Urinary Obstruction. Calculi, Cancer, Clots & BPH

Question 1

Urolithiasis and Nephrolithiasis

Answer 1

• Calculi (stones) in the urinary tract or kidney
  **30-50-year-olds
  **Males > females

-Pathophysiology
-Causes: may be unknown
-Depends on location and presence of obstruction or infection
-Pain and hematuria
-Diagnosis: radiography, blood chemistries, and stone analysis; strain all urine and save stones

Question 2

Urinary Calculi: Pathophysiology

Answer 2

1. r/t increased concentrations of calcium oxalate, calcium phosphate & uric acid = supersaturation
2. Factors that increase stone formation depends on stone type
   **Decreased calcium metabolism (meaning breaking down of Ca )- anything that slows urine drainage-infection, urinary stasis, immobility
   **Hypercalcemia (bloood )& hypercalciuria xk nephrons don’t recycle any on the calcium (urine)
   **Uric Acid – assess for gout
   **Struvite – alkaline environment, bacteria

Question 3

Potential Sites of Urinary Calculi?

Question 4

Renal Calculi: Clinical Manifestations

Answer 4

1. Depend on the location
   -Renal pelvis-deep backache (costovertebral angle), hematuria
   -Ureter=acute, colicky, wavelike, radiates to thigh & genitalia
   -Bladder= retention, irritation similar to UTI
2. Depend on obstruction, infection and edema
   -Obstruction
   -Infection – pyelonephritis, UTI (fever & chills)
   -Edema

Question 5

Renal Calculi: Assessment

Answer 5

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 if the stone blocks the urine way out it can cause an edema

Question 6

Renal Calculi: Diagnostics

Answer 6

Non contrast CT (no dye as opposed to regular CT)
Serum chemistry panel
24-hour urine for calcium, uric acid, sodium, pH, volume
Diet and medication history
Family history

Question 7

Renal calculi: Medical Management

Answer 7

1. Manage pain
2. Encourage fluids or use IV isotonic fluids (to push stones out)
3. Remove the stone and relieve obstruction
   -Prevent nephron destruction
   -Control infection
   4.Analyze the stone

Question 8

Methods of Treating Renal Stones

Answer 8

slides 10-11-12 but we have already done that in previous decks in Urinary Tract Infections Retention, Reflux & Incontinence

Question 9

Patient Education for stones (seen in previous decks seen )

Answer 9

Signs and symptoms to report
Follow-up care
Urine pH monitoring
Measures to prevent recurrent stones
Importance of fluid intake
Dietary education
Medication education as needed

Question 10

Genitourinary Trauma

Answer 10

1. Ureteral: motor vehicle accidents, sport injuries, falls
2. Bladder: pelvic fracture, multiple trauma, blow to lower abdomen
3. Urethral: blunt trauma to lower abdomen and pelvis
   —–s/s classic triad: blood visible at the meatus, inability to void, distended bladder

Question 11

Genitourinary Trauma Management

Answer 11

1. Medical management: control hemorrhage, pain and infection; monitor for oliguria, shock, s/s acute peritonitis
2. Surgical management: suprapubic catheter, surgical repair
3. Nursing management:
   -Assess frequently
   -Instruction about incision care and adequate fluid intake
   -Changes to report: fever, hematuria, flank pain

Question 12

Conditions of the Prostate: BPH

Answer 12

Benign prostatic hyperplasia (BPH; enlarged prostate)

Affects half of men older than 40 years of age and 50% of men older than 60 years of age

Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections

Develops over a period of time; changes in urinary tract slow and insidious

Symptoms depend on severity: dysuria, hesitancy, sensation of incomplete bladder emptying

Question 13

Management of BPH

Answer 13

1. Medical treatment
   -Alpha-adrenergic blockers
   -Measures to reduce pain and spasms
   -Catheter for acute condition; unable to void
2. Surgical treatment
   -Minimal invasive therapy
   -Surgical resection
   -TURP

Question 14

Urinary Tract Cancers

Answer 14

Bladder, kidney and renal pelvis, ureters, other structures such as prostate

Cancer of bladder:
-More common after age 55 years
-Leading cause of death
-Smoking increases risk 50%; refer to Chart 55-13

