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					GU System Handout 4 – Renal system B

Behavioral Objectives: By the end of this lecture the student will be able to:  Identify and describe the etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following: o Urinary retention o Urinary incontinence o Urinary suppression o Residual urine  Discuss common pharmacological interventions appropriate in treatment of patient with GU disorders  Describe general nursing consideration and intervention in pre and post-operative care of patients undergoing urological surgery  Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following GU disorders: o Pyelonephritis o Cystitis o Urinary tract infections (UTI) o Urethritis o Nephritic syndrome o Hydronephrosis o Renal calculi o Renal neoplasm’s

I.

Dysfunctional Voiding Patterns a. Urinal Incontinence i. Pathophysiology 1. Unplanned loss of _______________that is sufficient to be considered a problem 2. Continence requires intact ________________, _______________ & ___________-____________systems 3. Any break in ________________between these systems can lean to incontinence (or residual) ii. Types of incontinence 1. Stress Incontinence

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Involuntary loss of urine through an intact urethra due to a __________________________________ Treatment – mild: ___________________________ Treatment – moderate to severe: _______________

2. Urge Incontinence Involuntary loss of urine associated with a strong __________ to void that cannot be __________ Treatment i. ii. Pelvic floor ______________ iii. Bladder ____________ iv. Meds: ________________________ 3. Reflux incontinence       Involuntary loss of urine due to _____________in the _____________of normal ________________ Assoc. with _______________________________

4. Overflow incontinence Involuntary loss of urine due to ____________of the bladder

5. Overflow incontinence Involuntary loss of urine due to over-distention of the bladder Bladder is unable to _____________ over ________________  frequent _____________(just over flow)  incontinence Treatment: _________________________

iii. Behavior Therapy management 1. _________________ management    3. Pelvic Muscle Exercises Increase Decrease

2. Standardized ______________frequency

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_____________ exercises Goal : strengthen ___________________ muscles

4. Pharmacological Therapy Anticholinergic agents i. Oxybutynin/Ditropan ii. Action iii. Indications 5. Surgical management         b. Urinary Retention i. Pathophysiology 1. Urinary retention: the inability to __________the bladder completely 2. Residual urine: urine that remains ____________________________ 3. Assoc. with        _____________ d/t reflux spasm of sphincters Diabetes ______________ enlargement ____________ pathology Trauma ____________ ________________ disorders 3 Involve ________________________________the bladder/urethra

6. Nursing Management Fluids_________________ No _________________ after 4PM Avoid bladder irritants: _________________ ____________ Aspartame (_________________) High ____________ meals Void _________________ Enc pelvic floor exercises Stop ________________

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ii. Assessment 1. iii. Complications 1. Chronic _________________  pyelonephritis  ______________  kidney failure  iv. Nursing Management 1. Promoting normal urinary eliminations    2. Promoting urinary elimination  c. Neurogenic Bladder i. A dysfunction d/t a lesion of the _____________ system ii. Two types of neurogenic bladder 1. ______________ bladder / _____________ bladder  2. Flaccid bladder  Bladder becomes ________ _________incontinence  Bladder does not ___________ Can not _______________ discomfort iii. Management 1. Catheterization    2. Indwelling devices    Drainage bag ____________________ the level of the bladder Tubing not ___________________ and no too long _____________________ fluids     

3. Suprapubic catheterization

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II.

Urological surgery a. Brunner and Suddarth’s Medical Surgical nursing pg 1299-1306 b. Post-operative management i. Drainage tubes ii. Nephrostomy drainage 1. Tube inserted directly into the kidney for temporary or permanent urinary diversion 2. Nursing management        iii. Urethral stents 1. A tubular device that maintains position & patency of _______ c. Nursing process i. Diagnosis/interventions 1. Ineffective airway clearance related to the location of the surgical incision 2. Ineffective breathing pattern related to surgical incision and general anesthesia         Assess for _________________ Ensure _________________ Never _________________ Irrigate Encourage _____________________ _________________ technique Measure _________________

3. Acute pain related to the location of the surgical incision, and the position the patient assumed on the operative table during surgery and abdominal distention

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4. Urine retention related to pain, immobility and anesthesia     ii. Potential complications 1. Bleeding 2. Pneumonia 3. Infection 4. Fluid disturbances 5. Deep vein thrombosis III. Describe etiology, Pathophysiology, clinical manifestations, nursing management and patient education for Urinary tract infections (UTI) a. Brunner and Suddarth’s Medical Surgical nursing pg 1310-1315 b. Pathophysiology i. Urinary tract infections are caused by pathogenic micro-organisms in the urinary tract 1. Bacteria must gain access to the bladder  attach to the bladder  colonize in the epithelium of the urinary tract ii. Reflux 1. Backward flow of urine from the urethra to the bladder 2. ________________ __________bladder pressure  urine forced into _____________  stop coughing  ___________pressure  urine flows back into ________________ iii. The normal urinary tract is sterile above the urethra iv. Types of UTI’s 1. Cystitis – 2. Prostatitis – 3. Urethritis – f45f4a0f-0516-494e-837b-692058b901b1.doc 11/3/2009 6

