urology ppt
TRANSCRIPT
U R O L O G Y
THE RENAL SYSTEM
• STRUCTURES:– KIDNEYS
• RETROPERITONEAL• RENAL ARTERY & VEIN• NEPHRON
– URETER– URINARY BLADDER– URETHRA
Here is a normal adult kidney. The capsule has been removed and a pattern of fetal lobulations still persists, as it sometimes does. The hilum at the mid left contains some adipose tissue. At the lower right is a smooth-surfaced, small, clear fluid-filled simple renal cyst. Such cysts occur either singly or scattered around the renal parenchyma and are not uncommon in adults.
In cross section, this normal adult kidney demonstrates the lighter outer cortex and the darker medulla, with the renal pyramids into which the collecting ducts coalesce and drain into the calyces and central pelvis.
THE RENAL SYSTEM
• 4 MAIN FUNCTIONS OF THE KIDNEYS:
– EXCRETION OF WASTE PRODUCTS• FILTRATION• TUBULAR REABSORPTION• TUBULAR SECRETION
– REGULATION OF FLUID & ELECTROLYTES– BLOOD PRESSURE REGULATION– ERYTHROPOEITIN SECRETION
THE RENAL SYSTEM
PHYSIOLOGY:• RENIN-ANGIOTENSIN
• ERYTHROPOEITIN
• PROSTAGLANDIN
RELEASED BY CELLS NEAR THE GLOMERULUS WHEN GFR IS LOW OR WHEN SYMPA-NS IS STIMULATED
RELEASED IN RESPONSE TO HYPOXEMIA
•IS RELEASED BY RENAL MEDULLA; VASODILATOR; REGULATE RENAL BLOOD FLOW
THE RENAL SYSTEM
PHYSIOLOGY:• METABOLISM OF VIT D – FOR CALCIUM
METABOLISM
• DEGRADATION OF INSULIN• URGE TO VOID : 200-300 ml OF URINE
• BLADDER DISTENTION: 400 ml• PARASYMPA-NS : DESIRE TO VOID
• SYMPA-NS: MUSCLE RELAXATION & ELIMINATION
Double ureters are seen exiting from each kidney and extending to the bladder that has been opened. A small segment of aorta is seen between the normal, smooth-surfaced kidneys. A partial or complete duplication of one or both ureters occurs in about 1 in 150 persons. There is a potential for obstructive problems due to the abnormal flow of urine and the entrance of two ureters into the bladder in close proximity, but most of the time this is an incidental finding
RENAL DISORDERS
• RENAL FAILURE• GLOMERULONEPHRITIS• NEPHROTIC SYNDROME• NEPHROSCLEROSIS• HYDRONEPHROSIS• INFECTIONS • NEUROGENIC DISORDERS• BENIGN PROSTATIC HYPERTROPHY
CASE STUDY
• Draco, 54 y.o., with history of uncontrolled DM-II, came in because of difficulty of breathing & anuria.
• VS = 38 O; 113; 30; 170/120
• He has bipedal edema & pruritus
CASE STUDY
• What is your first nursing action?
• What other assessment would you do?
• What are your plans?
RENAL FAILURE (R. F.)
