CARE OF THE CLIENTS
WITH GENITO-URINARY
DISORDERS
Prepared by: Jem Sombilla RN,CNN,MAN
Clinical Instructor
OVERVIEW OF THE ANATOMY AND PHYSIOLOGY
OF EXCRETORY/URINARY SYSTEM
-maintain homeostasis by maintaining body fluid composition
and volume.
Components of Urinary System:
1.Kidneys
2.Ureters
3.Urinary Bladder
4.Urethra
1.Kidney
-major controlling output,remove waste product from the body
through formation of urine.
-bean shaped located at retroperitoneally at the level of 12 th
thoracic and 3rd lumbar vertebra(costovertebral angle).
-right kidney(lower than left kidney because of liver)
-left kidney(higher)
-3 parts of kidney:
3.1 renal cortex
3.2 renal medulla
3.3 renal pelvis
-nephrons
-(functional unit
of the kidneys),composed
of glomerulus and renal tubules
-site of formation of urine
-glomerulus(semi permeable
Capillaries surrounded by
Bowmans capsule)
-Renal tubles :3 parts
RENIN
1.Proximal Convuluted Tubules
2.Loop of Henle
3.Distal Convuluted Tubule
-1,200ml blood flows to the kidneys per Stimulate
minute(20-25% of C.O) Angiotensinogen
-GFR(Glomerular Filtration Rate) is 125ml/min.
From this, the kidneys form 0.5-1ml of urine per minute
thereby 30-60 cc /hr or approximately 1500mls /day.
Angiotensin Converting
Functions of the Kidneys:
Enzymes
-excrete waste product
-regulate fluid volume
-Production of hormones:
1.Erythropoetin-stimulate bone marrow to produce Angiotensin 1
RBC
2.Renin-regulate blood pressure
3.Aldosterone-retains Na and Water Angiotensin 2
-Activation of vItamin D
Vasoconstriction
And release of
aldosterone
2.Ureter
-two small tubes about 25cm long . They transport urine from the renal pelvis to the
urinary bladder.
3. Urinary bladder
-reservoir for urine
-composed of three layers of detrusor muscles. Contraction of these muscles expels
urine from the bladder.
-maximum capacity of 1000ml of urine.
-he bladder is guarded by internal urethral sphincter
--the trigone is a triangular shape in the floor of the bladder that is marked by the
openings for the 2 ureters and the internal orifice.
4. Urethra
-is the passageway of the urine into the external environment.
-the internal urethral sphincter is an involuntary muscle,
-the external urethral sphincter is a voluntary muscle.
-female urethra:1 1/2 to 2 1/2inches
-male urethra: 5 ½ to 6 ½ inches-8 inches
-the shorter urethra among females increase propensity to UTI.
Urine Formation
a.Glomerular Filtration
-water and solutes move from the blood to the glomerular capsule. The fluid that
enters the capsule is glomerular filtrate.
b.Tubular Reabsorption
-it is the movement of substances from filtrate in the renal tubules into the blood in
the peritubular capillaries. Only 1% of the filtrate remains in the tubules and
become urine.
-water and other substances that are useful to the body are reabsorbed.
c.Tubular Secretion
-the transport of substances from blood into the renal tubules. Potassium and
hydrogen are primarily eliminated from the body. Ammonia, uric acid, some drug
metabolites are likewise eliminated.
d.Micturition ak.a voiding, urination
-act of expelling urine from the bladder
Diagnostic Procedures:
1.Routine Analysis
-best time to collect: morning upon awakening
-instruction: cleanse the external genitalia with soap and water
discard the first flow, collect the midstream
-color: amber/straw
-ph: 4.5-8.0(average 6)slight acidic
-Specific gravity:1.010-1.025
-protein: absent
-RBC:0-5 hpf
-WBC:0-5 hpf
-Pus:Absent
-Glucose:Absent
-Ketones: Absent
-Casts:0-4
Note: If RBC, WBC ,Pus are present, increase it indicates UTI
-If Glucose, Ketones are present, increase it indicates DKA
2.Creatinine Clearance
-24 hour urine specimen or collection
-best indicator of glomerular function
-Instruction: discard the first voided then collect all the specimens thereafter, include the last
voided specimen.
