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Urology Ppt
 

Urology Ppt

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Urology Ppt Urology Ppt Presentation Transcript

  • U R O L O G Y
  • THE RENAL SYSTEM
    • STRUCTURES:
      • KIDNEYS
        • RETROPERITONEAL
        • RENAL ARTERY & VEIN
        • NEPHRON
      • URETER
      • URINARY BLADDER
      • URETHRA
  • Here is a normal adult kidney. The capsule has been removed and a pattern of fetal lobulations still persists, as it sometimes does. The hilum at the mid left contains some adipose tissue. At the lower right is a smooth-surfaced, small, clear fluid-filled simple renal cyst . Such cysts occur either singly or scattered around the renal parenchyma and are not uncommon in adults.
  • In cross section, this normal adult kidney demonstrates the lighter outer cortex and the darker medulla , with the renal pyramids into which the collecting ducts coalesce and drain into the calyces and central pelvis .
  • THE RENAL SYSTEM
    • 4 MAIN FUNCTIONS OF THE KIDNEYS:
      • EXCRETION OF WASTE PRODUCTS
        • FILTRATION
        • TUBULAR REABSORPTION
        • TUBULAR SECRETION
      • REGULATION OF FLUID & ELECTROLYTES
      • BLOOD PRESSURE REGULATION
      • ERYTHROPOEITIN SECRETION
  • THE RENAL SYSTEM
    • PHYSIOLOGY:
    • RENIN-ANGIOTENSIN
    • ERYTHROPOEITIN
    • PROSTAGLANDIN
    RELEASED BY CELLS NEAR THE GLOMERULUS WHEN GFR IS LOW OR WHEN SYMPA-NS IS STIMULATED RELEASED IN RESPONSE TO HYPOXEMIA
    • IS RELEASED BY RENAL MEDULLA; VASODILATOR ;
    • REGULATE RENAL BLOOD FLOW
  • THE RENAL SYSTEM
    • PHYSIOLOGY:
    • METABOLISM OF VIT D – FOR CALCIUM METABOLISM
    • DEGRADATION OF INSULIN
    • URGE TO VOID : 200-300 ml OF URINE
    • BLADDER DISTENTION: 400 ml
    • PARASYMPA-NS : DESIRE TO VOID
    • SYMPA-NS: MUSCLE RELAXATION & ELIMINATION
  • Double ureters are seen exiting from each kidney and extending to the bladder that has been opened. A small segment of aorta is seen between the normal, smooth-surfaced kidneys. A partial or complete duplication of one or both ureters occurs in about 1 in 150 persons. There is a potential for obstructive problems due to the abnormal flow of urine and the entrance of two ureters into the bladder in close proximity, but most of the time this is an incidental finding
  •  
  • RENAL DISORDERS
    • RENAL FAILURE
    • GLOMERULONEPHRITIS
    • NEPHROTIC SYNDROME
    • NEPHROSCLEROSIS
    • HYDRONEPHROSIS
    • INFECTIONS
    • NEUROGENIC DISORDERS
    • BENIGN PROSTATIC HYPERTROPHY
  • CASE STUDY
    • Draco, 54 y.o., with history of uncontrolled DM-II, came in because of difficulty of breathing & anuria.
    • VS = 38 O ; 113; 30; 170/120
    • He has bipedal edema & pruritus
  • CASE STUDY
    • What is your first nursing action?
    • What other assessment would you do?
    • What are your plans?
  • RENAL FAILURE (R. F.)
