DE ASIS, K.

J BSN 3-B MS

DISEASES OF THE KIDNEY AND URINARY TRACT

Renal Diseases
Acute Kidney Injury
•Acute kidney injury (AK) is the rapid loss of kidney function from renal cell damage.
• Occurs abruptly and can be reversible
•AKI leads to cell hypo-perfusion, cell death, and decompensation of renal function.
•The prognosis depends on the cause and the condition of the client.
•Near-normal or normal kidney function may resume gradually.
3 Major Types of AKI
TYPES DESCRIPTION CAUSATIVE FACTORS
Pre-renal Interference with renal perfusion Hemorrhage, hypovolemia, decreased
cardiac output, decrease renal perfusion
Intra-renal Damage to the renal parenchyma Prolonged pre-renal state, nephrotoxins,
intra tubular, destruction, infections
(glomerulonephritis), renal injury, vascular
lesions, acute pyelonephritis.
Post-renal Obstruction in the urinary anywhere Calculi (stones), prostatic hypertrophic
from tubules to the urethral meatus tumors.

3 Phases of AKI
Oliguric- urinary output less than 0.5ml/kg/h in children: less than 400ml daily in adults.
Diuretic- urinary output more than 400ml.
Recovery- return of glomerular filtration rate (GFR 70% to 80% of normal value).

Glomerular Filtration Rate (GFR)

 A test used to check how well the kidneys are working.
 Specifically, it estimates how much blood passes through the glomeruli each
minute.
 Glomeruli are the tiny filters in the kidneys that filter waste from the blood.
Nursing Assessment
 History of takin nephrotoxic drugs (salicylates, antibiotics, NSAIDs, ACE
inhibitors, ARBs)
 Alterations in urinary output
 Edema, weight gain (ask if waistbands have suddenly become too tight)
 Change in mental status
 Hematuria
 Dry mucous membranes
 Drowsiness, headache, muscle twitching seizures
Diagnostic Findings in Oliguric Phase
 Increased blood urea nitrogen (BUN) and creatinine
 Increased potassium (hyperkalemia)
 Decreased sodium (hyponatremia)
 Decreased pH (acidosis)
 Fluid overload (hypovolemic)

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 High urine specific gravity (>1.020 g/mL)

Diagnostic Findings in The Diuretic Phase
 Decreased fluid volume (hypovolemia)
 Decreased potassium (hypokalemia)
 Further decrease in sodium (hyponatremia)
 Low urine specific gravity (<1.020 g/mL)
Diagnostic laboratory work returning to normal range in recovery phase

Nursing Plans and Interventions

 Monitor intake and output (1&0) accurately: fluid restriction during the
 oliguric phase (600 mL plus previous 24- hr fluid loss)
 Weigh daily: in oliguric phase, client may gain up to 1 Ib/day.
 Document and report any change in fluid volume status.
 Nutritional therapy
 Adequate protein intake (0.6 to 2 g/kg/ day) depending on degree of catabolism
 Potassium restriction and measures to lower potassium (if elevated). Sodium
polystyrene (Kayexalate) may be prescribed if potassium is too elevated.
 Restrict sodium restriction.
 Assess level of consciousness for subtle changes.
 Prevent cross-infection.
 Monitor drug levels and interactions.
Fluid Volume Alterations
 Watch for signs of hyperkalemia: dizziness, weakness, cardiac irregularities,
muscle cramps, diarrhea, and nausea.
 Potassium has a critical safe range (3.5 to 5.0 mEq/L). Out of range (below or
above) affects the heart and any imbalance must be corrected by medications
or dietary modification. Limit high-potassium foods (apricots, bananas, orange
juice, cantaloupe, strawberries, avocados, spinach, fish) and salt substitutes,
which are high in potassium.
 Clients with renal failure retain sodium. With water retention, the sodium
becomes diluted and serum levels may appear near normal. With excessive
water retention, the sodium levels appear decreased (dilution). Limit fluid and
sodium intake in AKI clients.
 Monitor cardiac rate and rhythm (acute cardiac dysrhythmias are usually related
to hyperkalemia).

