Alteration in Urinary System.ppt22222
Transcript of Alteration in Urinary System.ppt22222
-
8/8/2019 Alteration in Urinary System.ppt22222
1/117
Medical Surgical Nursing
-
8/8/2019 Alteration in Urinary System.ppt22222
2/117
` Pair of bean-shaped, brownish-red structures
located retroperitoneal on the posterior wall of the
abdomen
` Weighs 113-170 g (about 4.5 oz)` 10-12 cm long
` 6 cm wide
` 2.5 cm thick
` Slightly lower than the left due to the location ofthe liver
-
8/8/2019 Alteration in Urinary System.ppt22222
3/117
` Adrenal gland lies on top of the kidney
` Renal parenchyma: 1)cortex 2)medulla
` Medulla : 5 cm wide, inner portion of the kidney
Contains loop of Henle, vasa recta, collecting ducts of thejuxtamedullary nephrons
` Cortex : 1 cm wide located farthest from the center
of the kidney and around the outermost edges
It contains the nephrons (functional units of the kidney)
-
8/8/2019 Alteration in Urinary System.ppt22222
4/117
` Urine formation` Excretion of waste products
` Regulation of electrolytes
` Regulation of acid-base balance
` Control of water balance` Control of blood pressure
` Renal clearance
` Regulation of RBC production
` Synthesis of Vitamin D to active form` Secretion of prostaglandin
` Regulates Ca and Phosphorous balance
` Activates growth hormone
-
8/8/2019 Alteration in Urinary System.ppt22222
5/117
` Kidneys receive 20% to 25% of the total cardiacoutput, which means that all of the bodys bloodcirculates through the kidneys approximately 12times per hour
` Renal artery divides into smaller and smallervessels, forming the afferent arterioles
` Each afferent arteriole branches form aGLOMERULUS, responsible for GLOMERULAR
FILTRATION` Blood leaves the glomerulus through efferent
arteriole and flows back to the inferior vena cavathrough capillaries and veins
-
8/8/2019 Alteration in Urinary System.ppt22222
6/117
` URETERS long, fibromuscular tubes that
connects each kidney to the bladder Each 24 to 30 cm long, originate at the lower portion of
the renal pelvis and terminate in the trigone of the
bladder wall
` BLADDER muscular, hollow sac located just
behind the pubic bone Capacity : 300-500ml
` URETHRA arises from the base of the bladder Male : passes through the penis
Female : opens just anterior to the vagina
-
8/8/2019 Alteration in Urinary System.ppt22222
7/117
-
8/8/2019 Alteration in Urinary System.ppt22222
8/117
-
8/8/2019 Alteration in Urinary System.ppt22222
9/117
-
8/8/2019 Alteration in Urinary System.ppt22222
10/117
-
8/8/2019 Alteration in Urinary System.ppt22222
11/117
-
8/8/2019 Alteration in Urinary System.ppt22222
12/117
` Urinalysis and urine culture
` Renal function tests
` Ultrasonography
` CT and MR
I
` Nuclear scans
` Intravenous urography, retrograde pyelography,cystography, renal angiography
` Endoscopic procedures
` Biopsies
-
8/8/2019 Alteration in Urinary System.ppt22222
13/117
Key Signs and Symptoms of
Urological Problems
EDEMA
x associated with fluid retention
x Renal dysfunctions usually
produce ANASARCA
-
8/8/2019 Alteration in Urinary System.ppt22222
14/117
Key Signs and Symptoms of
Urological Problems
PAIN
x Suprapubic pain= bladder
x Colicky pain on the flank= kidney
-
8/8/2019 Alteration in Urinary System.ppt22222
15/117
Key Signs and Symptoms ofUrological Problems
HEMATURIAx Painless hematuria may indicate
URINARY CANCER!
