OVERVIEW OF THE ANATOMY AND PHYSIOLOGY OF

EXCRETORY/URINARY SYSTEM 2.Ureter

-maintain homeostasis by maintaining body fluid -two small tubes about 25cm long. They transport urine
composition and volume. from the renal pelvis to the urinary bladder.
Components of Urinary System: 3. Urinary bladder
-reservoir for urine
1.Kidneys
-composed of three layers of detrusor muscles.
2.Ureters
Contraction of these muscles expels urine from the
3.Urinary Bladder
bladder.
4.Urethra
-maximum capacity of 1000ml of urine.
1.Kidney
-the bladder is guarded by internal urethral sphincter
-major controlling output, remove waste product from
-the trigone is a triangular shape in the floor of the
the body through formation of urine.
bladder that is marked by the openings for the 2 ureters
-bean shaped located at retroperitoneally at the level of
and the internal orifice.
12th thoracic and 3rd lumbar vertebra (costovertebral
4. Urethra
angle).
-is the passageway of the urine into the external
-right kidney (lower than left kidney because of liver)
environment.
-left kidney(higher)
-the internal urethral sphincter is an involuntary muscle,
3 PARTS OF KIDNEY
-the external urethral sphincter is a voluntary muscle.
3.1 renal cortex
-female urethra:1 1/2 to 2 1/2inches
3.2 renal medulla
-male urethra: 5 ½ to 6 ½ inches-8 inches
3.3 renal pelvis
-the shorter urethra among females increase propensity
Nephrons
to UTI.
-functional unit of the kidneys
Urine Formation
-composed of glomerulus and renal tubules
a. Glomerular Filtration
-site of formation of urine
-water and solutes move from the blood to the
Glomerulus
glomerular capsule. The fluid that enters the capsule is
-semi permeable Capillaries surrounded by
glomerular filtrate.
Bowman’s capsule
b. Tubular Reabsorption
3 PARTS OF RENAL TUBULES
-it is the movement of substances from filtrate in the
1.Proximal Convuluted Tubules
renal tubules into the blood in the peritubular
2.Loop of Henle
capillaries. Only 1% of the filtrate remains in the tubules
3.Distal Convuluted Tubule
and become urine.
-1,200ml blood flows to the kidneys per minute
-water and other substances that are useful to the body
(20-25% of C.O)
are reabsorbed.
-GFR (Glomerular Filtration Rate) is
c. Tubular Secretion
125ml/min. From this, the kidneys form 0.5-1ml of
-the transport of substances from blood into the renal
urine per minute thereby 30-60 cc /hr or approximately
tubules. Potassium and hydrogen are primarily
1500mls /day.
eliminated from the body. Ammonia, uric acid, some
Functions of the Kidneys:
drug metabolites are likewise eliminated.
-excrete waste product
d. Micturition aka voiding, urination
-regulate fluid volume
-act of expelling urine from the bladder
-Production of hormones:
Diagnostic Procedures:
1.Erythropoetin-stimulate bone marrow to produce
1.Routine Analysis
RBC
-best time to collect: morning upon awakening
2.Renin-regulate blood pressure
-instruction:
3.Aldosterone-retains Na and Water
cleanse the external genitalia with soap and water
-Activation of vitamin D
discard the first flow, collect the midstream
-color: amber/straw
 -ph: 4.5-8.0(average 6) slight acidic -Observe for urine retention, signs of infection and
-Specific gravity:1.010-1.025 excessive hematuria-notify the physician
-protein: absent -Monitor output and VS
-RBC:0-5 hpf -Hot sitz bath to relieve pelvic discomfort
-WBC:0-5 hpf -Warm, moist soak to relieve leg cramps due to
-Pus:Absent prolonged lithotomy position
-Glucose:Absent -Force fluids to prevent UTI
-Ketones: Absent 4. KUB-Kidney, Urether, Bladder
-Casts:0-4 -x ray visualization of the kidneys, ureters, bladder
Note: If RBC, WBC, Pus is present, increase it indicates -assure that the procedure is painless
UTI (urinary tract infection) -Bowel preparation (laxative in evening and enema in
-If Glucose, Ketones are present, increase it indicates the morning as ordered)
DKA (diabetic ketoacidosis) 5. Excretory Urogram/ Intravenous Pyelography (IVP)
2.Creatinine Clearance -x-ray visualization of the kidneys, ureters and bladder
-24 hour urine specimen or collection -contrast medium is administered IV (hypaque)
-best indicator of glomerular function Nursing interventions before the procedure:
-Instruction: -consent
-discard the first voided then collect all the specimens -NPO (nothing per orem) 6-8 hours
thereafter, include the last voided specimen. -bowel prep (laxative as ordered)
-if decrease creatinine level in the urine- indicates renal -assess allergy to iodine and seafoods
abnormality -prepare epinephrine at bed side.