-if decrease creatinine level in the urine- indicates renal abnormality
3.Blood Studies
BUN:10-20mg/dl
Serum Creatinine: 0.4-1.2mg/dl
Serum Uric Acid:2.5-8mg/dl
Albumin: 3.2-5.5mg/dl
RBC: 4.5-5Million/cu.mm
Hct:38-54%
Serum Electrolytes
Blood ph
3.Cystoscopy
-direct visualization of urethra, bladder wall, trigone,urethral opening using cystoscope.
Nursing Interventions before the procedure:
-secure written consent
-done under local/general anesthesia(depending on the level of anxiety)
-force fluids if under local anesthesia
-NPO, if under general anesthesia
-Inform client that desire to void is felt as cystoscope is inserted
-place the client in lithotomy position during the procedure
Nursing Interventions after the procedure:
-Bed rest until VS stable
-pink tinged urine is normal 24-48 hrs.
-sysuria, frequency, hematuria-common after the procedure
-Observe for urine retention, signs ofinfection and excessive hematuria-notify the physician
-Monitor output and VS
-Hot sitz bath to relieve pelvic discomfort
-Warm, moist soak to relieve leg cramps due to prolonged lithotomy position
-Force fluids to prevent UTI
4.KUB-Kidney, Urether, Bladder
-x ray visualization of the kidneys, ureters, bladder
-assure that the procedure is painless
-Bowel preparation(laxative in evening and enema in the morning as ordered)
5.Excretory Urogram/ Intravenous Pyelography(IVP)
-xray visualization of the kidneys, ureters and bladder
-contrast medium is administered IV(hypaque)
Nursing interventions before the procedure:
-consent
-NPO(nothing per orem) 6-8 hours
-bowel prep (laxative as ordered)
-assess allergy to iodine and seafoods
-prepare epinephrine at bed side.
Nursing interventions after the procedure:
-monitor VS
-increase OFI
-burning sensation on voiding may be experienced
-observe for signs of delayed allergic reactions
6.Retrogade Pyelogram(RPG)
-outlines renal pelvis and ureters
-contrast medium through cystoscope
Care before RPG:
-consent
-check for allergy
-inform on the discomfort of the procedure
-prepare epinephrine at bed side
Care after RPG:
-monitor VS
-observe urinary retention, infection and prolonged hematuria-notify the physician.
-Increase OFI
7.Voiding Cystourethrogram
-xray of the bladder, urethra with full bladder and while urinating
-contrast medium is introduced into the bladder through urinary catheter before x-ray.
-Done to detect causes:
-repeated UTI
-urinary incontinence
-reflux/backflow of urine
-to detect presence of injury to the bladder or urethra, BPH, structural defects in the bladder or urethra.
-Retrograde Cystourethrogram(x-ray during introduction of contrast medium)
-Voiding Cystourethrogram( x-ray during voiding as urine flows out of the bladder)
8.Cystometrogram
-records pressure exerted at varying phases of filling of the bladder
-helps evaluate neuro-sensory status and tonicity
-Assess time to initiate stream, degree of hesitance,intermittence of voiding,presence of terminal
dribbling.
-Retention catheter is inserted, residual volume is measured
-Retention catheter is attached to manometer, sterile normal saline is introduced into the bladder at
prescribed rate
-Amounts of bladder volume and pressures are recorded at intervals, including first desire to void and
feeling of maximum fullness.
9.KUB ultrasound
-detects tumor,cyst,obstruction and abcesses
-cleanse the bowel(laxative) as ordered
-Distend the bladder(give 2 glasses of water)-this permits better imaging
-withhold voiding
10.Renal Arteriogram
-x ray visualization of renal circulation as contrast medium is injected into renal artery thorough catheter.
Care before Renal Arteriogram:
-cleanse the bowel(laxative)
-shave the catheter insertion site(lumbar, femoral area)
-Locate and mark distal pulses
Care after Renal Arteriogram:
-VS until stable
-Apply cold on puncture site to prevent bleeding
-check for swelling and hematoma
-sandbag over the catheter insertion site
-palpate peripheral pulses to assess adequacy of circulation in the involved extremity
-check color, temp of extremity
-bed rest for 24 hours, no sitting
-measure U.O
11.Renal Biopsy
Nursing Interventions before the procedure:
-NPO 6-8 hours
-check PTT, Pro time(bleeding is the most common complication)
-mild sedation is done
-place the client in prone position during the procedure
-ultrasound and xray of the kidney should be available to locate the kidney
-local anesthesia is administered
-instruct cliet to hold breath and remain still during needle insertion to prevent trauma.