    • INABILITY OF THE KIDNEY TO FXN NORMALLY & EFFECTIVELY
    • ACUTE RENAL FAILRE
    • CHRONIC RENAL FAILURE
  • ACUTE RENAL FAILURE
    • SUDDEN DETERIORATION OF KIDNEY FUNCTION
    • 3 PHASES:
    • OLIGURIC
    • ANURIC
    • POLYURIC / RECOVERY + WASTING OF Na, K, & base HCO3
  • ACUTE RENAL FAILURE
    • CAUSES:
    • PRERENAL
      • SHOCK
      • MISMATCHED BT
    • RENAL
      • NEPHRITIS
      • NEPHROTOXIC INFECTION
    • POST RENAL
      • RENAL CALCULI
  • CHRONIC RENAL FAILURE
    • CAUSES:
    • PRERENAL
      • GOUT
      • DM
      • SUBACUTE BACTERIAL ENDOCARDITIS
    • RENAL
      • SLE
      • GLOMEROLU-NEPHRITIS
    • POSTRENAL
      • PROSTATIC OBSTRUCTION
  • R. F. - SIGNS & SYMPTOMS
    • UO ALTERATIONS
    • WEAK
    • INCREASINGLY DROWSY
    • RESTLESSNES
    • INSOMIA
    • DRY SKIN & MUCOUS MEMB
    • URINEFEROUS BREATH
    • NAUSEA/ VOMITING
    • CNS
      • IRRITABILITY
      • ANXIETY
      • HALLUCINATION
      • MUSCLE TWITCHING
      • CONVULSIONS
      • COMA
    • HPN
    • ANEMIA
    • EDEMATOUS
    • BRUISE EASILY
  • R. F. - MANAGEMENT
    • MODALTIES:
    • CONSERVATIVE TREATMENT
    • 2. AGGRESSIVE TREATMENT
  • CONSERVATIVE TREATMENT
    • DIET
      • P, K, & Na RESTRICTED
      • GIORDANA-GIOVANETTI : LOW P (MINIMAL ESSENTIAL A.A.), 20g; controlled K , 1.5g
    • TREATMENT OF INFECTION
      • ANTIBIOTICS
    • TREATMENT OF ALTERATIONS OF BODY CHEMISTRY
  • ALTERATIONS IN BODY CHEMISTRY
    • I. SUBSTANCES FROM PROTEIN METABOLISM:
      • UREA
      • CREATININE
      • URIC ACID
    • MGT:
    • PROTEIN RESTRICTION
    • PREVETION OF INFECTION
    • ANABOLIC HORMONES – CAUSE TISSUE BUILD UP & REVERSE BREAKDOWN
  • ALTERATIONS IN BODY CHEMISTRY
    • ELECTROLYTES:
      • HYPERKALEMIA
      • HYPOKALEMIA
      • HYPERNATREMIA
      • HYPONATREMIA
      • HYPOCALCEMIA, HYPERPHOSPHATEMIA, & BONE DSE
      • ACIDOSIS
  • HYPERKALEMIA
    • CAUSES IN RF:
    • SECRETED out from the cell TOGETHER WITH H ions IN EXCHANGE FOR Na
    • DECREASED EXCRETION FROM DECREASED G.F.R.
  • HYPERKALEMIA
    • S/SX:
    • FLACCID PARALYSIS
    • SLOW RESPIRATION
    • ANXIETY
  • HYPERKALEMIA
    • MANAGEMENT:
    • K RESTRICTED DIET
    • ION EXCHANGE RESIN: KAYEXALATE; SORBITOL IS GIVEN
    • IF WITH CARDIAC ARRHYTHMIA : Ca GLUCONATE
    • IV NaH2CO3
    • GLUCOSE & INSULIN
  • HYPOKALEMIA
    • S/SX:
    • MUSCLE WEAKNESS
    • PARALYSIS
    • LOSS OF REFLEXES
    • CARDIAC ARRHYTHMIA (PVC, TACHYCARDIA)
    • DIGITALIS TOXICITY CAN DEVELOP
    • ECG CHANGES:
    • DEPRESSED T WAVE
    • ELEVATED U WAVE
    • MANAGEMENT:
    • PARENTERAL POTASSIUM
  • HYPERNATREMIA
    • SSX:
    • FLUID RETENTION
    • WEIGHT GAIN
    • CHF
    • PULMONARY EDEMA
    • HPN
    • MANAGEMENT:
    • LIMIT Na INTAKE
    • DRUGS: DIGITALIS, DIURETICS, ANTIHPN
  • HYPONATREMIA
    • S/SX:
    • DHN
    • DRY MOUTH
    • LOSS OF SKIN TURGOR
    • MUSCLE CRAMPS, TWITCHING
    • COMA
    • MANAGEMENT:
    • INCREASE DIETARY SODIUM
    • Na H2CO3, Na Citrate
  • Ca, Ph, & BONE DSE
    • HYPOCALCEMIA
