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69 Cards in this Set
- Front
- Back
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obstruction in the lower urinary tract is blockage in 2 |
bladder or urethra |
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s/s obstructed urine flow 7 |
-straining to empty the bladder -feeling that bladder does not empty -hesitency -weak stream -frequency -overflow incontinence -bladder distention |
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bladder stones form in, from 4 |
-may form in bladder or upper urinary tract -Chronic Urinary retention cause LARGE STONE -URINARY STASIS large stones -Immoblity -paraplegia , quadrapalegia |
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s/s bladder stones 5 |
-hematuria -suprapubic pain -difficulty starting urine stream -symptoms of bladder infection -feeling that bladder is not completely empty |
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tests to detect bladder stones 3 for see if and 2 for cause |
-Cystoscopy KUB study -IVP , ultrasound detect bladder stones -blood chemistries & 24 hour urine for calcium & uric acid detect the cause of bladder stones |
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litholapaxy |
-stone-crushing instrument (lithotrite) through transurethral route -small and soft stones -under general anesthesia |
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large stones or non-crushable stones removed |
with suprapubic incision into bladder |
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uric acid stone diet |
-low-purine diet -limit organ meat & sweetbreads, game, gravies, anchovies, herring, mackeral , sardines, scallops -drink 8 oz water hourly or 2 L of fluids daily |
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calcium oxalate stone formation diet |
-adaquete calcium 3 cups milk daily (calcium binds with oxylate) -foods high in oxylate avoided -dark green vegetables, berries, tofu, nuts, chocolate, -reduce sodium to lower urinary calcium level -avoid excess protein intake |
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with bladder stones the nurse notify HCP if 2 |
-gross hematuria -moderate to severe pain not relieved with analgesic or gets worse |
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nurse role when litholapaxy sucessful 4 |
-catheter left in place to keep bladder continously empty for 1-2 days -ABS as ordered -encourage oral fluids to reduce inflammation of bladder mucosa -monitor output and pattern |
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if open removal necessary for large stones or hard nurse role |
-catheter left in place for a week to keep bladder empty and prevent tension on sutures -post op mgmt -same mgnt for suprapubic prostactomy (chap 55) |
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client that had stones needs to drink |
10 glasses of water per day report s/s of infection burning , chills, fever, pain |
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urethral strictures caused by 4 |
-untreated gonorrhea -chronic nongonococcal urethritis -trauma to lower urinary tract or pelvis (childbirth, accident, intercourse , surgical) -can be congenital |
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5 things urethral strictures cause |
-obstructs flow of urine -cause cx in bladder or upper urinary tract -kidney pelves distented w/ backflow of urine -bladder distention -diverticulum of muscular bladder , culture medium for bacteria |
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due to anatomical differences ____ experience urethral strictures more frequently |
men because of the length of urethra |
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urethral stricture can result in acute or chronic |
urinary retention . Which can cause hydronephrosis or hydroureter or both! |
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s/s of urethral strictures 6 |
-slow or decreased force of stream of urine -hesitancy -burning -frequency -nocturia -retention of residual urine in bladder which leads to bladder distention and infection |
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voiding problem with urethral stricture |
-pass more urine after voiding that is malodorous because it is from the diverticulum |
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cystourethrogram show stricture |
-stricture and bladder diverticulum |
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other tests used for stricture 3 |
-IVP, Cystoscopy, retrograde pyelogram |
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tx for urethral strictures |
dilation with Bougies (look like sperm) or Filiforms (straight like needle) sounds, or followers. -very painful although done gently |
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dilation begins with this size for strictures |
6 or 8 F physician increases size during dilation until a 24 F or 26 F can be tolerated . -maybe only 2 treatments needed however more tx may be needed until condition tx surgically or indefinently |
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if dilation for strictures unsussessful |
urethroplasty , surgical repair of the urethra -urine is diverted from the urethra by a cystostomy tube until urethra has been repaired |
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method of surgery for urethral stricture 4 is after stages |
-constricted area resected & mucosal graft taken from bladder insterted to restore continuity of urethra -after surgery client has splinting catheter in urethra that remains until healing has occured -2 stages, urinary diversion at first surgery -2nd stage plastic repair |
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after surgery of urethral stricture 2 |
-urethral catheter remain in place and securely anchored -turning and repositioning requires special attention to prevent excessive tension on urethral catheter |
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Tumors of bladder first sign |
-first sign is bloody urine and the reason to seek medical attention (painless hematuria) |
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most common tumors of the urinary system |
malignent bladder tumors |
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leading cause of bladder cancer |
tobacco use |
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tumors of bladder affect M/W more? |
men |
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environmental and occupational hazards thought to be associated with bladder tumors 8 |
-cigarette smoking & second hand smoke -xposure to dyes, paint, ink, leather or lead -recurrent or chronic bacterial infections of urinary tract -bladder stones -high urinary pH >7.5 -high cholesterol intake >200 -pelvic radiation therapy -cancer from prostate, colon, rectum |
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most common type of bladder tumor |
transitional cell carcinoma develops in the bladder's epithelial lining -papillary or -non papillary |
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papillary bladder tumor lesions
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-superficial and extend outward from the mucosal layer |
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nonpapillary bladder tumors |
-solid growths that grow inward , deep into bladder wall -more likely to metastasize to lymph nodes, liver , lungs & bone |
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2 other types of bladder tumors |
-squamous cell carcinoma -adenocarcinoma |
