Post on 23-Dec-2015
MEDICAL SURGICAL NURSING CARE
The Urinary System Disorders
Dr Ibrahim Bashayreh, RN, PhD
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URINARY INCONTINENCE
Involuntary urination Increased bladder pressure Lowered urethral resistance Pelvic muscle relaxation Impaired neural control Bladder problems
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URINARY INCONTINENCE
Types Stress Urge Overflow Reflex Functional
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URINARY INCONTINENCE - MANIFESTATIONS
Uncontrolled urination Several types
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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)
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URINARY INCONTINENCE - TREATMENT
Medications Inhibit detrusor muscle (is a layer of the urinary
bladder wall made of smooth muscle fibers arranged in spiral, longitudinal, and circular bundles contractions)
Increase bladder capacity Estrogen therapy
Surgery Bladder neck suspension Prostatectomy
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URINARY INCONTINENCE – NURSING CARE
Impaired Urinary Elimination Toileting Self-Care Deficit Social Isolation
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URINARY INCONTINENCE – NURSING CARE
Evaluating Keep voiding diary Identify wetting episodes Assess willingness to participate in social
activities Teaching
Home environment Voiding diary Therapies
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URINARY RETENTION
Occurs when bladder cannot empty May be caused by obstructive or functional
problem Benign prostatic hypertrophy Surgery Drugs Neurologic diseases Trauma
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URINARY RETENTION - MANIFESTATIONS
Manifestations Overflow voiding Incontinence Firm, distended bladder
May be displaced
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URINARY RETENTION
Complications Hydronephrosis Acute renal failure Urinary tract infection
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URINARY RETENTION – INTERDISCIPLINARY CARE
Diagnostic tests Portable bladder scan
Treatment depends on cause Surgery Medications Stimulation techniques Catheterization
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URINARY RETENTION - SURGERY
Surgery (removal of obstuction, resection of prostate)
Catheterization after surgery helps prevent overdistention
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URINARY RETENTION – NURSING CARE
Identify clients Take measures to promote urination
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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
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URINARY TRACT INFECTIONS
Bacteria from intestines can infect area Changes in urinary tract with aging can
increase risk
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CYSTITIS - MANIFESTATIONS
Bladder mucosa inflamed and congested with blood
Dysuria Frequency, urgency Hematuria Pyuria
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UTIS – DIAGNOSTIC TESTS
Urinalysis Urine culture & sensitivity CBC with differential IVP Voiding cystourethrography Cystoscopy
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UTIS - MEDICATIONS
Antibiotics 3 or 7 day treatment
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UTIS – NURSING CARE
Assessment Impaired Urinary Elimination Readiness for Enhanced Self Health
Management Teaching
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PYELONEPHRITIS
Inflammatory disorder of renal pelvis and parenchyma Acute
E. coli Chronic
Other disorders
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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
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GLOMERULONEPHRITIS
Inflammatory condition of glomerulus Acute or chronic Primary kidney disorder or secondary to
systemic disease
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GLOMERULONEPHRITIS
Affects structure and function of glomerulus Damages capillary membrane
Blood cells and proteins escape into filtrate Hematuria, proteinuria, azotemia (increase BUN
& Creatinin)
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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
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ACUTE GLOMERULONEPHRITIS - MANIFESTATIONS
Older adults may show less characteristic manifestations
Symptoms may subside spontaneously Some may develop chronic
glomerulonephritis
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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
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GLOMERULONEPHRITIS – DIAGNOSTIC TESTS
ASO titer (anti streptolysine O)
ESR BUN Serum creatinine
Serum electrolytes Urinalysis KUB x-ray Kidney scan or
biopsy
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GLOMERULONEPHRITIS – INTERDISCIPLINARY CARE
Focus is on identifying and treating underlying disease process and preserving kidney function
Often no specific treatment
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GLOMERULONEPHRITIS –TREATMENT
Medications Plasma exchange therapy Dietary management
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GLOMERULONEPHRITIS –NURSING CARE
Assessment Diagnosing, Planning, and Implementing
Excess Fluid Volume Fatigue Risk for Infection Ineffective Role Performance
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NEPHROTIC SYNDROME - MANIFESTATIONS
Significant proteinuria Low serum albumin levels High blood lipids Edema Thromboemboli Usually resolves without long-term effects
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HYDRONEPHROSIS
Abnormal dilation of renal pelvis and calyces Results from urinary tract obstructions or
backflow of urine Manifestations depend on how rapidly it
develops
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HYDRONEPHROSIS - MANIFESTATIONS
Acute (colicky flank pain, hematuria, pyuria, fever, nausea and vomiting, abdominal pain
Chronic (intermittent dull flank pain, hematuria, pyuria, fever, palpable mass)
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HYDRONEPHROSIS – INTERDISCIPLINARY CARE
Diagnosis Ultrasound CT scan Cystoscopy
Treatment Stents
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HYDRONEPHROSIS - SURGERY
Stents positioned during suergery or cystoscopy Pig-tail or J-shaped Temporary or long-term
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HYDRONEPHROSIS – NURSING CARE
Focuses on ensuring urinary drainage Monitor I&O Irrigate tubes only as ordered
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POLYCYSTIC KIDNEY DISEASE
Hereditary Cyst formation and massive kidney
enlargement Relatively common
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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
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A POLYCYSTIC KIDNEY AND A NORMAL KIDNEY FOR COMPARISON. (SOURCE: NMSB, CUSTOM MEDICAL STOCK PHOTOS, INC.)
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POLYCYSTIC KIDNEY DISEASE - MANIFESTATIONS
Enlarged kidneys Flank pain, hematuria, proteinuria, polyuria,
nocturia
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POLYCYSTIC KIDNEY DISEASE – INTERDISCIPLINARY CARE
Management is supportive Renal ultrasound to diagnose Fluids Medications
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POLYCYSTIC KIDNEY DISEASE – NURSING CARE
Diagnosing, Planning, and Implementing Excess Fluid Volume Grieving Ineffective Self Health Management Ineffective Coping
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CANCER OF THE URINARY TRACT
Bladder cancer Kidney tumors
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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 mucosaSmokingChemicals in environment
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BLADDER CANCER - MANIFESTATIONS
Painless hematuria Frequency Urgency Dysuria
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BLADDER CANCER – INTERDISCIPLINARY CARE
Diagnostic tests Bladder ultrasound Urinalysis Urine cytology Cystoscopy
Treatment Medications Surgery
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KIDNEY TUMORS
Uncommon Renal cell carcinoma most common primary
tumor Risk factors
Smoking Obesity Renal calculi
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KIDNEY TUMORS
Most arise from tubular epithelium Can occur anywhere Often metastasize
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KIDNEY TUMORS - MANIFESTATIONS
May be silent Flank pain Palpable mass Fever, fatigue Weight loss, anemia, polycythemia Hypercalcemia, hypertension, or hyperglycemia
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KIDNEY TUMORS – INTERDISCIPLINARY CARE
Diagnostic tests Renal ultrasound CT scan Kidney biopsy
Treatment Radical nephrectomy
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BLADDER AND KIDNEY CANCER – NURSING CARE Assessment Diagnosing, Planning, and Implementing
Impaired Urinary Elimination Risk for Impaired Skin Integrity Disturbed Body Image
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BLADDER AND KIDNEY TUMORS – NURSING CARE Diagnosing, Planning, and Implementing
Acute Pain Ineffective Breathing Pattern Disturbed Body Image
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