chapter 28

sugery for bladder cancer

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

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

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

Treatments of bladder cancer

include chemotherapy, radiation, or surgery

Continent urinary diversion

indiana pouch, conteinent ileal urinary diversion (kock pouch), and ureterosigmoidostomy

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

Ureteral trauma and dx

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

Cancer of the Bladder

Painless gross hematuria is the most common symptom

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

Patients with urolithiasis need to be encouraged to: A. increase their fluid intake B. participate in strenuous exercise C. supplement their diet with calcium D. limit their voiding to every 6-8 hours

A. increase their 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? A. painless gross hematuria B. deep flank and abdominal pain C. muscle spasm and abdominal rigidity over the flank D. decreasing kidney function associated with fever and hematuria

A. painless gross hematuria

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? A. Calcium B. Uric acid C. Struvite D. cystine

B. Uric acid

A pt is prescribed a diet moderately reduced in calcium to prevent renal stones. The nurse instructs the pt to avoid: A. citrus fruits B. milk C. pasta D. whole grain breads

B. milk

When being instructed on methods for managing the mucous in their urinary diversion, pts should be reminded to do which of the following? A. increase fiber intake B. consume high levels of citrus fruits and juices C. increase consumption of cranberry juice D. avoid caffeine consumption

C. increase consumption of cranberry juice

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? A. determine the stone type B. relieve any obstruction C. relieve the pain D. prevent nephron destruction

C. relieve the pain

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

tx of calculi

Type of stone usually dictate treatment option Seen more in spring time secondary to dehydration and more in men than women

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

struvite stones

causes: forms from ammonia-rich urine caused by staph or pseudomonas tx: increase fluids or abx

uric acid stones causes and tx

causes: gout and myeoproliferative diseases tx: low-purine diet and allopurinol

risks for bladder cancer

cigarette smoking, advanced age, recurrent uti or chronic bacterial infections, bladder stones, increased cholesterol intake

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

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

Signs and symptoms of calculi

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

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 vesicostomy: bladder is sutured to ab wall and creates a stoma 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

calcium renal stones causes

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

Nephrolithiasis

stones in the kidney

Urolithiasis

stones in the urinary tract

Urethral trauma

the classic triad of symptoms compromises blood at urinary meatus inability to void and distended bladder, catheter insertion, pelvic fx,

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

Stones are formed when

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