Nursing Interventions after the procedure:
-bed rest for 24 hours to prevent bleeding
-Monitor VS-to assess internal bleeding
-check for pain, nausea/vomiting-notify the physician
-provide fluid to 3L-to prevent infection
-Hct and Hgb level is done in 8 hours to detect bleeding
-Avoid strenuous activity for 2 weeks
-Notify the physician fo the following:
1.Bleeding
2.Hematoma
3.Infection
Common Assessment Abnormalities:
Anuria-no urination or 24 hr U.O less than 100ml
Burning on Urination-stingling pain in urethral area
Chemical cystitis-pain or difficult urination
Dysuria-painful or difficult urination
Enuresis-involuntary nocturnal urinating(bedwetting)
Frequency-increased incidence of urinating
Hematuria-blood in urine
Hesitancy-delay or diificulty in initiating urine
Incontinence-inability to voluntarily control discharges of urine
Nocturia-frequency of urination at night
Oliguria-diminished amount of urine in a given time(24 hr urine output: 100-400ml)
Pneumaturia-passage of urine containing gas
Polyuria-large volume of urine in a given time
Retention-inability to urinate even though bladder contains excessive amount of urine
Stress incontinence-involuntary urination with increased pressurw(sneezing, coughing,laughing)
GENITO-URINARY
DISORDERS
RENAL FAILURE
Two types of Renal Failure:
1.Acute Renal Failure
-sudden loss of renal function
-reversible
2.Chronic Renal Failure
-gradual, progressive loss of renal function
-irreversible
3 Stages of Acute Renal Failure
a.Oliguric Phase
-last for 1-3 weeks
-decreased U.O, increased BUN, Creatinine, edema, HPN, hyperkalemia, hypermagnesemia,
hyperphosphatemia, hyponatremia and metabolic acidosis.
b.Diuretic Phase
-last for 1week
-signifies that kidneys starting to regain their functions
-increased U.O(3-5 L/day) with excessive loss of potassium.
c.Recovery Phase
-takes 3-12 months for the kidneys to recover
-avoid nephrotoxic drugs
Stages of Chronic Renal Failure
1.Renal Impairement- 40 to 50% remaining GFR
2.Renal Insufficiencey-20-40% remaining GFR
3.Renal Failure-10-20% remaining GFR
4.ESRD(End Stage Renal Disease) a.k.a uremia less than 10% GRF
Clinical Manifestations of CKD:
-Oliguria
-increased BUN, serum creatinine(azotemia)
-Urineferous odor breath
-Stomatitis and GI bleeding( due to conversion of ureas into ammonia. Ammonia iiritates mucus
membrane including G.I tract)
-Destruction of RBC, WBC, platelets
-Sallow coloring or hyperpigmentation of the skin
-Renal encephalopathy(due to elevated urea and nitrogenous products in the brain)
-Uremic frost(accumulation of crystalized urea in the skin)-causing pruritus
-decreased libido, impotence, and infertility
-severe anemia-due to decrease erythropoietin secretions
-Edema
-Hyperkalemia
-Hypermagnesemia
-Hyponatremia or Hypernatremia
-Metabolic acidosis
-Hypocalcemia
-Hyperphosphatemia
-Renal osteodystrophy
-Hyperparathroidism
-Hyperglycemia
Collaborative Management:
1.Fluid control
2.Electrolyte control:
-for Hyperkalemia:
*low K diet
*glucose 10% with regular insulin per IV
*Resin Kayexalate
-for Metabolic Acidosis
*Sodium Bicarbonate
-for Hypocalcemia
*calcium salts and vitamin D supplements
-for hyperphosphatemia
*amphogel(aluminium hydroxide)-phosphate binder
3.Dietary Control(Renal diet
-high calorie, high carbohydrates,low protein, low K, low Na
4.Treatment for intercurrent disorders:
-for anemia:
*Epogen, Procrit(Epoetin Alfa)
*S/E of epogen: HPN
*BT
-for GI disorders/symptoms:
*Antacids, Histamine-H2 receptors
-for Hypocalcemia
*calcium supplement and Vit. D
Nursing Interventions:
1.Maintain fluid and electrolyte balance
-Weigh the client daily
-Measure I and O
-Assess presence and extent of edema
-Auscultate breath sounds
-Restrict fluid as indicated
-Monitor cardiac rhythm for dysrhythmia
-Avoid OTC Drugs(milk of magnesia-can cause magnesium toxicity)
2.Provide adequate Nutrition
-High carbohydrates, low protein, low Na,low K
3.Prevent Infection and Injury
-Maintains asepsis durng treatment and procedures
-Avoid aspirin products
-Encourage the client to use soft bristled toothbrush
4.Promote Comfort:
-relieve pain
-relieve pruritus due to uremic frost
5.Dialysis
Care of the Client undergoing Dialysis:
Dialysis-is done to remove metabolic waste products, excess electrolytes and excess fluids from the body.