x Early-stream hematuria= urethrallesion
x Late-stream hematuria= bladder lesion
-
8/8/2019 Alteration in Urinary System.ppt22222
16/117
Key Signs and Symptoms of
Urological Problems
DYSURIA
x Pain with urination= lower UTI
-
8/8/2019 Alteration in Urinary System.ppt22222
17/117
Key Signs and Symptoms ofUrological Problems
POLYURIAx More than 2 Liters urine per day
OLIGURIAx Less than 400 mL per day
ANURIAx Less than 50 mL per day
-
8/8/2019 Alteration in Urinary System.ppt22222
18/117
Key Signs and Symptoms of
Urological Problems
Urinary Urgency
Urinary retention
Urinary frequency
-
8/8/2019 Alteration in Urinary System.ppt22222
19/117
PHYSICAL EXAMINATION
Inspection
AuscultationPercussion
Palpation
-
8/8/2019 Alteration in Urinary System.ppt22222
20/117
Laboratory examination
1. Urinalysis
2. BUN and Creatinine levels of theserum
3. Serum electrolytes
-
8/8/2019 Alteration in Urinary System.ppt22222
21/117
Laboratory examination
Radiographic
IVP KUB x-ray
KUB ultrasound
CT and MRI Cystography
-
8/8/2019 Alteration in Urinary System.ppt22222
22/117
Provide PAIN relief
` Assess the level of pain
` Administer medications usually narcotic
ANALGESICS
-
8/8/2019 Alteration in Urinary System.ppt22222
23/117
Maintain Fluid and Electrolyte Balance
` Encourage to consume at least 2 liters of fluid
per day
` In cases of ARF, limit fluid as directed` Weigh client daily to detect fluid retention
-
8/8/2019 Alteration in Urinary System.ppt22222
24/117
Ensure Adequate urinary elimination
` Encourage to void at least every 2-3 hours
` Promote measures to relieve urinary retention:
Alternating warm and cold compress Bedpan
Open faucet
Provide privacy
Catheterization if indicated
-
8/8/2019 Alteration in Urinary System.ppt22222
25/117
`Bacterial invasion of the
kidneys or bladder
(CYSTITIS) usually
caused by Escherichia
coli
-
8/8/2019 Alteration in Urinary System.ppt22222
26/117
Predisposing factors include
1. Poor hygiene
2. Irritation from bubble baths3. Urinary reflux
4. Instrumentation
5. Residual urine, urinary stasis6. Dehydration
-
8/8/2019 Alteration in Urinary System.ppt22222
27/117
PATHOPHYSIOLOGY
` The invading organism ascends the urinary
tract, irritating the mucosa and causing
characteristic symptoms Ureter= ureteritis
Bladder= cystitis
Urethra=Urethritis
Pelvis= Pyelonephritis
-
8/8/2019 Alteration in Urinary System.ppt22222
28/117
Assessment findings
` Low-grade fever
` Abdominal pain` Enuresis
` Pain/burning on urination
` Urinary frequency
` Hematuria
-
8/8/2019 Alteration in Urinary System.ppt22222
29/117
Assessment findings: Upper UTI
` Fever and CHIILS
` Flank pain` Costovertebral angle tenderness
-
8/8/2019 Alteration in Urinary System.ppt22222
30/117
Laboratory Examination
1. Urinalysis
2. Urine Culture
-
8/8/2019 Alteration in Urinary System.ppt22222
31/117
Nursing interventions` Administer antibiotics as ordered
` Provide warm baths and allow client to void in
water to alleviate painful voiding.
` Force fluids. Nurses may give 3 liters of fluidper day
` Encourage measures to acidify urine
(cranberry juice, acid-ash diet).
-
8/8/2019 Alteration in Urinary System.ppt22222
32/117
`
Provide client teaching and dischargeplanning concerning
a. Avoidance of tub baths
b. Avoidance of bubble baths that might irritate
urethrac. Importance for girls to wipe perineum from
front to back
d. Increase in foods/fluids that acidify urine.
-
8/8/2019 Alteration in Urinary System.ppt22222
33/117
Pharmacology` 1. Sulfa drugs
Highly concentrated in the urine
Effective against E. coli!