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besides painless hematuria other early signs of bladder tumor |
-UTI w/ fever, dysuria, urgency & frequency |
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later symptoms of bladder tumor -re: metastases 3 -re:bleeding 2 |
metastasis -pelvic pain -urinary retention -frequency bleeding -SOB, fatigue (symptoms of anemia) |
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Tumor usually seen by (bladder) |
-Cystoscopic exam |
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bladder tumor confirmed |
biopsy |
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shows bladder tumor size and location |
Ultrasound |
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to detect kidney damage from bladder tumor |
-retrograde pyelogram |
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show bladder tumor shawdow or bony metastasis |
compound tomography scan & x-ray of pelvis |
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to determine degree of anemia and evaluate kidney function with bladder tumors |
routine laboratory tests, BUN, Creatinine , urinalysis |
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to see if there are cancer cells in the urine |
urine cytology |
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bladder tumor mestasis has not usually occured if |
-if tumor has not penetrated the muscle wall of the bladder |
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removal of tumor by fulguration -is , about, follow up |
-coagulation with transurethral resectoscope -high incidence of recurrence -cytoscopic exam Q 2-3 months first year -if no recurrence then Q 6 months of rest of life |
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small tumors of bladder can be removed by after wards |
-resection (cutting) -coagulation (fulguration) after topical application of antineoplastic drug by intravesicular injection (catheter) |
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after intravesicular injection antioplastic drug after small bladder tumor removal 2 |
-limit fluids before and after so drug remains concentrated in bladder mucosa for 2 hours -after 2 hours give liberal fluids after client voids to flush drug out |
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drug for intracevesicular injection bladder tumor that causes inflammatory reaction in bladder that destroys malignent cells |
BCG Basillus Calmette-Guerin , live weakened strain of Mycobacterium bovis |
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therapy injection for bladder tumor that injects in bladder or IV , stimulates production of lymphocytes and macrophages that may destroy malignent cells |
Roferon-A interferon alfa-2a |
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involves IV injection of photosensitizing agent that is absorbed in concentration by malignent cells , laser inserted through cytoscope is used to destroy those cells that have a high concentration of the photosensitinzing agent |
photodynamic therapy for bladder tumors |
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this tx done for for clients w/ bladder tumors that have surgery scheduled |
radiation therapy , which reduces the size and extent of the tumor and decreases the risk of metastasis |
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required when bladder tumor has penetrated muscle wall inludes 2 what removed |
cystectomy -surgical removal of the bladder -includes urinary diversion -bladder and lower third of both ureters are removed |
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female radical cystectomy required if parts removed 7 |
-required if tumor has extended past muscle through the bladder wall , removal of : -bladder -lower third of both ureters -uterus -fallopian tubes -ovaries -anterior vaginal wall -urethra |
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male radical cystectomy required if: removal of 4 |
-tumor has extended past muscle to through bladder wall , parts removed : -bladder -lower third of both ureters -prostate -seminal vesicles |
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after cystectomy is performed another procedure |
urine must be diverted to another collecting system through urinary diversion |
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conventional ileal conduit |
-type of cutaneous urinary diversion that requires external ostomy bag -ureters connected to isolated section of terminal bringing to abdominal wall for stoma |
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cutaneous ureterostomy |
cutaneous urinary diversion that requires ostomy bag -brings detached ureter through abdominal wall and attaches it to an opening in the skin |
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vesicostomy |
-cutaneous urinary diversion that requires an ostomy bag -surgeron sutures bladder through the abdominal and bladder walls for urinary drainage |
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nephrostomy |
-cutaneous urinary diversion that requires an ostomy bag -catheter inserted into renal pelves via an incision into the flank or by percutaneous placement into the kidney |
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Indiana pouch |
-type of continent urinary diversion -urine drained w/ catheter into stoma periodically -ureters introduced to segment of ileium and colon w/ stoma |
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Koch pouch |
-continent ileal urinary diversion -ureters to isolated segment of small bowel , ascending colon, or ileocolonic segment w/ valve -urine drained with catheter to stoma |
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male clients Koch pouch modification |
can be atteched one end of pouch to urethra allowing more normal voiding -type of continent urinary diversion |
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ureterosigmoidostomy |
-type of continent urinary diversion -uerters introduced to sigmoid colon allowing urine to flow through the colon and out of the rectum |
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post op period Kock Pouch, Indiana pouch 3 nurse care |
-nurse inspects stoma for bleeding or cyanosis -if ordered irrigate to prevent mucous plugs or blood clots -teach CIC at first Q 1 hour, later Q 4-6 |
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Ileal Conduit nursing care |
-bag over stoma transparent to make assessment easier -uses guaze pads to clean mucous away from stoma -dressing changed when wet or soiled or every day -inspect skin for sign of breakdown -inspect stoma for color, mucous etc each time change dressing bag |
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nurse contact doctor ASAP for stoma 3 and 1 with others 4 |
-excessive bleeding -cyanotic color stoma -seperation of stoma edges from skin -s/s peritonitis abdominal tenderness, distention, fever, severe pain |
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post op period ureterosigmoidostomy |
-catheter inserted in rectum to drain urine continusously -nurse checks color, clarity from catheter Q 1-2 hour -s/s electrolyte imbalance from urine & electrolyte retention -inspects anal & gluteal areas for s/s skin breakdown -catheter removed when peristalsis returns -nurse teaches kegal to improve sphincter control, after controlled teach to void Q 2 hour |
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the nurse tells the client with ureterosigmoidostomy never to have 3 and to check for _____ for the rest of their lives |
-enemas -suppositories -laxatives -observe for signs of electrolyte imbalance and void rectally Q 2 hours |