INABILITY OF THE KIDNEY TO FXN NORMALLY & EFFECTIVELY
• ACUTE RENAL FAILRE
• CHRONIC RENAL FAILURE
ACUTE RENAL FAILURE
SUDDEN DETERIORATION OF KIDNEY FUNCTION
3 PHASES:1. OLIGURIC
2. ANURIC
3. POLYURIC / RECOVERY + WASTING OF Na, K, & base HCO3
ACUTE RENAL FAILURECAUSES:• PRERENAL
– SHOCK – MISMATCHED BT
• RENAL – NEPHRITIS– NEPHROTOXIC INFECTION
• POST RENAL – RENAL CALCULI
CHRONIC RENAL FAILURE
CAUSES:• PRERENAL
– GOUT– DM– SUBACUTE
BACTERIAL ENDOCARDITIS
• RENAL– SLE– GLOMEROLU-
NEPHRITIS
• POSTRENAL– PROSTATIC
OBSTRUCTION
R. F. - SIGNS & SYMPTOMS
• UO ALTERATIONS• WEAK• INCREASINGLY
DROWSY• RESTLESSNES• INSOMIA• DRY SKIN & MUCOUS
MEMB• URINEFEROUS
BREATH
• NAUSEA/ VOMITING• CNS
– IRRITABILITY– ANXIETY– HALLUCINATION– MUSCLE TWITCHING– CONVULSIONS– COMA
• HPN• ANEMIA• EDEMATOUS• BRUISE EASILY
R. F. - MANAGEMENT
MODALTIES:
1. CONSERVATIVE TREATMENT
2. AGGRESSIVE TREATMENT
CONSERVATIVE TREATMENT
• DIET– P, K, & Na RESTRICTED– GIORDANA-GIOVANETTI : LOW P (MINIMAL
ESSENTIAL A.A.), 20g; controlled K, 1.5g
• TREATMENT OF INFECTION– ANTIBIOTICS
• TREATMENT OF ALTERATIONS OF BODY CHEMISTRY
ALTERATIONS IN BODY CHEMISTRY
I. SUBSTANCES FROM PROTEIN METABOLISM:– UREA– CREATININE– URIC ACID
MGT:• PROTEIN RESTRICTION• PREVETION OF INFECTION• ANABOLIC HORMONES – CAUSE TISSUE BUILD
UP & REVERSE BREAKDOWN
ALTERATIONS IN BODY CHEMISTRY
II. ELECTROLYTES:I. HYPERKALEMIAII. HYPOKALEMIAIII. HYPERNATREMIAIV. HYPONATREMIAV. HYPOCALCEMIA, HYPERPHOSPHATEMIA,
& BONE DSEVI. ACIDOSIS
HYPERKALEMIA
CAUSES IN RF:
• SECRETED out from the cell TOGETHER WITH H ions IN EXCHANGE FOR Na
• DECREASED EXCRETION FROM DECREASED G.F.R.
HYPERKALEMIA
S/SX:• FLACCID PARALYSIS
• SLOW RESPIRATION
• ANXIETY
HYPERKALEMIA
MANAGEMENT:
• K RESTRICTED DIET
• ION EXCHANGE RESIN: KAYEXALATE; SORBITOL IS GIVEN
• IF WITH CARDIAC ARRHYTHMIA : Ca GLUCONATE
• IV NaH2CO3
• GLUCOSE & INSULIN
HYPOKALEMIA
S/SX:
• MUSCLE WEAKNESS• PARALYSIS• LOSS OF REFLEXES• CARDIAC ARRHYTHMIA
(PVC, TACHYCARDIA)• DIGITALIS TOXICITY CAN
DEVELOP
ECG CHANGES:• DEPRESSED T WAVE• ELEVATED U WAVE
MANAGEMENT:• PARENTERAL POTASSIUM
HYPERNATREMIA
SSX:• FLUID RETENTION• WEIGHT GAIN• CHF• PULMONARY EDEMA• HPN
MANAGEMENT:• LIMIT Na INTAKE• DRUGS: DIGITALIS, DIURETICS, ANTIHPN
HYPONATREMIA
S/SX:• DHN• DRY MOUTH• LOSS OF SKIN TURGOR• MUSCLE CRAMPS, TWITCHING• COMA
MANAGEMENT:• INCREASE DIETARY SODIUM• Na H2CO3, Na Citrate
Ca, Ph, & BONE DSE