Can cause CRYSTALLURIA
` 2. Quinolones Not given to less than 18 because they can cause
cartilage degradation
` 3. Pyridium= urinary antiseptic Can cause urine discoloration
-
8/8/2019 Alteration in Urinary System.ppt22222
34/117
`Presence of stones
anywhere in the urinary tract
Calciumoxalate
and uric acid
-
8/8/2019 Alteration in Urinary System.ppt22222
35/117
Pathophysiology
` Predisposing factors
a. Diet: large amounts of calcium and oxalate
b. Increased uric acid levels
c. Sedentary life-style, immobility
d. Family history of gout or calculi
e. Hyperparathyroidism
-
8/8/2019 Alteration in Urinary System.ppt22222
36/117
Pathophysiology
Supersaturation of crystals due to stasis
Stone formation
May pass through the urinary tract
OBSTRUCTION, INFECTION and HYDRONEPHROSIS
-
8/8/2019 Alteration in Urinary System.ppt22222
37/117
Assessment findings
1. Abdominal or flank pain
2. Renal colic radiating to thegroin
3. Hematuria
4. Cool, moist skin
5. Nausea and vomiting
-
8/8/2019 Alteration in Urinary System.ppt22222
38/117
Diagnostic tests1. KUB Ultrasound and X-ray:
pinpoints location, number, and size
of stones2. IVP: identifies site of obstruction
and presence of non-radiopaque
stones3. Urinalysis: indicates presence of
bacteria, increased protein, increased
WBC and RBC (hematuria)
-
8/8/2019 Alteration in Urinary System.ppt22222
39/117
Medical management
1. Surgery
` a. Percutaneous nephrostomy: tube is insertedthrough skin and underlying tissues into renal
pelvis to remove calculi.` b. Percutaneous nephrostolithotomy: delivers
ultrasound waves through a probe placed onthe calculus.
-
8/8/2019 Alteration in Urinary System.ppt22222
40/117
Medical management
2. Extracorporeal shock-wave lithotripsy:
delivers shock waves from outside the body
to the stone, causing pulverization3. Pain management : Morphine or Meperidine
4. Diet modification
-
8/8/2019 Alteration in Urinary System.ppt22222
41/117
Nursing interventions
` 1. Strain all urine through gauze to
detect stones and crush all clots.
` 2. Force fluids (30004000 cc/day).
` 3. Encourage ambulation to prevent
stasis.
-
8/8/2019 Alteration in Urinary System.ppt22222
42/117
Nursing interventions
` 4. Relieve pain by administration of
analgesics as ordered and
application of moist heat to flank
area.
` 5. Monitor intake and output
-
8/8/2019 Alteration in Urinary System.ppt22222
43/117
Nursing interventions` 6. Provide modified diet,depending upon stone
consistency: Calcium, Oxalateand Uric acid stones
-
8/8/2019 Alteration in Urinary System.ppt22222
44/117
Nursing interventionsCalcium stones` limit milk/dairy productsprovide acid-ash diet to acidifyurine (cranberry or prune juice,meat, eggs, poultry, fish, grapes,
and whole grains)
-
8/8/2019 Alteration in Urinary System.ppt22222
45/117
Nursing interventionsOxalate stones
` avoid excess intake of foods/ fluids
high in oxalate (tea, chocolate,spinach)
` maintain alkaline-ash diet to
alkalinize urine (milk; vegetables;fruits except prunes, cranberries,and plums)
-
8/8/2019 Alteration in Urinary System.ppt22222
46/117
Nursing interventionsUric acid stones` reduce foods high in purine
(liver, beans, kidneys, venison,shellfish, meat soups, gravies,legumes)
`
maintain alkaline urine
-
8/8/2019 Alteration in Urinary System.ppt22222
47/117
Nursing interventions
` 7. Administer allopurinol (Zyloprim) as
ordered, to decrease uric acid production
Allopurinolx Rashes
x Nasal congestion
-
8/8/2019 Alteration in Urinary System.ppt22222
48/117
8. Provide client teaching and discharge
planning concerning
`
Prevention of Urinary stasis bymaintaining increased fluid intake
especially in hot weather and during
illness; mobility; voiding whenever
the urge is felt and at least twiceduring the night
-
8/8/2019 Alteration in Urinary System.ppt22222
49/117
8. Provide client teaching and discharge
planning concerning:
`
Adherence to prescribed diet` Need for routine urinalysis (at least
every 34 months)
` Need to recognize and report signs/
symptoms of recurrence (hematuria,
flank pain).