Chronic Renal Failure

 A slow, progressive, irreversible loss in kidney function, with a GFR less than or
equal to 60 mL per minute for 3 months or longer.
 It occurs in stages (with loss of 75% of functioning nephrons, the client becomes
symptomatic) and eventually results in uremia or ESRD (with loss of 90% to 95%
of functioning nephrons).

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 DE ASIS, K.J BSN 3-B MS

PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD)

Stage Estimated GFR
At risk: normal kidney function More than 90ml/min
Mild CKD 60-89ml/min
Moderate CKD 30-59ml/min
Severe CKD 15-29ml/min
ESRD Less than 15ml/min
Primary cause
 May follow AKI
 Diabetes mellitus and other metabolic disorders
 Hypertension
 Chronic urinary obstruction
 Recurrent infections
 Renal artery occlusion
 Autoimmune disorders
Nursing Assessment: Neurologic Manifestations
 Asterixis
 Ataxia (alteration in gait)
 Inability to concentrate or decreased attention span
 Lethargy and daytime drowsiness
 Myoclonus
 Paresthesias
 Seizures
 Slurred speech
 Tremors, twitching, or jerky movements
 Coma

Nursing Assessment: Cardiovascular Manifestations

 Hypertension  Pericardial effusion
 Heart failure  Pericardial friction rub
 Peripheral edema  Uremic pericarditis
 Cardiomyopathy  Cardiac tamponade

Nursing Assessment: Respiratory Manifestations

 Crackles  Kussmaul's respirations
 Deep sighing, yawning  Pleural effusion
 Depressed cough reflex  Pulmonary edema
 Shortness of breath  Uremic halitosis
 Tachypnea  Uremic pneumonia

Nursing Assessment: Hematologic Manifestations

 Abnormal bleeding and bruising
 Anemia

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 DE ASIS, K.J BSN 3-B MS

Nursing Assessment: Gastrointestinal Manifestations

 Anorexia, nausea, vomiting  Stomatitis
 Changes in taste acuity and  Uremic colitis (diarrhea)
sensation  Uremic fetor
 Constipation  Uremic gastritis (possible
 Diarrhea gastrointestinal)
 Metallic taste in the mouth

Nursing Assessment: Urinary Manifestations

 Polyuria, nocturia (early)  Hematuria
 Proteinuria  Oliguria, anuria (later)
 Diluted, straw-colored
appearance

Nursing Assessment: Integumentary Manifestations

 Decreased skin turgor  Pruritus
 Dry skin  Purpura
 Yellow-gray pallor  Soft tissue calcifications
 Ecchymosis  Uremic frost (late, premorbid)

Nursing Assessment: Musculoskeletal Manifestations

 Bone pain  Pathological fractures
 Muscle weakness and cramping  Renal osteodystrophy

Nursing Assessment: Reproductive Manifestations

 Decreased fertility  Impotence
 Decreased libido  Infrequent or absent menses

Nursing Plans and Interventions

 Monitor serum electrolyte levels.
 Weigh daily
 Monitor strict 180
 Check for jugular vein distention and
 other signs of fluid overload
 Monitor for peripheral edema and
 pulmonary edema.
 Provide low-protein, low-sodium, low-
 potassium, low-phosphate diet.
 Administer phosphate binders with food because client is unable to excrete
phosphates (no magnesium-based antacids).
 Encourage client's protein intake to be of high biologic value (eggs, milk, meat)
because the client is on a low-protein diet.

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 Teach client fluid allowance is 500 to 600 mL greater than the previous day's 24-
hour output.
 Alternate periods of rest with periods of activity.
 Encourage strict adherence to medication regimen; teach client to obtain
healthcare provider's permission before taking any over-the-counter medications.
 Administer prescribed sodium polystyrene sulfonate (Kayexalate) for acute
hyperkalemia.

Observe for complications.