• HYPOCALCEMIA• HYPERPHOSPHATEMIA• BONE DEMININERALIZATION
MANAGEMENT:• LARGE DOSE OF VIT D
ACIDOSIS
S/SX:• LETHARGY• DISORIENTATION• INCREASED HR• KAUSMAUL’S RESP
MANAGEMENT:• NaHCO3, NaLACTATE
Large love
AGGRESSIVE TREATMENT
• HEMOFILTRATION
• PERITONEAL DIALYSIS
• HEMODIALYSIS
HEMOFILTRATION
• CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH)
INDICATION:• FLUID OVERLOAD FROM OLIGURIA• RENAL FAILURE
A-V SHUNTULTRAFILTRATION
HEMOFILTRATION
ADVANTAGE:
• DOES NOT REQUIRE DIALYSIS MACHINE OR DIALYSIS PERSONNEL
DISADVANTAGE:• 36-48 HRS
DIALYSIS
INDICATION:• GFR FALLS BELOW 3ml/min
PURPOSE:• REMOVING WASTE PRODUCTS FROM THE BODY
TYPES:• PERITONEAL DIALYSIS• HEMODIALYSIS
PERITONEAL DIALYSIS
CONTRAINDICATION:
• EXTENSIVE ABDOMINAL ADHESION
• PERITONITIS
• GANGRENOUS OR PERFORATED BOWEL
PERITONEAL DIALYSIS
COMPOSITION OF SOLUTION:
• DEXTROSE: 1.5% & 4.5%
• PHYSIOLOGIC CONC OF ELECTROLYTES
• SLIGHTLY HYPERTONIC
PERITONEAL DIALYSIS
36-48 HRS P.D. = 6-8 HRS HEMO
3 PERIODS:• INSTILLATION
• EQUILIBRIUM: OSMOSIS, DIFFUSION & FILTATION
• DRAINAGE
PERITONEAL DIALYSIS
NURSING RESPONSIBILITIES:
• CYCLING THE FLUID
• OBSERVE FOR COLOR OF THE OUTFLOW
• ACCURATE RECORDING ON THE FLOW SHEET
• FREQUENT MONITORING OF VS, WEIGHT & GEN CONDITION
PERITONEAL DIALYSIS
NURSING RESPONSIBILITIES:
• PREVENT COMPLICATIONS OF IMMOBILITY
• CHECK TUBING PATENCY
• INFORM DOCTOR FOR FLLUID BALANCE EVERY SHIFT
• COLLECT SAMPLES OF DIALYSATE REMOVED
PERITONEAL DIALYSIS
NURSING RESPONSIBILITIES:
• TEST URINE FOR GLUCOSE EVERY 6 HRS
• OBSERVE FOR COMPLICATIONS:– PHYSIOLOGIC– TECHNICAL
PERITONEAL DIALYSIS
PHYSIOLOGIC COMPLICATIONS:
• PERITONITIS
• PROTEIN LOSS
• HYPERGLYCEMIA & HHONK
• PULMONARY EDEMA
PERITONEAL DIALYSIS
PHYSIOLOGIC COMPLICATIONS:
• PERFORATION OF INTESTINES
• HYPOTENSION
• HYPOSTATIC PNEUMONIA
• RESPIRATORY ACIDOSIS
• ABDOMINAL DISCOMFORT
PERITONEAL DIALYSIS
TECHNICAL COMPLICATIONS:
• INCOMPLETE/ SLOW DRAINAGE– TURN THE PATIENT SIDE TO SIDE– SEMIFOWLER’S + GENTLE PRSSURE ON THE
ABDOMEN
• LEAKAGE / BLEEDING– NORMAL DURING THE FIRST EXCHANGE
PERITONEAL DIALYSIS
NEWER TECHNIQUE:
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)
• 30-40 MIN TO PERFORM• 4 x A DAY• 24/7
HEMODIALYSISINDICATION:
• ACUTE RENAL FAILURE• CHRONIC RENAL FAILURE
PURPOSE:
• LOWER THE LEVEL OF METABOLIC WASTE PRODUCTS:– UREA, CREATININE, URIC ACID
• CORRECT ABNORMAL ELECTROLYTE CONC
HEMODIALYSIS
• DIALYZER