3.Blood Studies Nursing interventions after the procedure:
BUN: 10-20mg/dl -monitor VS
Serum Creatinine: 0.4-1.2mg/dl -increase OFI
Serum Uric Acid: 2.5-8mg/dl -burning sensation on voiding may be experienced
Albumin: 3.2-5.5mg/dl -observe for signs of delayed allergic reactions
RBC: 4.5-5Million/cu.mm 6. Retrograde Pyelogram (RPG)
Hct: 38-54% -outlines renal pelvis and ureters
Serum Electrolytes -contrast medium through cystoscope
Blood ph Care before RPG:
3.Cystoscopy -consent
-direct visualization of urethra, bladder wall, trigone, -check for allergy
urethral opening using cystoscope. -inform on the discomfort of the procedure
Nursing Interventions before the procedure: -prepare epinephrine at bed side
-secure written consent Care after RPG:
-done under local/general anesthesia (depending on the -monitor VS
level of anxiety) -observe urinary retention, infection and prolonged
-force fluids if under local anesthesia hematuria-notify the physician.
-NPO, if under general anesthesia -Increase OFI
-Inform client that desire to void is felt as cystoscope is 7.Voiding Cystourethrogram
inserted -x-ray of the bladder, urethra with full bladder and
-place the client in lithotomy position during the while urinating
procedure -contrast medium is introduced into the bladder
Nursing Interventions after the procedure: through urinary catheter before x-ray.
-Bed rest until VS stable Done to detect causes:
-pink tinged urine is normal 24-48 hrs. -repeated UTI
-dysuria, frequency, hematuria- common after the -urinary incontinence
procedure -reflux/backflow of urine
-to detect presence of injury to the bladder or urethra,
BPH, structural defects in the bladder or urethra.
-Retrograde Cystourethrogram (x-ray during
introduction of contrast medium)
-Voiding Cystourethrogram (x-ray during voiding as
urine flows out of the bladder)
8.Cystometrogram
-records pressure exerted at varying phases of filling of
the bladder
-helps evaluate neuro-sensory status and tonicity
-Assess time to initiate stream, degree of hesitance,
intermittence of voiding, presence of terminal dribbling.
-Retention catheter is inserted, residual volume is
measured
-Retention catheter is attached to manometer, sterile
normal saline is introduced into the bladder at
prescribed rate
-Amounts of bladder volume and pressures are
recorded at intervals, including first desire to void and
feeling of maximum fullness.
9.KUB ultrasound
-detects tumor,cyst,obstruction and abcesses
-cleanse the bowel(laxative) as ordered
-Distend the bladder (give 2 glasses of water)-this
permits better imaging
-withhold voiding
10.Renal Arteriogram
-x ray visualization of renal circulation as contrast
medium is injected into renal artery thorough catheter.
Care before Renal Arteriogram:
-cleanse the bowel(laxative)
-shave the catheter insertion site (lumbar, femoral area)
-Locate and mark distal pulses
Care after Renal Arteriogram:
-VS until stable
-Apply cold on puncture site to prevent bleeding
-check for swelling and hematoma
-sandbag over the catheter insertion site
-palpate peripheral pulses to assess adequacy of
circulation in the involved extremity
-check color, temp of extremity
-bed rest for 24 hours, no sitting
-measure U.O
11.Renal Biopsy
Nursing Interventions before the procedure:
-NPO 6-8 hours
-check PTT, Pro time (bleeding is the most common
complication)
-mild sedation is done
-place the client in prone position during the procedure
-ultrasound and xray of the kidney should be available
to locate the kidney
-local anesthesia is administered
-instruct client to hold breath and remain still during
needle insertion to prevent trauma.