Dialyzer-Serves as the artificial kidney
TWO TYPES OF DIALYSIS:
1.Hemodialysis
-requires vascular access: arteriovenous fistula(AV Fistula), external arteriovenous shunt(AV shunt),
arteriovenous graft(AV graft), jugular and femoral vein catheterization.
-ita takes 3 to 4hours/session , 2-3 times/week
Nursing Interventions for Hemodialysis:
-Arm precaution(no BP taking or puncturing of the (AV shunt, AV fistula, graft) affected area.
-Assess for the patency of AV fistula by auscultating for bruit and palpating for thrill.
-BT as ordered during HD.
-Usually, anti HPN drugs are omitted during hemodialysis
-Manintain activity and nutrition
-Promote comfort
-Prevent disequilibrium syndrome(commonly experience during initial hemodialysis, rapid removal
of waste products from the blood than from the brain-due to the presence of blood brain barrier thus
causing cerebral edema and increase ICP).
-Signs and symptoms of Disequilibrium Syndrome:
a.Restlessness
b.Headache
c.nausea/vomiting
d.Hypertension
-To prevent disequilibrium syndrome, initial hemodialysis should be done for 30 mins only then will
be increased gradually.
2.Peritoneal Dialysis
-requires peritoneal catheter
-catheter is inserted below the umbilicus
Nursing Interventions for Peritoneal Dialysis:
-Dialysate solution should be warmed at body temperature(to increase capillary permeability and
enhance removal of waste products)
-Cycle of peritoneal Dialysis:
*Infusion time-10 mins
*Dwell time or Equilibration time- 20 mins
* Drainage time-30 mins
-If the drainage stops, turn the client to sides
-Position the client in semi fowlers
-Cloudy dialysates indicates peritonitis-notify the physician and collect specimen for culture
-Monitor urine and blood glucose levels-dialysate solution contains glucose
-CAPD(Continous Ambulatory Peritoneal Dialysis) is done at home- teach the client on asepsis to
prevent infection.
Dialysis may improve the following:
1.Edema
2.Elevated BUN, serum creatinine
3.Elevated electrolytes
4.Elevated BP
Note: Dialysis cannot resolve anemia
RENAL TRANSPLANTATION
-also indicated for ESRD
Common problem: Rejections
Medications to prevent GVHD(Graft-Versus-Host Disease) or Rejection Reaction:
1.Imuran(Azathioprine)
2.Sandimmune, Neoral(Cyclosporin)
3.Prograf(Tacrolimus)
4.Rapamune(Sirolimus)
5.Cellcept(Mycophenolate mofetil)
6.Deltasone(Prednisone)
Priority: Infection-because these drugs are immunosuppressant.
URINARY TRACT INFECTION
Etiologic agent: Escherichia Coli(E.Coli)-most common
Klebsiella,Proteus,Pesudomonas
High risk: female because of short urethra and absence of prostatic fluid.