• SHUNTS:
– CANNULA
– A-V SHUNT
HEMODIALYSIS
CARE OF THE SHUNT:
• DRY STERILE DRESSING
• ENSURE PATENCY
• BRUIT
• NOTIFY PHYSICIAN STAT WITH PRSENCE OF BLOOD CLOT
HEMODIALYSIS
CARE OF THE SHUNT:
• AVOID TRAUMA TO THE ARM WITH SHUNT
• ACCIDENTAL SEPARATION: DIRECT PRESSURE/ VASCULAR CLAMPS
• OBSERVE FOR SHUNT-RELATED INFECTION:– Fever, lethargy, elevated WBC
HEMODIALYSIS
COMPLICATIONS:
• TECHNICAL
• PROCEDURE COMPLICATONS
• MEDICAL
HEMODIALYSIS
TECHNICAL COMPLICATIONS:
• BLOOD LEAKS
• TUBING SEPARATION
• DIALYSATE CONC ERRORS– HEMOLYSIS, CEREBRAL DISTURBANCE
HEMODIALYSIS
PATIENT COMPLICATIONS DURING PROCEDURE:
• DIALYSIS DISEQUILIBRIUM SYNDROME
• HYPERTENTION
• HYPOTENSION
• NAUSEA & VOMITING
• HEADACHE
• ACUTE BLEEDING
HEMODIALYSISPATIENT COMPLICATIONS DURING
PROCEDURE:• FEVER
• MUSCLE CRAMPS
• CARDIAC ARRHYTHMIAS
• CHEST PAIN
• SHORTNESS OF BREATH
• RESTLESSNESS
• DEPRESSION & HOSTILITY
HEMODIALYSIS
MEDICAL COMPLICATIONS:
• HPN
• CHF & PULMONARY EDEMA
• ANEMIA
• HEPATITIS
• LOW SEXUAL POTENCY
RENAL TRANSPLANTATION
• AUTOGRAFT
• ISOGRAFT
• ALLOGRAFT/ HOMOGRAFT
• XENOGRAFT
RENAL TRANSPLANTATION
TREATMENT to prevent REJECTION:
• AZATHIOPRINE (IMMURAN)
• ADRENAL CORTICOSTEROIDS
• ANTILYMPHOCYTES GLOBULIN
• ACTINOMYCIN-C
• LOCAL IRRADIATION THERAPY
RENAL TRANSPLANTATION
S/SX OF TISSUE REJECTION:
• WEIGHT GAIN
• IRRITABILITY
• SWELLING OF THE OPERATIVE SIGHT
• DECREASED W.B.C.
MATRIX
GLOMERULONEPHRITIS
• ACUTE G.N.
• CHRONIC G.N.
ACUTE G.N.
• INFLAMMATORY REACTION TO GLOMERULI FROM AN IMMUNE MECHANISM
• FROM BETA HEMOLYTIC GROUP A STREP INFECTION: – THROAT– SKIN– SCARLET FEVER
ACUTE G.N. - PATHOPHYSIO
STREP THROAT
STREP TOXINS AS ANTIGENS
ANTIGEN-ANTIBODY COMPLEX IN THE CIRCULATION
Ag-Ab COMPLEX LODGE IN THEGLOMERULI
GLOMERULARINFLAMMATION
ACUTE G.N.
CLINICAL MANIFESTATIONS:
• PREVIOUS STREP INFECTION
• MALAISE, HEADACHE, FACIAL EDEMA, FLANK PAIN & TENDERNESS
• HPN
ACUTE G.N.
LABS:
• URINE : SCANTY & BLOODY, SG, RBC & WBC CASTS
• ASO
• BUN & CREATININE
• ANEMIA
ACUTE G.N.
MANAGEMENT:
• PROTECTION FROM INJURY
• TREAT COMPLICATIONS PROMPTLY
ACUTE G.N.
COMPLICATIONS:
• HPN
• ENCEPHALOPATHY
• C.H.F.
• PULMONARY EDEMA
ACUTE G.N.PROMPT TREATMENT OF
COMPLICATIONS
• PENICILLIN
• BED REST UNTIL LABS RETURN TO NORMAL
• DIET: P RESTRICTED ( RENAL INSUFFICIENCY) Na RESTRICTED (HPN, EDEMA & CHF) HIGH C TO REDUCE P CATABOLISM FLUIDS
CHRONIC G.N. – PATHOPHYSIO
ACUTE G.N.