Nursing Interventions after the procedure:
-bed rest for 24 hours to prevent bleeding
-Monitor VS-to assess internal bleeding
-check for pain, nausea/vomiting-notify the physician
-provide fluid to 3L-to prevent infection
-Hct and Hgb level is done in 8 hours to detect bleeding
-Avoid strenuous activity for 2 weeks
-Notify the physician of the following:
1.Bleeding
2.Hematoma
3.Infection
Common Assessment Abnormalities:
Anuria-no urination or 24 hr U.O less than 100ml
Burning on Urination-stingling pain in urethral area
Chemical cystitis-pain or difficult urination
Dysuria-painful or difficult urination
Enuresis-involuntary nocturnal urinating(bedwetting)
Frequency-increased incidence of urinating
Hematuria-blood in urine
Hesitancy-delay or diificulty in initiating urine
Incontinence-inability to voluntarily control discharges
of urine
Nocturia-frequency of urination at night
Oliguria-diminished amount of urine in a given time(24
hr urine output: 100-400ml)
Pneumaturia-passage of urine containing gas
Polyuria-large volume of urine in a given time
Retention-inability to urinate even though bladder
contains excessive amount of urine
Stress incontinence-involuntary urination with
increased pressure (sneezing, coughing, laughing)
GENITO-URINARY DISORDERS
1. RENAL FAILURE
Two types of Renal Failure:
Acute Renal Failure
-sudden loss of renal function
-reversible
Chronic Renal Failure
-gradual, progressive loss of renal function
-irreversible
Stages of Acute Renal Failure
a. Oliguric Phase
-last for 1-3 weeks
 -decreased U.O, increased BUN, Creatinine, edema, -Metabolic acidosis
HPN, hyperkalemia, hypermagnesemia, -Hypocalcemia
hyperphosphatemia, hyponatremia and metabolic -Hyperphosphatemia
acidosis. -Renal osteodystrophy
b. Diuretic Phase -Hyperparathyroidism
-last for 1week -Hyperglycemia
-signifies that the kidneys starting to regain their Collaborative Management:
functions 1.Fluid control
-increased U.O(3-5 L/day) with excessive loss of 2.Electrolyte control:
potassium. -for Hyperkalemia:
c. Recovery Phase *low K diet
-takes 3-12 months for the kidneys to recover *glucose 10% with regular insulin per IV
-avoid nephrotoxic drugs *Resin Kayexalate
Stages of Chronic Renal Failure -for Metabolic Acidosis
1.Renal Impairement- 40 to 50% remaining GFR *Sodium Bicarbonate
2.Renal Insufficiencey-20-40% remaining GFR -for Hypocalcemia
3.Renal Failure-10-20% remaining GFR *calcium salts and vitamin D
4.ESRD (End Stage Renal Disease) a.k.a uremia less supplements
than 10% GRF -for hyperphosphatemia
*amphogel(aluminium hydroxide)-
phosphate binder
3.Dietary Control(Renal diet
-high calorie, high carbohydrates,low protein, low K, low
Na
4.Treatment for intercurrent disorders:
-for anemia:
*Epogen, Procrit(Epoetin Alfa)
*S/E of epogen: HPN
*BT
-for GI disorders/symptoms:
Clinical Manifestations of CKD:
*Antacids, Histamine-H2 receptors
-Oliguria
-for Hypocalcemia
-increased BUN, serum creatinine(azotemia)
*calcium supplement and Vit. D
-Urineferous odor breath
-Stomatitis and GI bleeding (due to conversion of ureas
Nursing Interventions:
into ammonia. Ammonia irritates mucus membrane
1.Maintain fluid and electrolyte balance
including G.I tract)
-Weigh the client daily
-Destruction of RBC, WBC, platelets
-Measure I and O
-Sallow coloring or hyperpigmentation of the skin
-Assess presence and extent of edema
-Renal encephalopathy (due to elevated urea and
-Auscultate breath sounds
nitrogenous products in the brain)
-Restrict fluid as indicated
-Uremic frost (accumulation of crystalized urea in the
-Monitor cardiac rhythm for dysrhythmia
skin)-causing pruritus
-Avoid OTC Drugs(milk of magnesia-can cause
-decreased libido, impotence, and infertility
magnesium toxicity)
-severe anemia-due to decrease erythropoietin
2.Provide adequate Nutrition
secretions