    • HYPERPHOSPHATEMIA
    • BONE DEMININERALIZATION
    • MANAGEMENT:
    • LARGE DOSE OF VIT D
  • ACIDOSIS
    • S/SX:
    • LETHARGY
    • DISORIENTATION
    • INCREASED HR
    • KAUSMAUL’S RESP
    • MANAGEMENT:
    • NaHCO3, NaLACTATE
  • Large love
  • AGGRESSIVE TREATMENT
    • HEMOFILTRATION
    • PERITONEAL DIALYSIS
    • HEMODIALYSIS
  • HEMOFILTRATION
    • CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH)
    • INDICATION:
    • FLUID OVERLOAD FROM OLIGURIA
    • RENAL FAILURE
    • A-V SHUNT
    • ULTRAFILTRATION
  • HEMOFILTRATION
    • ADVANTAGE:
    • DOES NOT REQUIRE DIALYSIS MACHINE OR DIALYSIS PERSONNEL
    • DISADVANTAGE:
    • 36-48 HRS
  • DIALYSIS
    • INDICATION:
    • GFR FALLS BELOW 3ml/min
    • PURPOSE:
    • REMOVING WASTE PRODUCTS FROM THE BODY
    • TYPES:
    • PERITONEAL DIALYSIS
    • HEMODIALYSIS
  • PERITONEAL DIALYSIS
    • CONTRAINDICATION:
    • EXTENSIVE ABDOMINAL ADHESION
    • PERITONITIS
    • GANGRENOUS OR PERFORATED BOWEL
  • PERITONEAL DIALYSIS
    • COMPOSITION OF SOLUTION:
    • DEXTROSE: 1.5% & 4.5%
    • PHYSIOLOGIC CONC OF ELECTROLYTES
    • SLIGHTLY HYPERTONIC
  • PERITONEAL DIALYSIS
    • 36-48 HRS P.D. = 6-8 HRS HEMO
    • 3 PERIODS:
    • INSTILLATION
    • EQUILIBRIUM: OSMOSIS, DIFFUSION & FILTATION
    • DRAINAGE
  • PERITONEAL DIALYSIS
    • NURSING RESPONSIBILITIES:
    • CYCLING THE FLUID
    • OBSERVE FOR COLOR OF THE OUTFLOW
    • ACCURATE RECORDING ON THE FLOW SHEET
    • FREQUENT MONITORING OF VS, WEIGHT & GEN CONDITION
  • PERITONEAL DIALYSIS
    • NURSING RESPONSIBILITIES:
    • PREVENT COMPLICATIONS OF IMMOBILITY
    • CHECK TUBING PATENCY
    • INFORM DOCTOR FOR FLLUID BALANCE EVERY SHIFT
    • COLLECT SAMPLES OF DIALYSATE REMOVED
  • PERITONEAL DIALYSIS
    • NURSING RESPONSIBILITIES:
    • TEST URINE FOR GLUCOSE EVERY 6 HRS
    • OBSERVE FOR COMPLICATIONS:
      • PHYSIOLOGIC
      • TECHNICAL
  • PERITONEAL DIALYSIS
    • PHYSIOLOGIC COMPLICATIONS:
    • PERITONITIS
    • PROTEIN LOSS
    • HYPERGLYCEMIA & HHONK
    • PULMONARY EDEMA
  • PERITONEAL DIALYSIS
    • PHYSIOLOGIC COMPLICATIONS:
    • PERFORATION OF INTESTINES
    • HYPOTENSION
    • HYPOSTATIC PNEUMONIA
    • RESPIRATORY ACIDOSIS
    • ABDOMINAL DISCOMFORT
  • PERITONEAL DIALYSIS
    • TECHNICAL COMPLICATIONS:
    • INCOMPLETE/ SLOW DRAINAGE
      • TURN THE PATIENT SIDE TO SIDE
      • SEMIFOWLER’S + GENTLE PRSSURE ON THE ABDOMEN
    • LEAKAGE / BLEEDING
      • NORMAL DURING THE FIRST EXCHANGE
  • PERITONEAL DIALYSIS
    • NEWER TECHNIQUE:
    • CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)
    • 30-40 MIN TO PERFORM
    • 4 x A DAY
    • 24/7
  • HEMODIALYSIS
    • INDICATION:
    • ACUTE RENAL FAILURE
    • CHRONIC RENAL FAILURE
    • PURPOSE:
    • LOWER THE LEVEL OF METABOLIC WASTE PRODUCTS:
      • UREA, CREATININE, URIC ACID
    • CORRECT ABNORMAL ELECTROLYTE CONC
  • HEMODIALYSIS
    • DIALYZER
    • SHUNTS:
      • CANNULA
      • A-V SHUNT
  • HEMODIALYSIS
    • CARE OF THE SHUNT:
    • DRY STERILE DRESSING
    • ENSURE PATENCY
    • BRUIT
