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N363: Practice of Nursing IV > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Pyelonephritis

A

Can be acute or chronic inflammation/infection of the renal pelvis

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2
Q

Acute Pyelonephritis s/s

A

chills

fever

leukocytosis

bacteriuria

pyuria

low back pain

flank pain

NV

HA

malaise

painful urination

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3
Q

Chronic Pyelonephritis s/s

A

Usually NO symptoms of infection unless an acute exacerbation occurs

Noticeable signs may include fatigue, HA, poor appetite, polyuria, excessive thirst and weght loss

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4
Q

When is chronic pyelonephritis diagnosed

A

often incidentally when being evaluated for HTN

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5
Q

What to look for on assessment for chronic pyelonephritis

A

poor urine concentrating ability

pyuria

azotemia

proteinuria

anemia

acidosis

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6
Q

Azotemia

A

nitrogenous waste in urine

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7
Q

When do we usually see s/s of pyelonephritis

A

usually only in acute exacerbations not so much chronic

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8
Q

How is the extent of chronic pyelonephritis checked

A

usually by IV urogram and lab work (lab work includes creatinine clearance, BUN,, and creatinine levels)

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9
Q

What is an important vital to check whenver a kidney issue is expected

A

Blood pressure - it is an important function of the kidneys

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10
Q

Common Nursing Dx for pyelnoephritis

A

1 PAIN

Infection

Alterations in voiding patterns

Knowledge deficits r/t lack of understanding of tests and procedures

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11
Q

Goals with Pyelonephritis

A

Pain reduction

Medication compliance

proper hygiene

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12
Q

Patient education on pyelonephritis is focused on ___.

A

prevention

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13
Q

Interventions for Pyelonephritis

A

Monitor VS, I&O, and Weight

Encourage fluids up to 3000 mL a day

Encourage adequate rest

Instruct on high calorie low protein diet

warm moist compresses to flank area

encourage warm baths (this one can cause infection though)

administer antibiotics analgesics antipyretics urinary antseptics and antiemetics as prescribed

monitor for signs of renal failure

education

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14
Q

How much fluid should be given a day to dilute urine in pyelonephritis

A

3-4 L / 3000mL-4000mL

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15
Q

What is an important sign of concerning I&O changes

A

increases or decreases in weight

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16
Q

Education topics for pyelonephritis

A

prevent further infection by adequate fluid consumption and regular bladder emptying, perineal hygiene and taking meds as prescribed

keep follow up appointments

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17
Q

Chronic Kidney Disease

A

Umbrella term to describe kidney damage or a decrease in the glomerular filtration rate for 3+ months

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18
Q

Untreated CKD can result in…

A

ESRD and a need for kidney transplant or dialysis

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19
Q

Risk Factors for CKD

A

Primary Cause: Diabetes

HTN

CV Disease

Obesity

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20
Q

What is different between Acute Kidney Injury and CKD

A

Acute Kidney injury is one time and reversible if you ID and treat promptly before it damages the function of the kidneys

CKD is 3+ months of this and the kidneys may progress to CRF

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21
Q

Stages of Chronic Renal Failure (CRF)

A

Stage 1: Slight Damage

  1. Mild Decrease in Fxn
  2. Moderate Decrease
  3. Severe Decrease
  4. ESRD
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22
Q

What is the double sided issues with the gerontologic risk factors for renal disease

A

while they increase CKD incidence they also mask th s/s of it and make it harder to diagnose

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23
Q

Why do diuretics need to be monitored carefully when given to elderly

A

We need to assess for dehydration that can further compromise renal function and contribute further to renal failure

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24
Q

Conservative Gerontological management of CKD includes

A

nutritional therapy

fluid control

phosphate binders

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25
Q

Why are blood transfusions administered during dialysis

A

so excess K+ can be removed

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26
Q

When is peritoneal dialysis appropriate

A

for patients who cannot tolerate hemodialysis or have severe HTN, HF, and pulmonary edema that does not respond to hemodialysis

may be tx of choice for those unwilling or unable to go to hemodialysis

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27
Q

Peritoneal Dialysis Procedure

A

sterile dialysate is introduced into the peritoneal cavity through an abdominal catheter at intervals

waste products move from an area of higher concentration (blood) to an area of lower concentration (dialysate) through a semi permeable membrane (peritoneum)