-High carbohydrates, low protein, low Na,low K
-Edema
3.Prevent Infection and Injury
-Hyperkalemia
-Maintains asepsis durng treatment and procedures
-Hypermagnesemia
-Avoid aspirin products
-Hyponatremia or Hypernatremia
-Encourage the client to use soft bristled toothbrush * Drainage time-30 mins
4.Promote Comfort: -If the drainage stops, turn the client to sides
-relieve pain -Position the client in semi fowlers
-relieve pruritus due to uremic frost -Cloudy dialysates indicates peritonitis-notify the
5.Dialysis physician and collect specimen for culture
Care of the Client undergoing Dialysis: -Monitor urine and blood glucose levels-dialysate
Dialysis-is done to remove metabolic waste products, solution contains glucose
excess electrolytes and excess fluids from the body. -CAPD(Continous Ambulatory Peritoneal Dialysis) is
Dialyzer-Serves as the artificial kidney done at home- teach the client on asepsis to prevent
TWO TYPES OF DIALYSIS: infection.
1.Hemodialysis Dialysis may improve the following:
-requires vascular access: arteriovenous fistula(AV 1.Edema
Fistula), external arteriovenous shunt(AV shunt), 2.Elevated BUN, serum creatinine
arteriovenous graft(AV graft), jugular and femoral vein 3.Elevated electrolytes
catheterization. 4.Elevated BP
-it takes 3 to 4hours/session , 2-3 times/week Note: Dialysis cannot resolve anemia
Nursing Interventions for Hemodialysis: RENAL TRANSPLANTATION
-Arm precaution(no BP taking or puncturing of the (AV -also indicated for ESRD
shunt, AV fistula, graft) affected area. Common problem: Rejections
-Assess for the patency of AV fistula by auscultating for Medications to prevent GVHD(Graft-Versus-Host
bruit and palpating for thrill. Disease) or Rejection Reaction:
-BT as ordered during HD. 1.Imuran(Azathioprine)
-Usually, anti HPN drugs are omitted during 2.Sandimmune, Neoral(Cyclosporin)
hemodialysis 3.Prograf(Tacrolimus)
-Maintain activity and nutrition 4.Rapamune(Sirolimus)
-Promote comfort 5.Cellcept(Mycophenolate mofetil)
-Prevent disequilibrium syndrome(commonly 6.Deltasone(Prednisone)
experience during initial hemodialysis, rapid removal of Priority: Infection-because these drugs are
waste products from the blood than from the brain-due immunosuppressant.
to the presence of blood brain barrier thus causing 2. URINARY TRACT INFECTION
cerebral edema and increase ICP). Etiologic agent: Escherichia Coli(E.Coli)-most
-Signs and symptoms of Disequilibrium Syndrome: common
a.Restlessness Klebsiella,Proteus,Pesudomonas
b.Headache High risk: female because of short urethra and
c.nausea/vomiting absence of prostatic fluid.
d.Hypertension Predisposing Factors:
-To prevent disequilibrium syndrome, initial 1.Urinary stasis (due to BPH, stone tumor, urinary
hemodialysis should be done for 30 mins only then will retention, renal impairement)
be increased gradually. 2.Foreign Bodies (calculi, catheters, urinary tract
2.Peritoneal Dialysis instrumentation-cystoscopy)
-requires peritoneal catheter 3.Anatomic Factors-(fistula,obesity)
-catheter is inserted below the umbilicus 4.Immune response-(aging process, HIV,DM)
Nursing Interventions for Peritoneal Dialysis: 5.Functional disorders-(due to constipation,voiding
-Dialysate solution should be warmed at body dysfunction)
temperature(to increase capillary permeability and 6.Other factors:
enhance removal of waste products) -pregnancy
-Cycle of peritoneal Dialysis: -hypoestrogenic state
*Infusion time-10 mins -multiple sex partners
*Dwell time or Equilibration time- 20 mins -poor personal hygiene
Clinical Manifestations: -Trovan(Trovafloxacin)
-Frequency(voiding at close intervals) Note: administer fluoroquinolones with a full
-Urgency(strong desire to void even with small amount) glass of water and ensure adequate urine output. To
-Dysuria prevent crystalluria.