-
8/8/2019 Alteration in Urinary System.ppt22222
50/117
`Sudden interruption of
kidney function to regulatefluid and electrolytebalance and remove toxicproducts from the body
-
8/8/2019 Alteration in Urinary System.ppt22222
51/117
`Most important
manifestation: OLIGURIA
-
8/8/2019 Alteration in Urinary System.ppt22222
52/117
The Nephron producesThe Nephron produces
urine to eliminate wasteurine to eliminate waste
Impaired urine productionImpaired urine production
and azotemiaand azotemia
Secretes ErythropoietinSecretes Erythropoietin
to increase RBCto increase RBC
ANEMIAANEMIA
Metabolism of Vitamin DMetabolism of Vitamin D Calcium and PhosphateCalcium and Phosphate
imbalancesimbalances
Produces bicarbonateProduces bicarbonateand secretes acidsand secretes acids Metabolic ACIDOSISMetabolic ACIDOSIS
Excretes excessExcretes excess
POTASSIUMPOTASSIUM
HYPERKALEMIAHYPERKALEMIA
-
8/8/2019 Alteration in Urinary System.ppt22222
53/117
PATHOPHYSIOLOGY1. Pre-renal failure
2. Intra-renal failure
3. Post-renal failure
-
8/8/2019 Alteration in Urinary System.ppt22222
54/117
-
8/8/2019 Alteration in Urinary System.ppt22222
55/117
PATHOPHYSIOLOGYPrerenal CAUSE:` Factors interfering with perfusion
and resulting in diminished bloodflow and glomerular filtrate,ischemia, and oliguria; includeCHF, cardiogenic shock, acutevasoconstriction, hemorrhage,burns, septicemia, hypotension,anaphylaxis
-
8/8/2019 Alteration in Urinary System.ppt22222
56/117
PATHOPHYSIOLOGYIntrarenal CAUSE:` Conditions that cause damage to the
nephrons; include acute tubularnecrosis (ATN), endocarditis, diabetesmellitus, malignant hypertension,acute glomerulonephritis, tumors,
blood transfusion reactions,hypercalcemia, nephrotoxins (certainantibiotics, x-ray dyes, pesticides,anesthetics)
-
8/8/2019 Alteration in Urinary System.ppt22222
57/117
PATHOPHYSIOLOGYPostrenal CAUSE:` Mechanical obstruction anywhere
from the tubules to the urethra;includes calculi, BPH, tumors,strictures, blood clots, trauma, andanatomic malformation
-
8/8/2019 Alteration in Urinary System.ppt22222
58/117
Three phases of acute renal failure
1. Oliguric phase
2. Diuretic phase
3. Convalescence or recovery phase
-
8/8/2019 Alteration in Urinary System.ppt22222
59/117
Four phases of acute renal failure(Brunner andSuddarth)
1. Initiation phase
2. Oliguric phase3. Diuretic phase4. Convalescence or recovery phase
-
8/8/2019 Alteration in Urinary System.ppt22222
60/117
Assessment findings: The Three Phases of AcuteRenal Failure
1. Oliguric phase` Urine output less than 400 cc/24 hours`
duration 12 weeks` Manifested by dilutional hyponatremia,
hyperkalemia, hyperphosphatemia,hypocalcemia, hypermagnesemia, andmetabolic acidosis
` Diagnostic tests: BUN and creatinine elevated
-
8/8/2019 Alteration in Urinary System.ppt22222
61/117
Assessment findings: The Three Phases ofAcute Renal Failure
2. Diuretic phase` Diuresis may occur (output 35 liters/day)
due to partially regenerated tubulesinability to concentrate urine
` Duration: 23 weeks; manifested byhyponatremia, hypokalemia, and
hypovolemia` Diagnostic tests: BUN and creatinine
slightly elevated
-
8/8/2019 Alteration in Urinary System.ppt22222
62/117
Assessment findings: The ThreePhases of Acute Renal Failure
3. Recovery or convalescent phase:
` Renal function stabilizes with gradualimprovement over next 312 months
-
8/8/2019 Alteration in Urinary System.ppt22222
63/117
Laboratory findings:1. Urinalysis: Urine osmo and sodium2. BUN and creatinine levels increased
3. Hyperkalemia4. Anemia5. ABG: metabolic acidosis
-
8/8/2019 Alteration in Urinary System.ppt22222
64/117
Nursing interventions
` Monitor fluid and Electrolyte Balance
` Reduce metabolic rate
` Promote pulmonary function` Prevent infection
` Provide skin care
` Provide emotional support
-
8/8/2019 Alteration in Urinary System.ppt22222
65/117
Nursing interventions1. Monitor and maintain fluid and electrolyte
balance.` Measure l & O every hour. note excessive
losses in diuretic phase` Administer IV fluids and electrolyte
supplements as ordered.` Weigh daily and report gains.` Monitor lab values; assess/treat fluid and
electrolyte and acid-base imbalances asneeded
-
8/8/2019 Alteration in Urinary System.ppt22222
66/117
Nursing interventions2. Monitor alteration in fluid volume.` Monitor vital signs, PAP, PCWP,
CVP as needed.` Weigh client daily.` Maintain strict I & O records.
