Topic 9: Renal & Urethral Surgery & Urinary Diversions

Question 1

Laparoscopic nephrectomy

Answer 1

remove a diseased kidney or obtain a kidney from a living donor for transplant into a person with ESRD

Question 2

Open approach

Answer 2

incision about 6-10 inches is made in flank or abdominal area

Question 3

Pre-op Management renal and urethral surgery

Answer 3

· Ensure adequate fluid intake and normal electrolyte balance
· Tell patient they may have muscle ache after surgery if there is a flank incision

Question 4

Post-op Management renal and urethral surgery

Answer 4

· Measure and record UO every 1-2 hours
· Do not clamp or irrigate catheter without a specific order
· UO should be at least 0.5ml/kg/hr
· Observe color and consistency of urine
· WEIGH patient daily
· Ensure adequate ventilation
· Encourage turning, coughing, deep breathing, may need to give ADEQUATE PAIN MEDICATIONS
· Incentive spirometry every 2 hours while awake
· Early and frequent ambulation
Oral intake is restricted until bowel sounds are present

Question 5

urinary diversion causes

Answer 5

bladder cancer, neurogenic bladder, congenital anomalies, strictures, chronic infections with deteriorating renal function, renal trauma, bladder removal.

Question 6

Three main types of urinary diversion

Answer 6

· Cutaneous ureterostomy
· Ileal conduit
· Nephrostomy

Question 7

Cutaneous Ureterostomy

Answer 7

ureters are excised from bladder and brought through abdominal wall, and stoma is created (somas may be created from both ureters or brought together to make one stoma)

Question 8

Ileal Conduit

Answer 8

ureters are implanted into part of the ileum or colon that has been resected from the intestinal tract. Abdominal stoma is created

Question 9

Nephrostomy

Answer 9

catheter is inserted into pelvis of kidney. Procedure may be done to one or both kidneys and may be temporary or permanent. Often done in advanced disease as palliative procedure

Question 10

Pre-Op Management urinary diversion

Answer 10

· Discuss psychosocial aspects of living with a stoma
· Assess readiness to learn before teaching program

Question 11

Post-Op Management urinary diversion

Answer 11

· Kept NPO and NG tube (may be needed for a few days)
· Tell patient that mucus in the urine is a normal occurrence
· Encourage high fluid intake to “flush” the ileal conduit or continent diversion
· For continent diversion: teach to catheterize at first every few hours, then can be extended to every 4-6 hours
· Irrigate pouch with normal saline or sterile water
· Body image

Question 12

Teaching for Ileal Conduit Appliances: · Temporary Appliance

Answer 12

o Cut hole in pouch to fit over stoma (pouch 0.1 in [0.2cm] larger than stoma)
o Remove old pouch
o Clen area gently and remove old adhesives
o Wash area with warm water
o Place wick (rolled up 4x4 in pad over stoma to keep area dry during rest of procedure
o Dry skin around stoma
o Apply tincture of benzoin or other skin protectant around stoma to area where pouch will be placed
o Apply pouch by first smoothing its edges toward side and lower part of body
o Remove wick and complete application of bag
o If patient is ambulatory, apply bad so it lies vertically
o Connect drainage tubing to pouch
o Keep drainage pouch on same side of bed as the stoma

Question 13

Teaching for Ileal Conduit Appliances: · Permanent Appliance

Answer 13

o Keep appliance in place for 2-14 days
o Change appliance when fluid intake has been restricted for several hours
o Sit or stand in front of mirror
o Moisten edge of faceplate with adhesive solvent and gently remove
o Clean skin with adhesive solvent
o Wash skin with warm water (may be done while showering)
o Dry skin and inspect
o Place wick over stoma to keep skin free from urine
o Apply skin cement to faceplate and skin
o Place appliance over stoma
o Wash removed appliance with soap and lukewarm water, soak in distilled vinegar, rinse with lukewarm water and air dry