-Foul smelling urine -may cause neurotoxicity, hepatic and
-Suprapubic pain renal toxicity
-Malaise, fever, chills, n/v 4.Sulfonamides
-Low back pain -Sulfadiazine
-Routine urinalysis -Thiosulfil Forte(Sulfamethizole)
-C and S -Gantanol (Sulfamethoxazole)
Management: -Gantrisin(Sulfisoxazole)
-C and S before antibiotic therapy -Bactrim(Trimethoprim-sulfa-methoxazole)
-Increase fluid intake 3-4 l/day Note:
-Acidify urine(cranberry juice or prune juice) -sulfonamides may cause rash, fever and
-Hot sitz bath-to relieve pelvic discomfort photosensitivity. Avoid exposure to sun.
-Practice the 3 W’S: -it also cause Steven Johnsons Syndrome-most severe
W-ash hands before and after using toilet hypersensitivity response, produces symptoms that
W-ear cotton underwear include widespread lesions of the skin and mucous
W-ipe perineum from front to back membranes,with fever, malaise and toxaemia.
-Avoid wearing tight clothing (tight jeans) -take meds on empty stomach with a full glass of water
-Empty the bladder 2-3 hours -increase fluid intake to prevent crystalluria
-Empty the bladder before and immediately after sexual 4.Cholinergic
intercourse -Urecholine(Bethanecol Chloride)
Medications for UTI: -to treat urinary retention and neurogenic
1.Analgesic bladder
-Pyridium(Phenazopyridine Hydrochloride) -antidote: atrophine So4
-it causes red-orange discoloration of urine 5.Antispasmodic
2.Antiseptics -Ditropan( Oxybutynin)
-Cinobac(Cinoxacin) -Pro-Banthine(Propantheline Bromide)
-Mandelamine(Methenamine) -to treat urinary frequency
-Hiprex(Methenamine Hippurate) -Do not administer these medications among
-Negram(Nalidixic Acid) clients with glaucoma. These meds are anticholinergic
-Furadantin, and they dilate pupils and obstruct aqueous humor
Macrodantin,Macrobid(Nitrofurantoin) outflow.
-Nitrofurantoin causes brown urine-this is 3. URINARY CALCULI(URINARY STONES)
harmless -urinary stones causes obstruction of urine flow
-Mandelamine(Methanamine)-requires acidic Most common cause: UTI that leads to urinary
urine with ph of 5.5 to be effective, should not be stasis
combined with sulfonamides- to prevent crystalluria. Other Risk Factors:
3.Fluoroquinolones 1.Metabolic Abnormalities-result in increased urine
-Cipro(Ciprofloxacin) levels of calcium, oxaluric acid, uric acid or citric
-Penetrex(Enoxacin) acid.
-Tequin(Gatifloxacin) 2.Climate- warm climate that increase fluid loss
-Levaquin(Levofloxacin) 3.Diet-large intake of proteins that increase uric
-Maxaquin(Lomefloxacin) acid, calcium.