S/S: visible painless hematuria; pelvic or back pain may indicate metastasis

Diagnosis: ureteroscopy, excretory
urography, CT, MRI, ultrasonography

Question 15

Bladder Cancer Management don’t confuse with prostste

Answer 15

1. Medical management: depends on the grade and stage of the tumor
   -Chemotherapy
   -Radiation
2. Surgical management:
   -Transurethral resection (cut bad tissue ) or fulguration (use electric shock to eliminate it )
   -Followed by bacille Calmette–Guérin (BCG) treatment
   -Cystectomy
   -Urinary diversion

Question 16

Nursing Management of Bladder Cancer

Answer 16

Immediate postop: monitor urine volume hourly

Provide stoma and skin care (xk ahora no tienen donde guardar esa orina xk se les quito despues del cancer )

Test urine and care for ostomy

Encourage fluids and relieve anxiety

Patient education about self-care: managing ostomy

Sure, here are some additional nursing management considerations for bladder cancer:

Urine testing: The nurse should obtain urine samples for laboratory testing, including urinalysis and urine culture, to monitor for signs of infection and to ensure that the urine is clear of cancer cells.

Stoma care: For individuals who undergo a cystectomy, a surgical procedure to remove the bladder, an ostomy may be created to allow for urine to drain from the body. The nurse should provide education on ostomy care, including how to change the pouch, clean the skin around the stoma, and manage any skin irritation.

Question 17

Urinary Diversion

Answer 17

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

Cutaneous urinary diversion: ileal conduit, cutaneous ureterostomy, vesicostomy, nephrostomy

Continent urinary diversion: Indiana pouch, Kock pouch, uretherosigmoidostomy

Question 18

Nursing Diagnosis: Preoperative Urinary Diversion

Answer 18

Anxiety
Imbalanced nutrition
Deficient knowledge

Question 19

Urinary Diversion. Nursing Diagnosis: Postoperative Bladder Cancer

Answer 19

Risk for impaired skin integrity

Acute pain

Disturbed body image

Potential for sexual dysfunction

Deficient knowledge

Question 20

Ostomy Care –General Overview

Answer 20

What is an ostomy? Describes a surgical procedure that creates an alternative exit route from internal organs or segments of the urinary tract , diverting flow of body waste (urine, feces) to the external surface of the body

What is a stoma? Refers to the opening where the ureter or bowel can be visualized protruding through the abdominal wall.

What is a diversion? The surgical creation of an alternative route for effluent (waste products) of the urinary or GI tract
-Continent –internal reservoirs
-Incontinent –effluent flows spontaneously

Question 21

Ostomy Care-Urostomy

Answer 21

Most urinary ostomies involve the bladder and ureters

Types

• Non-Continent (It is a non-continent type of urinary diversion, meaning that the urine drains freely from the body and is collected in an external pouch or bag.)
  Ileal conduit – used after bladder removal where the ureters are re-routed and drain freely into part of the ileum that was cut
  **Advantages – well established surgery, long term results are well understood
  **Disadvantages – requires an external pouching system that needs to be replaced at regular intervals; empty every 3-4 hours; potential for backup of urine into the kidneys (risk for infection)

Ureterostomy

Vesicostomy (bladder )

Question 22

Cutaneous Urinary Diversions check slide 26

Question 23

Ostomy Care- Urostomy

Answer 23

Types:

1. Continent (made inisde the body after the removal of the bladder using one own’s bowel)–goal is to provide a segment of the intestines to construct a low- pressure pouch to store urine

• Indiana pouch –a continent urinary diversion that is drained by catheterization
• Mitrofanoff continent urinary diversion (a valve is cerated using your own tissue)
• Orthotopic Neobladder – 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

Question 24

Continent Urinary Diversions slide 28

Question 25

Urinary stoma

Answer 25

1. Indications for stoma
   - Conditions: Cystectomy, neurogenic bladder, interstitial cystitis(chronic inflammation), refractory radiation cystitis, bladder incontinence
   -Divert urine (urostomy)
   -Access
   -Protect anastomoses (to prevent disruption or damage to surgical connections made between two structures, such as blood vessels or organs, during a surgical procedure.)
2. Stoma categories
   -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 – involves both ureters being brought through the abdominal wall. There may be two small stomas.