 Anemia (administer antianemic drug, e.g. Erythropoietin)
 Renal osteodystrophy (abnormal calcium metabolism causes bone pathology
 Severe, resistant HTN
 Infection
 Metabolic acidosis
 Living related or cadaver renal transplant
 Monitor for rejection.
 Monitor for infection.
 Teach client to maintain immunosuppressive drug therapy meticulously.

Uremic Syndrome
Systemic clinical and laboratory manifestations of severe and/or end-stage kidney
disease due to accumulation of nitrogenous waste products in the blood caused by the
kidneys' inability to filter out these waste products.
Nursing Assessment
 Oliguria
 Presence of protein, red blood cells, and casts in
 the urine
 Elevated levels of urea, uric acid, potassium, and
 magnesium in the urine
 Hypotension or hypertension
 Alterations in the level of consciousness
 Electrolyte imbalances
 Stomatitis
 Nausea or vomiting
 Diarrhea or constipation

Nursing Plans and Interventions

 Monitor vital signs for hypertension,
 tachycardia, and an irregular heart rate.
 Monitor serum electrolyte levels.
 Monitor intake and output and for oliguria.
 Provide a limited but high-quality protein diet as prescribed
 Provide a limited sodium, nitrogen, potassium, and phosphate diet as prescribed

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 Assist the client to cope with body image disturbances caused by uremic
syndrome.

Hemodialysis
Hemodialysis is an intermittent renal replacement therapy involving the process of
cleansing the client's blood.

5 Reasons of Dialysis
A-acidosis
E-electrolyte imbalances(hyperkalemia)
I-intoxication
O-other causes
U- uremia

Functions of Hemodialysis
 Cleanses the blood of accumulated waste products
 Removes the by products of protein metabolism such as urea, creatinine and uric
acid from the blood.
 Removes excess body fluids
 Corrects electrolyte levels in the body.
Types of Dialysis
Types Description Nursing Implication
Hemodialysis Requires venous access (AV shunt, fistula or Heparinization is required
graft).
Treatment is 3-8 hours in length 3x per weak Requires expensive equipment

Correction of fluid and electrolytes imbalance Rapid shift of fluid & electrolytes may cause
is rapid disequilibrium syndrome

Potential blood loss Potential Hepatitis B and C

Does not result in protein loss Do not take BP or perform venipuncture on

the arm of the AV shunt, fistula or graft

Assess access site for bruit and trill

Peritoneal Surgical placement of abdominal catheter Heparinization is NOT required

Slow process: up to 8-10 hrs for repeated is Fairly expensive

slow

Correction of fluid and electrolyte imbalance Simple to perform. Easy to use at home.
is slow

Does not cause blood loss Dialysate is similar to IV fluid.

Protein is lost in dialysate Potential complications:

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 Bowel or bladder perforation

 Exit site and tunnel infection
 Peritonitis
Air Embolism in A Client Under HD
 Stop the hemodialysis.
 Turn the client on the left side, with the head down (Trendelenburg's position).
 Notify the attending physician for the hospitalized client.
 Administer oxygen.
 Assess vital signs and pulse oximetry.
 Document the event, actions taken, and client’s response.
Kidney transplantation
 A human kidney from a compatible donor is implanted into a recipient.
 Kidney transplantation is performed for irreversible kidney failure
 The recipient must take immunosuppressive medications for life.
Clinical Signs of Transplant Rejection
 Temperature higher than 100° F (37.8° C)
 Pain or tenderness over the grafted kidney
 2- to 3-Ib (0.9 to 1.4 kg) weight gain in 24 hours
 Edema
 Hypertension
 Malaise
 Elevated blood urea nitrogen and serum creatinine levels
 Decreased creatinine clearance
 Elevated white blood cell count
 Rejection indicated by ultrasound or biopsy.
Graft Rejection
Hyper-acute Occurs within 48hrs after the transplant. (removal of rejected kidney)
Acute Occurs within 1 week postoperatively, but can occur any time post-
transplantation. (potentially reversible with increased
immunosuppressive therapy.
Chronic Occurs slowly months to years after transplant. (immunosuppressive
medications and dialysis if necessary)
Urinary Tract Infection (UTI)
Infection or inflammation at any site in the urinary tract.
 Pyelonephritis- kidney  Cystitis- bladder
 Urethritis urethra  Prostatitis- prostate