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28
Q

How much longer is peritoneal dialysis

A

pretty continuous - does what hemodialysis does in 6-8 hours over 36-48 hours

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29
Q

Types of Peritoneal Dialysis

A

Acute Intermittent Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis

Continuous Cyclic Peritoneal Dialysis

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30
Q

Acute Intermittent Peritoneal Dialysis

A

A nurse warms, spikes, and hangs each container of dialysate

Requires strict asepsis

If dialysate does not drain right, nurse will facilitate draining by turning patient from side to side or raising the head of the bed - NEVER push the catheter further into the peritoneal cavity

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31
Q

Common routine for acute intermittent peritoneal dialysis

A

hourly exchanges that involve 10 minute infusion, 30 minute dwell time and 20 minute drain time

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32
Q

Impotant assessments to be done with acute intermittent peritoneal dialysis

A

I&O

VS

Weight

Patient status

Skin turgor and mucous membranes to evaluate fluid status

presence of edema check

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33
Q

Continuous Ambulatory Dialysis (CAP)

A

2nd most common form

performed at home 4-5 times a day every day

Longer dwell time –> better results

managed by the patient or a trained caregiver

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34
Q

Continuous Cyclic Peritoneal Dialysis

A

uses a cycler machine and combines overnight intermitted PD with a prolonged dwell time during the day

lower infection rates since fewer bag changes and tubing disconnections occur

greater freedom to work

May need home visits by nurse or f/u calls or visits to outpatient settings to make sure dialysate is ok and BP is monitored carefully

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35
Q

Renal Calculi Cause what pain

A

RENAL COLIC - originating in lumbar region radiating around the side and down toward the testicle in mean and to the bladder in women

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36
Q

Ureteral Calculi cause what pain

A

UTERAL COLIC radiates toward the genitalia and thigh

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37
Q

s/s of Urinary Stone Disease

A

renal or ureteral colic

sharp severe sudden onset pain

dull aching kidneys

NV, pallor, diaphoresis during acute pain

urinary frequency with alternating retention

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38
Q

Signs of a UTI during Urinary Stone Disease

A

low grade fever

RBCs and WBCs and Bacteria in Urinalysis

Hematuria

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39
Q

Nursing Dx for Urinary Stone Disease

A

Pain - #1 until cause is eliminated

Risk for INfection

risk for inadequate renal function

Nutrition, risk for…

Patient specific dx

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40
Q

Nursing Goals with Urinary Stone Disease

A

relieve pain of renal colic

eradicate stone

determine stone type

prevent nephron destruction

control infection

relieve obstruction

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41
Q

Nursing interventions for Urinary Stone Disease

A

Monitor VS, I&O

Assess fever, chills, infection and Monitor for NVD

Force fluids to facilitate stone passage and prevent infection

Strain all urine and send stones for lab analysis

Provide warm baths and heat to flank area

Administer analgesics regularly to relieve pain and assess response to pain meds

Relaxation techniques to assist pain relief

Diet education based on stone composition

Maintain urinary pH depending on stone type

Turn and reposition

prep for surgeyr if needed

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42
Q

How many fluids sould be forced a day with urinary stones

A

3000 mL/ 3 L

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43
Q

What is the biggest concern with urinary stone disease regarding nursing dx

A

The pain

it can be so excruciating nothing seems to relieve it

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44
Q

If a patient has an Alkalytic Stone/Urine what diet should we discuss with them?

A

Acid Ash Diet

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45
Q

If a patient has an Acidic Stone/Urine what diet should we discuss with them?

A

Alkaline Ash Diet

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46
Q

Acid Ash Diet

A

Drops pH

Cranberries
Plums
Grapes
Prunes
tomatoes
Eggs
Cheese
Whole Grain
Meat and Poultry

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47
Q

Alkaline Ash Diet

A

Raises pH

Legumes
Milk and Milk Product
Green Vegis
rhubarb

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48
Q

Calcium Stones

A

formed from high levels of calcium so avoid high calcium foods

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49
Q

What is the confusing recommendation regarding calcium stones

A

new research says avoiding calcium can be bad due to low bone density and osteoporosis and may not really change stone results much so its best to have a little calcium in the diet rather than non

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50
Q

High Calcium Foods

A

Milk and other dairy products

beans

lentils

dried fruits

flour

chocolate

cocoa

canned and smoked fish (NOT TUNA)

