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Nursing Management:Nursing Management:
Renal and Urologic Problems Renal and Urologic Problems
Chapter 46 OverviewChapter 46 Overview
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Infectious and Inflammatory Infectious and Inflammatory Disorders of Urinary SystemDisorders of Urinary System
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Urinary Tract Infection Urinary Tract Infection
• ClassificationClassification
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Urinary Tract Infection Urinary Tract Infection
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Fig. 46-1. Sites of infectious processes in the upper and lower urinary tracts.
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Urinary Tract Infection Urinary Tract Infection
• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies• Collaborative Care and Drug Collaborative Care and Drug
TherapyTherapy
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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
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Acute Pyelonephritis Acute Pyelonephritis
• Etiology and PathophysiologyEtiology and Pathophysiology
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Acute Pyelonephritis Acute Pyelonephritis
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Fig. 46-2. Acute pyelonephritis. Cortical surface shows grayish white areas of inflammation and abscessformation (arrow).
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Acute Pyelonephritis Acute Pyelonephritis
• Clinical Manifestations and Clinical Manifestations and Diagnostic StudiesDiagnostic Studies
• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy
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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
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Chronic Pyelonephritis Chronic Pyelonephritis
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Urethritis Urethritis
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Urethral Diverticula Urethral Diverticula
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Interstitial Cystitis/Painful Interstitial Cystitis/Painful Bladder Syndrome Bladder Syndrome
• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy
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Nursing Management: Nursing Management: Interstitial Cystitis/Painful Bladder Syndrome Interstitial Cystitis/Painful Bladder Syndrome
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Renal Tuberculosis Renal Tuberculosis
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Immunologic Disorders of Immunologic Disorders of KidneyKidney
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Glomerulonephritis Glomerulonephritis
• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations
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Acute Poststreptococcal Acute Poststreptococcal Glomerulonephritis Glomerulonephritis
• Clinical Manifestations and Clinical Manifestations and ComplicationsComplications
• Diagnostic StudiesDiagnostic Studies
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Nursing and Collaborative Management: Nursing and Collaborative Management: Acute Poststreptococcal GlomerulonephritisAcute Poststreptococcal Glomerulonephritis
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Goodpasture Syndrome Goodpasture Syndrome
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Nursing and Collaborative Management: Nursing and Collaborative Management:
Goodpasture Syndrome Goodpasture Syndrome
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Rapidly Progressive Rapidly Progressive Glomerulonephritis Glomerulonephritis
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Chronic Glomerulonephritis Chronic Glomerulonephritis
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Nephrotic Syndrome Nephrotic Syndrome
• Etiology and Clinical ManifestationsEtiology and Clinical Manifestations
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Nursing and Collaborative Management: Nursing and Collaborative Management:
Nephrotic Syndrome Nephrotic Syndrome
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Obstructive Uropathies Obstructive Uropathies
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Fig. 46-3. Sites and causes of upper and lower urinary tract obstruction.
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Obstructive Uropathies Obstructive Uropathies
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Fig. 46-4. Hydronephrosis of the kidney. Note the marked dilation of the pelvis and calycesand thinning of the renal parenchyma.
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Urinary Tract Calculi Urinary Tract Calculi
• Etiology and PathophysiologyEtiology and Pathophysiology
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Urinary Tract Calculi Urinary Tract Calculi
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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.
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Urinary Tract Calculi Urinary Tract Calculi
• TypesTypes• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies
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Urinary Tract Calculi Urinary Tract Calculi
• Collaborative CareCollaborative Care Endourologic proceduresEndourologic procedures
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Urinary Tract Calculi Urinary Tract Calculi
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Fig. 46-6. A, Calcium oxalate stones. B, Plain abdominal x-ray showing large bladder calculus.
