1. Obstructive disorders of the Urinary system

2. Medical Management -Diagnostic Tests: KUB, Renal Ultrasound, blood chemistries, endoscopy -Establish urinary drainage Indwelling catheter Suprapubic Cystostomy Ureterostomy Nephrostomy Stent Insertion Relieve pain- narcotics, anticholinergics
Ureterostomy-ilieal conduit
Nephrostomy-percutaneous puncture, incision in the back
Stent insertion-cystoscopy
Anticholinergics-Atropine to dec. smooth muscle motility, anti-spasmodic effect

3. Nursing Interventions - observe for signs of hematuria - aseptic care of the surgical site -note restoration of urinary function -provide safe environment to prevent injury or infection

4. Etiology/pathophysiology -Causes: Kinks, cysts, tumors, calculi, prostatic hypertrophy -May lead to infection that thrives due to urine stasis -May lead to ischemia due to compression or atrophy of renal tissue -Clinical Manifestations/Assessment -Continuous need to void -Voiding small amounts frequently -Pain -Nausea

5. Etiology/Pathophysiology:
Hydronephrosis
Etiology/Pathophysiology:
-Dilation of the renal pelvis-can be congenital or
develop at any time
-Unilateral or bilateral
-Due to the obstruction of the urinary tract
-The obstruction builds up pressure from the
accumulation of urine that can’t flow past it
-The pressure may cause functional and anatomical
damage to the renal system.
-- The renal pelvis and ureters dilate
--Pressure causes fibrosis and loss of function
of affected nephrons causing kidney
obstruction _

7. -Dull flank pain (slow onset) A degree of pain will depend on the
Clinical Manifestations:
-Dull flank pain (slow onset)
A degree of pain will depend on the
stretching of the urinary tract structures
-Severe stabbing pain (sudden onset)
-Nausea/Vomiting
-Frequency, dribbling, burning and difficulty
starting urination

8. Medical Management -Diagnostic Tests: UA, Renal function studies (BUN, Creatinine), cystoscopy, IVP, KUB, CT, US -Surgery to relieve obstruction -Nephrectomy- if kidney is severely damaged -Antibiotics -Narcotics/antispasmodics

9. Nursing interventions -Assessment: Subjective-pain, voiding pattern, history of obstructive disorders -Objective-vomiting, hematuria, edema, urine output, abdominal mass, bladder distention, tenderness over kidneys/bladder -Administer meds as ordered, I & O, observe for signs of infection, vital signs, pain assessment, encourage intake of 2L/day unless restricted, anchor drainage tubes, catheter care -if surgery is done: incision observation, care and dressing changes as ordered -Patient and family teaching

10. Urolithiasis (kidney stone)
Etiology/Pathophysiology
-Calculi develop from minerals that have
precipitated out of solution and adhere,
forming stones that vary in size and
shape
-Why do these stones form? Not sure!
-Contributing factors: predisposed,
diet, meds
-Identified according to location:
nephrolithiasis, ureterolithiasis,
cystolithiasis
Nutrition and Diet Tx- Box 21-3

12. Clinical Manifestations/Assessments -Flank or pelvic pain -Nausea/vomiting -Hematuria Medical management -Diagnostic tests: KUB, IVP, US, Cystoscopy, UA, etc. -Medication: antibiotics, analgesics -Fluids -Ambulation (if possible) -Surgical procedures: cystoscopy, ureterolithotomy, nephrolithotomy

13. -Lithotripsy- “ extracorporeal shock wave” -Pt is submerged in a special tank of water -Ultrasonic shock waves are used to pulverize the stone -Urine still must be strained -Pt. may still experience renal colic as the stone fragments pass.

15. Nursing Interventions -Assessment Subjective-pt
Nursing Interventions -Assessment Subjective-pt.’s pain description Objective-presence of hematuria, nausea, vomiting, restlessness - Strain all urine and observe characteristics -Daily fluid intake of 2L (unless contraindicated) -Medication: drug therapy will be specific to the stone composition -Administer analgesics -Monitor lab and diagnostic test results, especially BUN and Creatinine -Pt. and family teaching- hydration, dietary modifications, medication administration, exercise, keep follow up appointments with MD and when to contact the MD.

