MEDICAL SURGICAL NURSING CARE

 The Urinary System Disorders

22/12/2010 1
URINARY INCONTINENCE

22/12/2010
 Involuntary urination
 Increased bladder pressure

 Lowered urethral resistance

 Pelvic muscle relaxation

 Impaired neural control

 Bladder problems

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URINARY INCONTINENCE

22/12/2010
 Types
 Stress
 Urge
 Overflow
 Reflex
 Functional

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URINARY INCONTINENCE - MANIFESTATIONS

22/12/2010
 Uncontrolled urination
 Several types

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 URINARY INCONTINENCE – DIAGNOSTIC
TESTS

22/12/2010
 Postvoid residual urine
 Ultrasonic bladder scan

 Cystometrography (Measurement of bladder function, as

by a cystometer)
 Uroflowmetry (is a test that measures the volume of urine
released from the body, the speed with which it is
released, and how long the release takes)

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URINARY INCONTINENCE - TREATMENT

22/12/2010
 Medications
 Inhibit detrusor muscle (is a layer of the urinary
bladder wall made of smooth muscle fibers arranged
in spiral, longitudinal, and circular bundles
contractions)
 Increase bladder capacity
 Estrogen therapy

 Surgery
 Bladder neck suspension
 Prostatectomy

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URINARY INCONTINENCE – NURSING CARE

22/12/2010
 Impaired Urinary Elimination
 Toileting Self-Care Deficit

 Social Isolation

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URINARY INCONTINENCE – NURSING CARE

22/12/2010
 Evaluating
 Keep voiding diary
 Identify wetting episodes
 Assess willingness to participate in social activities

 Teaching
 Home environment
 Voiding diary
 Therapies

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URINARY RETENTION

22/12/2010
 Occurs when bladder cannot empty
 May be caused by obstructive or functional
problem
 Benign prostatic hypertrophy
 Surgery
 Drugs
 Neurologic diseases
 Trauma

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URINARY RETENTION - MANIFESTATIONS

22/12/2010
 Manifestations
 Overflow voiding
 Incontinence
 Firm, distended bladder
 May be displaced

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URINARY RETENTION

22/12/2010
 Complications
 Hydronephrosis
 Acute renal failure
 Urinary tract infection

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URINARY RETENTION – INTERDISCIPLINARY
CARE

22/12/2010
 Diagnostic tests
 Portable bladder scan
 Treatment depends on cause
 Surgery
 Medications
 Stimulation techniques
 Catheterization

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URINARY RETENTION - SURGERY

22/12/2010
 Surgery (removal of obstuction, resection of
prostate)
 Catheterization after surgery helps prevent
overdistention

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URINARY RETENTION – NURSING CARE

22/12/2010
 Identify clients
 Take measures to promote urination

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URINARY TRACT INFECTIONS

22/12/2010
 Affect up to 20% of women
 Incidence increases with aging

 Healthcare-associated infections common

(catheter)
 Classified according to region and primary site
affected
 Cystitis is most common

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URINARY TRACT INFECTIONS

22/12/2010
 Bacteria from intestines can infect area
 Changes in urinary tract with aging can increase
risk

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CYSTITIS - MANIFESTATIONS

22/12/2010
 Bladder mucosa inflamed and congested with
blood
 Dysuria

 Frequency, urgency

 Hematuria

 Pyuria

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UTIS – DIAGNOSTIC TESTS

22/12/2010
 Urinalysis
 Urine culture & sensitivity

 CBC with differential

 IVP

 Voiding cystourethrography

 Cystoscopy

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UTIS - MEDICATIONS

22/12/2010
 Antibiotics
 3 or 7 day treatment

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UTIS – NURSING CARE

22/12/2010
 Assessment
 Impaired Urinary Elimination

 Readiness for Enhanced Self Health

Management
 Teaching

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PYELONEPHRITIS

22/12/2010
 Inflammatory disorder of renal pelvis and
parenchyma
 Acute
 E. coli
 Chronic
 Other disorders

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 PYELONEPHRITIS - MANIFESTATIONS

22/12/2010
 Acute
 Rapid onset
 Chills, fever
 Malaise, vomiting

 Flank pain, costovertebral tenderness (the angle

formed by the lower border of the12th, or bottom, rib
and the spine)
 Cystitis
 Chronic
 Fibrosis, scarring, renal failure

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GLOMERULONEPHRITIS

22/12/2010
 Inflammatory condition of glomerulus
 Acute or chronic

 Primary kidney disorder or secondary to systemic

disease

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GLOMERULONEPHRITIS

22/12/2010
 Affects structure and function of glomerulus
 Damages capillary membrane
 Blood cells and proteins escape into filtrate
 Hematuria, proteinuria, azotemia (increase BUN &
Creatinin)

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ACUTE GLOMERULONEPHRITIS -
MANIFESTATIONS

22/12/2010
 Usually follows infection of group A beta-
hemolytic Streptococcus
 Manifestations develop abruptly
 Hematuria, proteinuria, edema, hypertension,
fatigue,
 Anorexia, nausea, vomiting, headache
 Elevated BUN and serum creatinine

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ACUTE GLOMERULONEPHRITIS -
MANIFESTATIONS

22/12/2010
 Older adults may show less characteristic
manifestations
 Symptoms may subside spontaneously

 Some may develop chronic glomerulonephritis

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 CHRONIC GLOMERULONEPHRITIS -
MANIFESTATIONS

22/12/2010
 Symptoms develop slowly caused by progressive
destruction of glomeruli and loss of nephrons
 Signs of renal failure may be reason to seek diagnosis

