surgery of the urinary tract

Question 1

Preoperative management

Answer 1

Ensure adequate fluids and normal electrolytes

May have pain from positioning in OR

Question 2

Postoperative management basics

Answer 2

Urine output - measure and record 1 to 2 hr output
check dressing
note color and consistency; catheter patency
daily weights

Question 3

Postoperative management respiratory status

Answer 3

Nephrectomy flank incision is painful - administer analgesia so patient can participate with turning, coughing, and deep breathing, incentive spiromety, and early/frequent ambulation

Question 4

Postoperative management: abdominal distention

Answer 4

Monitor for paralytic ileus; check bowel sounds

IV fluids then oral fluids when bowel sounds return

Progress to regular diet

Question 5

Urinary diversion

Answer 5

Urine blocked from:

bladder cancer
neurogenic bladder
congenital anomalies
strictures
bladder trauma
chronic bladder inflammation
OR surgery

Question 6

Types of urinary diversion

Answer 6

Cutaneous ureterostomy
-ureters are cut off from bladder and ureteral stoma is made (can anastomose the 2 ureters so you only make one hole)

Ileal conduit
-ureters are implanted into a piece of the ileum that’s been snipped out and an abdominal stoma is made

nephrostomy
-catheter is stuck into pelvis of kidney —> can be temporary or permanent

Question 7

Things to be careful about with an ileal conduit

Answer 7

meticulous skin care

Avoid:

• alkaline encrustations with dermatitis and yeast infections
• product allergies
• shearing effect excoriations

Change appliances

Continent diversion = internal pouch to hold urine

Patient teaching: how and when to catheterize and irrigate