Question 26

Urostomy Basics

Answer 26

-Urine and mucus pass through the stoma
-There is no sensation in the stoma (no nerve endings)
-The mucus-lined inner surface of the stoma is vascular and can bleed
-Mucus provides a cleansing process
-There is no voluntary control of urine

-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

Question 27

Urostomy Care

Answer 27

Assess stoma and peristomal skin
Assess output
Assess appliance for fit and comfort
Monitor fluid, electrolytes, nutrition
Manage pain
Mobilize

Question 28

Ostomy Care

Answer 28

-Organizing, Assessing, Changing

**Gather materials for emptying and changing flange/ pouch
**Choose the right time
**Change flange/pouch no more than 3 times/week
**Size the stomal opening

Question 29

Choosing Products

Answer 29

1. Goals:
   -Provide patient with an odor-proof secure pouch
   -Promote self-care
   -Cost effective system
2. Pouches:
   -One piece vs. two piece
   -Precut vs cut to fit vs. moldable
   -Disposable vs. reusable
3. Sealants (cremas)
   -Provide the skin with an extra protective layer
   -Some have alcohol and may burn non intact skin
4. Barriers
   -Used to protect skin from drainage and treat skin loss
   -Create more level skin surface for adherence
5. Clips
   -ONE PER BOX OF POUCHES: DO NOT MISPLACE

Question 30

check slide 34

Question 31

Urolithiasis and Nephrolithiasis

more common in men
Yes, urolithiasis and nephrolithiasis are more common in men than women. In fact, men are up to four times more likely to develop these conditions than women. This is believed to be due to anatomical differences, such as the longer length of the male urethra, which can make it more difficult for stones to pass through.

Question 32

*Struvite – alkaline environment, bacteria
Struvite stones are a type of kidney stone that is composed of magnesium, ammonium, and phosphate. They are commonly associated with urinary tract infections (UTIs) caused by bacteria that produce urease, an enzyme that breaks down urea in the urine and creates an alkaline environment.

The alkaline environment allows the bacteria to thrive and promotes the formation of struvite stones.

Question 33

colicky
The term “colicky” generally refers to a type of pain that is associated with the colon, which is also known as the large intestine

Question 34

POCT for hematuria

POCT (Point-of-care testing) for hematuria refers to diagnostic tests that can be performed at the point-of-care, meaning in a clinical setting such as a doctor’s office or emergency room, rather than being sent to a laboratory for analysis. POCT for hematuria typically involves the use of dipstick tests that detect the presence of blood in urine samples.

Question 35

Alpha-adrenergic blockers BPH

Alpha-adrenergic blockers work by relaxing the smooth muscle tissue in the prostate and bladder neck, which can help to relieve urinary symptoms and improve urine flow.

Question 36

TURP bph TURP is not typically used to treat prostate cancer Only bph
Transurethral resection of the prostate (TURP) is a surgical procedure that is commonly used to treat the symptoms of benign prostatic hyperplasia.

It’s surgical procedures like transurethral resection of the prostate, or TURP can be done to remove part or all of the prostate.

Answer 36

TURP is not typically used to treat prostate cancer

Question 37

Cancer of the bladder is a type of cancer that affects the cells lining the bladder. It is considered one of the leading causes of death from cancer, particularly in developed countries.

Answer 37

don’t confuse it with prostate

Question 38

Bacille Calmette–Guérin (BCG) is a type of immunotherapy that is used to treat certain types of cancer, particularly bladder cancer. BCG is a weakened form of the bacteria that causes tuberculosis, which is used to stimulate the immune system to attack cancer cells.

Question 39

DRE is recommended as part of the regular health checkup for every man older than 50 years of age. It is a screening for cancer of the prostate gland. It enables the examiner to assess the size, shape, and consistency of the prostate gland.

Question 40

is ileal conduit the same as urostomy?

Yes, an ileal conduit is a type of urostomy. Urostomy is a general term that refers to a surgical procedure in which an artificial opening (stoma) is created in the abdomen to allow urine to drain out of the body. An ileal conduit is a specific type of urostomy in which a section of the ileum (a portion of the small intestine) is used to create a channel for urine to flow from the kidneys to the stoma.