-
8/8/2019 Alteration in Urinary System.ppt22222
67/117
Nursing interventions2. Assess every hour forhypervolemia Maintain adequate ventilation.
Restrict FLUID intake Administer diuretics andantihypertensives
-
8/8/2019 Alteration in Urinary System.ppt22222
68/117
Nursing interventions3. Promote optimal nutritional status.
` Administer TPN as ordered.
` With enteral feedings, check forresidual and notify physician ifresidual volume increases.
` Restrict protein intake to 1 g/kg/day
` Restrict POTASSIUM intake
` HIGH CARBOHYDRATE DIET, calciumsupplements
-
8/8/2019 Alteration in Urinary System.ppt22222
69/117
Nursing interventions4. Prevent complications from
impaired mobility (pulmonaryembolism, skin breakdown, andatelectasis)
5. Prevent fever/infection. Assess for signs of infection.
Use strict aseptic technique for woundand catheter care.
-
8/8/2019 Alteration in Urinary System.ppt22222
70/117
Nursing interventions6. Support client/significant others and reduce/
relieve anxiety. Explain pathophysiology and relationship to
symptoms. Explain all procedures and answer all questions in
easy-to-understand terms Refer to counseling services as needed
7. Provide care for the client receiving dialysis
-
8/8/2019 Alteration in Urinary System.ppt22222
71/117
Nursing interventions8. Provide client teaching and discharge
planning concerning` Adherence to prescribed dietary regimen` Signs and symptoms of recurrent renal
disease` Importance of planned rest periods` Use of prescribed drugs only
` Signs and symptoms of UTI or respiratoryinfection need to report to physicianimmediately
-
8/8/2019 Alteration in Urinary System.ppt22222
72/117
`Gradual, Progressiveirreversible destruction ofthe kidneys causing severe
renal dysfunction.`The result is azotemia toUREMIA
-
8/8/2019 Alteration in Urinary System.ppt22222
73/117
Predisposing factors:
DM= worldwide leading cause
Recurrent infectionsExacerbations of nephritis
urinary tract obstruction
hypertension
-
8/8/2019 Alteration in Urinary System.ppt22222
74/117
PATHOPHYSIOLOGY
As renal functions decline
Retention of end-products of
metabolism
-
8/8/2019 Alteration in Urinary System.ppt22222
75/117
PATHOPHYSIOLOGY
STAGE 1= reduced renal reserve,40-75% loss of nephron function
STAGE 2= renal insufficiency, 75-90% loss of nephron function
STAGE 3= end-stage renal disease,
more than 90% loss. DIALYSIS ISTHE TREATMENT!
-
8/8/2019 Alteration in Urinary System.ppt22222
76/117
Assessment findings` 1. Nausea, vomiting; diarrhea orconstipation; decreased urinary
output` 2. Dyspnea` 3. Stomatitis` 4. Hypertension (later), lethargy,convulsions, memory impairment,pericardial friction rub
-
8/8/2019 Alteration in Urinary System.ppt22222
77/117
DermatologicDermatologic dry skindry skin, pruritus, uremic, pruritus, uremicfrostfrost
CNSCNS seizures, altered LOC,seizures, altered LOC,
anorexia, fatigueanorexia, fatigueCVSCVS Acute MI, edema,Acute MI, edema,
hypertension, pericarditishypertension, pericarditis
PulmoPulmo Uremic lungsUremic lungs
HemaHema AnemiaAnemia
MusculoskeletalMusculoskeletal loss of strength, footloss of strength, footdrop, osteodystrophydrop, osteodystrophy
-
8/8/2019 Alteration in Urinary System.ppt22222
78/117
Diagnostic tests:` a. 24 hour creatinine clearanceurinalysis
` b. Protein, sodium, BUN, Creaand WBC elevated
` c. Specific gravity, platelets, and
calcium decreased` D. CBC= anemia
-
8/8/2019 Alteration in Urinary System.ppt22222
79/117
Medical management` 1. Diet restrictions` 2. Multivitamins`
3. Hematinics and erythropoietin` 4. Aluminum hydroxide gels` 5. Anti-hypertensive` 6. Anti-seizures
`DIALYSIS
-
8/8/2019 Alteration in Urinary System.ppt22222
80/117
Nursing interventions1. Prevent neurological
complications.