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51
Q

High Oxalate Foods to avoid when you have an oxalate stone

A

asparagus

beets

celery

cabbage

nuts

tea

fruits

tomatoes

green beans

chocolate

beer

colar

dark green leafy vegis

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52
Q

High Purine Foods to avoid when you have a purine stone (uracid stone)

A

organ meets

sardines

herring

venison

goose

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53
Q

What can cause increases in calcium and uric acid and lead to stones that you should discuss with the patient about decreasing

A

high protein and sodium diets

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54
Q

Stones that are how big usually are easier to pass

A

6 mm or less

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55
Q

Why is forcing fluids not going to help with ureteral stones and higher

A

because there is not enoguh peristalsis occurring for it to pass

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56
Q

Nephrostomy

A

A tube is placed to dilateand allow the stone and urine to come through

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57
Q

Urinary Diversion

A

a surgical procedure that diverst urine from the bladder into an exit site

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58
Q

Reasons for Doing a Urinary Diversion

A

Bladder cancer or other pelvic malignancies

birth defects

strictures

neurogenic bladder

chronic infection/intractable cystitis

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59
Q

What is the last resort for incontinence

A

urinary diversion

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60
Q

What are the3 types of urinary diversion

A

Indiana Pouch

Kock Pouch

Ureterosigmoidostomy

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61
Q

Nephrotic Syndrome

A

glomerular disease characterized by proteinuria, hypoalbuminemia, diffuse edema, high serum cholesterol, hyperlipidemia

basically any condition that seriously damages the glomerular membrane and increases the permeability to plasma proteins

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62
Q

Etiology of Nephrotic Syndrome

A

any renal condition that damages glomerular capillary membrane

salt and water retention contribute to edema

thromboemboli are common

prognosis is poor (<50% experience complete remission adn at least 30% develop ESRF)

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63
Q

Assessment for Nephrotic Syndrome

A

severe generalized edema - results in edema which is usually dependent edema (hands, feet, and sacrum)

symptoms of renal failure

loss of appetite and fatigue

may also see ascites

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64
Q

Potential Causes for Nephrotic Syndrome

A

Glomerular Nephritis

Diabetes

Lupus

Multiple Myeloma

Renal Vein Thrombosis

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65
Q

Therapeutic Management for Nephrotic Syndrome

A

Non specific but therapeutic management for RF, edema, etc

Med management and diet therapy

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66
Q

What is unique about nephrotic syndrome compared to other renal issues

A

because of the increase plasma protein permeability with this specific sydrome you have to talk to them about INCREASING PROTEINS IN THE DIET

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67
Q

Nursing Dx for Nephrotic Syndrome

A

Fluid overload

Fatigue

Insufficent Ability to Perform Usual Roles

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68
Q

Planning and Interventions for Nephrotic Syndrome

A

control edema

high protein diet

administer drug therapy as prescribed

bedrest

monitor laboratory and diagnostic tests

observe for s/s of pulmonary edema

I/O and weight

fluid restriction

immune system depression increase risk of infection

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69
Q

Client Education Topics for Nephrotic Syndrome

A

efforts to maintain general health

avoid infection

nutritious diet

medications

knowledge of renal function

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70
Q

Potential Complications due to Nephrotic Syndrome

A

Infection - deficient immune response

Thromboembolism - in renal vein

Could cause acute renal failure (d/t hypovolemia associated with nephrotic syndrome)

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71
Q

Structures of the Renal System

A

Kidneys and Nephrons x2

Ureters x2

Bladder

Urethra

Male Prostate

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72
Q

Nephrons ____

A

filter

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73
Q

Are the left and right kidneys perfectly symmetrical?

A

No, the left kidney is higher than the right one because of the location of the liver

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74
Q

As a risk factor, childhood diseases can lead to what possible renal/urologic disorder

A

chronic kidney disease

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75
Q

As a risk factor, advanced age can lead to what possible renal/urologic disorder

A

incomplete bladder emptying, etc

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76
Q

As a risk factor, cystoscopy or catheterization can lead to what possible renal/urologic disorder

A

UTI or incontinence

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77
Q

As a risk factor, immobilization can lead to what possible renal/kidney disorder

A

kidney stone formation

78
Q

As a risk factor, diabetes can lead to what possible renal/urologic disorder

A

Chronic Kidney Disease (CKD)

