Decreased Blood Supply to Kidneys  Intrarenal Failure  Damage to Nephrons  Postrenal Failure  Obstruction

60. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury (cont’d)  Nephrotoxins  Diagnostic Contrast Media (Dyes)  Medications  IV Aminoglycosides, Tobramycin (Tobrex), Amikacin (Amikin), Cisplatin (Platinol)  Chemicals

61. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury (cont’d)  Prevention  Check Serum BUN and Creatinine Prior to Dyes or Meds  Hydrate Before/After Contrast Media  Monitor Peak/Through Levels of Nephrotoxic Drugs per Institutional Policy

62. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury (cont’d)  Phases  Oliguric  Diuretic  Recovery

63. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Kidney Injury (cont’d)  Therapeutic Interventions  Treat Cause  Supportive Treatment  Dialysis  Continuous Renal Replacement Therapy

64. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Continuous Renal Replacement Therapy  Removes Fluid Continuously Along with Hemodialysis  Removes Fluid/Solutes in Controlled, Continuous Manner in Unstable Patients  Blood Flows Through Hemofilter, Excess Fluids/Solutes Move into Collection Bag

65. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Kidney Disease  Gradual Decrease in Kidney Function  Irreversible

66. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Kidney Disease (cont’d)  Etiology  Diabetic Nephropathy  Nephrosclerosis  Glomerulonephritis  Autoimmune Diseases

67. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pathophysiology  Large Proportion of Nephrons Damaged  Progressive  Renal Insufficiency: 75% of Nephrons Lost  End-stage: 90% of Nephrons Lost  Uremia: Urea in the Blood  Affects All Body Systems

68. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Symptoms of Chronic Kidney Disease  Fluid Accumulation  Electrolyte Imbalances  Waste Products Retained  Acid-base Imbalances  Anemia

69. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Symptoms of Chronic Kidney Disease (cont’d)

70. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Diet  High Calorie  Low Protein (Unless Dialysis)  Low Sodium, Potassium, Phosphorus  Increased Calcium  Vitamins

71. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Fluid Restriction

72. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Medications  Diuretics  Antihypertensives  Phosphate Binder  Calcium/vitamin D Supplements  Kayexalate prn

73. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Dialysis  Symptoms of Fluid Overload  High Potassium  Neurological Signs  Uremia

74. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemodialysis

75. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Undergoing Hemodialysis

76. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Hemodialysis  Artificial Kidney Removes Waste Products and Excess Water from Blood

77. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Vascular Access  Temporary  Lifesite Hemodialysis Access System  A-V Fistula  A-V Graft

78. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Vascular Access Care  Thrill, Bruit  Protect  Postoperative  NV Checks, Pain  Elevate Extremity

79. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemodialysis Access Sites

80. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Peritoneal Dialysis  Continuous Dialysis Done by Patient  Peritoneal Membrane is Semipermeable Membrane, Across which Excess Wastes/ Fluids Move from Blood  Peritoneal Catheter  Exchange Process: Fill, Dwell Time, Drain

81. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peritoneal Dialysis

82. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Kidney Transplant  Living-related Donor or Cadaver Donor  Antirejection Drugs

83. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Transplanted Kidney

84. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Excess Fluid Volume  Impaired Skin Integrity  Activity Intolerance  Risk for Injury  Risk for Infection  Imbalanced Nutrition: Less Than Body Requirements

85. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care  Excess Fluid Volume  Monitor Weight  Intake and Output  Fluid Restriction  Monitor for Fluid Retention

86. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care (cont’d)  Electrolyte Imbalance  Monitor Levels  Dietary Restrictions  Monitor Dysrhythmias

87. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care (cont’d)  Waste Products  Oral Care, Skin Care  Lotion  Protect from Injury  Impaired Hematological Function  Protect from Injury/Infection