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URS

Definition:
A ureteral stent, sometimes we called ureteric stent, is a thin tube
inserted into the ureter to prevent or to treat obstruction of the urine flow
from the kidney.
The stent is usually inserted with the aid of a cystoscope. One or both end
of the stent may be coiled to prevent it from moving out of place, this is
called a JJ stent, double J stent or Pig-tail stent.

Uses :
1. To prevent damaged to a blocked kidney, until a procedure to remove the
stone can be performed.
2. Placed in a ureter that has been irritated or scratched during a uteroscopy
procedure that involves the removal of a stone, sometimes referred to as a
basket grab procedure. Stents place. (to ensure that the ureter does not
spasm and collapse after the trauma of the procedure.)
Main complication:

Dislocation, infection and blockage by encrustation.


- Recently stents with coatings, such as heparin, were approved to
reduce the infection and encrustation to reduce the number of
extent exchanges.

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Other complications:

Increased urgency and frequency of urination


Blood in the urine (hematuria)
Pain in the kidney, bladder, or groin
Pain in the kidneys during, and for a short time after urination. (these effects
are generally temporary and disappear with the removal of a stent)
Drugs used for the treatment of OAB (Over Active Bladder) are sometimes
given to reduce or eliminate the increased urgency and frequency of
urination caused by the presence of the stent.
Irritation of the urethra (because stents often have a thread, used for
removal, that passes through the urethra and remains outside the body)
Discomfort during strenuous physical activity.
Significantly hinder sex.
In men, ejaculation/orgasm the prostate may have movement that is
discomforting to the patient and similar to severe cramping or irritation.

Nursing carePre-op
Assess vital signs as a baseline data
Monitor Intake and Output chart
Assess level of anxiety
Explain the procedure to patient
Make sure that the consent have been signed by patient
Tell patients about the equipment that will be attached to patient after
operation.
Report to doctors if any abnormalities happens.

Post-op

Assess vital signs of patient


Monitor Input and output chart
Strict Intake and output charting especially for fluid intake.
Intravenous infusion as doctor ordered.
Serve medications as doctors ordered (e.g IV Tramal 50mg to
relieve pain, Cap. Tolterodine Tartrate ER 4mg to treat over active
bladder ).
Explain to patient the nature of diseases process.
Encourage early ambulation and range of motion exercises.
Tell family members to give moral supports to patient.
Assess for any signs of bleeding from the incisional part.
Assess for any signs of infections such as redness, inflammation and increase
in body temperature.

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Nursing Care Plan


ACTUAL
Nursing Diagnosis :
Knowledge deficit related to post operative complications.
Goals :
Patient will be able to explain the nature of its disease, operation and its
complications.
Nursing Interventions :
1) Explain briefly the present disease, its cause and prevention.
2) Explain to patient about the operation & post operative complications. E.g
bleeding,signs of infection.
3) Explain to patient the importance of taking drugs according to schedule.
4) Explain type and importance of well balance diet, exercise & healthy
lifestyles to promote healing.
5) Inform patient to keep surgical wound clean.
6) Avoid heavy lifting for 1-3 months.
7) Consults doctor immediately if there are signs of infections.
Evaluation : Patient understand and able to explain the nature of diseases,
operations, and its complications.

POTENTIAL
Nursing Diagnosis :
Potential urinary incontinence related to loss of bladder tone.
Goals :
Patient urinary function will return to normal.
Nursing Interventions :
1) Assess and identify cause of incontinence & frequency of micturiation
2) Offer bedpan or urinal at specific time to train patient to pass urine at
specific time.
3) Insert urinary catheter under strict aseptic technique as ordered.
4) Clamp and release catether at specific times as ordered.
5) Teach patient pelvic floor exercise to regain muscle tone.
6) Monitor intake and output regularly and documentation.
Evaluation : Patient able to pass urine normally.

RickyHamat ISK