Understanding Medical Surgical Nursing 4 th Edition Linda

Slides: 87

Download presentation

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Urinary Tract Infections (UTIs) § Invasion of Urinary Tract by Bacteria § Women Greater Than Men § Aging § Older Men Due to Enlarged Prostate § Women Due to Declining Estrogen Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper UTI Predisposing Factors § § § Stasis of Urine Contamination in Perineal/Urethral Area Instrumentation Reflux of Urine Previous UTIs Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper UTI § Urethritis: Inflammation of Urethra § Cystitis: Inflammation/Infection of Bladder Wall § Pyelonephritis: Infection of the Kidneys Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper UTI Nursing Data Collection § Dysuria, Flank Pain, Fever, Chills, Malaise § Urine Examined for Cloudiness, Blood, Foul Odor § Predisposing Factors § Urinalysis and Culture Results Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Diagnoses § § Acute Pain Impaired Urinary Elimination Risk for Injury Deficient Knowledge Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Care § § Monitor Symptoms Monitor Intake and Output Pain Control Teaching § Medications: Take All Antibiotics § Prevention Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Urological Obstructions § Obstruction of Urine Flow is Always Significant § Backup of Urine Destroys Kidney Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Urological Obstructions (cont’d) § Urethral Strictures § Urethra Lumen Narrowing Due to Scar Tissue § Renal Calculi § Hard, Generally Small Stones § Kidney Stones § Nephrolithiasis Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi § Pathophysiology § Urinary Salts Settle Out § Calcium Oxalate Most Common Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi (cont’d) § Etiology § § § Heredity Chronic Dehydration Infection Immobility Men Greater than Women Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi (cont’d) § Signs and Symptoms § Flank Pain § Renal Colic § Dysuria § Costovertebral Tenderness § Hematuria Frequency § Urgency § Enuresis § GI Upset Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi (cont’d) § Diagnosis § § Kidney-Ureter-Bladder X-Ray Intravenous Pyelogram (IVP) Renal Ultrasound Urinalysis Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi Therapeutic Interventions § § § Small Stones Passed IV Fluids Pain Control Thiazide Diuretics Allopurinol Lithotripsy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi Surgery § § § Cystoscopy Cystolitholapaxy Cystotomy Ureterolithotomy Nephrolithotomy § Nephrostomy Tube Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi (cont’d) § Nursing Diagnoses § Acute Pain § Risk for Infection § Deficient Knowledge Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Calculi Nursing Care § § § Monitor Symptoms Strain All Urine Intake and Output Pain Control Hydration Teaching Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Hydronephrosis § Obstruction in Urinary Tract § Kidney Enlarges as Urine Collects § Treat Cause Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Hydronephrosis (cont’d) § Signs and Symptoms § § § Frequency Urgency Dysuria Flank and Back Pain Kidney Disease Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Hydronephrosis Therapeutic Interventions § § Treat Cause Urinary Catheter Stents Nephrostomy Tube § Intake and Output § No Clamping Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder § § Most Common Urinary Tract Cancer Men Greater than Women Ages 50 to 70 Years Etiology § Smoking § Industrial Pollution Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Signs and Symptoms § Early § Painless § Hematuria Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Signs and Symptoms (cont’d) § Late § Pelvic Pain § Lower Back Pain § Dysuria § Inability to Void Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Diagnosis § Urinalysis § Telomerase § Urine for Cytology, Culture § Cystoscopy and Transurethral Biopsy § IVP Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Therapeutic Interventions § Chemotherapy § Bacille Calmette-Guérin Vaccine § Photodynamic Therapy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Therapeutic Interventions (cont’d) § Surgery § Cystoscopy and Pyelogram with Fulguration § Laser § Robotic Laparoscopic Radical Cystectomy § Urinary Diversion Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Therapeutic Interventions (cont’d) § Incontinent Urinary Diversion § Ileal Conduit Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Therapeutic Interventions (cont’d) § Continent Urinary Diversion § Kock Pouch § Indiana Pouch § Mainz Pouch § Florida Pouch Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Therapeutic Interventions (cont’d) § Othotopic Bladder Substitution § Studer Pouch § Hemi-Kock Pouch § Ileal W–Neobladder Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Bladder (cont’d) § Nursing Care § § WOC Nurse Monitor Urine Output Education Pre-op and Post-op Care Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney § Rare § Risk Factors § § Smoking Obesity Hypertension Long-term Kidney Dialysis Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney (cont’d) § Risk Factors (cont’d) § Radiation Exposure § Asbestos § Industrial Pollution Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney (cont’d) § Later Signs and Symptoms § Hematuria § Dull Pain in Flank Area § Mass Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney Diagnosis § § § IVP Cystoscopy and Pyelogram Ultrasound CT Scan MRI Renal Biopsy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney (cont’d) § Therapeutic Interventions § § § Radical Nephrectomy Nephron-sparing Surgery Radiation Therapy Immunotherapy Chemotherapy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Cancer of the Kidney (cont’d) § Nursing Care § Monitor Urine Output § Education § Pre-op and Post-op Care Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Renal Trauma (cont’d) § Nursing Care § § Intake and Output Vital Signs IV Fluids Pain Control Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Polycystic Kidney Disease § Multiple Cysts in the Kidney § Signs and Symptoms § § Dull Heaviness in Flank/Back Hematuria Hypertension