Nursing Management: Renal and Urologic Problems Chapter 46 Overview Copyright © 2011, 2007 by...

transcript

Nursing Management:Nursing Management:

Renal and Urologic Problems Renal and Urologic Problems

Chapter 46 OverviewChapter 46 Overview

Infectious and Inflammatory Infectious and Inflammatory Disorders of Urinary SystemDisorders of Urinary System

Urinary Tract Infection Urinary Tract Infection

• ClassificationClassification

Fig. 46-1. Sites of infectious processes in the upper and lower urinary tracts.

• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies• Collaborative Care and Drug Collaborative Care and Drug

TherapyTherapy

Nursing Management:Nursing Management:Urinary Tract Infection Urinary Tract Infection

• Nursing Assessment Nursing Assessment • Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing Implementation Nursing Implementation

Health promotion Health promotion Acute intervention Acute intervention Ambulatory and home careAmbulatory and home care

• EvaluationEvaluation

Acute Pyelonephritis Acute Pyelonephritis

• Etiology and PathophysiologyEtiology and Pathophysiology

Fig. 46-2. Acute pyelonephritis. Cortical surface shows grayish white areas of inflammation and abscessformation (arrow).

• Clinical Manifestations and Clinical Manifestations and Diagnostic StudiesDiagnostic Studies

• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy

Nursing Management: Nursing Management: Acute Pyelonephritis Acute Pyelonephritis

• Nursing AssessmentNursing Assessment• Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing ImplementationNursing Implementation

Health promotion Health promotion Acute intervention and home and Acute intervention and home and

ambulatory careambulatory care• EvaluationEvaluation

Chronic Pyelonephritis Chronic Pyelonephritis

Urethritis Urethritis

Urethral Diverticula Urethral Diverticula

Interstitial Cystitis/Painful Interstitial Cystitis/Painful Bladder Syndrome Bladder Syndrome

• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy

Nursing Management: Nursing Management: Interstitial Cystitis/Painful Bladder Syndrome Interstitial Cystitis/Painful Bladder Syndrome

Renal Tuberculosis Renal Tuberculosis

Immunologic Disorders of Immunologic Disorders of KidneyKidney

Glomerulonephritis Glomerulonephritis

• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations

Acute Poststreptococcal Acute Poststreptococcal Glomerulonephritis Glomerulonephritis

• Clinical Manifestations and Clinical Manifestations and ComplicationsComplications

• Diagnostic StudiesDiagnostic Studies

Nursing and Collaborative Management: Nursing and Collaborative Management: Acute Poststreptococcal GlomerulonephritisAcute Poststreptococcal Glomerulonephritis

Goodpasture Syndrome Goodpasture Syndrome

Nursing and Collaborative Management: Nursing and Collaborative Management:

Goodpasture Syndrome Goodpasture Syndrome

Rapidly Progressive Rapidly Progressive Glomerulonephritis Glomerulonephritis

Chronic Glomerulonephritis Chronic Glomerulonephritis

Nephrotic Syndrome Nephrotic Syndrome

• Etiology and Clinical ManifestationsEtiology and Clinical Manifestations

Nephrotic Syndrome Nephrotic Syndrome

Obstructive Uropathies Obstructive Uropathies

Fig. 46-3. Sites and causes of upper and lower urinary tract obstruction.

Obstructive Uropathies Obstructive Uropathies

Fig. 46-4. Hydronephrosis of the kidney. Note the marked dilation of the pelvis and calycesand thinning of the renal parenchyma.

Urinary Tract Calculi Urinary Tract Calculi

• Etiology and PathophysiologyEtiology and Pathophysiology

Fig. 46-5. A, Renal staghorn calculus. The renal pelvis is filled with a large calculus that is shaped to itscontours, resembling the horns of a stag (S). B, Imbedded staghorn calculus (yellow arrow) inhydronephrotic, infected, nonfunctioning kidney.

• TypesTypes• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies

• Collaborative CareCollaborative Care Endourologic proceduresEndourologic procedures

Fig. 46-6. A, Calcium oxalate stones. B, Plain abdominal x-ray showing large bladder calculus.

• Collaborative Care, continued Collaborative Care, continued LithotripsyLithotripsy Surgical therapySurgical therapy Nutritional therapyNutritional therapy

Nursing Management:Nursing Management:Urinary Tract Calculi Urinary Tract Calculi

• Nursing AssessmentNursing Assessment• Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing ImplementationNursing Implementation• EvaluationEvaluation

Strictures Strictures

• Ureteral StricturesUreteral Strictures• Urethral StrictureUrethral Stricture

Renal Trauma Renal Trauma

Renal Vascular Problems Renal Vascular Problems

Nephrosclerosis Nephrosclerosis

Renal Artery Stenosis Renal Artery Stenosis

Renal Vein Thrombosis Renal Vein Thrombosis

Hereditary Renal Diseases Hereditary Renal Diseases

Polycystic Kidney Disease Polycystic Kidney Disease

Fig. 46-7. A, Comparison of polycystic kidney with normal kidney. B, Cysts in the liver.

