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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