Chapter 3 7

1. Chapter 37 Nursing Care of Patients with Disorders of the Urinary System

2. 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. UTI Predisposing Factors • Stasis of Urine • Contamination in Perineal/Urethral Area • Instrumentation • Reflux of Urine • Previous UTIs

4. UTI Symptoms • Dysuria • Urgency • Frequency • Cloudy, Foul-smelling Urine

5. UTI • Urethritis: Inflammation of Urethra • Cystitis: Inflammation/Infection of Bladder Wall • Pyelonephritis: Infection of the Kidneys

6. UTI Nursing Data Collection • Dysuria, Flank Pain, Fever, Chills, Malaise • Urine Examined for Cloudiness, Blood, Foul Odor • Predisposing Factors • Urinalysis and Culture Results

7. Nursing Diagnoses • Acute Pain • Impaired Urinary Elimination • Risk for Injury • Deficient Knowledge

8. Nursing Care • Monitor Symptoms • Monitor Intake and Output • Pain Control • Teaching • Medications: Take All Antibiotics • Prevention

9. Urological Obstructions • Obstruction of Urine Flow is Always Significant • Backup of Urine Destroys Kidney

10. Urological Obstructions (cont’d) • Urethral Strictures • Urethra Lumen Narrowing Due to Scar Tissue • Renal Calculi • Hard, Generally Small Stones • Kidney Stones • Nephrolithiasis

11. Calculi in Urinary Tract

12. Renal Calculi • Pathophysiology • Urinary Salts Settle Out • Calcium Oxalate Most Common

13. Renal Calculi (cont’d) • Etiology • Heredity • Chronic Dehydration • Infection • Immobility • Men Greater than Women

14. Renal Calculi (cont’d) • Signs and Symptoms • Flank Pain • Renal Colic • Dysuria • Costovertebral Tenderness • Hematuria Frequency • Urgency • Enuresis • GI Upset

15. Renal Calculi (cont’d) • Diagnosis • Kidney-Ureter-Bladder X-Ray • Intravenous Pyelogram (IVP) • Renal Ultrasound • Urinalysis

16. Renal Calculi Therapeutic Interventions • Small Stones Passed • IV Fluids • Pain Control • Thiazide Diuretics • Allopurinol • Lithotripsy

17. Extracorpeal Shock Wave Lithotripsy

18. Renal Calculi Surgery • Cystoscopy • Cystolitholapaxy • Cystotomy • Ureterolithotomy • Nephrolithotomy • Nephrostomy Tube

19. Renal Calculi (cont’d) • Prevention • Foods • Hydration • Exercise

20. Renal Calculi (cont’d) • Complications • UTIs • Hydronephrosis

21. Renal Calculi (cont’d) • Nursing Diagnoses • Acute Pain • Risk for Infection • Deficient Knowledge

22. Renal Calculi Nursing Care • Monitor Symptoms • Strain All Urine • Intake and Output • Pain Control • Hydration • Teaching

23. Hydronephrosis • Obstruction in Urinary Tract • Kidney Enlarges as Urine Collects • Treat Cause

24. Hydronephrosis (cont’d)

25. Hydronephrosis (cont’d) • Signs and Symptoms • Frequency • Urgency • Dysuria • Flank and Back Pain • Kidney Disease

26. Hydronephrosis Therapeutic Interventions • Treat Cause • Urinary Catheter • Stents • Nephrostomy Tube • Intake and Output • No Clamping

27. Cancer of the Bladder • Most Common Urinary Tract Cancer • Men Greater than Women • Ages 50 to 70 Years • Etiology • Smoking • Industrial Pollution

28. Cancer of the Bladder (cont’d) • Signs and Symptoms • Early • Painless • Hematuria

29. Cancer of the Bladder (cont’d) • Signs and Symptoms (cont’d) • Late • Pelvic Pain • Lower Back Pain • Dysuria • Inability to Void

30. Cancer of the Bladder (cont’d) • Diagnosis • Urinalysis • Telomerase • Urine for Cytology, Culture • Cystoscopy and Transurethral Biopsy • IVP

31. Cancer of the Bladder (cont’d) • Therapeutic Interventions • Chemotherapy • Bacille Calmette-Guérin Vaccine • Photodynamic Therapy

32. Cancer of the Bladder (cont’d) • Therapeutic Interventions (cont’d) • Surgery • Cystoscopy and Pyelogram with Fulguration • Laser • Robotic Laparoscopic Radical Cystectomy • Urinary Diversion

33. Cancer of the Bladder (cont’d) • Therapeutic Interventions (cont’d) • Incontinent Urinary Diversion • Ileal Conduit

34. Cancer of the Bladder (cont’d) • Therapeutic Interventions (cont’d) • Continent Urinary Diversion • Kock Pouch • Indiana Pouch • Mainz Pouch • Florida Pouch

35. Cancer of the Bladder (cont’d) • Therapeutic Interventions (cont’d) • Othotopic Bladder Substitution • Studer Pouch • Hemi-Kock Pouch • Ileal W–Neobladder

36. Cancer of the Bladder (cont’d) • Nursing Care • WOC Nurse • Monitor Urine Output • Education • Pre-op and Post-op Care

37. Cancer of the Kidney • Rare • Risk Factors • Smoking • Obesity • Hypertension • Long-term Kidney Dialysis

38. Cancer of the Kidney (cont’d) • Risk Factors (cont’d) • Radiation Exposure • Asbestos • Industrial Pollution

39. Cancer of the Kidney (cont’d) • Later Signs and Symptoms • Hematuria • Dull Pain in Flank Area • Mass

40. Cancer of the Kidney Diagnosis • IVP • Cystoscopy and Pyelogram • Ultrasound • CT Scan • MRI • Renal Biopsy

41. Cancer of the Kidney (cont’d) • Therapeutic Interventions • Radical Nephrectomy • Nephron-sparing Surgery • Radiation Therapy • Immunotherapy • Chemotherapy

42. Cancer of the Kidney (cont’d) • Nursing Care • Monitor Urine Output • Education • Pre-op and Post-op Care

43. Renal Trauma • Flank pain • Hematuria • Treat injury

44. Renal Trauma (cont’d) • Nursing Care • Intake and Output • Vital Signs • IV Fluids • Pain Control

45. Polycystic Kidney Disease • Multiple Cysts in the Kidney • Signs and Symptoms • Dull Heaviness in Flank/Back • Hematuria • Hypertension • UTI

46. Polycystic Kidney Disease (cont’d) • Progressive • No Treatment

47. 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. Diabetic Nephropathy Therapeutic Interventions • Early • Control Blood Glucose and Blood Pressure • Restricted-protein Diet • Later • Dialysis • Kidney Transplant

49. Diabetic Nephropathy (cont’d) • Nursing Care • Education on Glucose and Blood Pressure Control

50. Nephrotic Syndrome • Large Amounts of Protein Lost in Urine • Increased Glomerular Membrane Permeability