Medical Surgical Nursing Care

1. Medical Surgical Nursing Care • The Urinary System Disorders • Dr Ibrahim Bashayreh, RN, PhD

2. Urinary Incontinence • Involuntary urination • Increased bladder pressure • Lowered urethral resistance • Pelvic muscle relaxation • Impaired neural control • Bladder problems

3. Urinary Incontinence • Types • Stress • Urge • Overflow • Reflex • Functional

4. Urinary Incontinence - Manifestations • Uncontrolled urination • Several types

5. Urinary Incontinence – Diagnostic Tests • Postvoid residual urine • Ultrasonic bladder scan • Cystometrography (Measurement of bladder function, as by a cystometer) • Uroflowmetry (is a test that measures the volume of urine released from the body, the speed with which it is released, and how long the release takes)

6. Urinary Incontinence - Treatment • Medications • Inhibit detrusor muscle (is a layer of the urinary bladder wall made of smooth musclefibers arranged in spiral, longitudinal, and circular bundles contractions) • Increase bladder capacity • Estrogen therapy • Surgery • Bladder neck suspension • Prostatectomy

7. Urinary Incontinence – Nursing Care • Impaired Urinary Elimination • Toileting Self-Care Deficit • Social Isolation

8. Urinary Incontinence – Nursing Care • Evaluating • Keep voiding diary • Identify wetting episodes • Assess willingness to participate in social activities • Teaching • Home environment • Voiding diary • Therapies

9. Urinary Retention • Occurs when bladder cannot empty • May be caused by obstructive or functional problem • Benign prostatic hypertrophy • Surgery • Drugs • Neurologic diseases • Trauma

10. Urinary Retention - Manifestations • Manifestations • Overflow voiding • Incontinence • Firm, distended bladder • May be displaced

11. Urinary Retention • Complications • Hydronephrosis • Acute renal failure • Urinary tract infection

12. Urinary Retention – Interdisciplinary Care • Diagnostic tests • Portable bladder scan • Treatment depends on cause • Surgery • Medications • Stimulation techniques • Catheterization

13. Urinary Retention - Surgery • Surgery (removal of obstuction, resection of prostate) • Catheterization after surgery helps prevent overdistention

14. Urinary Retention – Nursing Care • Identify clients • Take measures to promote urination

15. Urinary Tract Infections • Affect up to 20% of women • Incidence increases with aging • Healthcare-associated infections common (catheter) • Classified according to region and primary site affected • Cystitis is most common

16. Urinary Tract Infections • Bacteria from intestines can infect area • Changes in urinary tract with aging can increase risk

17. Cystitis - Manifestations • Bladder mucosa inflamed and congested with blood • Dysuria • Frequency, urgency • Hematuria • Pyuria

18. UTIs – Diagnostic Tests • Urinalysis • Urine culture & sensitivity • CBC with differential • IVP • Voiding cystourethrography • Cystoscopy

19. UTIs - Medications • Antibiotics • 3 or 7 day treatment

20. UTIs – Nursing Care • Assessment • Impaired Urinary Elimination • Readiness for Enhanced Self Health Management • Teaching

21. Pyelonephritis • Inflammatory disorder of renal pelvis and parenchyma • Acute • E. coli • Chronic • Other disorders

22. Pyelonephritis - Manifestations Acute Rapid onset Chills, fever Malaise, vomiting Flank pain, costovertebral tenderness (the angle formed by the lower border of the12th, or bottom, rib and the spine) Cystitis Chronic Fibrosis, scarring, renal failure

23. Glomerulonephritis • Inflammatory condition of glomerulus • Acute or chronic • Primary kidney disorder or secondary to systemic disease

24. Glomerulonephritis • Affects structure and function of glomerulus • Damages capillary membrane • Blood cells and proteins escape into filtrate • Hematuria, proteinuria, azotemia (increase BUN & Creatinin)

25. Acute Glomerulonephritis - Manifestations • Usually follows infection of group A beta-hemolytic Streptococcus • Manifestations develop abruptly • Hematuria, proteinuria, edema, hypertension, fatigue, • Anorexia, nausea, vomiting, headache • Elevated BUN and serum creatinine