-Avelox(Moxifloxacin) 4.Genetic Factors
-Noroxin(Norfloxacin) 5.Lifestyle
-Floxin(Ofloxacin) Clinical Manifestations:
-Zagam(Sparfloxacin)
 -Colicky pain(pain from lumbar area and Risk factors:
radiates to the lower abdomen) -cigarette smoking
-Nausea/Vomiting, diarrhea or constipation -chronic cystitis
-Hematuria, dysuria, frequency -large phenacetin intake( a chemical component
-Fever, chills of an analgesisc)
Types of Urinary Calculi: -Bladder calculi
1.Alkaline Stones -Pelvic radiation
-Calcium Oxalate stones -Use of cyclophosphamide
-Calcium Phosphate stones -Schistosomiasis
- Struvite or Staghorn stone Clinical Manifestations:
2.Acidic Stones -Painelss hematuria( most characteristic)
-Uric acid stones -dysuria, gross hematuria
-Cystine stones -obstruction to urine flow
Management -development of fistula between the bladder and
-increase fluid intake(3l/day)-to help pass the stone uterus or between the bladder and colon(urine is
-strain all urine-if a stone is passed, submit to expelled from the vagina or fecal material is
laboratory. excreted in the urine)
-Adjust urine ph Management:
*For Calcium Stones (Alkaline) 1.Surgery: Urinary Diversion
-limit dairy products *Ileal Conduit-after removal of the bladder ,
-acid ash diet (cranberry juice, prune juice, ureters are implanted into a segment of the ileum with
meat, eggs, poultry,tomatoes, grapes, whole grains, the formation of the abdominal stoma.There is
corns) contnous outflow of urine from the stoma.The client
*For oxalate stones(alkaline) needs to wear urinary appliance to collect the urine.
-avoid excess tea, chocolate, spinach, broccoli, *Koch pouch a.k.a Continent Ileal Urinary
almonds, cashew, beans Reservoir – a pouch is created from a segment of the
*For acidic stones ileum. The ureters are implanted into the side of the
-alkaline ash diet (vegetables, milk, fruits except pouch. The nipple valves(inlet and outlet) close as the
cranberries, plums and prunes, small amount of beef, pouch is filled with urine.The client inserts straight
halibut, veal, salmon) catheter into the pouch every 4-6 hours to empty the
*For uric acid stones pouch.
-avoid purine rich foods *Indiana Pouch-is a continent reservoir created
-encourage ambulation from the ascending colon and terminal ileum, making a
-relieve pain pouch larger than the Koch pouch.The client inserts
-Allopurinol for uric acid straight catheter into the pouch every 4-6 hours to
-Surgery(nephrolithotomy, pyelolithotomy, empty the pouch.
uretero-lithotomy) *Ureterostomy-the ureters are attached to the
-ESWL(Extracoporeal Shock Wave Lithotripsy)-crushing surface of the abdomen , where the urine flows directly
of stone with the use of high frequency or ultrasonic into a drainage appliance
waves while the body is half immersed in water. There *Percutaneous nephrostomy-it involves
is no incision. insertion of a nephrostomy tube into the kidney for
-take 3-4L/day of fluid for a month to flushed drainage. This procedure is done when the cancer is
the crushed stone after ESWL. inoperable to prevent obstruction of urine flow from
-Percutaneous Lithotripsy-a guide is inserted under kidneys.
fluoroscopy near the area of the stone. Ultrasonic *Vesicostomy-the bladder is sutured to the
waves break stones into fragments. A nephrostomy abdomen and a stoma is created in the bladder wall.
tube will be in place. 2.Chemotherapy

4. BLADDER CANCER
-more common among males
 2.1Intravesicular instillation-the medication is
introduced into a urethral catheter and retained for 2
hours. The clients position is changed every 15-30 mins
-After 2 hours, the clients void in sitting
position. The client will increase fluids to flush the
bladder
-The urine is considered as biohazard ands sent
to the radio isotope laboratory for monitoring.
-Disinfect the toilet with household bleach for 6
hours after the client has voided.
-Chemoagent used: Thiotepa,
Mutamycin(Mitomycin),Adriamycin(Doxorubicin),Cytox
an(Cyclophosphamide) and Bacille Calmette-Guerin.
2.3 Systemic chemotherapy
-Platinol(cisplastin), Adriamycin
(Doxorubicin), Cytoxan(Cyclophosphamide),
Folex(Methotrexate) and Pyridoxine.
3.Radiation Therapy
-Internal and External
5. Benign Prostatic Hyperplasia(BPH)
-gradual enlargement of the prostate gland with
hypertrophy and hyperplasia of normal tissues.
-the enlargement causes compression of the
urethra and base of the bladder leading to urinary
obstruction.
-if untreated: renal failure
Cause: Unknown
Risk Factors:
-Men over 50 yrs. Of age(Aging process)- the
estrogen levels become higher than androgen level
causing hyperplasia of the prostate.