Neurogenic Bladder

79
Q

As a risk factor, HTN can lead to what possible renal/urologic disorder

A

renal insufficiency

CRF

80
Q

As a risk factor, multiple sclerosis can lead to what renal/urologic disorder

A

incontinence

neruogenic bladder

81
Q

As a risk factor, Parkinsons Disease can lead to what renal/urologic disorder

A

incontinence

82
Q

As a risk factor, Gout, Chrohns, and Hyperparathyroidism can lead to what renal/urologic disorder

A

Kidney stones

83
Q

As a risk factor, BPH can lead to what renal/urologic disorder

A

obstruction

84
Q

What information should be taken upon reanl/urologic assessment in the health history

A

Chief Complaint

Pain (Reason, pattern, intensity, what makes it worse or better etc)

Past health history (hx of UTi, tests, renal angiograms, caths, STDs, etc)

Family Hx

Social Hx (Habits and behaviors)

Voiding Patterns (when is normal, how much, smell, at night a lot?)

Medications (What is taken, what may affect UO/micturation/renal toxicity)

85
Q

What is an important bit of information to teach elderly patients about their renal function

A

to drink plenty of water everyday even if they are not thirsty as it is good for their renal function

86
Q

When is a lot of renal/urologic issues and diagnoses found

A

they tend to be found when clients are seeking care for other symptoms like for a cold

87
Q

Urinary Frequency

A

voiding more than every 3 hours

88
Q

Urinary Urgency

A

Having a strong desire to void

89
Q

Dysuria

A

Painful urination

90
Q

Urinary Hesitancy

A

delay in initiation

91
Q

Nocturia

A

excessive urination at nightr

92
Q

Incontinence

A

Involuntary loss of urine

93
Q

Enuresis

A

Bed wetting

94
Q

Polyuria

A

increased volume of urine

95
Q

Oliguria

A

UO less than 500 mL a day

96
Q

Anuria

A

Less than 50 mL of UO a day

97
Q

When are oliguria and anuria most common

A

chronic renal failure

98
Q

Hematuria

A

RBC in urine

99
Q

Proteinuria

A

Protein in urine (should not be there)

100
Q

The most accurate indicator of fluid loss or gain in patients who are acutely ill is ___

A

weight

101
Q

Areas of Emphasis for the Renal/Urologic Physical Exam

A

Abdomen
Suprapubic Region
Genitalia
Lower Back
Lower Extremities

KIDNEYS - Not always palpable

Bladder percussion

Areas of Edema

Checking DTRs and Gait

102
Q

Renal dysfunction may produce tenderness…

A

at the CVA (can very rarely palpate the kidney here too)

103
Q

Why are DTRs and Gait checked with renal physical exams

A

Because the peripheral nerve innervating the bladder also innervates the lower extremities

104
Q

It is important to document ____ and ____ of urine

A

color and amount

105
Q

What are some urinary diagnostic tests commonly seen

A

Urinalysis and Urine Culture

Renal Fxn Tests: Specific Gravity and 24 hour Urine Test

Serum Tests: Creatinine, BUN, BUN:Creatinine

Biopsy

106
Q

Another name for 24 hour urine test is…

A

creatinine clearance test

107
Q

What is normal urine specific gravity

A

1.010 - 1.025

108
Q

Urine C&S is often used for suspected ___

A

UTIs

109
Q

Normal BUN:Creatinien ratio

A

10:1

110
Q

What is the process of urine collection/clean catch (midstream)

A
  1. Nurse has pt wash genitals and perineal area prior w/ soap and water
  2. Males: Void directly into container; Females - Hold container between legs
  3. Begin voiding, then place specimen container in stream of urine and collect 30-60 mL
111
Q

How should males clean their genitals prior to a clean catch

A

clean the meatus and head of penis with a circular motion

Use each towelette (3 total) once

112
Q

How should females clean their genitals prior to a clean catch

A

front to back

use each towelette (3 total) once

113
Q

What is the gold standard of urine collection for determining renal fxn

A

24 hour urine collection

114
Q

How does a 24 hour urine collection work

A

A special orange speciment container with a preservative is obtained from the lab in order to collect urine (unless the pt has an indwelling catheter)

Signs are posted in the client room, chat, and bathroom regarding all urine needing to be collected in the next 24 hours

Client will void and discard the first urination at the start of the 24 hour period and then begin collecting everything after that

Once 24 hours is up container is put on ice and the client should void one last time to collect that urine before being sent to the lab

115
Q

Urinary Retention

A

Inadequate bladder emptying disorder

Residual urine stays in the bladder after voiding and can result in overflow incontinence