Normally, the entire urinary tract is sterile. The most common infectious agent is
Escherichia coli. Persons at highest risk for acquiring urinary tract infections (UTls):
 Clients diagnosed with diabetes
 Pregnant women
 Men with prostatic hypertrophy
 Immunosuppressed persons
 Catheterized clients

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 Anyone with urinary retention, either short term or long term

 Older women (bladder prolapse)

Nursing Assessment
 Signs of infection, including fever and chills
 Urinary frequency, urgency, or dysuria
 Hematuria
 Pain at the costovertebral angle / flank pain
 Elevated serum WBCs (>10,000)
 Disorientation or confusion in older adults maybe a sign of UTI.
Diagnosis
 Clean-catch midstream urine collection for culture to identify specific causative
organism
 Intravenous pyelogram (IVP) to determine kidney functioning
 Cystogram to determine bladder functioning
 Cystoscopy to determine bladder and urethra abnormalities.
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Nursing Plans and Interventions

 Administer antibiotics specific to infectious agent.
 Instruct client in the appropriate medication regimen.
 Instruct client to complete full medication regimen.
 Encourage fluid intake of 3000 mL of fluid/day.
 Maintain 1&0.
 Administer mild analgesics (acetaminophen, or aspirin).
 Encourage client to void every 2 to 3 hours to prevent residual urine from
stagnating in bladder.
 Avoid unnecessary catheterization.
 Remove indwelling catheters within 24 to 48 hours of insertion during
hospitalizations.
 Routine perineal hygiene especially with use of bedpan or if fecal incontinence is
present
 Develop and implement a teaching plan.
o Take entire prescription as directed
o Consume oral fluids up to 3 L/ day (water, juices); should not consume
citrus juices.
o Shower rather than bathe as a preventive measure. If bathing is
necessary, never take a bubble or oil bath and avoid feminine hygiene
sprays.
o Cleanse from front to back after toileting (women and girls
o Avoid urinary tract irritants: alcohol, sodas, citrus juices, spices.
o Void immediately after intercourse
o Void every 2 to 3 hours during the day
o Wear cotton undergarments and loose clothing to help decrease perineal
moisture
o Practice good hand-washing technique.
Nephrotic Syndrome: Glomerulonephritis
 Glomerulonephritis refers to a group of kidney disorders characterized by
inflammatory injury in the glomerulus, most of which are caused by an
immunological reaction.
 The disorder results in proliferative and inflammatory changes within the
glomerular structure.
 Destruction, inflammation, and sclerosis of the glomeruli of the kidneys occurs
 Inflammation of the glomeruli results from an antigen-antibody-reaction
produced by an infection elsewhere in the body.
 Loss of kidney function develops.
CAUSES OF GLOMERULONEPHRITIS
 Immunological diseases

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 Autoimmune diseases
 Antecedent group A ß-hemolytic streptococcal infection of the pharynx or skin
 History of pharyngitis or tonsillitis 2 to 3 weeks before symptoms

GLOMERULONEPHRITIS

Types of Glomerulonephritis
Acute- occurs 2 to 3 weeks after a streptococcal infection
Chronic- may occur after the acute phase or slowly over time
Nursing Assessment
 Periorbital and facial edema that is more prominent in the morning
 Anorexia
 Decreased urinary output
 Cloudy, smoky, brown-colored urine (hematuria)
 Pallor, irritability, lethargy
 In an older child: Headaches, abdominal or flank pain, dysuria
 Hypertension
 Proteinuria that produces a persistent excessive foam in the urine
 Azotemia
 Increased blood urea nitrogen and creatinine levels
 Increased anti-streptolysin O (ASO) titer (used to diagnose disorders caused by
streptococcal infections).
Complications of Glomerulonephritis
 Kidney failure
 Hypertensive encephalopathy
 Pulmonary edema
 Heart failure
 Seizures
Nursing plans and intervention
 Monitor vital signs, intake and output, and characteristics of urine.
 Measure daily weights at the same time of day, using the same scale, and
wearing the same clothing.

