Chapter 28 Urinary disorders

sugery for bladder cancer

cystectomy is the removal ofthe bladder and a urinary diversion procedure is required

Medical interventions for stones

Pain management: opioids and NSAIDS, hot baths or cloths to flank area Nutritional therapy: iv fluids, encourage fluid intake

Genitourinary Trauma

Urethral trauma Ureteral trauma Bladder trauma

The nurse advises a pt with renal stones to avoid eating shellfish, and organ meats. She states that these foods should be avoided because she knows that his renal stones are composed of which of the following substances?

Uric acid

When being instructed on methods for managing the mucous in their urinary diversion, pts should be reminded to do which of the following?

increase consumption of cranberry juice

Patients with urolithiasis need to be encouraged to:

increase their fluid intake

Continent urinary diversion

indiana pouch, catheter into stoma, one output conteinent ileal urinary diversion (kock pouch), female one output-male two outputs might pee through urethra Ureterosigmoidostomy, thorugh colon one output

A pt is prescribed a diet moderately reduced in calcium to prevent renal stones. The nurse instructs the pt to avoid:

milk

medical management for GU trauma

goals are to control hemorrhage, pain, and infection and maintain urinary drainage, monitor HCT and HGB, monitor for oliguria, hemorrahagic shock, s/s of peritonitis

Surgical treatment of renal stones

-Ureteroscopy: insert ureteroscope into the ureter and then try to grab the stone -Extracorporeal shock wave lithotripsy: noninvasive -Endourologic (percutaneous) stone removal: a nephroscope is introduced through percutaneous route into renal parchyma stone may be extracted by forceps

urinary diversions

Cutaneous urinary diversion: Urine drains through an opening created in the abdominal wall and skin Continent urinary diversion: A portion of the intestine is used to create a new reservoir for urine Both require vigilant nursing care

Cancer of the Bladder

Painless gross hematuria is the most common symptom microscopic unable to detect visually

tx of calculi

Type of stone usually dictate treatment option reduce calcium intake nutritional interventions

Bladder trauma

blunt trauma may result in contusion evident as an eccymosis or rupture of the bladder and complications from these injuries including hemorrhage, shock, sepsis, and extravasation of blood in tissues

risks for bladder cancer

cigarette smoking, environmental exposure advanced age recurrent uti or chronic bacterial infections bladder stones increased cholesterol intake high PH pelvic radiation

Nursing Process: The Patient With Urinary Calculi Assessment and Goals and interventions

Assessment often reveals pain, nausea, vomiting, diarrhea, and abdominal distention Goals and interventions address relief of pain, prevention of recurrence, and absence of complications, pt needs to strain their urine monitor urine output and assessment. Strain urine in hospital to check passage of stone

A 68 year old man has been diagnosed with bladder cancer. Discuss what therapies are available in the treatment of bladder cancer.

Chemo radiation or surgery

Surgery is often required for Genitourinary Trauma post procedural care

Patients can be instructed about care of the incision and the importance of an adequate fluid intake

Signs and symptoms of calculi

depend on the presence of obstruction infection edema but pain is common especially with a traveling stone

Ureteral trauma

gunshot wounds account for 95% of uretal injuries and range from contusions to complete transection. IV urography detects 90% of uretal injuries and performed on the operating table in pts undergoing emergent surgery Urine go into abdominal cavity creates risk to +systems

Cutaneous urinary diversions

ileal conduit: transplants the ureters to an isolated section and brings one end through abdominal wall cutaneous urostomy: brings detached ureter through ab wall and other ureter still attached. two outputs vesicostomy: bladder is sutured to ab wall and creates a stoma, potentially two outputs nephrostomy: catheter is into the renal pelvis through incision through flank. has two outputs and will have nephrosotmy bag that needs to be in dependent position to allow gravity to drain

Treatments of bladder cancer

include chemotherapy, radiation, or surgery can include removal of bladder, urethra and some reproductive organs

calcium renal stones causes

most common type of stones that ppl have causes: hypercalcemia, hyperparathyroididsm cancer excessive intake of vit d and milk Polycythemia Vera leukemia insufficient fluid intake

An elderly man is seeing his urologist for an annual check up. The provider is concerned with s/s he detects for bladder cancer. Which of the following s/s is diagnostic for bladder cancer?

painless gross hematuria

A women comes to her provider's office with s/s of kidney stones. Which of the following should be the primary medical management goal?

relieve the pain

Renal colic

spams in the kidney with pain

Calculi

stones affect men more than women occur in the spring and summer due to dehydration -Urolithiasis -Nephrolithiasis

Nephrolithiasis

stones in the kidney

Urolithiasis

stones in the urinary tract

if there is a urethra trauma is suspected

the doctor needs to check to make sure that the urethra is intact before insertion of catheter

Urethral trauma

trauma to the urethra stone in urethra, blunt trauma, surgery, STDs. insertion of objects through urethra do not insert catheter until urethra is intact

Stones are formed when

urinary concentrations of calcium oxalate, calcium phosphate, and uric acid increase