Nursing and Collaborative Management:Nursing and Collaborative Management:

Polycystic Kidney DiseasePolycystic Kidney Disease

Medullary Cystic Disease Medullary Cystic Disease

Alport Syndrome Alport Syndrome

Renal Involvement in Metabolic Renal Involvement in Metabolic and Connective Tissue Diseasesand Connective Tissue Diseases

Urinary Tract TumorsUrinary Tract Tumors

Kidney CancerKidney Cancer

Fig. 46-8. Cross section of kidney with renal cell carcinoma. The carcinoma (blue arrow) is on the pole ofthe kidney. Note that the renal vein is involved and thrombosed (yellow arrow).

Table 46-15. Robson's System of Staging Renal Carcinoma.

Bladder CancerBladder Cancer

Fig. 46-9. A, Papillary transitional cell carcinoma (T) seen arising from the dome of the bladder as acauliflower-like lesion (blue arrow). B, Opened bladder showing a bladder cancer at an advanced stage.Yellow areas represent ulcerations and necrosis (yellow arrow).

Nursing and Collaborative Management:Nursing and Collaborative Management:

• Surgical TherapySurgical Therapy• Radiation Therapy and Radiation Therapy and

ChemotherapyChemotherapy• Intravesical TherapyIntravesical Therapy

Urinary Incontinence and Urinary Incontinence and Retention Retention

• Diagnostic StudiesDiagnostic Studies• Collaborative Care: Urinary Collaborative Care: Urinary

IncontinenceIncontinence Drug TherapyDrug Therapy Surgical TherapySurgical Therapy

Nursing Management: Nursing Management: Urinary Incontinence Urinary Incontinence

• Collaborative Care: Urinary Collaborative Care: Urinary RetentionRetention Drug therapyDrug therapy Surgical therapySurgical therapy

Nursing Management: Nursing Management: Urinary Retention Urinary Retention

Instrumentation Instrumentation

Fig. 46-10. Types of urinary catheters. A, Simple urethral catheter. B, Mushroom-tip de Pezzer catheter (canbe for suprapubic catheterization). C, Wing-tip Malecot catheter. D, Indwelling urethral catheter with inflatedballoon. E, Indwelling Tiemann catheter with coudé tip–inflated balloon. F, Three-way indwelling catheter(third lumen can be used for irrigation).

Instrumentation Instrumentation

• Urethral CatheterizationUrethral Catheterization• Ureteral CathetersUreteral Catheters• Suprapubic CathetersSuprapubic Catheters• Nephrostomy TubesNephrostomy Tubes• Intermittent CatheterizationIntermittent Catheterization

Surgery of the Urinary TractSurgery of the Urinary Tract

Renal and Ureteral Surgery Renal and Ureteral Surgery

• Preoperative ManagementPreoperative Management• Postoperative ManagementPostoperative Management

Urine outputUrine output Respiratory statusRespiratory status Abdominal distentionAbdominal distention

• Laparoscopic NephrectomyLaparoscopic Nephrectomy

Urinary Diversion Urinary Diversion

Fig. 46-11. Methods of urinary diversion. A, Ureteroileosigmoidostomy. B, Ileal loop (ileal conduit).C, Ureterostomy (transcutaneous ureterostomy and bilateral cutaneous ureterostomies). D, Nephrostomy.

• Incontinent Urinary DiversionIncontinent Urinary Diversion

Fig. 46-12. Urinary stoma. Symmetric, no skin breakdown, protrudes about 1.5 cm; mucosa is healthy red. This configuration is flat when the patient is upright or supine.

• Continent Urinary DiversionsContinent Urinary Diversions

Fig. 46-13. Creation of a Kock pouch with implantation of ureters into one intussuscepted portion of the pouch and creation of a stoma with the other intussuscepted portion.

• Orthotopic Bladder ReconstructionOrthotopic Bladder Reconstruction

Nursing Management: Nursing Management: Urinary Diversion Urinary Diversion

• Preoperative ManagementPreoperative Management• Postoperative ManagementPostoperative Management

Fig. 46-14. Ammonia salt encrustation secondary to alkaline urine.

Fig. 46-15. Retracted urinary stoma with pressure sore from faceplate above stoma (arrow).

Nursing Management: Renal and Urologic Problems Chapter 46 Overview Copyright © 2011, 2007 by...

Documents