    • NOTIFY PHYSICIAN STAT WITH PRSENCE OF BLOOD CLOT
  • HEMODIALYSIS
    • CARE OF THE SHUNT:
    • AVOID TRAUMA TO THE ARM WITH SHUNT
    • ACCIDENTAL SEPARATION: DIRECT PRESSURE/ VASCULAR CLAMPS
    • OBSERVE FOR SHUNT-RELATED INFECTION:
      • Fever, lethargy, elevated WBC
  • HEMODIALYSIS
    • COMPLICATIONS:
    • TECHNICAL
    • PROCEDURE COMPLICATONS
    • MEDICAL
  • HEMODIALYSIS
    • TECHNICAL COMPLICATIONS:
    • BLOOD LEAKS
    • TUBING SEPARATION
    • DIALYSATE CONC ERRORS
      • HEMOLYSIS, CEREBRAL DISTURBANCE
  • HEMODIALYSIS
    • PATIENT COMPLICATIONS DURING PROCEDURE:
    • DIALYSIS DISEQUILIBRIUM SYNDROME
    • HYPERTENTION
    • HYPOTENSION
    • NAUSEA & VOMITING
    • HEADACHE
    • ACUTE BLEEDING
  • HEMODIALYSIS
    • PATIENT COMPLICATIONS DURING PROCEDURE:
    • FEVER
    • MUSCLE CRAMPS
    • CARDIAC ARRHYTHMIAS
    • CHEST PAIN
    • SHORTNESS OF BREATH
    • RESTLESSNESS
    • DEPRESSION & HOSTILITY
  • HEMODIALYSIS
    • MEDICAL COMPLICATIONS:
    • HPN
    • CHF & PULMONARY EDEMA
    • ANEMIA
    • HEPATITIS
    • LOW SEXUAL POTENCY
  • RENAL TRANSPLANTATION
    • AUTOGRAFT
    • ISOGRAFT
    • ALLOGRAFT/ HOMOGRAFT
    • XENOGRAFT
  • RENAL TRANSPLANTATION
    • TREATMENT to prevent REJECTION:
    • AZATHIOPRINE (IMMURAN)
    • ADRENAL CORTICOSTEROIDS
    • ANTILYMPHOCYTES GLOBULIN
    • ACTINOMYCIN-C
    • LOCAL IRRADIATION THERAPY
  • RENAL TRANSPLANTATION
    • S/SX OF TISSUE REJECTION:
    • WEIGHT GAIN
    • IRRITABILITY
    • SWELLING OF THE OPERATIVE SIGHT
    • DECREASED W.B.C.
  • MATRIX
  • GLOMERULONEPHRITIS
    • ACUTE G.N.
    • CHRONIC G.N.
  • ACUTE G.N.
    • INFLAMMATORY REACTION TO GLOMERULI FROM AN IMMUNE MECHANISM
    • FROM BETA HEMOLYTIC GROUP A STREP INFECTION:
      • THROAT
      • SKIN
      • SCARLET FEVER
  • ACUTE G.N. - PATHOPHYSIO
    • GLOMERULAR
    • INFLAMMATION
    STREP THROAT STREP TOXINS AS ANTIGENS ANTIGEN-ANTIBODY COMPLEX IN THE CIRCULATION Ag-Ab COMPLEX LODGE IN THE GLOMERULI
  • ACUTE G.N.
    • CLINICAL MANIFESTATIONS:
    • PREVIOUS STREP INFECTION
    • MALAISE, HEADACHE, FACIAL EDEMA, FLANK PAIN & TENDERNESS
    • HPN
  • ACUTE G.N.
    • LABS:
    • URINE : SCANTY & BLOODY, SG, RBC & WBC CASTS
    • ASO
    • BUN & CREATININE
    • ANEMIA
  • ACUTE G.N.
    • MANAGEMENT:
    • PROTECTION FROM INJURY
    • TREAT COMPLICATIONS PROMPTLY
  • ACUTE G.N.
    • COMPLICATIONS:
    • HPN
    • ENCEPHALOPATHY
    • C.H.F.
    • PULMONARY EDEMA
  • ACUTE G.N.
    • PROMPT TREATMENT OF COMPLICATIONS
    • PENICILLIN
    • BED REST UNTIL LABS RETURN TO NORMAL
    • DIET : P RESTRICTED ( RENAL INSUFFICIENCY)
    • Na RESTRICTED (HPN, EDEMA & CHF)
    • HIGH C TO REDUCE P CATABOLISM
    • FLUIDS
  • CHRONIC G.N. – PATHOPHYSIO ACUTE G.N. REPEATED AG-AB REACTIONS GLOMERULI BECOME SCARRED; RENAL ARTERIAL BRANCHES THICKENED GLOMERULAR DAMAGE KIDNEY: 1/5 OF ORIGINAL SIZE
  • end stage of chronic glomerulonephritis. Notice their small size. They each measure about 2 x 3". These are severely contracted kidneys. Notice the cortices and the finely granular surfaces.