REPEATED AG-AB REACTIONS
GLOMERULI BECOME SCARRED;RENAL ARTERIAL BRANCHES THICKENED
GLOMERULAR DAMAGE
KIDNEY: 1/5 OFORIGINAL SIZE
end stage of chronic glomerulonephritis. Notice their small size. They each measure about 2 x 3". These are severely contracted kidneys. Notice the cortices and the finely granular surfaces.
Here's an end stage kidney of chronic glomerulonephritis. Notice again it is extremely contracted and finely granular. This is the kidney of a 38 year old man who presented with an insidious onset of the three signs of uremia, that is loss of appetite, lethargy, and the laboratory finding of an increased BUN. He had no antecedent history of acute glomerulonephritis.
CHRONIC G.N.
CLINICAL MANIFESTATION:
• ASYMPTOMATIC
• 1ST INDICATION OF DSE: EPISTAXIS, STROKE, CONVULSION
• FEET SLI. SWOLLEN @ NIGHT
• WEIGHT LOSS, HEADACHE, NOCTURIA
CHRONIC G.N.
CLINICAL MANIFESTATION:
• PHYSICAL EXAM:– YELLOW GRAY SKIN PIGMENTATION– PERIORBITAL & PERIPHERAL EDEMA– HPN– ANEMIA – PALE PALP CONJ
CHRONIC G.N.
MANAGEMENT:
• DIET ESP PROTEIN, Na & FLUIDS IS READJUSTED ACCORDING TO THE METABOLIC NEEDS OF THE PATIENT
• BED REST
• DIALYSIS EARLY IN THE COURSE TO MINIMIZE RISK OF RENAL FAILURE
NEPHROTIC SYNDROME
CAUSES:
• CHRONIC G. N.
• DIABETES MILLETUS
• AMYLOIDOSIS
• RENAL THROMBOSIS
NEPHROTIC SYNDROME
S/SX:
• PROTEINURIA
• HYPOALBUMINEMIA
• EDEMA
• HYPERLIPEDEMIA
NEPHROTIC SYNDROME
S/SX:
• SLOW ONSET OF FLUID RETENTION
• HEMATURIA
• URINARY STASIS
NEPHROTIC SYNDROME
MANAGEMENT:
• BED REST
• HIGH P DIET
• DIURETICS- EDEMA
• STEROIDS - PROTEINURIA
NEPHROSCLEROSIS
• HPN• RENAL ARTERIOSCLEROSIS
CLIN MANIFESTATION:
URINE: LOW S.G. SM PROTEIN OCC HYALINE & GRANULAR CAST
HYDRONEPHROSIS
OBSTRUCTION OF
URINARY FLOWDISTENTION OF PELVIS & CALYCES
THINNING OF RENAL PARENCHYMA
GRADUAL DESTRUCTIONOF THE KIDNEY
COMPENSATORYHYPERTROPHY OF THE
CONTRALATERAL KIDNEYIMPAIRMENT OFRENAL FUNCTION
HYDRONEPHROSIS
CLIN MANIFESTATIONS:
• Asymptomatic
• Flank & back pain
• Hematuria
HYDRONEPHROSIS
MANAGEMENT
• Urinary diversion: Nephrostomy
• Antimicrobials
INFECTIONS OF THE URINARY TRACT
PREDISPOSING FACTORS:
• FEMALE : PROXIMITY OF THE URETHRA TO THE VAGINAL-RECTAL ORIFICES
• INFANTS AFFECTED MORE OFTEN THAN OLDER CHILDREN
• ELDERLY
INFECTIONS OF THE URINARY TRACT
CAUSE:
• ORGANISMS FROM THE BOWEL– E. coli– Pseudominas – Enterococci
INFECTIONS OF THE URINARY TRACT
• Ascending infection & Vesico - Ureteral
reflux
• Sexual activity
• Instrumentation
- KIDNEY-
URETER
BLADDER
URETERO-VESICAL
JUNCTIONVESICO-
URETERALREFLUX
U.T.I. S/SX
CYSTITIS:
– FREQUENCY– URGENCY– DYSURIA– BLADDER SPASM– WALLS MAY BLEED WITH SEVERE
INFLAMMATION
This is an opened urinary bladder. The mucosa shows many petechial hemorrhages and is swollen and congested. This is hemorrhagic
cystitis. It is frequently seen with lower urinary tract infections and is particularly common in the
presence of an indwelling urinary catheter.