16. Renal tumors Etiology/Pathophysiology -Mostly adenocarcinomas
-Usually develop unilaterally
-Renal cell carcinomas, as a primary
malignant tumor, arise from cells of the
proximal convoluted tubules
Risk factors
-Smoking
-Family history
-Pre-existing renal disorders, such as
polycystic kidney disease and renal cystic
disease secondary to renal failure
-Transitional cell tumors of the renal pelvis
cause hematuria and can be confirmed by
cytological study.

18. Clinical manifestations -Early- intermittent painless hematuria -Late- weight loss, dull flank pain, palpable mass in flank area, gross hematuria Medical management -Radical Nephrectomy -Radiation -Chemotherapy

19. Nursing Interventions -Assessment Subjective-Inquire about blood in the urine, pain, weight loss, fatigue Objective-Physical assessment, hematuria -Adequate hydration to reduce the discomfort when voiding -Administer analgesia -Encourage active/ passive ROM exercises -Pt./family teaching: community resources, support groups, home health care, importance of follow-up care

20. Renal Cysts Etiology/Pathophysiology
-A single cyst may not matter, but
multiple cysts interfere with kidney
function
-The most significant problem arise with
polycystic kidney disease (PKD)
-Cysts form in the kidney and can cause
pressure on the kidney structure and
compromise function
-A patient with a long standing renal
insufficiency or a dialysis pt. may
develop PKD

22. Clinical Manifestations -Determined by the degree of kidney structure involved -Abdominal and flank pain -Voiding disturbances - Recurrent UTIs -Hematuria -Hypertension

23. Medical management -Diagnostic Tests: Radiographic imaging, blood work -No specific treatment -Pain relief -Heat (unless bleeding) -Analgesics -Antibiotics -Antihypertensives -Dialysis -Renal transplant

24. Nursing Interventions -Assessment- Subjective: Abdominal/flank pain, headaches, GI complaints, voiding disturbances, history of recurrent UTIs Objective: Monitor BP, check for hematuria, note the pt.’s complaints and response to treatment. -Patient/family information about genetic counseling -Severity of the disease and patient complaints will determine the nursing intervention

25. Tumors of the Urinary Bladder
Etiology/Pathophysiology
-Most common site of cancer in the
urinary tract
-Ranges from benign papilloma to
invasive carcinoma
Clinical Manifestations
-Painless intermittent hematuria
-Changes in voiding pattern

26. Medial management -Localized tumor: remove by burning (fulguration) -Invasive lesion- partial or total cystectomy (Surgery will include diversion such as an ileal conduit) Nursing Interventions -Assess voiding patterns -Observe characteristics of urine -Importance of follow-up care

27. Conditions affecting the prostate gland
BPH- Benign Prostatic Hypertrophy
Etiology/Pathophysiology
-enlargement of the prostate gland which
encircles the urethra at the base of the
bladder
-pressure on the urethra prevents complete
emptying of the bladder
-function of the prostate gland is to secrete
an alkaline fluid that helps to neutralize
seminal fluid and increase sperm motility
-common in men over 50 years old

29. Clinical manifestations -Frequent urination -Difficulty starting urination -Dysuria -Frequent UTIs -Hematuria -Oliguria -Nocturia

30. Medical management -Diagnostic Test: blood chemistries, measuring residual urine by cystoscopy, IVP, rectal exam, cytological evaluation -Relieve obstruction- foley catheter -Medication to shrink prostate gland -Prostatectomy -Post-Operative: TURP- bladder irrigations -urine will be pink to red colored -Suprapubic/abdominal catheter: assess drainage

31. Transurethral Resection of the Prostate (TURP)

32. Nursing Interventions -Assessment Subjective- inquire about urine stream, difficulty starting, frequency, nocturia Objective-voiding pattern -Insertion of a foley catheter as ordered, avoid a rapid decompression (after 1000 ml is drained, wait 5 minutes before proceeding to drain more) -Post-op TURP: maintain patency of foley catheter and bladder irrigation system, vital signs, close monitoring of urine for signs of hemorrhaging -Medicate for pain and bladder spasms -Patient/family education