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 Limit activity; provide safety measures.

 Diet restrictions of sodium depend on the stage and severity of the disease,
especially the extent of the edema: in addition, potassium may be restricted
during periods of oliguria.
 Monitor for complications
 Administer diuretics (if significant edema and fluid overload are present),
antihypertensive (for hypertension), and antibiotics (to a child with evidence of
persistent streptococcal infections) as prescribed.
 Initiate seizure precautions and administer anti-convulsants as prescribed for
seizures associated with hypertensive encephalopathy.
 Instruct parents to report signs of bloody urine, headache or edema.

Nephrotic Syndrome
Is a kidney disorder characterized by massive proteinuria, hypoalbuminemia
(hypoproteinemia) and edema.

Nursing Assessment
 Child gains weight
 Periorbital and facial edema most prominent in the morning
 Leg, ankle, labial, or scrotal edema
 Urine output decreases; urine dark and frothy
 Ascites (fluid in abdominal cavity)
 Blood pressure normal or slightly decreased
 Lethargy, anorexia, and pallor
 Massive proteinuria
 Decreased serum protein (hypo-protein) and elevated serum lipid levels
Classic Manifestation of Nephrotic Syndrome
Massive proteinuria, hypoalbuminemia, hyperlipidemia and edema.
Nursing Interventions
 Monitor vital signs, intake and output, and daily weights.
 Monitor urine for specific gravity and protein
 Monitor for edema.

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 Nutrition: A regular diet without added salt may be prescribed if the child is in
remission; sodium is restricted during periods of massive edema (fluids may also
be restricted).
 Diuretics may be prescribed to reduce edema.
 Corticosteroid therapy is prescribed as soon as the diagnosis has been
determined; monitor the child closely for signs of infection and other adverse
effects of corticosteroids.
 Immunosuppressant therapy may be prescribed to reduce the relapse rate and
induce long-term remission, or, if the child is unresponsive to corticosteroid
therapy immunosuppressant therapy may be administered along with the
corticosteroid
 Plasma expanders such as salt-poor human albumin may be prescribed for a
severely edematous child.
 Instruct parents about testing the urine for protein, medication administration,
side effects of medications, and general care of the child

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 Instruct parents on the signs of infection and the need to avoid contact with
other children who may be infectious.

Urinary Tract Obstruction

Partial or complete blockage of the flow of urine at any point in the urinary system.
Urinary tract obstruction may be caused by:
 Foreign body (calculi)  Strictures
 Tumors  Functional (e.q., neurogenic
bladder)
When urinary tract obstruction occurs, urine is retained above the point of
obstruction.
 Hydrostatic pressure builds, causing dilation of the organs above the obstruction.
 If hydrostatic pressure continues to build, it can lead to renal failure.
CAUSES
 Family history of stone formation
 Diet high in calcium, vitamin D, protein, oxalate, purines, or alkali
 Obstruction and urinary stasis
 Dehydration
 Use of diuretics, which can cause volume depletion
 UTIs and prolonged urinary catheterization
 Immobilization
 Hypercalcemia and hyperparathyroidism
 Elevated uric acid level, such as in gout
Nursing assessment
Pain
 May experience renal colic
 Radiating down the thigh and to the genitalia.
Nursing Assessment
Location of the pain can help to determine the location of the stone.
 Flank pain usually means the stone is in the kidney or upper ureter. If the pain
radiates to the abdomen or scrotum, the stone is likely to be in the ureter or
bladder.
 Excruciating spastic-type pain is called colic.