U.T.I. S/SX
PYELONEPHRITIS
• PRIMARY LOWER UTI• FLANK PAIN• MUSCLE SPASM• CHILLS• FEVER• DYSURIA
This is another section of a kidney with acute suppurative pyelonephritis. Notice the
parenchyma is congested and swollen. There is a calculus in the calyx.
U.T.I.
TREATMENT:
• ANTIBIOTICS
• INCREASE FLUIDS – 3-4L /DAY
• EARLY TREATMENT TO PREVENT COMPLICATIONS
U.T.I.
COMPLICATIONS:
•SEPTICEMIA
•RENAL FAILURE
NEUROGENIC DISORDERS
• PARASYMPATHETIC NERVOUS SYSTEM – SACRAL CORD 2,3,4
• PERCEPTION TO URINATE:300-500 ML OF URINE
• MAXIMUM BLADDER CAPACITY:1L OF URINE
NEUROGENIC DISORDERS
TYPES:
• LESION ABOVE THE SACRAL MICTURITION CENTER (SMC)– SPASTIC, NEUROPATHIC BLADDER
• LESION BELOW THE SMC– FLACCID, NEUROPATHIC BLADDER
SPASTIC BLADDER• REDUCED CAPACITY• INVOLUNTARY DETRURSOR CONTRACTIONS• HYPERTROPHY OF THE BLADDER• SPASTICITY OF PELVIC MUSCLES• AUTONOMIC DYSREFLEXIA
S/SX:
• INVOLUNTARY URINATION• VOIDING CAN BE TRIGGERED BY
STIMULATION OF GENETALIA OR ABDOMEN, WITH SPASM OF EXTREMITIES
FLACCID (ATONIC) BLADDER
TYPES:• SENSORY• MOTOR
• LARGE CAPACITY• LACK OF VOLUNTARY DETRURSOR MUSCLES• MILD WALL HYPERTROPHY (TRABECULATIONS)• DECREASED TONE OF EXTERNAL SPHINCTER
FLACCID (ATONIC) BLADDER
• LOSS OF SENSORY / MOTOR SUPPLY TO THE BLADDER
• SHOCK PHASE OF SCI
• BLADDER : – FLACCID & DISTENDED– RETENTION WITH OVERFLOW INCONTENENCE– SMOOTH MUSCLE STILL ACTIVE + WEAK STRIATED
SPHINCTER MUSCLES = TRABECULATIONS
• GENITAL PROBLEMS : LOSS OF ERECTION
NEUROGENIC BLADDER
DIAGNOSIS:
• HISTORY
• NEUROLOGICAL EXAM & STUDIES (EMG)
• RADIOLOGIC EXAM (VOIDING CYSTOURETHROGRAM)
• UROLOGIC STUDIES (UTZ)
NEUROGENIC BLADDER
INTERVENTIONS:
• INTERMITTENT CATHETER DRAINAGE
• CREDE’S METHOD
• ALCOHOL, TEA & COFFEE AS DIURETICS
• ELECTRONIC STIMULATION OF THE BLADDER
UROLITHIASIS
CAUSE:
• URINARY STASIS• UREA- SPLITTING ORGANISMS
– E. coli– Proteus – Staph, Strep
UROLITHIASIS
Types of Stones:
• ACID STONES– URIC ACID– CYSTINE
• ALKALINE STONES– PHOSPHATE– CALCIUM OXALATE
Alkaline Stone formationAlkaline Stone formation
UREA-SPLITTINGORGANISMS IN
THE URINEURINE BECOMESALKALINE
CALCIUM PHOSPHATEBECOMES INSOLUBE
UROLITHIASIS
There was a large renal calculus (stone) that obstructed the calyces of the lower pole of this kidney, leading to a focal hydronephrosis (dilation of the collecting system). The stasis from the obstruction and dilation led to infection.
The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good corticomedullary demarcations.