` Assess every hour for signs ofuremia (fatigue, loss of appetite,decreased urine output, apathy,confusion, elevated blood
pressure, edema of face and feet,itchy skin, restlessness, seizures).
-
8/8/2019 Alteration in Urinary System.ppt22222
81/117
Nursing interventions1. Prevent neurological complications.` Assess for changes in mental
functioning.` Orient confused client to time, place,
date, and persons` Institute safety measures to protect
client from falling out of bed.
-
8/8/2019 Alteration in Urinary System.ppt22222
82/117
Nursing interventions2. Promote optimal GI function.` Assess/provide care for stomatitis
` Monitor nausea, vomiting, anorexia` Administer antiemetics as ordered.` Assess for signs of Gl bleeding
-
8/8/2019 Alteration in Urinary System.ppt22222
83/117
Nursing interventions` 3. Monitor/prevent alteration in fluid
and electrolyte balance`
4. Assess for hyperphosphatemia(paresthesias, muscle cramps,seizures, abnormal reflexes), andadministeraluminum hydroxide gels(Amphojel) as ordered
-
8/8/2019 Alteration in Urinary System.ppt22222
84/117
-
8/8/2019 Alteration in Urinary System.ppt22222
85/117
Nursing interventions6. Monitor for bleeding complications,
prevent injury to client.
` Monitor Hgb, hct, platelets, RBC.` Hematest all secretions.` Administer hematinics as ordered.` Avoid lM injections
-
8/8/2019 Alteration in Urinary System.ppt22222
86/117
Nursing interventions7. Promote/maintain maximal
cardiovascular function.`
Monitor blood pressure and reportsignificant changes.` Auscultate for pericardial friction
rub.`
Perform circulation checks routinely.
-
8/8/2019 Alteration in Urinary System.ppt22222
87/117
Nursing interventions7. Promote/maintain maximal
cardiovascular function.`
Administer diuretics as ordered andmonitor output.` Modify drug doses8. Provide care for client receiving
dialysis.
-
8/8/2019 Alteration in Urinary System.ppt22222
88/117
Aluminum hydroxideAluminum hydroxide
(Amphogel)(Amphogel)
Binds withBinds withPHOSPHATE toPHOSPHATE to
decrease phosphorusdecrease phosphorus
KayexalateK
ayexalate Binds withBinds withPOTASSIUM toPOTASSIUM to
manage hyperkalemiamanage hyperkalemia
DiureticsDiuretics To decrease edemaTo decrease edema
ErythropoietinErythropoietin
(Epogen)(Epogen)
To increase RBCTo increase RBC
AntiAnti--HypertensivesHypertensives To manageTo manage
HypertensionHypertension
-
8/8/2019 Alteration in Urinary System.ppt22222
89/117
` a procedure that is used to remove
fluid and uremic wastes from the
body when the kidneys cannot
function
-
8/8/2019 Alteration in Urinary System.ppt22222
90/117
` Two methods
` 1. Hemodialysis
` 2. Peritoneal dialysis
-
8/8/2019 Alteration in Urinary System.ppt22222
91/117
-
8/8/2019 Alteration in Urinary System.ppt22222
92/117
-
8/8/2019 Alteration in Urinary System.ppt22222
93/117
` Diffusion
` Osmosis
` Ultrafiltration
-
8/8/2019 Alteration in Urinary System.ppt22222
94/117
Nursing management1. Meet the patient's psychosocial
needs
2. Remember to avoid anyprocedure on the arm with thefistula (HEMO)
Monitor WEIGHT, blood pressureand fistula site for bleeding
-
8/8/2019 Alteration in Urinary System.ppt22222
95/117
Nursing management3. Monitor symptoms of uremia
4. Detect complications like infection, bleeding(Hepatitis B/C and HIV infection in
Hemodialysis) Peritonitis in peritonealdialysis
5. Warm the solution to increase diffusion ofwaste products (PERITONEAL)
6. Manage discomfort and pain
-