Question 41

An ileal conduit is a type of urostomy that involves using a section of the ileum

Answer 41

they cut it

Question 42

Mitrofanoff continent urinary diversion

The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, is a continent urinary diversion surgery that is used to create a new way for urine to leave the body when the bladder has been removed or is non-functional. Like other continent urinary diversions, it allows the patient to store urine internally and empty it at regular intervals using a catheter.

Question 43

refractory radiation cystitis: can cause cystitis and force us to put in place a stoma.

Refractory radiation cystitis is a complication that can occur after radiation therapy to the pelvic region, particularly for treatment of prostate or gynecologic cancers.

Question 44

No, Benign Prostatic Hyperplasia (BPH) is not the same as cancer of the prostate gland. BPH is a non-cancerous condition that occurs when the prostate gland enlarges and begins to put pressure on the urethra, which can lead to symptoms such as difficulty urinating, frequent urination, and nocturia (waking up at night to urinate). BPH is a common condition in older men and is not typically life-threatening, although it can affect quality of life.

Prostate cancer, on the other hand, is a malignant condition that occurs when abnormal cells grow and divide in the prostate gland, forming a tumor. Prostate cancer can spread to other parts of the body and can be life-threatening if not detected and treated early. Symptoms of prostate cancer may include difficulty urinating, blood in the urine or semen, erectile dysfunction, and pain in the back, hips, or pelvis.

While BPH and prostate cancer are different conditions, they can share some symptoms, such as difficulty urinating

Question 45

Renal Calculi edema

Renal calculi, also known as kidney stones, can cause edema (swelling) if they obstruct the flow of urine from the kidney to the bladder. When urine is unable to pass through the urinary tract due to a blockage caused by a kidney stone, pressure can build up in the affected kidney, leading to swelling and edema. This can cause pain and discomfort in the affected area.

Edema may also occur as a result of the body’s response to the inflammation caused by a kidney stone

Question 46

Androgens increase with age and these inhibit the apoptosis of or programmed cell death, allowing luminal and basal cells in the prostate to keep growing and multiplying casuing BPH (Benign prostatic hyperplasia)

Answer 46

Benign prostatic hyperplasia

It is true that androgen levels, which include testosterone, tend to increase with age even though testosterone levels go down in older men.

Question 47

The pain caused by kidney stones can stimulate the nausea center in the brain, leading to a feeling of nausea and the urge to vomit.

Question 48

The pain caused by renal stones can radiate to the abdomen, causing discomfort, and distention (being stretched or swollen)

Answer 48

being stretched or swollen,

Question 49

Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

Question 50

Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

Question 51

Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi.

Question 52

Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void

Question 53

Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

Question 54

An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results inabnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in thebladder, which increases the potential of a urinary tract infectio

Question 55

NOOOOOOO Te confundas
Sangre no orina

elevated BUN and creatinine value meaning

Elevated levels of blood urea nitrogen (BUN) and creatinine typically indicate that the kidneys are not functioning properly. BUN is a waste product that is formed in the liver and excreted by the kidneys, while creatinine is a byproduct of muscle metabolism that is also eliminated by the kidneys.

When the kidneys are healthy, they filter out these waste products and maintain normal levels of BUN and creatinine in the blood. However, if the kidneys are damaged or not functioning properly, they may not be able to filter out these waste products, leading to an accumulation of BUN and creatinine in the blood.

Answer 55

if they kidneys don’t work well they stay in the body more accurately in the blood showing high levels of these last 2

Question 56

what is a brush biopsy

A brush biopsy is a minimally invasive diagnostic procedure that is used to collect cells from the surface of a tissue or lesion. During a brush biopsy, a small, brush-like device is used to gently scrape the surface of the tissue, collecting a sample of cells for analysis.

Question 57

Preparation for an open biopsy is similar to that for any major abdominal surge you keep the pt NPO

Patients are often kept NPO (nothing by mouth) before surgery to reduce the risk of aspiration during the procedure.

Answer 57

Patients are often kept NPO (nothing by mouth) before surgery to reduce the risk of aspiration during the procedure.

Question 58

A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe?

