CoC for Patients With Urinary Problems & Renal Calculi Flashcards
- Urine formation & excretion of wastes occurs in the nephron
Kidney Physiology
- Urine formation & excretion of wastes
- Regulator of electrolyte & water excretion
- Acid-base balance
- Erythropoietin production
- Renin-Angiotensin BP control
- Vit D conversion to active form
Renal Calculi
- Urolithiasis - stones anywhere in the urinary system
- Renal calculi are usually within the kidneys but can be anywhere in the urinary system
Hydronephrosis/Hydroureter
- Obstructive uropathies occur either when there’s a stricture or a stone that’s blocking the urine flow from the kidney to the bladder & out through the urethra
- If there’s a backup, pt may end up w/hydronephrosis and/or hydroureter
Calculus Formation
- Calcium oxalate
- Calcium phosphate
- Uric acid
- Struvite
- Cystine
Risk Factors
- Dehydration/warm climates
> Dehydration leads to more solutes being circulated & the kidneys have a more difficult time getting rid of them (“solution to pollution is dilution”) - Immobility
- Stasis of urine & infection
- Urine pH
- Supersaturation/crystallization
Renal Calculi Sx’s
- Pain (flank/anxiety)
- Renal colic
- Ureteral colic
- Hematuria [presence of blood in the urine]
- Pyuria (pus in urine [typically from bacterial infection])
- Urgency/frequency
- Infection
- Dec u/o
Diagnostics
- KUB, CT scan, US
- IV urography
- Retrograde pyelography
- Serum chemistry, 24 hr urine, stone analysis
Medical treatment - calcium ___
- Inc hydration
- Reduce dietary ___ - spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, Ovaltine, tea, Worcestershire sauce
- Cellulose phosphate, cholestyramine [reduces high blood cholesterol lvls]
- Calcium lactate, reduce sodium intake
oxalate
oxalate
Medical treatment: calcium ___
- Treat hyperparathyroid disorder
- Treat other stones
- Inc hydration
phosphate
Medical treatment: ___ (NH4MgPO4)
- Antimicrobial agents (! these are usually created in the environment of bacteria)
- Acetohydroxamic acid
- Surgery for staghorn calculi
- Inc hydration
struvite
Medical treatment: ___
- Alkalinize urine w/potassium citrate
- Allopurinol (a xanthine oxidase inhibitor)
- Reduce dietary __ - sardines, herring, mussels, liver, kidney, goose, venison, meat soups, chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
- Inc hydration
uric acid
uric acid
Medical treatment: ___
- Inc hydration
- Penicillamine
- Tiopronin
- Potassium citrate to maintain alkaline urine
cystine
Treatments
Ureteroscopy
Extracorporeal shock wave lithotripsy
Percutaneous nephrolithotomy
Complications
! Obstruction (stone/edema/clot)
! Infection (UTI/pyelonephritis/urosepsis)
! Hemorrhage
Nursing Interventions & Patient Teaching
- Pain assessment & management
- Straining all urine
- Monitor hematuria, u/o, VS
- S/S of infection
Patient Teaching
- Rx teaching as needed
- Periodic urine C&S
- Urine pH monitoring
Bladder Cancer - Risk Factors
- Smoking
- Environmental carcinogen exposure
- Recurrent bacterial infections, bladder stones
- High urinary pH
- High cholesterol intake
- Pelvic radiation therapy
- Cancer from prostate, colon, rectum
1 sign is ?
Bladder Cancer Symptoms
- UTI common complication; frequency, urgency, dysuria
- Change in flow of urine
- Pelvic or back pain
(visible, painless) hematuria
Diagnostics
- Cytology of fresh urine
- CT scan
- Cystoscopy w/bx
- US
Urinary Diversion
Reasons
> Bladder cancer or other pelvic malignancies
> Birth defects, trauma, strictures
> Neurogenic bladder, chronic infection or intractable cystitis
- Used as a last resort for incontinence
Types
- Cutaneous urinary diversion
> ileal conduit
> cutaneous ureterostomy
> vesicostomy
> nephrostomy
- Continent urinary diversion
> Indiana pouch, Kock pouch
> ureterosigmoidostomy
Care of an Ostomy Bag
- Typically lasts 3-5 days before leakage; never tape down a leaking appliance
- Empty >1/3 full to prevent bag from separating from skin
- Cleanse w/sterile saline, skin prep, wick w/gauze on stoma to prevent leak while cleaning, measure wafer to widest section of stoma & create hole 1/8th in or greater
> Apply around stoma, may use karaya powder for skin protection
> Apply bag (if 2 piece) may have cover or corn starch
- Control odor w/ascorbic acid which helps to acidify urine & decrease odor & skin irritation
> Avoid asparagus, cheese, eggs; add a few drops of white vinegar or deodorant into bottom of bag
- If reusable bag, have 2. 1 to wear while the other is being cleaned w/3:1 sol’n of water & white vinegar for 30 min, rinsed w/tepid water & air dried away from direct sunlight
- Sleep w/attachment to drainage bag
Postop Complications
- Peritonitis
- Stoma ischemia & necrosis
- Stoma retraction & separation
> anti-reflux valve appliance
> karaya powder, stoma adhesive, properly fitting wafer - Dec kidney function
Nursing Interventions
- Monitor labs & u/o
- Hourly basis monitoring w/minimum output 30 cc/hr in urine collection system (i.e., Foley); urometer to measure
Preop Nursing Diagnoses
- Anxiety
- Imbalanced nutrition
- Deficient knowledge
Postop Nursing Diagnoses
- Risk for impaired skin integrity
- Acute pain
- Disturbed body image
- Potential for sexual dysfunction
- Deficient knowledge