116
Q

Results of Urinary Retention

A

Overflow Incontinence

Urinary Stasis –> Bacterial Growth –> Infection/Stones

117
Q

If urinary retention is left untreated what will happen

A

A UTI will begin or possible stone formation

118
Q

S/Sx of Urinary Retention

A

Difficulty starting to urinate

Difficulty fully emptying the bladder

Weak dribble/stream of urine

Leaking throughout the day

Inability to feel when the bladder is full

Lack of urge to urinate

Increased abdominal pressure

119
Q

Interventions for Urinary Retention

A

Privacy

Warm Sitz Bath

Normal Standing or Sitting Position to Void

Faucets and Warm Water

Bedside Commode or Toilet

Analgesia after surgical interventions

Catheterizations

Establish normal voiding and evaluate outcomes

120
Q

Urinary Incontinence

A

Involuntary loss of urine caused by functional issues, neurogenic issues, etc

121
Q

What are the 5 main types of incontinence

A

Stress

Urge

Functional

Iatrogenic

Mixed

122
Q

Stress Incontinence

A

Involuntary loss of urine as a result of sneezing, coughing, laughing, multiple child births

123
Q

Urge Incontinence

A

Involuntary loss of urine alongside a strong urge to void that cannot be suppressed

Need to void but cannot reach the toilet in time

124
Q

Functional Incontinence

A

Instances in which lower urinary function is intact but other factors (cognition) make it difficult

125
Q

Iatrogenic Incontinence

A

Involuntary loss of urine d/t extrinsic factors and medical factors -

Primarily medications

126
Q

Mixed Incontinence

A

Empasses several types of urinary incontinence, is involuntary leakage associated with urgency and also exertion, sneeze, or cough

127
Q

Urinary Tract Infections

A

Infections of the urinary tract that can be acute, chronic, uncomplicated, complicated, lower or upper

128
Q

Examples of lower UTIs

A

Cystitis

Urethritis

Prostatitis

129
Q

Examples of Upper UTIs

A

pyelonephritis

interstitial nephritis

renal abscesses

130
Q

Cystitis

A

lower UTI of the bladder

131
Q

Urethritis

A

lower UTI of the urethra

132
Q

Prostatitis

A

lower UTI of the prostate gland

133
Q

Pyelonephritis

A

Inflammation of the renal pelvis

Upper UTI

134
Q

Interstitial Nephritis

A

Inflammation of the kidney

Upper UTI

135
Q

Clinical Manifestatiosn of Uncomplicated UTIs

A

Burning on urination

Frequency, urgency, nocturia, incontinence

Suprapubic or pelvic pain

Hematuria and back pain

136
Q

Clinical manifestations of complicated UTIs

A

can range from asymptomatic to Gram Negative sepsis with chock (aka urosepsis)

have a lower response rate to treatment

tend to reoccur

137
Q

Major Goal for UTIs

A

Controlling Pain

Teach and educate patients and make sure they know when to come to the hospital

138
Q

What are some potential complications from UTIs

A

Urosepsis

Acute kidney injury and/or chronic kidney disease

139
Q

Risk Factors for UTIs

A

Female Gender
Diabetes
Pregnancy
Neurologic Disorders
Gout
Altered States caused by incomplete emptying of the bladder and urinary stasis

Decreased natural host defenses or immunosuppression

Inability or failure to empty the bladder completely

Inflammation or abrasion of the urethral mucosa

Instrumentation of the urinary tract (cath, cytoscopic, procedure)

Obstructed Urinary flow from:
congenital abnormalities, urethral strictures, contractures of bladder neck, bladder tumors, calculi, and compression of ureters

140
Q

Why are females more likely to get a UTI

A

they have a shorter urethra/anatomy

141
Q

What are some area of education to provide the patient to prevent recurrent UTI

A

Hygiene - showering rather than bathing, cleaning area front to back each bowel movement

Fluid intake - flush the system and bacteria

Voiding habits - every 2-3 hours to prevent bacteria buildup

Absorbic acid or other treatments as prescribed like probiotics

142
Q

Urosepsis

A

Gram negative bacteremia originating in urinary tract

It is an infection from the urinary tract spreading into the blood leading to systemic infection

143
Q

The most common organism cause of Urosepsis is ___

A

E. Coli

144
Q

the most common cause of urosepsis is

A

Presence of indwelling catheter or untreated UTI in medically compromised patients