The right kidney’s proximity to the pancreas, liver, and gallbladder

Answer 59

The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct,liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenicflexure), stomach, pancreas, and spleen may also result in intestinal symptom

Question 60

Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine arecomponents of serum, not urine

Question 61

BUN and creatinine arecomponents of blood, not urine

Answer 61

.

Question 62

Stress incontinence is the involuntary loss of urine through an intact urethra as a result of suddenincrease in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia orinvoluntary urethral relaxation in the absence of normal sensations usually associated with voiding.Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder.Functional incontinence refers to those instances in which the function of the lower urinary tract isintact, but other factors (outside the urinary system) make it difficult or impossible for the patient toTest Bank - Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)1035
reach the toilet in time for voidin

Question 63

Hydronephrosis

Hydronephrosis is a condition that occurs when the kidney becomes swollen or enlarged due to the buildup of urine inside the kidney.
Don’t mix with hydrocele

Answer 63

.

Question 64

A patient has been admitted to the medical unit with a diagnosis of ureteral colic (pain ) secondary to urolithiasis. When planning the patients admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply.
A)Diarrhea
B)High fever
C)Hematuria
D)Urinary frequency
E)Acute pain

Ans: C, D, E

Feedback: Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain,
radiating down the thigh and to the genitalia. Often, the patient has the desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic. Diarrhea is not associated with this presentation and fever is usually absent due to the noninfectious nature of the health problem

Answer 64

.

Question 65

People who smoke develop bladder cancer twice as often as those who do not smok

Question 66

Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept below 6.5 by administration of ascorbic acid by mouth.

Answer 66

.

Question 67

In a transurethral resection of the prostate, or TURP, may be done, where “transurethral” means, well, through the urethra! During a TURP, an instrument called a cystoscope is inserted through the tip of the penis and into the urethra to access the prostate gland. Then, the enlarged part or even the entire prostate can be removed.

Question 68

Pouch creation: The Indiana pouch is created from a segment of the patient’s own bowel, which is then connected to the ureters and brought to the surface of the skin as a stoma. The Kock pouch also uses a segment of the patient’s own bowel, but the pouch is created as a self-contained unit with a nipple valve that allows the patient to empty the pouch by catheterization.

Yes, both the Indiana pouch and the Kock pouch can be used to simulate a bladder after its removal, as they are both types of continent urinary diversion procedures that create a new reservoir or pouch within the body to store urine.

Question 69

Cutaneous urinary diversion, bedcause they come out of the skin completly : vs

Continent urinary diversion:

Cutaneous urinary diversion and continent urinary diversion are two different types of surgical procedures used to redirect urine out of the body when the bladder is no longer functional or has been removed.

Cutaneous urinary diversion refers to procedures where the ureters are redirected to a stoma on the skin surface, such as an ileal conduit, cutaneous ureterostomy, vesicostomy, or nephrostomy. These procedures create a direct connection between the ureters and the skin, allowing urine to be expelled from the body through the stoma.

On the other hand, continent urinary diversion refers to procedures that create a new internal reservoir within the body to store urine, such as the Indiana pouch, Kock pouch, or ureterosigmoidostomy. These procedures involve using a segment of the patient’s own bowel to create a new reservoir or pouch that can hold urine. The pouch is then connected to the ureters and brought to the surface of the skin as a stoma, which the patient can then use to empty the pouch.

Answer 69

vesicostomy etymology

The term “vesicostomy” comes from the combination of two words: “vesico-“ which refers to the urinary bladder, and “-stomy” which means the creation of an opening between an organ and the surface of the body.

Question 70

Cutaneous urinary diversion: vs

Continent urinary diversion:

Cutaneous urinary diversion and continent urinary diversion are two different types of surgical procedures used to redirect urine out of the body when the bladder is no longer functional or has been removed.

Cutaneous urinary diversion refers to procedures where the ureters are redirected to a stoma on the skin surface, such as an ileal conduit, cutaneous ureterostomy, vesicostomy, or nephrostomy. These procedures create a direct connection between the ureters and the skin, allowing urine to be expelled from the body through the stoma.