Clinical Manifestations:
-Nocturia-usual intial manifestations
-Frequency, urgency, hesitancy , UTI, increased
residual urine
Diagnostic:
-rectal examination, cystospoy, ULTZ
Management:
SURGERY-the only successful management for BPH
1.Transurethral Resection of the Prostate(TURP)
-no incision
-the prostatic tissues ae excised through a
resectoscope
-need a CBI(Continous Bladder Irrigation) or
Cystoclysis-done post op to irrigate the bladder and
remove blood clots. This is done through the use of 3-
way foley catheter.it does not cause incontinence or
impotence post op.
2.Suprapubic Prostatectomy
-involves removal of the prostate gland through
abdominal and bladder incison
-client will have cystostomy tube and 2 way
foley catheter-to drain urine adequately and prevent
leakage through the incision.(Whenever bladder
incision is done, cystostomy tube will be in place)
-continuous bladder irrigation is prescribed and
administered to keep the urine pink.
-the surgery does not cause incontinence or
impotence
3.Retropubic Prostatectomy
-is removal of the prostate gland through a
lower abdominal incision. There is no incision into the
bladder .
-continuous bladder irrigation maybe done.
-not cause incontinence and impotence.
4.Perienal Prostatectomy
-removal of the prostate gland through an
incision made between the scrotum and anus.
-the procedure causes incontinence and
sterility.
-avoid inserting rectal tubes, taking rectal
temperature and administering enemas.
Post-OP care for Prostatectomy:
*Care of the Client with CBI (Continuous Bladder
Irrigation or Cystoclysis)
-Maintain patency of drainage( if drainage is
reddish increase the flow rate of CBI)
-Practice asepsis
-Use sterile NSS-to prevent water intoxication
and infection, hypotonic solution like sterile water can
cause water intoxication)
-Monitor U.O
-Monitor hemorrhage
-1st 24 hrs: pink urine is normal
-3 days: amber urine
-Prevent thrombophlebitis-most common
complication of surgery
-Client may feel urge to void or a sensation of
the bladder- due to pressure on the internal sphincter
by the balloon of the catheter.
-Advise client not to strain or void around the
catheter-to prevent bladder spasm
-Relieve pain
-Increase fluid intake-to prevent constipation
and straining thus preventing the risk for bleeding
-Provide Client Teaching to Prevent Bleeding,
Thrombophlebitis, and Infection Post OP:
1.Urianry retention and dribbling of urine may occur -Characterized by cystic formation and hypertrophy
after removal of the catheter. of the kidneys.
2.Notify the client about U.retention -may lead to:
3.If dribbling of urine occurs-teach the client Kegels *cystic rupture
exercise to regain control of voiding. *Infection
4.Avoid the following activities for 3 wks after discharge: *Scar tissue formation
-vigorous exercise *damaged nephrons
-heavy lifting -it is characterized by sodium wasting and
-sexual intercourse hyperkalemia. It eventually lead to RENAL FAILURE.
5.Avoid the following for 32 weeks after discharge:
-straining with defecation
-prolonged sitting or standing
-crossing the legs
Management:
1.Hormone Therapy
-Lupron(Leuprolide acetate)
-Eulexin (Flutamide)
-DES(Diethylstilbesterol-an estrogen
preparation)
2.Surgery(Prostatectomy)
3.Chemotherapy and Radiation Therapy
6. TOXIC SHOCK SYNDROME
Cause : Staphylococcus Aureus
-proliferation of S.aureus in Blood Soaked
Packings( Tampons, nasal packs,vaginal packs)
Clinical Manifestations:
-High fever
-diarrhea
-hypotension
-acidosis
-vomiting
-red, macular rash
-petechiae
-bleeding at IV sites
-shock lung
Management:
1.Care of client with Shock
2.Patient teaching
-use sanitary napkins at nights instead of
tampon
-change tampon regularly and insert carefully to
avoid abrasions
-practice good handwashing
-do not use tampons until TSS bacteria is no
longer present in vaginal flora
7. POLYCYSTIC KIDNEY DISEASE(PKD)
-Iinherited disorder causing your kidneys to enlarge
and lose function over time.