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Urinary Tract Calculi Urinary Tract Calculi
• Collaborative Care, continued Collaborative Care, continued LithotripsyLithotripsy Surgical therapySurgical therapy Nutritional therapyNutritional therapy
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Nursing Management:Nursing Management:Urinary Tract Calculi Urinary Tract Calculi
• Nursing AssessmentNursing Assessment• Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing ImplementationNursing Implementation• EvaluationEvaluation
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Strictures Strictures
• Ureteral StricturesUreteral Strictures• Urethral StrictureUrethral Stricture
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Renal Trauma Renal Trauma
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Renal Vascular Problems Renal Vascular Problems
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Nephrosclerosis Nephrosclerosis
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Renal Artery Stenosis Renal Artery Stenosis
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Renal Vein Thrombosis Renal Vein Thrombosis
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Hereditary Renal Diseases Hereditary Renal Diseases
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Polycystic Kidney Disease Polycystic Kidney Disease
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Fig. 46-7. A, Comparison of polycystic kidney with normal kidney. B, Cysts in the liver.
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Nursing and Collaborative Management:Nursing and Collaborative Management:
Polycystic Kidney DiseasePolycystic Kidney Disease
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Page 45
Medullary Cystic Disease Medullary Cystic Disease
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Page 46
Alport Syndrome Alport Syndrome
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Renal Involvement in Metabolic Renal Involvement in Metabolic and Connective Tissue Diseasesand Connective Tissue Diseases
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Urinary Tract TumorsUrinary Tract Tumors
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Kidney CancerKidney Cancer
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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).
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Kidney CancerKidney Cancer
• Clinical Manifestations and Clinical Manifestations and Diagnostic StudiesDiagnostic Studies
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Nursing and Collaborative Management: Nursing and Collaborative Management:
Kidney CancerKidney Cancer
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Table 46-15. Robson's System of Staging Renal Carcinoma.
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Bladder CancerBladder Cancer
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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).
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Bladder CancerBladder Cancer
• Clinical Manifestations and Clinical Manifestations and Diagnostic StudiesDiagnostic Studies
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Nursing and Collaborative Management:Nursing and Collaborative Management:
Bladder CancerBladder Cancer
• Surgical TherapySurgical Therapy• Radiation Therapy and Radiation Therapy and
ChemotherapyChemotherapy• Intravesical TherapyIntravesical Therapy
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Urinary Incontinence and Urinary Incontinence and Retention Retention
• Diagnostic StudiesDiagnostic Studies• Collaborative Care: Urinary Collaborative Care: Urinary
IncontinenceIncontinence Drug TherapyDrug Therapy Surgical TherapySurgical Therapy
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Nursing Management: Nursing Management: Urinary Incontinence Urinary Incontinence
• Collaborative Care: Urinary Collaborative Care: Urinary RetentionRetention Drug therapyDrug therapy Surgical therapySurgical therapy
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Nursing Management: Nursing Management: Urinary Retention Urinary Retention
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Instrumentation Instrumentation
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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).
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Instrumentation Instrumentation
• Urethral CatheterizationUrethral Catheterization• Ureteral CathetersUreteral Catheters• Suprapubic CathetersSuprapubic Catheters• Nephrostomy TubesNephrostomy Tubes• Intermittent CatheterizationIntermittent Catheterization
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Surgery of the Urinary TractSurgery of the Urinary Tract
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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
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Urinary Diversion Urinary Diversion
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Fig. 46-11. Methods of urinary diversion. A, Ureteroileosigmoidostomy. B, Ileal loop (ileal conduit).C, Ureterostomy (transcutaneous ureterostomy and bilateral cutaneous ureterostomies). D, Nephrostomy.
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Urinary Diversion Urinary Diversion
• Incontinent Urinary DiversionIncontinent Urinary Diversion
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Urinary Diversion Urinary Diversion
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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.
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Urinary Diversion Urinary Diversion
• Continent Urinary DiversionsContinent Urinary Diversions
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Urinary Diversion Urinary Diversion
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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.
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Urinary Diversion Urinary Diversion
• Orthotopic Bladder ReconstructionOrthotopic Bladder Reconstruction
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Nursing Management: Nursing Management: Urinary Diversion Urinary Diversion
• Preoperative ManagementPreoperative Management• Postoperative ManagementPostoperative Management
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Nursing Management: Nursing Management: Urinary Diversion Urinary Diversion
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Fig. 46-14. Ammonia salt encrustation secondary to alkaline urine.
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Nursing Management: Nursing Management: Urinary Diversion Urinary Diversion
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Fig. 46-15. Retracted urinary stoma with pressure sore from faceplate above stoma (arrow).