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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
                                Increase
                                Decrease
                      2. Standardized ______________frequency
                             
                      3. Pelvic Muscle Exercises


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                                   _____________ exercises
                                   Goal : strengthen ___________________ muscles
                      4. Pharmacological Therapy
                                   Anticholinergic agents
                                        i. Oxybutynin/Ditropan
                                       ii. Action
                                      iii. Indications
                      5. Surgical management
                                   Involve ________________________________the bladder/urethra
                      6. Nursing Management
                                   Fluids_________________
                                   No _________________ after 4PM
                                   Avoid bladder irritants: _________________ ____________
                                    Aspartame (_________________)
                                   High ____________ meals
                                   Void _________________
                                   Enc pelvic floor exercises
                                   Stop ________________
         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


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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
                                     Assess for _________________
                                     Ensure _________________
                                     Never _________________
                                     Irrigate
                                     Encourage _____________________
                                     _________________ technique
                                     Measure _________________
               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
                                                                                       
                                                                                       
                                                                                       
                                                                                       


                       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 –

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                       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
         c. Clinical Manifestations
                i. Lower UTI
                       1.                                             5.
                       2.                                             6.
                       3.                                             7.
                       4.
                ii. Upper UTI
                       1.                                             5.
                       2.                                             6.
                       3.                                             7.
                       4.
               iii. Gerontologic considerations




         d. Assessment and Diagnostic findings
         e. Medical management/pharmacological therapy
                i. Antibacterial
                ii. Cephalosporin
               iii. Bactrim/Septra

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               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.                                      iii.
                ii.                                      iv.
         d. Clinical manifestations
         e. Assessment and diagnostic findings
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                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:
                         1. Marked increase in _____________ in the urine (proteinuria)

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                           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.                                      iii.
                  ii.                                      iv.
           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
   VIII.   Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
           education for Renal calculi, nephrolithiasis

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         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.                                    3.
                       2.                                    4.
         c. Clinical manifestations
                i. Pain / discomfort


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

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               iii. Nursing Process
                       1. Diagnosis
                                     Acute pain
                                     Deficient knowledge to prevent recurrence of renal stone
                       2. Interventions
                                                                      
                                                                      
                                                                      
                                                                      
                                                                      
   IX.   Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
         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




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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)?




aa6524cd-edc8-4345-bef1-3b65b0b0f2e6.doc                                                       13
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