145
Q

What is the 2 major problems regarding urosepsis

A
  1. Bacterium ability to develop resistant straints
  2. Urosepsis can lead to septic shock if not treated aggressively
146
Q

The most common s/sx of urosepsis are

A

FEVER - most common and earliest

Perfuse/Sweat more than normal

Different Vitals

C&S Results from Urine

147
Q

Interventions for urosepsis are done…

A

after the culture and sensitivity

148
Q

Interventions for Urosepsis

A

Administer IV antibiotics as prescribed - usually until afebrile for 3-5 days

Use of oral antibiotics

Secure, smallest, and aseptic catheterization only when needed

Great perineal care

149
Q

Bacteriuria increases with ___ and ___

A

age and disability

150
Q

What is the most common cause of bacterial sepsis in those 65+

A

UTIs

151
Q

What is the mortality rate like for older patients with UTIs

A

> 50%

152
Q

S/S of UTI in Older Populations

A

Fatigue (most common and subjective complaint in this gorup)

Altered confusion, cognition

153
Q

Factors that contribute to UTIs in older adults

A

cognitive impairment

frequent use of antimicrobial agents

high incidence of multiple chronic medical conditions

immunocompromise

immobility and incomplete bladder emptying

obstructed flow of urine

indwelling catheters

154
Q

Clinical Manifestations of Cystitis

A

R/t actual inflammatory response

Frequency, urgency, and voiding in small amounts

Burning upon urination and inability to void

incomplete bladder emptying and spasm

lower abdominal or back discomfort

cloudy, dark foul smelling urine

hematuria

malaise, chills, fever, n/v

nocturia

incontinence

suprapubic, pelvic, or back pain

confudion in older populations

155
Q

What does hematuria indicate in cystitis

A

infection and inflammation spreading up toward the kidneys (also cloudy dark foul smelling urine)

156
Q

Education for Cystitis Patient

A

Pharmacological Therapy

Prevent recurrence

Deficient knowledge gaps

157
Q

Interventions for Cystitits

A

Collect urine for C&S - ID bacteria

Instruct to force fluids - especially if taking a sulfonamide

Use strict aseptic technique when inserting a urinary catheter and provide meticulous perineal care

Maintain closed urinary drainage systems for clients with indwelling catheters

administer prescribed meds

education

158
Q

How many fluids should be forced a day for cystitis

A

3000 mL/day or 10 oz/hr x 10 hour

159
Q

Why is it particularly important to force fluids if a patient is on a sulfonamide (Bactrim)

A

They can form crystals in concentrated urine

160
Q

Education Points for Cystitis

A

acid ash diet - discourage caffeine products and avoid alcohol

heat to abdomen or sitz bath for c/o discomfort

avoid bubble baths and perfumed hygiene products

avoid tight fitting clothing and nylon undergarments

follow up urine culture following treatment

Medications (Analgesic, antiseptic, antispasmodic, antibiotic, antimicrobial)

161
Q

What is the msot frequent cause of Urethritis in men

A

gonorrhea and chlamydia

162
Q

What is the most frequent cause of Urethritis in women

A

feminine hygiene sprays

perfumed toilet paper and sanitary napkins

spermicidal jellies

UTIs and change in vaginal mucosa lining

163
Q

BPH - Benign Prostatic Hyperplasia

A

hyperplastic process - increased number of cells - of the prostate gland in men

a NON CANCEROUS enlargement

164
Q

The most common disease or condition in aging men is…

A

BPH (51% of men have it with no clear cause known)

165
Q

S/S of BPH

A

frequency

urgency

nocturia

difficulty initiating

when they do have a stream feels like nothing empties fully - hard to fully empty

dribbling

person QOL decrease

sleep patterns change

166
Q

Complications from BPH

A

Stasis

Retention

UTI

Obstruction

167
Q

Treament for BPH is tailored toward…

A

improving patient QOL - we want to make sure we improve urine output, relieve obstruction, and prevent further progression of the disease

168
Q

Treatments for BPH

A

encouraging fluids

catheterization in severe PH (or urology has to do it if its too large and needs a metal cath)

medications - PROSCAR + Hytrin/Cardua/Flomax (Proscar shrinks gland)

Surgery

169
Q

Which prostate surgical procedure requires no incisions

A

TURP - Transurethral resection

(Technically ablation too)