Sometimes a very large calculus nearly fills the calyceal system, with extensions into calyces that give the appearance of a stag's (deer) horns. Hence, the name "staghorn calculus". Seen here is a horn-like stone extending into a
dilated calyx, with nearly unrecognizable overlying renal cortex from severe hydronephrosis and pyelonephritis. Nephrectomy may be performed because the kidney is non-functional and serves only as a source for infection.
UROLITHIASIS
S/SX:
• CVA PAIN – COLICKY & EXCRUCIATING – RADIATES TO THE LABIA OR SCROTUM
• ASHEN FACE• DIAPHORESIS• FREQUENCY• HEMATURIA• FEVER - INFECTION
UROLITHIASIS
MEDICAL TREATMENT:
• ACID STONES - ALKALINE ASH DIET: • FRUITS • VEGETABLES • MILK
• ALKALINE STONES - ACID ASH DIET : • MEAT • FISH • EGGS • CEREALS
UROLITHIASIS
MEDICAL TREATMENT:
• RESTRICT CALCIUM
• ALUMINUM HYDROXIDE – PHOSPHATE STONES
• PERCUTANEOUS STONE REMOVAL
– NEPHROSTOMY. NEPHROLITHOTOMY (LASER, UTZ, ELECTROHYDRAULIC)
– STONE DISSOLUTION - CHEMOLYSIS
UROLITHIASIS
SURGICAL PROCEDURES:
• PYELOLITHOTOMY – RENAL PELVIS
• NEPHROLITHOTOMY
• NEPHRECTOMY
• URETEROLITHOTOMY
• CYSTOLITHOTOMY
UROLITHIASIS
STONE DESTRUCTION:
LITHOTRIPSY
– ULTRASONIC
– ELECTROHYDRAULIC
RENAL TUMORS
• INSIDUOUS & SLOW
• HEMATURIA- EROSION OF PELVIS
• BLADDER TUMOR – RARE
• DIAGNOSIS – CYSTOSCOPY WITH BIOPSY
• TX : SURGERY, IRRADIATION, CHEMOTHERAPY
In the upper pole of this kidney is a well circumscribed tumor which has a
yellowish-brown color and shows central necrosis. This is a renal cell carcinoma.
obstructive disease . In the center of the photograph is the sigmoid colon and rectum of a patient with adenocarcinoma of the rectum. This has invaded the bladder and has occluded the orifices of the ureter on both sides. The right ureter shows extreme hydroureter.
BENIGN PROSTATIC HYPERTROPHY
S/SX:
• INCOMPLETE EMPTYING
• FREQUENCY• INTERMITTENCY• URGENCY
• WEAK STREAM• STRAINING• NOCTURIA• CYSTITIS• HYDRONEPHROSIS• URINARY CALCULI
BENIGN PROSTATIC HYPERTROPHY
DIAGNOSIS:
• DRE : SMOOTH, FIRM & ELASTIC ENLARGEMENT
• IMAGING : IVP OR RENAL UTZ
• PSA - OPTIONAL
BENIGN PROSTATIC HYPERTROPHY
MANAGEMENT:
• MILD SYMPTOMS : – WATCHFUL WAITING + MEDICATIONS
• SURGERY :– PROSTATECTOMY
BENIGN PROSTATIC HYPERTROPHY
MEDICATIONS:
• ALPHA – BLOCKERS – (eg PRAZOSIN)
• 5 ALPHA REDUCTASE INHIBITOR– (eg FINASTERIDE)
T.U.R.P.
TRANSURETHRAL RESECTION OF THE PROSTATE
• MOST COMMON APPROACH
• RESECTOSCOPE PASSED THRU URETHRA
• EXCESSIVE PROSTATIC TISSUE IS CAUTERIZED
• LARGE FOLEY CATH – FOR HEMOSTASIS & URINARY DRAINAGE
T.U.R.P.
PRE OP NURSING CARE:
• EXPLAIN ABOUT CATHETER & OCC DECOMPRESSION DRAINAGE
• INSTRUCT: NO STRAINING WITH VOIDING SENSATIONS
• INSTRUCT: TCDB
T.U.R.P.