Predisposing Factors:
1.Urinary stasis( due to BPH, srone tumor, urinary retention,renal impairement)
2.Foreign Bodies(calculi, catheters,urinary tract instrumentation-cystoscopy)
3.Anatomic Factors-(fistula,obesity)
4.Immune response-(aging process, HIV,DM)
5.Functional disorders-(due to constipation,voiding dysfunction)
6.Other factors:
-pregnancy
-hypoestrogenic state
-multiple sex partners
-poor personal hygiene
Clinical Manifestations:
-Frequency(voiding at close intervals)
-Urgency(strong desire to void even with small amount)
-Dysuria
-Foul smelling urine
-Suprapubic pain
-Malaise, fever, chills, n/v
-Low back pain
-Routine urinalysis
-C and S
Management:
-C and S before antibiotic therapy
-Increase fluid intake 3-4 l/day
-Acidify urine(cranberry juice or prune juice)
-Hot sitz bath-to relieve pelvic discomfort
-Practice the 3 W’S:
W-ash hands before and after using toilet
W-ear cotton underwear
W-ipe perineum from front to back
-Avoid wearing tight clothing (tight jeans)
-Empty the bladder 2-3 hours
-Empty the bladder before and immediately after sexual intercourse
Medications for UTI:
1.Analgesic
-Pyridium(Phenazopyridine Hydrochloride)
-it causes red-orange discoloration of urine
2.Antiseptics
-Cinobac(Cinoxacin)
-Mandelamine(Methenamine)
-Hiprex(Methenamine Hippurate)
-Negram(Nalidixic Acid)
-Furadantin, Macrodantin,Macrobid(Nitrofurantoin)
-Nitrofurantoin causes brown urine-this is harmless
-Mandelamine(Methanamine)-requires acidic urine with ph of 5.5 to be
effective, should not be combined with sulfonamides- to prevent crystalluria.
3.Fluoroquinolones
-Cipro(Ciprofloxacin)
-Penetrex(Enoxacin)
-Tequin(Gatifloxacin)
-Levaquin(Levofloxacin)
-Maxaquin(Lomefloxacin)
-Avelox(Moxifloxacin)
-Noroxin(Norfloxacin)
-Floxin(Ofloxacin)
-Zagam(Sparfloxacin)
-Trovan(Trovafloxacin)
Note: administer fluoroquinolones with a full glass of water and ensure adequate urine output. To
prevent crystalluria.
-may cause neurotoxicity, hepatic and renal toxicity
4.Sulfonamides
-Sulfadiazine
-Thiosulfil Forte(Sulfamethizole)
-Gantanol (Sulfamethoxazole)
-Gantrisin(Sulfisoxazole)
-Bactrim(Trimethoprim-sulfa-methoxazole)
Note:sulfonamides may cause rash, fever and photosensitivity. Avoid exposure to sun.
-it also cause Steven Johnsons Syndrome-most severe hypersensitivity response, produces
symptoms that include widespread lesions of the skin and mucous membranes,with fever, malaise and
toxaemia.
-take meds on empty stomach with a full glass of water
-increase fluid intake to prevent crystalluria
4.Cholinergic
-Urecholine(Bethanecol Chloride)
-to treat urinary retention and neurogenic bladder
-antidote: atrophine So4
5.Antispasmodic
-Ditropan( Oxybutynin)
-Pro-Banthine(Propantheline Bromide)
-to treat urinary frequency
-Do not administer these medications among clients with glaucoma.These meds are
anticholinergic and they dilate pupils and obstruct aqueous humor outflow.
URINARY CALCULI(URINARY STONES)
-urinary stones causes obstruction of urine flow
Most common cause: UTI that leads to urinary stasis
Other Risk Factors:
1.Metabolic Abnormalities-result in increased urine levels of calcium, oxaluric acid, uric acid
or citric acid.
2.Climate- warm climate that increase fluid loss
3.Diet-large intake of proteins that increase uric acid, calcium.
4.Genetic Factors
5.Lifestyle
Clinical Manifestations:
-Colicky pain(pain from lumbar area and radiates to the lower abdomen)
-Nausea/Vomiting, diarrhea or constipation
-Hematuria, dysuria, frequency
-Fever, chills
Types of Urinary Calculi:
1.Alkaline Stones
-Calcium Oxalate stones
-Calcium Phosphate stones
- Struvite or Staghorn stone
2.Acidic Stones
-Uric acid stones
-Cystine stones
Management
-increase fluid intake(3l/day)-to help pass the stone
-strain all urine-if a stone is passed, submit to laboratory.