26. Acute Glomerulonephritis - Manifestations • Older adults may show less characteristic manifestations • Symptoms may subside spontaneously • Some may develop chronic glomerulonephritis

27. Chronic Glomerulonephritis - Manifestations Symptoms develop slowly caused by progressive destruction of glomeruli and loss of nephrons Signs of renal failure may be reason to seek diagnosis

28. Glomerulonephritis – Diagnostic Tests • ASO titer (anti streptolysine O) • ESR • BUN • Serum creatinine • Serum electrolytes • Urinalysis • KUB x-ray • Kidney scan or biopsy

29. Glomerulonephritis – Interdisciplinary Care • Focus is on identifying and treating underlying disease process and preserving kidney function • Often no specific treatment

30. Glomerulonephritis –Treatment • Medications • Plasma exchange therapy • Dietary management

31. Glomerulonephritis –Nursing Care • Assessment • Diagnosing, Planning, and Implementing • Excess Fluid Volume • Fatigue • Risk for Infection • Ineffective Role Performance

32. Nephrotic Syndrome - Manifestations • Significant proteinuria • Low serum albumin levels • High blood lipids • Edema • Thromboemboli • Usually resolves without long-term effects

33. Hydronephrosis • Abnormal dilation of renal pelvis and calyces • Results from urinary tract obstructions or backflow of urine • Manifestations depend on how rapidly it develops

34. Hydronephrosis - Manifestations Acute (colicky flank pain, hematuria, pyuria, fever, nausea and vomiting, abdominal pain Chronic (intermittent dull flank pain, hematuria, pyuria, fever, palpable mass)

35. Hydronephrosis – Interdisciplinary Care • Diagnosis • Ultrasound • CT scan • Cystoscopy • Treatment • Stents

36. Hydronephrosis - Surgery • Stents positioned during suergery or cystoscopy • Pig-tail or J-shaped • Temporary or long-term

37. Hydronephrosis – Nursing Care • Focuses on ensuring urinary drainage • Monitor I&O • Irrigate tubes only as ordered

38. Polycystic Kidney Disease • Hereditary • Cyst formation and massive kidney enlargement • Relatively common

39. Polycystic Kidney Disease • Renal cysts develop in nephron • Cysts fill, enlarge and multiply • Causes kidneys to enlarge • Gradual destruction of functional kidney tissue • Slowly progressive • Flank pain, hematuria, proteinuria, polyuria, nocturia

40. A polycystic kidney and a normal kidney for comparison. (Source: NMSB, Custom Medical Stock Photos, Inc.)

41. Polycystic Kidney Disease - Manifestations • Enlarged kidneys • Flank pain, hematuria, proteinuria, polyuria, nocturia

42. Polycystic Kidney Disease – Interdisciplinary Care • Management is supportive • Renal ultrasound to diagnose • Fluids • Medications

43. Polycystic Kidney Disease – Nursing Care • Diagnosing, Planning, and Implementing • Excess Fluid Volume • Grieving • Ineffective Self Health Management • Ineffective Coping

44. Cancer of the Urinary Tract • Bladder cancer • Kidney tumors

45. Bladder Cancer • Bladder cancer is 10th leading cause of cancer deaths • Major risk factors • Carcinogens in urine related to a history of smoking (probably because of the excretion of carcinogens such as 4-aminobiphenyl), • which increases the risk about four-fold. • Chronic inflammation or infection of bladder mucosa • Smoking • Chemicals in environment

46. Bladder Cancer - Manifestations Painless hematuria Frequency Urgency Dysuria

47. Bladder Cancer – Interdisciplinary Care • Diagnostic tests • Bladder ultrasound • Urinalysis • Urine cytology • Cystoscopy • Treatment • Medications • Surgery

48. Kidney Tumors • Uncommon • Renal cell carcinoma most common primary tumor • Risk factors • Smoking • Obesity • Renal calculi

49. Kidney Tumors • Most arise from tubular epithelium • Can occur anywhere • Often metastasize

50. Kidney Tumors - Manifestations May be silent Flank pain Palpable mass Fever, fatigue Weight loss, anemia, polycythemia Hypercalcemia, hypertension, or hyperglycemia