UTI Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Diabetic Nephropathy § Long-term Complication of Diabetes § Most Common Cause of Chronic Kidney Disease § Atherosclerotic Changes Decrease Blood to Kidney § Smaller Doses of Insulin as Progresses § Chronic Kidney Disease Develops Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Diabetic Nephropathy Therapeutic Interventions § Early § Control Blood Glucose and Blood Pressure § Restricted-protein Diet § Later § Dialysis § Kidney Transplant Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Diabetic Nephropathy (cont’d) § Nursing Care § Education on Glucose and Blood Pressure Control Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nephrotic Syndrome § Large Amounts of Protein Lost in Urine § Increased Glomerular Membrane Permeability Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nephrosclerosis § Hypertension Damages Kidneys by Sclerotic Changes § Therapeutic Interventions § Antihypertensives § Nursing diagnosis § Impaired Health Maintenance Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis § Inflammatory Disease of the Glomerulus § Glomerulus More Porous § Proteins, WBCs, RBCs Leak into Urine Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis (cont’d) § Causes § Acute Post-streptococcal § Goodpasture’s Syndrome § Chronic Glomerulonephritis Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis (cont’d) § Signs and Symptoms § § § Oliguria Hypertension Electrolyte Imbalances Edema Flank Pain Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis (cont’d) § Diagnosis § § Urinalysis Ultrasound X-Ray Biopsy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis (cont’d) § Therapeutic Interventions § Resolves § Kidney Disease Treatment Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Glomerulonephritis Nursing Care § § § Vital Signs Symptom Support Rest Fluid, Sodium, Protein Restrictions Education Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Acute Kidney Injury § Sudden Loss of Kidney Function § Azotemia § Waste Products Accumulate § Oliguric § May Recover Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Acute Kidney Injury Causes § Prerenal Failure § Decreased Blood Supply to Kidneys § Intrarenal Failure § Damage to Nephrons § Postrenal Failure § Obstruction Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Acute Kidney Injury (cont’d) § Nephrotoxins § Diagnostic Contrast Media (Dyes) § Medications § IV Aminoglycosides, Tobramycin (Tobrex), Amikacin (Amikin), Cisplatin (Platinol) § Chemicals Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Acute Kidney Injury (cont’d) § Prevention § Check Serum BUN and Creatinine Prior to Dyes or Meds § Hydrate Before/After Contrast Media § Monitor Peak/Through Levels of Nephrotoxic Drugs per Institutional Policy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Acute Kidney Injury (cont’d) § Therapeutic Interventions § § Treat Cause Supportive Treatment Dialysis Continuous Renal Replacement Therapy Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Continuous Renal Replacement Therapy § Removes Fluid Continuously Along with Hemodialysis § Removes Fluid/Solutes in Controlled, Continuous Manner in Unstable Patients § Blood Flows Through Hemofilter, Excess Fluids/Solutes Move into Collection Bag Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Chronic Kidney Disease § Gradual Decrease in Kidney Function § Irreversible Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Chronic Kidney Disease (cont’d) § Etiology § § Diabetic Nephropathy Nephrosclerosis Glomerulonephritis Autoimmune Diseases Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Pathophysiology § § § Large Proportion of Nephrons Damaged Progressive Renal Insufficiency: 75% of Nephrons Lost End-stage: 90% of Nephrons Lost Uremia: Urea in the Blood Affects All Body Systems Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Symptoms of Chronic Kidney Disease § § § Fluid Accumulation Electrolyte Imbalances Waste Products Retained Acid-base Imbalances Anemia Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions § Diet § § § High Calorie Low Protein (Unless Dialysis) Low Sodium, Potassium, Phosphorus Increased Calcium Vitamins Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions (cont’d) § Medications § § § Diuretics Antihypertensives Phosphate Binder Calcium/vitamin D Supplements Kayexalate prn Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions (cont’d) § Dialysis § § Symptoms of Fluid Overload High Potassium Neurological Signs Uremia Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions § Hemodialysis § Artificial Kidney Removes Waste Products and Excess Water from Blood Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions (cont’d) § Vascular Access § § Temporary Lifesite Hemodialysis Access System A-V Fistula A-V Graft Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions (cont’d) § Vascular Access Care § Thrill, Bruit § Protect § Postoperative § NV Checks, Pain § Elevate Extremity Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions Peritoneal Dialysis § Continuous Dialysis Done by Patient § Peritoneal Membrane is Semipermeable Membrane, Across which Excess Wastes/ Fluids Move from Blood § Peritoneal Catheter § Exchange Process: Fill, Dwell Time, Drain Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions § Kidney Transplant § Living-related Donor or Cadaver Donor § Antirejection Drugs Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Diagnoses § § § Excess Fluid Volume Impaired Skin Integrity Activity Intolerance Risk for Injury Risk for Infection Imbalanced Nutrition: Less Than Body Requirements Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Care § Excess Fluid Volume § § Monitor Weight Intake and Output Fluid Restriction Monitor for Fluid Retention Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Care (cont’d) § Electrolyte Imbalance § Monitor Levels § Dietary Restrictions § Monitor Dysrhythmias Copyright © 2011. F. A. Davis Company

Understanding Medical Surgical Nursing, 4 th Edition Linda S. Williams / Paula D. Hopper Nursing Care (cont’d) § Waste Products § Oral Care, Skin Care § Lotion § Protect from Injury § Impaired Hematological Function § Protect from Injury/Infection Copyright © 2011. F. A. Davis Company

Related presentations