-Adjust urine ph
*For Calcium Stones(Alkaline)
-limit dairy products
-acid ash diet (cranberry juice, prune juice, meat, eggs, poultry,tomatoes, grapes, whole
grains, corns)
*For oxalate stones(alkaline)
-avoid excess tea, chocolate, spinach, broccoli, almonds, cashew, beans
*For acidic stones
-alkaline ash diet (vegetables, milk, fruits except cranberries, plums and prunes, small
amount of beef, halibut, veal, salmon)
*For uric acid stones
-avoid purine rich foods
-encourage ambulation
-relieve pain
-Allopurinol for uric acid
-Surgery(nephrolithotomy, pyelolithotomy, uretero-lithotomy)
-ESWL(Extracoporeal Shock Wave Lithotripsy)-crushing of stone with the use of high
frequency or ultrasonic waves while the body is half immersed in water. There is no incision.
-take 3-4L/day of fluid for a month to flushed the crushed stone after ESWL.
-Percutaneous Lithotripsy-a guide is inserted under fluoroscopy near the area of the stone.
Ultrasonic waves break stones into fragments. A nephrostomy tube will be in place.
BLADDER CANCER
-more common among males
Risk factors:
-cigarette smoking
-chronic cystitis
-large phenacetin intake( a chemical component of an analgesisc)
-Bladder calculi
-Pelvic radiation
-Use of cyclophosphamide
-Schistosomiasis
Clinical Manifestations:
-Painelss hematuria( most characteristic)
-dysuria, gross hematuria
-obstruction to urine flow
-development of fistula between the bladder and uterus or between the bladder and colon(urine
is expelled from the vagina or fecal material is excreted in the urine)
Management:
1.Surgery: Urinary Diversion
*Ileal Conduit-after removal of the bladder , ureters are implanted into a segment of
the ileum with the formation of the abdominal stoma.There is contnous outflow of urine
from the stoma.The client needs to wear urinary appliance to collect the urine.
*Koch pouch a.k.a Continent Ileal Urinary Reservoir – a pouch is created from a
segment of the ileum. The ureters are implanted into the side of the pouch. The nipple
valves(inlet and outlet) close as the pouch is filled with urine.The client inserts straight
catheter into the pouch every 4-6 hours to empty the pouch.
*Indiana Pouch-is a continent reservoir created from the ascending colon and
terminal ileum, making a pouch larger than the Koch pouch.The client inserts straight
catheter into the pouch every 4-6 hours to empty the pouch.
*Ureterostomy-the ureters are attached to the surface of the abdomen , where the
urine flows directly into a drainage appliance
*Percutaneous nephrostomy-it involves insertion of a nephrostomy tube into the kidney for
drainage. This procedure is done when the cancer is inoperable to prevent obstruction of urine flow
from kidneys.
*Vesicostomy-the bladder is sutured to the abdomen and a stoma is created in the bladder wall.
2.Chemotherapy
2.1Intravesicular instillation-the medication is introduced into a urethral catheter and retained
for 2 hours. The clients position is changed every 15-30 mins
-After 2 hours, the clients void in sitting position. The client will increase fluids to flush the
bladder
-The urine is considered as biohazard ands sent to the radio isotope laboratory for
monitoring.
-Disinfect the toilet with household bleach for 6 hours after the client has voided.
-Chemoagent used: Thiotepa,
Mutamycin(Mitomycin),Adriamycin(Doxorubicin),Cytoxan(Cyclophosphamide) and Bacille
Calmette-Guerin.
2.3 Systemic chemotherapy
-Platinol(cisplastin), Adriamycin (Doxorubicin),
Cytoxan(Cyclophosphamide), Folex(Methotrexate) and
Pyridoxine.
3.Radiation Therapy
-Internal and External
Benign Prostatic Hyperplasia(BPH)
-gradual enlargement of the prostate gland with hypertrophy and hyperplasia of normal tissues.
-the enlargement causes compression of the urethra and base of the bladder leading to urinary
obstruction.
-if untreated: renal failure
Cause: Unknown
Risk Factors:
-Men over 50 yrs. Of age(Aging process)- the estrogen levels become higher than
androgen level causing hyperplasia of the prostate.