POST OP NURSING CARE:
• PREVENT COMPLICATIONS
• URINARY DRAINAGE
• HEALING HEALTH HABITS
• HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
T.U.R.P.
POST OP NURSING CARE:
• PREVENT COMPLICATIONS
• URINARY DRAINAGE
• HEALING HEALTH HABITS
• HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
COMPLICATIONS- T.U.R.P.
HEMORRHAGE
• ARTERIAL BLEEDING : BRIGHT RED URINE WITH CLOTS
• MONITOR FOR SIGNS OF SHOCK
• VENOUS BLEEDING : NORMAL 48 HRS & 6-8D POST OP
COMPLICATIONS- T.U.R.P
THROMBOSIS & EMBOLISM
• TURNING
• EXERCISE LEG
• ENCOURAGE AMBULATION
COMPLICATIONS- T.U.R.PBLADDER SPASM
• PROPHYLACTIC ANTISPASMODIC
• AMBULATION
• DETERMINE PATENCY OF CATHETER
• IRRIGATE CATHETER AS ORDERED
• FREQUENCY OF SPASM SHOULD DECREASE WITHIN 48H
• AVOID RECTAL PRESSURE – STOOL SOFTENER, INCREASE BULK IN FOOD
T.U.R.P.
POST OP NURSING CARE:
• PREVENT COMPLICATIONS
• URINARY DRAINAGE
• HEALING HEALTH HABITS
• HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
URINARY DRAINAGE
• F 18-16 3-WAY FOLEY CATHETER– HEMOSTASIS– OUTLET OF URINE
• FLUIDS – DILUTE URINE – MINIMIZE INFECTION
• MONITOR IRRIGATING SOLUTION– WATER INTOXICATION IS POSSIBLE
URINARY DRAINAGE• REFER IF NO VOIDING WITHIN 5-6H AFTER
CATHETER REMOVAL
• NORMAL: URGENCY, FREQUENCY & DYSURIA AFTER REMOVAL
• INCONTINENCE : – NOT NORMAL– CAUSED BY BLADDER SPASM
• FLUIDS: 12-14 GLASSES A DAY
• EXERCISE TO STRENGTHEN PERINEAL MUSCLES
T.U.R.P.
POST OP NURSING CARE:
• PREVENT COMPLICATIONS
• URINARY DRAINAGE
• HEALING HEALTH HABITS
• HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
HEALTH HABITS
• ADEQUATE NUTRITION
• PERINEAL APPROACH – HOT SITZ BATH
T.U.R.P.
POST OP NURSING CARE:
• PREVENT COMPLICATIONS
• URINARY DRAINAGE• HEALING HEALTH HABITS
• HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
ADJUSTING TO CHANGES IN SELF-CONCEPT
• POSSIBILITY OF PERMANENT/ TEMPORARY INTERFERENCE IN SEXUAL FXN
• STERILITY WITH SEVERING OF VAS DEFERENS
• CLOUDY URINE :T– EMPORARY RETROGRADE EJACULATION
FROM DAMAGE TO INTERNAL SPHINCTER
DISCHARGE INSTRUCTIONS
• MGH – IF ABLE TO EMPTY BLADDER SPONTANEOUSLY
• NO HEAVY LIFTING 6 WKS POST OP
• NO SEXUAL INTERCOURSE – 6 WKS POST OP
• HEMATURIA WITH VENOUS BLOOD IS NORMAL
• REPORT BRIGHT RED BLEEDING & DYSURIA
This is an opened urinary bladder and prostate below
The hyperplastic prostate gland has obliterated the lower part of the cystic cavity. There is hemorrhagic cystitis and prominent trabeculae in the hypertrophied bladder.
This is another enlarged prostate gland, but it does not show the sharply defined
capsule that you saw in hyperplasia of the prostate. This is adenocarcinoma of the
prostate gland which is invading the
pelvic tissue.
• A client who is in acute renal failure develops pulmonary edema. Nursing interventions for this person should include all of the following, except:
a. Oxygenb. Coughing & deep breathingc. Semi-fowler’s positiond. Replacing lost fluids