  • Here's an end stage kidney of chronic glomerulonephritis. Notice again it is extremely contracted and finely granular. This is the kidney of a 38 year old man who presented with an insidious onset of the three signs of uremia, that is loss of appetite, lethargy, and the laboratory finding of an increased BUN. He had no antecedent history of acute glomerulonephritis.
  • CHRONIC G.N.
    • CLINICAL MANIFESTATION:
    • ASYMPTOMATIC
    • 1 ST INDICATION OF DSE: EPISTAXIS, STROKE, CONVULSION
    • FEET SLI. SWOLLEN @ NIGHT
    • WEIGHT LOSS, HEADACHE, NOCTURIA
  • CHRONIC G.N.
    • CLINICAL MANIFESTATION:
    • PHYSICAL EXAM:
      • YELLOW GRAY SKIN PIGMENTATION
      • PERIORBITAL & PERIPHERAL EDEMA
      • HPN
      • ANEMIA – PALE PALP CONJ
  • CHRONIC G.N.
    • MANAGEMENT:
    • DIET ESP PROTEIN, Na & FLUIDS IS READJUSTED ACCORDING TO THE METABOLIC NEEDS OF THE PATIENT
    • BED REST
    • DIALYSIS EARLY IN THE COURSE TO MINIMIZE RISK OF RENAL FAILURE
  • NEPHROTIC SYNDROME
    • CAUSES:
    • CHRONIC G. N.
    • DIABETES MILLETUS
    • AMYLOIDOSIS
    • RENAL THROMBOSIS
  • NEPHROTIC SYNDROME
    • S/SX:
    • PROTEINURIA
    • HYPOALBUMINEMIA
    • EDEMA
    • HYPERLIPEDEMIA
  • NEPHROTIC SYNDROME
    • S/SX:
    • SLOW ONSET OF FLUID RETENTION
    • HEMATURIA
    • URINARY STASIS
  • NEPHROTIC SYNDROME
    • MANAGEMENT:
    • BED REST
    • HIGH P DIET
    • DIURETICS- EDEMA
    • STEROIDS - PROTEINURIA
  • NEPHROSCLEROSIS
    • HPN
    • RENAL ARTERIOSCLEROSIS
    • CLIN MANIFESTATION:
    • URINE: LOW S.G.
    • SM PROTEIN
    • OCC HYALINE & GRANULAR CAST
  • HYDRONEPHROSIS OBSTRUCTION OF URINARY FLOW DISTENTION OF PELVIS & CALYCES THINNING OF RENAL PARENCHYMA GRADUAL DESTRUCTION OF THE KIDNEY COMPENSATORY HYPERTROPHY OF THE CONTRALATERAL KIDNEY IMPAIRMENT OF RENAL FUNCTION
  • HYDRONEPHROSIS
    • CLIN MANIFESTATIONS:
    • Asymptomatic
    • Flank & back pain
    • Hematuria
  • HYDRONEPHROSIS
    • MANAGEMENT
    • Urinary diversion: Nephrostomy
    • Antimicrobials
  •  
  • INFECTIONS OF THE URINARY TRACT
    • PREDISPOSING FACTORS:
    • FEMALE : PROXIMITY OF THE URETHRA TO THE VAGINAL-RECTAL ORIFICES
    • INFANTS AFFECTED MORE OFTEN THAN OLDER CHILDREN
    • ELDERLY
  • INFECTIONS OF THE URINARY TRACT
    • CAUSE:
    • ORGANISMS FROM THE BOWEL
      • E. coli
      • Pseudominas
      • Enterococci
  • INFECTIONS OF THE URINARY TRACT
    • Ascending infection &
    • Vesico - Ureteral reflux
    • Sexual activity
    • Instrumentation
  • - KIDNEY- URETER BLADDER URETERO-VESICAL JUNCTION VESICO- URETERAL REFLUX
  • U.T.I. S/SX
    • CYSTITIS:
      • FREQUENCY
      • URGENCY
      • DYSURIA
      • BLADDER SPASM
      • WALLS MAY BLEED WITH SEVERE INFLAMMATION
  • This is an opened urinary bladder. The mucosa shows many petechial hemorrhages and is swollen and congested. This is hemorrhagic cystitis. It is frequently seen with lower urinary tract infections and is particularly common in the presence of an indwelling urinary catheter.