On the other hand, continent urinary diversion refers to procedures that create a new internal reservoir within the body to store urine, such as the Indiana pouch, Kock pouch, or ureterosigmoidostomy. These procedures involve using a segment of the patient’s own bowel to create a new reservoir or pouch that can hold urine. The pouch is then connected to the ureters and brought to the surface of the skin as a stoma, which the patient can then use to empty the pouch.

Question 71

Interstitial nephritis the same as Pyelonephritis ?

No, interstitial nephritis and pyelonephritis are not the same conditions.

Pyelonephritis is a bacterial infection of the kidney, usually caused by a urinary tract infection that has spread to the kidneys. It can cause symptoms such as fever, chills, flank pain, and painful or frequent urination. Treatment usually involves antibiotics and supportive care.

Interstitial nephritis, on the other hand, is a type of kidney inflammation that affects the spaces between the kidney tubules (the interstitium).

Question 72

ureteral colic aka colicky pain.

Ureteral colic, also known as renal colic, is a type of pain that occurs when a kidney stone or other blockage obstructs the flow of urine through the ureter, causing the ureter and kidney to swell.

Question 73

It seems like you have provided a list of various treatments and recommendations for managing interstitial cystitis (IC), a chronic bladder condition. Here is some information on each of these:

Calcium phosphorus (Prelief): Prelief is a dietary supplement that can be taken before meals to reduce the acidity of foods and beverages, which may help alleviate symptoms of IC.

Antidepressants: Certain types of antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), may be used to manage pain and discomfort associated with IC.

Pentosan (Elmiron) for IC enhances the protective effects of glycosaminoglycan layer of the bladder: Pentosan polysulfate sodium (PPS), sold under the brand name Elmiron, is a medication that is believed to help restore the protective layer of the bladder, which can become damaged in people with IC.

Dimethylsulfoxide (DMSO): DMSO is a medication that is sometimes used to alleviate symptoms of IC, as it may have anti-inflammatory and pain-relieving effects.

Reduce stress: Stress can exacerbate symptoms of IC, so finding ways to manage stress, such as through relaxation techniques, exercise, and therapy, may be helpful.

Relaxation techniques: Techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation can help reduce stress and promote relaxation.

Avoid tight clothing around suprapubic area: Wearing tight clothing around the suprapubic area (the area above the pubic bone) can put pressure on the bladder and exacerbate symptoms of IC, so it’s best to avoid this.

Question 74

Review continuous bladder irrigation, peritoneal dialysis and the indications for and management of these interventions.

Sure, here is an overview of continuous bladder irrigation and peritoneal dialysis, including their indications and management:

Continuous Bladder Irrigation (CBI):
Continuous bladder irrigation is a procedure used to flush out the bladder continuously with sterile fluid, typically following surgery or in the treatment of conditions such as bladder cancer or clot retention. The procedure involves inserting a three-way Foley catheter into the bladder and connecting it to a closed system that infuses and drains sterile fluid. The goal is to prevent blood clots from forming and causing obstruction in the bladder.

Indications:

Treatment of clot retention
Treatment of hematuria
Treatment of bladder cancer
Postoperative bladder irrigation
Management:

Monitor the patient’s urine output, color, and clarity regularly
Assess the patient’s pain and comfort level and provide appropriate interventions as needed
Ensure the patency of the catheter and the drainage system
Monitor the patient’s fluid and electrolyte balance and adjust the irrigation rate and solution as necessary
Monitor for signs of infection, such as fever or increased pain, and provide appropriate interventions as needed.

Peritoneal Dialysis (PD):
Peritoneal dialysis is a treatment for kidney failure that involves using the patient’s peritoneal membrane as a dialysis membrane. The procedure involves instilling sterile dialysate solution into the peritoneal cavity through a catheter, which is left in place for several hours to allow for diffusion and ultrafiltration of waste products and excess fluid across the peritoneal membrane.

Indications:

Chronic kidney disease
End-stage renal disease
Acute renal failure
Drug overdose or poisoning
Management:

Monitor the patient’s vital signs and fluid and electrolyte balance regularly
Assess the patient’s pain and comfort level and provide appropriate interventions as needed
Monitor for signs of infection, such as fever or increased pain, and provide appropriate interventions as needed
Monitor the patient’s dialysate volume and composition and adjust as necessary based on the patient’s needs and laboratory results
Ensure proper catheter placement and function and provide appropriate care and maintenance to reduce the risk of infection and complications.