Clinical Manifestations:
-Nocturia-usual intial manifestations
-Frequency, urgency, hesitancy , UTI, increased residual urine
Diagnostic:
-rectal examination, cystospoy, ULTZ
Management:
SURGERY-the only successful management for BPH
1.Transurethral Resection of the Prostate(TURP)
-no incision
-the prostatic tissues ae excised through a resectoscope
-need a CBI(Continous Bladder Irrigation) or Cystoclysis-done post op to irrigate the
bladder and remove blood clots. This is done through the use of 3-way foley catheter.it does
not cause incontinence or impotence post op.
2.Suprapubic Prostatectomy
-involves removal of the prostate gland through abdominal and bladder incison
-client will have cystostomy tube and 2 way foley catheter-to drain urine adequately
and prevent leakage through the incision.(Whenever bladder incision is done, cystostomy
tube will be in place)
-continuous bladder irrigation is prescribed and administered to keep the urine pink.
-the surgery does not cause incontinence or impotence
3.Retropubic Prostatectomy
-is removal of the prostate gland through a lower abdominal incision. There is no
incision into the bladder .
-continuous bladder irrigation maybe done.
-not cause incontinence and impotence.
4.Perienal Prostatectomy
-removal of the prostate gland through an incision made between the scrotum and
anus.
-the procedure causes incontinence and sterility.
-avoid inserting rectal tubes, taking rectal temperature and idministerig enemas.
Post-OP care for Prostatectomy:
*Care of the Client with CBI(Continous Bladder Irrigation or Cystoclysis)
-Maintain patency of drainage( if drainage is reddish increase the flow rate of CBI)
-Practice asepsis
-Use sterile NSS-to prevent water intoxication and infection, hypotonic solution like sterile
water can cause water intoxication)
-Monitor U.O
-Monitor haemorrhage
-1st 24 hrs: pink urine is normal
-3 days: amber urine
-Prevent thrombophlebitis-most common complication of surgery
-Client may feel urge to void or a sensation of the bladder- due to pressure on the internal
sphincter by the balloon of the catheter.
-Advise client not to strain or void around the catheter-to prevent bladder spasm
-Relieve pain
-Increase fluid intake-to prevent constipation and straining thus preventing the risk for
bleeding
-Provide Client Teaching to Prevent Bleeding, Thrombophlebitis, and Infection Post OP:
1.Urianry retention and dribbling of urine may occur after removal of the catheter.
2.Notify the client about U.retention
3.If dribbling of urine occurs-teach the client Kegels exercise to regain control of voiding.
4.Avoid the following activities for 3 wks after discharge:
-vigorous exercise
-heavy lifting
-sexual intercourse
5.Avoid the following for 32 weeks after discharge:
-straining with defecation
-prolonged sitting or standing
-crossing the legs
PROSTATE
CANCER
-most common type of cancer among males
-it is androgen dependent adenocarcinoma\
Predisposing Factors:
-Men who are over 50 yrs.of age
-High frequency of sexual experience or multiple sexual partner
-Chemical carcinogen
Clinical Manifestations:
-hard enlarged prostate
-Elevated PSA(Prostatic specific antigen)
-elevated serum acid phosphatase
-urinary obstruction
-UTI
Management:
1.Hormone Therapy
-Lupron(Leuprolide acetate)
-Eulexin (Flutamide)
-DES(Diethylstilbesterol-an estrogen preparation)
2.Surgery(Prostatectomy)
3.Chemotherapy and Radiation Therapy
TOXIC SHOCK SYNDROME
Cause : Staphylococcus Aureus
-proliferation of S.aureus in Blood Soaked Packings( Tampons, nasal packs,vaginal
packs)
Clinical Manifestations:
-High fever
-diarrhea
-hypotension
-acidosis
-vomiting
-red, macular rash
-petechiae
-bleeding at IV sites
-shock lung
Management:
1.Care of client with Shock
2.Patient teaching
-use sanitary napkins at nights instead of tampon
-change tampon regularly and insert carefully to avoid abrasions
-practice good handwashing
-do not use tampons until TSS bacteria is no longer present in vaginal flora
POLYCYSTIC KIDNEY DISEASE(PKD)
-Iinherited disorder causing your kidneys to enlarge and lose function over time.
-Characterized by cystic formation and hypertrophy of the kidneys.
-may lead to:
*cystic rupture
*Infection
*Scar tissue formation
*damaged nephrons
-it is characterized by sodium wasting and hyperkalemia. It eventually lead to
RENAL FAILURE.