8/8/2019 Alteration in Urinary System.ppt22222
96/117
Nursing management
7. To determine effectiveness, check
serum creatinine, BUN and
electrolytes
-
8/8/2019 Alteration in Urinary System.ppt22222
97/117
` BPH
` Prostatic cancer
-
8/8/2019 Alteration in Urinary System.ppt22222
98/117
DIGITAL RECTAL EXAMINATION- DRE
` Recommended for men annually with age over
40 years
` Screening test for cancer
` Askpatient to BEAR DOWN
-
8/8/2019 Alteration in Urinary System.ppt22222
99/117
-
8/8/2019 Alteration in Urinary System.ppt22222
100/117
TESTICULAR EXAMINATION
` Palpation of scrotum for nodules and masses
or inflammation
` BEGINSDURING ADOLESCENCE
-
8/8/2019 Alteration in Urinary System.ppt22222
101/117
Prostate specific antigen (PSA)
` Elevated in prostate cancer
` Normal is 0.2 to 4 nanograms/mL
`
Cancer= over 4
-
8/8/2019 Alteration in Urinary System.ppt22222
102/117
BENIGN PROSTATIC HYPERPLASIA
` Enlargement of the prostate that causes
outflow obstruction
` Common in men older than 50 years old
-
8/8/2019 Alteration in Urinary System.ppt22222
103/117
-
8/8/2019 Alteration in Urinary System.ppt22222
104/117
BENIGN PROSTATIC HYPERPLASIA
Assessment findings
1. DRE: enlarged prostate gland that is rubbery,
large and NON-tender
2. Increased frequency, urgency and hesitancy
3. Nocturia, DECREASE IN THE VOLUME AND
FORCE OF URINESTREAM
-
8/8/2019 Alteration in Urinary System.ppt22222
105/117
BENIGN PROSTATIC HYPERPLASIA
Medical management
1. Immediate catheterization
2.
Prostatectomy3. TRANSURETHRAL RESECTION of the
PROSTATE (TURP)
4. Pharmacology: alpha-blockers, alpha-
reductase inhibitors. SAW palmetto
-
8/8/2019 Alteration in Urinary System.ppt22222
106/117
-
8/8/2019 Alteration in Urinary System.ppt22222
107/117
-
8/8/2019 Alteration in Urinary System.ppt22222
108/117
-
8/8/2019 Alteration in Urinary System.ppt22222
109/117
NURSING INTERVENTION: TURP
` Maintain the three way bladder irrigation to
prevent hemorrhage
` Only initially the drainage is pink-tinged and
never reddish
` Administer anti-spasmodic to prevent
bladder spasms
-
8/8/2019 Alteration in Urinary System.ppt22222
110/117
` a slow growing malignancy of the prostategland
` Usually an adenocarcinoma
` This usualy spread via blood stream to the
vertebrae
-
8/8/2019 Alteration in Urinary System.ppt22222
111/117
-
8/8/2019 Alteration in Urinary System.ppt22222
112/117
` Predisposing factor Age
-
8/8/2019 Alteration in Urinary System.ppt22222
113/117
` Assessment Findings
1. DRE: hard, pea-sized nodules on the anterior
rectum
2. Hematuria
3. Urinary obstruction
4. Pain on the perineum radiating to the leg
-
8/8/2019 Alteration in Urinary System.ppt22222
114/117
` Diagnostic tests
1. Prostatic specific antigen (PSA)
2. Elevated SERUM ACID PHOSPHATASE
indicates SPREAD or Metastasis
-
8/8/2019 Alteration in Urinary System.ppt22222
115/117
Medical and surgical management
1. Prostatectomy
2. TURP
3. Chemotherapy: hormonal therapy to slow the
rate of tumor growth
4. Radiation therapy
-
8/8/2019 Alteration in Urinary System.ppt22222
116/117
Nursing Interventions
1. Prepare patient for chemotherapy
2. Prepare for surgery
-
8/8/2019 Alteration in Urinary System.ppt22222
117/117
Nursing Interventions: Post-prostatectomy1. Maintain continuous bladder irrigation. Note
that drainage is pink tinged w/in 24 hours
2. Monitor urine for the presence of blood clots
and hemorrhage3. Ambulate the patient as soon as urine begins
to clear in color