4. Pyelonephritis – 5. Interstitial nephritis – v. Defense mechanisms 1. 2. 3. Men vs Women vi. Predisposing factors to urinary tract infections 1. Factors increasing urinary ____________ 2. ________________ bodies 3. ______________ factors 4. Factors _________________ immune response 5. _________________ disorders c. Clinical Manifestations i. Lower UTI 1. 2. 3. 4. ii. Upper UTI 1. 2. 3. 4. iii. Gerontologic considerations 5. 6. 7. 5. 6. 7.

d. Assessment and Diagnostic findings e. Medical management/pharmacological therapy i. Antibacterial ii. Cephalosporin f45f4a0f-0516-494e-837b-692058b901b1.doc 11/3/2009 7

iii. Bactrim/Septra iv. Urinary analgesic - phenazopyridine (Pyridium f. Nursing process i. Assessment

ii. Diagnosis 1. Acute pain related to inflammation of the urinary tract 2. Deficient knowledge detection, preventions and recurrence and meds iii. Nursing interventions 1. Hygiene    2. Fluid intake    3. Voiding habits    IV.         

Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Pyelonephritis a. Brunner and Suddarth’s Medical Surgical nursing pg 1315-17 b. Pyelonephritis is a bacterial infection of the__________________, ________and interstitial tissue of one or both_____________________. c. Pathophysiology i. ii. d. Clinical manifestations iii. iv.

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e. Assessment and diagnostic findings i. Ultrasound ii. CT scan iii. UA f. Medical Management

g. Pharmacological therapy

h. Complications i. End Stage Renal Disease ii. Hypertension iii. Kidney stones iv. Urosepsis V. Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Urethritis a. Brunner and Suddarth’s Medical Surgical nursing pg 1357 b. Pathophysiology i. Inflammation of the _______________ c. Clinical manifestations – Men 1. 2. 3. 4. d. Clinical Manifestations - Women i. Asymptomatic e. Treatment VI. Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Nephrotic syndrome a. Brunner and Suddarth’s Medical Surgical nursing pg 1320-21 b. Pathophysiology i. Primary ______________________ disease characterized by: f45f4a0f-0516-494e-837b-692058b901b1.doc 11/3/2009 9

1. Marked increase in _____________ in the urine (proteinuria) 2. Decrease in ______________ in the blood (hypoalbuminemia) 3. ______________ 4. High serum _________________ and low-density lipoprotein c. Clinical Manifestation i. #1 – _______________ ii. Malaise iii. ____________ iv. Irritability v. Fatigue d. Assessment and diagnostic findings i. Proteinuria ii. Hyperlipidemia iii. Hypoalbuminemia e. Complications i. ii. f. Medical Management i. Diuretic ii. Nonsteroidal anti-inflammatory iii. Diet g. Nursing management - edema VII. Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Hydronephrosis a. Brunner and Suddarth’s Medical Surgical nursing pg 1357 b. Pathophysiology i. __________________of the renal pelvis and calyces of one or both kidneys due to an _____________________ c. Clinical manifestations d. Medical management iii. iv.

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VIII.

Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Renal calculi, nephrolithiasis a. Brunner and Suddarth’s Medical Surgical nursing pg 1337-42 b. Pathophysiology i. Stones are formed in the urinary tract when urinary concentrations of the substances such as calcium oxalate, calcium phosphate and uric acid increase ii. Calculus = iii. Lithiasis = iv. Certain factors favor the formation of stones: 1. 2. c. Clinical manifestations i. Pain / discomfort 3. 4.

ii. Hematuria d. Assessment and diagnostic findings i. X-ray ii. Ultrasonography iii. 24-hour urine test iv. Cystoscopy

v. IVP

e. Medical management i. Opioid analgesic ii. Antibiotics iii. NSAIDs iv. Diet f. Surgical Management i. Ureteroscopy 1. First visualize the stone f45f4a0f-0516-494e-837b-692058b901b1.doc 11/3/2009 11

2. Destroy the stone ii. ESWL - Extracorporeal shock wave lithotripsy

iii. Nursing Process 1. Diagnosis        IX. education for Renal neoplasm’s a. Brunner and Suddarth’s Medical Surgical nursing pg 1344-47 b. Pathophysiology i. Risk factor ii. c. Clinical Manifestations i. ii. d. Medical treatment Acute pain Deficient knowledge to prevent recurrence of renal stone     

2. Interventions

Describe etiology, pathophysiology, clinical manifestations, nursing management and patient

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X.

Study Questions a. What is a cystoscopy and what are nursing considerations in caring for a patient following this procedure? b. Where can kidney stone be found? c. What are risk factors for developing kidney stones? d. Signs and symptoms of kidney stones? e. What are the nursing interventions in caring for a patient with kidney stones? f. What are common medical treatments used in the treatment of kidney stones? g. A serious complication of fluid overload is what? h. What are the symptoms of Pyelonephritis? i. What is the Pathophysiology of Pyelonephritis (how do you get it?)? j. What is the most common organism to cause UTI’s? k. What are the signs and symptoms of a UTI l. Define stress incontinence m. What signs and symptoms are associated with bladder cancer? n. What are measures to prevent to recurrence of UTI? o. What are the body’s defense mechanisms to prevent UTI’s? p. How do you measure residual volume? q. What is IVP (intravenous pyelogram)?

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