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GLOMERULONEPHRITIS –
DIAGNOSTIC TESTS

22/12/2010
 ASO titer (anti  Serum electrolytes
streptolysine O)  Urinalysis
 ESR
 KUB x-ray
 BUN
 Kidney scan or biopsy
 Serum creatinine

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GLOMERULONEPHRITIS – INTERDISCIPLINARY
CARE

22/12/2010
 Focus is on identifying and treating underlying
disease process and preserving kidney function
 Often no specific treatment

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GLOMERULONEPHRITIS –
TREATMENT

22/12/2010
 Medications
 Plasma exchange therapy

 Dietary management

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GLOMERULONEPHRITIS –
NURSING CARE

22/12/2010
 Assessment
 Diagnosing, Planning, and Implementing
 Excess Fluid Volume
 Fatigue
 Risk for Infection
 Ineffective Role Performance

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NEPHROTIC SYNDROME - MANIFESTATIONS

22/12/2010
 Significant proteinuria
 Low serum albumin levels

 High blood lipids

 Edema

 Thromboemboli

 Usually resolves without long-term effects

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HYDRONEPHROSIS

22/12/2010
 Abnormal dilation of renal pelvis and calyces
 Results from urinary tract obstructions or
backflow of urine
 Manifestations depend on how rapidly it develops

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 HYDRONEPHROSIS - MANIFESTATIONS

22/12/2010
 Acute (colicky flank pain, hematuria, pyuria, fever,
nausea and vomiting, abdominal pain
 Chronic (intermittent dull flank pain, hematuria,
pyuria, fever, palpable mass)

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HYDRONEPHROSIS – INTERDISCIPLINARY
CARE

22/12/2010
 Diagnosis
 Ultrasound
 CT scan
 Cystoscopy

 Treatment
 Stents

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HYDRONEPHROSIS - SURGERY

22/12/2010
 Stents positioned during suergery or cystoscopy
 Pig-tail or J-shaped
 Temporary or long-term

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HYDRONEPHROSIS – NURSING CARE

22/12/2010
 Focuses on ensuring urinary drainage
 Monitor I&O

 Irrigate tubes only as ordered

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POLYCYSTIC KIDNEY DISEASE

22/12/2010
 Hereditary
 Cyst formation and massive kidney enlargement

 Relatively common

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POLYCYSTIC KIDNEY DISEASE

22/12/2010
 Renal cysts develop in nephron
 Cysts fill, enlarge and multiply
 Causes kidneys to enlarge
 Gradual destruction of functional kidney tissue
 Slowly progressive

 Flank pain, hematuria, proteinuria, polyuria,

nocturia

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 A POLYCYSTIC KIDNEY AND A NORMAL KIDNEY FOR COMPARISON. (SOURCE: NMSB, CUSTOM MEDICAL
STOCK PHOTOS, INC.)

22/12/2010
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POLYCYSTIC KIDNEY DISEASE -
MANIFESTATIONS

22/12/2010
 Enlarged kidneys
 Flank pain, hematuria, proteinuria, polyuria,
nocturia

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POLYCYSTIC KIDNEY DISEASE –
INTERDISCIPLINARY CARE

22/12/2010
 Management is supportive
 Renal ultrasound to diagnose

 Fluids

 Medications

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POLYCYSTIC KIDNEY DISEASE –
NURSING CARE

22/12/2010
 Diagnosing, Planning, and Implementing
 Excess Fluid Volume
 Grieving
 Ineffective Self Health Management
 Ineffective Coping

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CANCER OF THE URINARY TRACT

22/12/2010
 Bladder cancer
 Kidney tumors

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BLADDER CANCER

22/12/2010
 Bladder cancer is 10th leading cause of cancer
deaths
 Major risk factors
 Carcinogens in urine related to a history of
smoking (probably because of the excretion of
carcinogens such as 4-aminobiphenyl),
 which increases the risk about four-fold.

 Chronic inflammation or infection of bladder

mucosa
 Smoking

 Chemicals in environment 45
 BLADDER CANCER - MANIFESTATIONS

22/12/2010
 Painless hematuria
 Frequency

 Urgency

 Dysuria

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BLADDER CANCER – INTERDISCIPLINARY
CARE

22/12/2010
 Diagnostic tests
 Bladder ultrasound
 Urinalysis
 Urine cytology
 Cystoscopy

 Treatment
 Medications
 Surgery

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KIDNEY TUMORS

22/12/2010
 Uncommon
 Renal cell carcinoma most common primary
tumor
 Risk factors
 Smoking
 Obesity
 Renal calculi

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KIDNEY TUMORS

22/12/2010
 Most arise from tubular epithelium
 Can occur anywhere

 Often metastasize

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 KIDNEY TUMORS - MANIFESTATIONS

22/12/2010
 May be silent
 Flank pain

 Palpable mass

 Fever, fatigue

 Weight loss, anemia, polycythemia

 Hypercalcemia, hypertension, or hyperglycemia

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KIDNEY TUMORS – INTERDISCIPLINARY CARE

22/12/2010
 Diagnostic tests
 Renal ultrasound
 CT scan
 Kidney biopsy

 Treatment
 Radical nephrectomy

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BLADDER AND KIDNEY CANCER –
NURSING CARE

22/12/2010
 Assessment
 Diagnosing, Planning, and Implementing
 Impaired Urinary Elimination
 Risk for Impaired Skin Integrity
 Disturbed Body Image

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BLADDER AND KIDNEY TUMORS –
NURSING CARE

22/12/2010
 Diagnosing, Planning, and Implementing
 Acute Pain
 Ineffective Breathing Pattern
 Disturbed Body Image

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