  • U.T.I. S/SX
    • PYELONEPHRITIS
    • PRIMARY LOWER UTI
    • FLANK PAIN
    • MUSCLE SPASM
    • CHILLS
    • FEVER
    • DYSURIA
  • This is another section of a kidney with acute suppurative pyelonephritis. Notice the parenchyma is congested and swollen. There is a calculus in the calyx.
  • U.T.I.
    • TREATMENT:
    • ANTIBIOTICS
    • INCREASE FLUIDS – 3-4L /DAY
    • EARLY TREATMENT TO PREVENT COMPLICATIONS
  • U.T.I.
    • COMPLICATIONS:
        • SEPTICEMIA
        • RENAL FAILURE
  • NEUROGENIC DISORDERS
    • PARASYMPATHETIC NERVOUS SYSTEM – SACRAL CORD 2,3,4
    • PERCEPTION TO URINATE:
    • 300-500 ML OF URINE
    • MAXIMUM BLADDER CAPACITY:
    • 1L OF URINE
  • NEUROGENIC DISORDERS
    • TYPES:
    • LESION ABOVE THE SACRAL MICTURITION CENTER (SMC)
      • SPASTIC, NEUROPATHIC BLADDER
    • LESION BELOW THE SMC
      • FLACCID, NEUROPATHIC BLADDER
  • SPASTIC BLADDER
    • REDUCED CAPACITY
    • INVOLUNTARY DETRURSOR CONTRACTIONS
    • HYPERTROPHY OF THE BLADDER
    • SPASTICITY OF PELVIC MUSCLES
    • AUTONOMIC DYSREFLEXIA
    • S/SX:
    • INVOLUNTARY URINATION
    • VOIDING CAN BE TRIGGERED BY STIMULATION OF GENETALIA OR ABDOMEN, WITH SPASM OF EXTREMITIES
  • FLACCID (ATONIC) BLADDER
    • TYPES:
    • SENSORY
    • MOTOR
    • LARGE CAPACITY
    • LACK OF VOLUNTARY DETRURSOR MUSCLES
    • MILD WALL HYPERTROPHY (TRABECULATIONS)
    • DECREASED TONE OF EXTERNAL SPHINCTER
  • FLACCID (ATONIC) BLADDER
    • LOSS OF SENSORY / MOTOR SUPPLY TO THE BLADDER
    • SHOCK PHASE OF SCI
    • BLADDER :
      • FLACCID & DISTENDED
      • RETENTION WITH OVERFLOW INCONTENENCE
      • SMOOTH MUSCLE STILL ACTIVE + WEAK STRIATED SPHINCTER MUSCLES = TRABECULATIONS
    • GENITAL PROBLEMS : LOSS OF ERECTION
  •  
  • NEUROGENIC BLADDER
    • DIAGNOSIS:
    • HISTORY
    • NEUROLOGICAL EXAM & STUDIES (EMG)
    • RADIOLOGIC EXAM
    • (VOIDING CYSTOURETHROGRAM)
    • UROLOGIC STUDIES (UTZ)
  • NEUROGENIC BLADDER
    • INTERVENTIONS:
    • INTERMITTENT CATHETER DRAINAGE
    • CREDE’S METHOD
    • ALCOHOL, TEA & COFFEE AS DIURETICS
    • ELECTRONIC STIMULATION OF THE BLADDER
  • UROLITHIASIS
    • CAUSE:
    • URINARY STASIS
    • UREA- SPLITTING ORGANISMS
      • E. coli
      • Proteus
      • Staph, Strep
  • UROLITHIASIS
    • Types of Stones:
    • ACID STONES
      • URIC ACID
      • CYSTINE
    • ALKALINE STONES
      • PHOSPHATE
      • CALCIUM OXALATE
  • Alkaline Stone formation UREA-SPLITTING ORGANISMS IN THE URINE URINE BECOMES ALKALINE CALCIUM PHOSPHATE BECOMES INSOLUBE UROLITHIASIS
  •  
  • There was a large renal calculus (stone) that obstructed the calyces of the lower pole of this kidney, leading to a focal hydronephrosis (dilation of the collecting system). The stasis from the obstruction and dilation led to infection. The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good corticomedullary demarcations.