Answer 74

.

Question 75

Review the indications for renal replacement therapy, the assessment of an AV fistula and the care and precautions of the CVC dialysis access device.

Sure, here is an overview of the indications for renal replacement therapy, the assessment of an AV fistula, and the care and precautions of the CVC dialysis access device:

Indications for Renal Replacement Therapy (RRT):
Renal replacement therapy is used to manage patients with end-stage renal disease or acute kidney injury who are unable to maintain adequate fluid, electrolyte, and metabolic balance without intervention. Indications for RRT include:

Severe fluid overload or electrolyte imbalances
Uremic symptoms, such as nausea, vomiting, and lethargy
Hyperkalemia that is refractory to medical management
Decreased urine output or anuria
Signs of uremia or encephalopathy
Uncontrolled hypertension or heart failure
Assessment of an AV Fistula:
An arteriovenous (AV) fistula is a surgical connection between an artery and a vein used for hemodialysis access. Assessment of the AV fistula should be done regularly to ensure patency and identify any signs of complications, such as infection or stenosis.

Assessment should include:

Checking for a thrill or bruit over the fistula site, which indicates adequate blood flow
Monitoring the fistula for signs of infection, such as redness, swelling, or drainage
Assessing the patency of the fistula by measuring blood flow and pressure
Monitoring for signs of stenosis, such as decreased blood flow or aneurysm formation
Care and Precautions of the CVC Dialysis Access Device:
A central venous catheter (CVC) is a type of dialysis access device used for temporary access to the vascular system. Proper care and precautions are essential to reduce the risk of complications, such as infection and clotting.

Care and precautions for the CVC dialysis access device include:

Using sterile technique for insertion and dressing changes
Cleaning the insertion site with chlorhexidine or other appropriate antiseptics
Regularly flushing the catheter with saline or heparin to maintain patency
Avoiding the use of the catheter for non-dialysis related procedures
Monitoring for signs of infection or clotting, such as redness, swelling, or decreased blood flow
Educating the patient on proper hygiene and care of the catheter and surrounding skin
Monitoring the patient’s fluid and electrolyte balance and adjusting dialysate as necessary.

Question 76

What is TURP? TURP post op care. A three-way foley cath is inserted after surgery.

::::::::::::::::::::After the surgery:::::::::::::::::::::::::::::: Continuous bladder irrigations are done to flush all the blood out of the bladder to prevent clots from developing.

TURP stands for transurethral resection of the prostate, which is a surgical procedure used to remove part or all of the prostate gland in men with benign prostatic hyperplasia (BPH) or prostate cancer.

Postoperative care after TURP typically includes:

Monitoring the patient’s vital signs, urine output, and fluid and electrolyte balance
Providing pain management and bladder spasms control as needed
Administering prophylactic antibiotics to prevent infection
Assessing the patient’s bladder function and catheter patency
Checking the urine for color, clarity, and presence of clots or bleeding
Encouraging early ambulation and deep breathing exercises to prevent complications such as blood clots in the legs or lungs
Educating the patient on proper catheter care and hygiene
Providing clear instructions on follow-up care and scheduling of postoperative appointments.
As mentioned, a three-way Foley catheter is inserted after TURP surgery. This catheter has three ports or channels. One port is used to inflate the balloon at the tip of the catheter to keep it in place. The second port is used to drain urine from the bladder, and the third port is used for continuous bladder irrigation (CBI).

CBI involves flushing the bladder with sterile saline solution to prevent blood clots from forming and to promote healing. The purpose of CBI is to keep the urine clear of blood or clots and to promote healing of the bladder lining. The rate and volume of the irrigation solution are determined by the surgeon or healthcare provider based on the patient’s individual needs.

Patients who undergo TURP surgery will typically have CBI for a specified period, typically up to 48-72 hours, depending on the patient’s condition and the surgeon’s preference. During this time, the patient’s urine output, color, and clarity will be closely monitored, and adjustments to the irrigation solution may be made as needed. Once the CBI is discontinued, the patient will continue to have a Foley catheter in place for several more days or until their urinary function has recovered sufficiently.

Answer 76

.