Urinary obstruction Flashcards
stones more common in
males. more common in southeast in summer, hot climates. diet - sodium intake, and high protein. can be heredity and if you have one stone, more likely to have more.
80% of stones are
calcium
most common place for stones - elvis
ureter pelvic junction - this is a post-renal obstruction.
upper ureteral stones - renal pelvis - symptoms (just 2 things)
flank pain. deep backache (costovertebral angle), hematuria
lower stones -ureter (low on colick) and where does it radiate?
genital pain. cute, colicky, wavelike, radiates to thigh & genitalia
Bladder stone symptoms - do you pee? (something is blocking it)
Bladder- retention, irritation similar to UTI
caculi assessment - assess for fluid what?
Pain
N, V, D, and abdominal distention
Assess for UTI
Assess for obstruction
POCT for hematuria
Strain urine for stones or gravel
Assess for signs of FVE because we give the patient so much fluid to flush the stone
caculi diagnostics - (cutie calculi)
Non contrast CT
Serum chemistry panel
Diet and medication history
Family history
lithotripsy - how big?
less than 2 mm small in urethra or pelvis, can’t use for bleeding disorders or pregnant women
complications of untreated stones (just 3 things)
pylonephritis, urosepsis, and irrerversible renal damage. check BUN and creatinine. can also use a renal stent. neprhostomy tube goes in the back, right into the kidneys.
patient education
Signs and symptoms to report - increasing SOB, new blood, hydration, diet,
Follow-up care
Urine pH monitoring
Measures to prevent recurrent stones
Importance of fluid intake
Dietary education
Medication education as needed
Ureteral trauma - causes (my urethra was damaged playing sports on my motorcycle and fell)
Ureteral: motor vehicle accidents, sport injuries, falls
Bladder trauma - causes - think pelvis
Bladder: pelvic fracture, multiple trauma, blow to lower abdomen
any time pt has blunt trauma/genital urinary trauma, we do a
bladder scan and abdominal CT. age has nothing to do with it.
genitourinary trauma management - bleeding? and monitor for what?
Medical management: control hemorrhage, pain and infection; monitor for oliguria, shock, s/s acute peritonitis (inflammation of abdomen)
Surgical management: suprapubic catheter, surgical repair
Nursing management for urinary trauma
Nursing management:
Assess frequently
Instruction about incision care and adequate fluid intake
Changes to report: fever, hematuria, flank pain
90% of men over the age of 80 have
BPH
prostate location
goes around the urethra
high protein and fat may cause an (not stones)
enlarged prostate
symptoms of BPH (Ted is hesitant and in pain)
Symptoms depend on severity: dysuria, hesitancy
complications of BPH (think holding it in too long)
acute urinary rentention, UTI, bladder stones, bladder damage, kidney damage.
medications for BPH (ted tries to be an alpha)
Alpha-adrenergic blockers (side effects headache, hypotension) (end in sin)
Measures to reduce pain and spasms
Catheter for acute condition; unable to void
TURP (ted is a turp)
trans-uretheral resection of prostate - most common surgery for BPH. basically removing the entire inner prostate.
bladder cancer - more common after what age?
More common after age 55 years
Leading cause of death
Smoking increases risk 50%
most common sign or symptom of bladder cancer
visible painless hematuria; pelvic or back pain palpation during exams
how common is bladder cancer?
4th most common men, 8th for women
surgical treatment for bladder cancer (jean was a turp w/ tb)
Transurethral resection (TURP for bladder) or fulguration (electricity to kill unhealthy cells)
Followed by bacille Calmette–Guérin (BCG) treatment
Cystectomy (remove bladder)
Urinary diversion
how often to monitor urine output after surgery?
every hour
nursing care after surgery
stoma and skin care, test urine, encourage fluids, education about ostomy
most ostomies involve
bladder and urethra
continent diversion (the bowel is a continent)
using part of bowels to create a bladder
continent
can manage flow of urine without external devices
ileal conduit (Ileana drains bc shes not a contintent)
Ileal conduit – used after bladder removal where the ureters are re-routed and drain freely into part of the ileum. Needs an external bag. non-continent, can be perm or temp. most common.
main nursing diagnosis for pre-op
imbalanced nutrition
post-op ostomy - nursing diagnosis
risk for impaired skin integrity, acute pain, disturbed body image, sexual dysfunction.
won’t be tested on
diversions
urinary stoma
more a pale pink, and they are smaller. pouch with a spout at the end, not a bag.
calculi -urine test - tests for what? (Cuspv Calculi test)
24-hour urine for calcium, uric acid, sodium, pH, volume
Indiana pouch (Indiana is a continent)
a continent urinary diversion that is drained by catheterization
Mitrofanoff (Mitro is also a continent)
Mitrofanoff continent urinary diversion
Orthotopic Neobladder (Neo is valsalva)
– replaces the old bladder with a new one constructed form bowel
Voiding is accomplished by the Valsalva maneuver
Used for those who can maintain their sphincter muscle
Scheduled voiding
Pelvic floor exercises
End stoma
End stoma –is formed when the proximal end of the small intestines or colon is used to make the storage pouch for the urinary diversion
Ureterostomy
Ureterostomy – involves both ureters being brought through the abdominal wall. There may be two small stomas.
stoma characteristics
Pale pink in color is appropriate for a urinary stoma
Moist and glossy
Protrude about 2.5 cm above skin level
Might appear edematous post op; older stoma may have more texture, grooves and folds
Change flange/pouch
no more than 3 times/week
race with highest incident of kidney stones
white males
stones are made of what? 3 things
increased concentrations of calcium oxalate, calcium phosphate & uric acid = supersaturation
Factors that increase stone formation depends on stone type (struv is an alchy)
Decreased calcium metabolism- anything that slows urine drainage-infection, urinary stasis, immobility
Hypercalcemia & hypercalciuria
Uric Acid stone – assess for gouT
Struvite stones – have they had a lot of UTIs, alkaline environment, bacteria
edema from stone is from
3rd spacing, infection, and obstruction
alpha adrenergics for stones
reduce ureteral spasm, increase pressure proximal to the stone, and relax the ureter in the region of and distal to the stone.
if stone is larger than 10 mm, need to
have surgery
bigger stone and stones in renal pelvis - what type of surgery?
lithotomy
urethral trauma - classic triad
s/s classic triad: blood visible at the meatus, inability to void, distended bladder
BPH - which race the most?
all effected equally
BPH - % of men that get it
Affects half of men older than 40 years of age and 50% of men older than 60 years of age
how to test for BPH
UA, rectal exam, and PSA test
how long BPH meds to start working? (ted will live 2 weeks to 4 months)
2 weeks to 4 months
side effects of BPH meds
headaches, dizziness, hypotension, delayed ejaculation
transuretheral microwave therapy for BPH
wave passes through urethra, heats inside of prostate and causes shrinkage
needle ablation for BPH
scars prostate causing it to shrink. can also use stents.
nursing diagnoses - ostomy - pre - op
imbalanced nutrition 1st, then anxiety and deficient knowledge
nursing diagnoses - ostomy - post - op
impaired skin integrity, acute pain, disturbed body image, potential sexual dysfunction, deficient knowledge
effluent is
urine
symptoms of BPH - how does bladder feel?
sensation of incomplete bladder emptying, bladder usually feels full,
symptoms of BPH - urine? (Ted is dribbling at night)
wake up at night to urinate. dribbling.