  • Sometimes a very large calculus nearly fills the calyceal system, with extensions into calyces that give the appearance of a stag's (deer) horns. Hence, the name "staghorn calculus". Seen here is a horn-like stone extending into a dilated calyx, with nearly unrecognizable overlying renal cortex from severe hydronephrosis and pyelonephritis. Nephrectomy may be performed because the kidney is non-functional and serves only as a source for infection.
  • UROLITHIASIS
    • S/SX:
    • CVA PAIN
      • COLICKY & EXCRUCIATING
      • RADIATES TO THE LABIA OR SCROTUM
    • ASHEN FACE
    • DIAPHORESIS
    • FREQUENCY
    • HEMATURIA
    • FEVER - INFECTION
  • UROLITHIASIS
    • MEDICAL TREATMENT:
    • ACID STONES - ALKALINE ASH DIET:
        • FRUITS
        • VEGETABLES
        • MILK
    • ALKALINE STONES - ACID ASH DIET :
        • MEAT
        • FISH
        • EGGS
        • CEREALS
  • UROLITHIASIS
    • MEDICAL TREATMENT:
    • RESTRICT CALCIUM
    • ALUMINUM HYDROXIDE – PHOSPHATE STONES
    • PERCUTANEOUS STONE REMOVAL
      • NEPHROSTOMY. NEPHROLITHOTOMY (LASER, UTZ, ELECTROHYDRAULIC)
      • STONE DISSOLUTION - CHEMOLYSIS
  • UROLITHIASIS
    • SURGICAL PROCEDURES:
    • PYELOLITHOTOMY – RENAL PELVIS
    • NEPHROLITHOTOMY
    • NEPHRECTOMY
    • URETEROLITHOTOMY
    • CYSTOLITHOTOMY
  • UROLITHIASIS
    • STONE DESTRUCTION:
    • LITHOTRIPSY
      • ULTRASONIC
      • ELECTROHYDRAULIC
  • RENAL TUMORS
    • INSIDUOUS & SLOW
    • HEMATURIA- EROSION OF PELVIS
    • BLADDER TUMOR – RARE
    • DIAGNOSIS – CYSTOSCOPY WITH BIOPSY
    • TX : SURGERY, IRRADIATION, CHEMOTHERAPY
  • In the upper pole of this kidney is a well circumscribed tumor which has a yellowish-brown color and shows central necrosis. This is a renal cell carcinoma.
  • obstructive disease . In the center of the photograph is the sigmoid colon and rectum of a patient with adenocarcinoma of the rectum. This has invaded the bladder and has occluded the orifices of the ureter on both sides. The right ureter shows extreme hydroureter.
  • BENIGN PROSTATIC HYPERTROPHY
    • S/SX:
    • INCOMPLETE EMPTYING
    • FREQUENCY
    • INTERMITTENCY
    • URGENCY
    • WEAK STREAM
    • STRAINING
    • NOCTURIA
    • CYSTITIS
    • HYDRONEPHROSIS
    • URINARY CALCULI
  • BENIGN PROSTATIC HYPERTROPHY
    • DIAGNOSIS:
    • DRE : SMOOTH, FIRM & ELASTIC ENLARGEMENT
    • IMAGING : IVP OR RENAL UTZ
    • PSA - OPTIONAL
  • BENIGN PROSTATIC HYPERTROPHY
    • MANAGEMENT:
    • MILD SYMPTOMS :
      • WATCHFUL WAITING + MEDICATIONS
    • SURGERY :
      • PROSTATECTOMY
  • BENIGN PROSTATIC HYPERTROPHY
    • MEDICATIONS:
    • ALPHA – BLOCKERS
      • (eg PRAZOSIN)
    • 5 ALPHA REDUCTASE INHIBITOR
      • (eg FINASTERIDE)
  • T.U.R.P.
    • TRANSURETHRAL RESECTION OF THE PROSTATE
    • MOST COMMON APPROACH
    • RESECTOSCOPE PASSED THRU URETHRA
    • EXCESSIVE PROSTATIC TISSUE IS CAUTERIZED
    • LARGE FOLEY CATH – FOR HEMOSTASIS & URINARY DRAINAGE
  • T.U.R.P.
    • PRE OP NURSING CARE:
    • EXPLAIN ABOUT CATHETER & OCC DECOMPRESSION DRAINAGE
    • INSTRUCT: NO STRAINING WITH VOIDING SENSATIONS
    • INSTRUCT: TCDB
  •  
  • T.U.R.P.