170
Q

Transurethral Resection (TURP)

A

Prostatic tissue is removed through the urethra by optical instruments

Used for glands of various sizes and ideal for those who are at surgical risk

171
Q

Advantages of TURP

A

avoids abdominal incision

safer for surgical risk pateints

shorter length of stay in hospital and recovery periods

lower morbidity rates

causes less pain

can be used as a palliative approach with hx of radiation therapy

172
Q

Disadvantages of TURP

A

requires a highly skilled surgeon

recurrent obstruction, urethral trauma, and strictures can develop

delayed bleeding can occur

173
Q

Important Nursing Consideration Post Op with TURP

A

monitor for hemorrhage

observe for symptoms or urethral stricture such as dysuria, straining, weak urinary stream

CBI - cont. bladder irradiation

give antispasmodics

174
Q

Nursing Interventions Post TURP

A

Assess for bleeding

Assess and treat pain

Infection

DVT Prevention/prophylaxis - get them walking ASAP

Obstruction monitoring

Antispasmodics as prescribed

Teach exercises for sphincter control

Continuous Bladder Irrigation (CBI)

175
Q

What bleeding may be normal at first following TURP

A

Bleeding should be red/pink for 24 hours after and then turn a more tea like color

but if color remains bright red or has clots in it, then it is abnormal bleeding and indicates arterial bleeding - contact the provider

176
Q

Continuous Bladder Irrigation

A

a 3 way (lumen) irrigation system to decrease bleeding and keep the bladder free from clots

Its a bag putting fluid into the stomach and it continuously allows bladder irrigation to prevent clot buildup and keep things moving

177
Q

What is one major potential complication that can occur from CBI

A

TURP Syndrome

178
Q

TURP Syndrome

A

A syndrome caused by CBI caused by neurologic, lyte, and cardiac imbalance from too much absorption of the irrigated fluid

179
Q

S/S of TURP Syndrome

A

HTN

NV

Confusion

Cardiac Issues

180
Q

What should be done if you suspect TURP syndrome

A

stop CBI and let the provider know

181
Q

What are the 3 lumens on CBI used for

A

1 is for inflating a balloon (30 mL) to hold it in place

1 is for outflow

and 1 is for instillation (inflow)

182
Q

How much fluid should be given to Post Op TURP Patients

A

2400-3000 mL/d if possible

183
Q

When can you begin ambulating a post op TURP patient

A

ASAP - so as soon as the urine is more clear (not when pink/red)

184
Q

What does ARTERIAL bleeding appear like post TURP and what should be done if this occurs

A

bright red urine with numerous clots –> If this occurs increase CBI and notify physicial immediately

185
Q

What does VENOUS bleeding appear like Post TURP and what should be done if this occurs

A

burgundy colored UO –> If this occurs inform MD who may apply traction on catheter

186
Q

Important rule to CBI

A

What is put in must come out - so what is instilled better be in bag outflow or else something is wrong like tube kinking, urinary retention etc which can cause over distention leading to secondary hemorrhage

187
Q

Catheter Traction

A

Maintaining tautness to the catheter (straight leg not bent) taped to the abd/thigh which is done by the MD

Never released without MD order - usually after bright red/burgundy colored drainage diminished

Important to Post TURP Care

188
Q

What should be run through the CBI

A

Normal Saline (or glycine) to prevent water intoxication

189
Q

At what rate should CBI be run

A

at a rate to keep the urine pink

If bright red or has clots than run it faster (40 gtt/minute once bright red clears)

190
Q

What should be done if the CBI catheter is obstructed

A

Turn off CBI, irrigate catheter with 30-50 mL NS and notify MD if obstruction is unresolved

191
Q

What two things are important to watch for when using CBI / post TURP

A

Turp Syndrome

Severe Hyponatremia (Water intoxication)

(Both caused by excessive CBI absorption)

192
Q

Important TURP Post Op Care Considerations

A

Expect red-light pink urine 24 hours - then amber for 3 days

Continuous feelings of urge to void is normal

Avoid attempts to void around catheter - causes bladder spasms

Antibitoics, Analgesics, Stool Softeners, and AntiSpasmodics as prescriped

Monitor 3 way foley cath: 30-45 mL retention balloon

Maintain CBI with NS

Educate on post op diet, s/s to watch for

Control pain

Stress importance of doctor follow up

N363: Practice of Nursing IV (16 decks)

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