    • POST OP NURSING CARE:
    • PREVENT COMPLICATIONS
    • URINARY DRAINAGE
    • HEALING HEALTH HABITS
    • HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
  • T.U.R.P.
    • POST OP NURSING CARE:
    • PREVENT COMPLICATIONS
    • URINARY DRAINAGE
    • HEALING HEALTH HABITS
    • HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
  • COMPLICATIONS- T.U.R.P.
    • HEMORRHAGE
    • ARTERIAL BLEEDING : BRIGHT RED URINE WITH CLOTS
    • MONITOR FOR SIGNS OF SHOCK
    • VENOUS BLEEDING : NORMAL 48 HRS
    • & 6-8D POST OP
  • COMPLICATIONS- T.U.R.P
    • THROMBOSIS & EMBOLISM
    • TURNING
    • EXERCISE LEG
    • ENCOURAGE AMBULATION
  • COMPLICATIONS- T.U.R.P
    • BLADDER SPASM
    • PROPHYLACTIC ANTISPASMODIC
    • AMBULATION
    • DETERMINE PATENCY OF CATHETER
    • IRRIGATE CATHETER AS ORDERED
    • FREQUENCY OF SPASM SHOULD DECREASE WITHIN 48H
    • AVOID RECTAL PRESSURE – STOOL SOFTENER, INCREASE BULK IN FOOD
  • T.U.R.P.
    • POST OP NURSING CARE:
    • PREVENT COMPLICATIONS
    • URINARY DRAINAGE
    • HEALING HEALTH HABITS
    • HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
  • URINARY DRAINAGE
    • F 18-16 3-WAY FOLEY CATHETER
      • HEMOSTASIS
      • OUTLET OF URINE
    • FLUIDS
      • DILUTE URINE
      • MINIMIZE INFECTION
    • MONITOR IRRIGATING SOLUTION
      • WATER INTOXICATION IS POSSIBLE
  • URINARY DRAINAGE
    • REFER IF NO VOIDING WITHIN 5-6H AFTER CATHETER REMOVAL
    • NORMAL: URGENCY, FREQUENCY & DYSURIA AFTER REMOVAL
    • INCONTINENCE :
      • NOT NORMAL
      • CAUSED BY BLADDER SPASM
    • FLUIDS: 12-14 GLASSES A DAY
    • EXERCISE TO STRENGTHEN PERINEAL MUSCLES
  • T.U.R.P.
    • POST OP NURSING CARE:
    • PREVENT COMPLICATIONS
    • URINARY DRAINAGE
    • HEALING HEALTH HABITS
    • HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
  • HEALTH HABITS
    • ADEQUATE NUTRITION
    • PERINEAL APPROACH – HOT SITZ BATH
  • T.U.R.P.
    • POST OP NURSING CARE:
    • PREVENT COMPLICATIONS
    • URINARY DRAINAGE
    • HEALING HEALTH HABITS
    • HELPING CLIENT ADJUST TO CHANGES IN SELF-CONCEPT
  • ADJUSTING TO CHANGES IN SELF-CONCEPT
    • POSSIBILITY OF PERMANENT/ TEMPORARY INTERFERENCE IN SEXUAL FXN
    • STERILITY WITH SEVERING OF VAS DEFERENS
    • CLOUDY URINE :T
      • EMPORARY RETROGRADE EJACULATION FROM DAMAGE TO INTERNAL SPHINCTER
  • DISCHARGE INSTRUCTIONS
    • MGH – IF ABLE TO EMPTY BLADDER SPONTANEOUSLY
    • NO HEAVY LIFTING 6 WKS POST OP
    • NO SEXUAL INTERCOURSE – 6 WKS POST OP
    • HEMATURIA WITH VENOUS BLOOD IS NORMAL
    • REPORT BRIGHT RED BLEEDING & DYSURIA
  • This is an opened urinary bladder and prostate below The hyperplastic prostate gland has obliterated the lower part of the cystic cavity. There is hemorrhagic cystitis and prominent trabeculae in the hypertrophied bladder.
  • This is another enlarged prostate gland, but it does not show the sharply defined capsule that you saw in hyperplasia of the prostate. This is adenocarcinoma of the prostate gland which is invading the pelvic tissue.
    • A client who is in acute renal failure develops pulmonary edema. Nursing interventions for this person should include all of the following, except:
    • Oxygen
    • Coughing & deep breathing
    • Semi-fowler’s position
    • Replacing lost fluids
  •