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 During kidney stone attacks, it is preferable to administer pain medications at

regularly scheduled intervals rather than PRN to prevent spasm and optimize
comfort.
Symptoms of obstruction
 Fever, chills
 Nausea, vomiting, diarrhea
 Abdominal distention
 Change in voiding pattern
 Dysuria, hematuria
 Urgency, frequency, hesitancy, nocturia, dribbling
 Difficulty in starting a stream
 Incontinence
Nursing interventions
 Administer narcotic analgesics to control pain and alpha-adrenergic blockers to
relax smooth muscle in the ureter to facilitate stone passage.
 Apply moist heat to the painful area unless prescribed otherwise.
 Encourage high oral fluid intake to help dislodge the stone.
 Administer intravenous (IV) antibiotics if infection is present.
 Strain all urine!
 Send any stones found when straining to the laboratory for analysis.
 Accurately document 1&00
 Develop and implement a teaching plan to include
 Pursue follow-up care, because stones tend to recur.
 Maintain a high fluid intake of 3 to4L/day.
 Follow prescribed diet (based on composition of stone).
 Avoid long periods of remaining in supine position.
Cystoscopy
 Cystoscopy may be done for stones in the
bladder or lower ureter.
 One or two ureteral catheters are inserted
past the stone.
 The catheters are left in place for 24 hours
to drain the urine trapped proximal to the
stone and to dilate the ureter.
 A continuous chemical irrigation may be
prescribed to dissolve the stone.

Treatment Options for Renal Calculi

Cystoscopy
Pre- procedure interventions:
 Verify that an informed consent was obtained.
 If a biopsy is planned, withhold food and fluids for the time prescribed.

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 If a cystoscopy alone is planned, no special preparation is necessary, and the

procedure may be performed in the doctor's office.
Post-procedure interventions:
 Monitor vital signs.
 Increased fluid intake as prescribed.
 Monitor intake and output and assess urine characteristics.
 Encourage deep-breathing exercises to relieve bladder spasms and administer
analgesics as prescribed.
 Administer sitz or tub baths for back and abdominal pain if prescribed.
 Note that leg cramps are common because of the lithotomy position maintained
during the procedure.
 Inform the client that burning on urination, pink-tinged or tea-colored urine, and
urinary frequency are common after cystoscopy and resolve in a few days.
 Monitor for bright-red urine or clots, and notify AP if a fever occurs; an increase
in WBC count suggests infection.
Extracorporeal shockwave lithotripsy (ESWL)
 A noninvasive mechanical procedure for breaking up stones located in the kidney
or upper ureter so that they can pass spontaneously or be removed by other
methods
 A stent may be placed to facilitate passing stone fragments.
 Fluoroscopy is used to visualize the stone, and ultrasonic waves are delivered to
the area of the stone to disintegrate it.
 The stones are passed in the urine within a few days.
 The client is taught to watch for signs of urinary obstruction, bleeding, or
hematoma formation.
 Instruct the client to increase fluid intake to flush out the stone fragments.

Percutaneous lithotripsy
 An invasive procedure in which
a guide is inserted under
fluoroscopy near the area of the
stone; an ultrasonic wave is
aimed at the stone to break it
into fragments.
 Percutaneous lithotripsy may be
performed via cystoscopy or
nephoscopy (a small flank
incision is needed for nephoscopy)

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 The client might have an indwelling urinary catheter.

 A nephrostomy tube may be placed to administer chemical irrigations to break up
the stone; the nephrostomy tube may remain in place for 1 to 5 days.
 Encourage the client to drink 3000 to 4000mL of fluid per day as prescribed
following the procedure.
 Instruct the client to monitor for complications of infection, hemorrhage, and
extravasation of fluid into the retroperitoneal cavity.
Partial or total nephrectomy
 Performed for extensive kidney damage, renal infection, severe obstruction from
stones or tumors, and prevention of stone recurrence
 Monitor the incision, particularly if a drain is. in place, because it will drain large
amounts of urine.
 Protect the skin from urinary drainage, changing dressings frequently if
necessary; place an ostomy pouch over the drain to protect the skin if urinary
drainage is excessive.
 Monitor the nephrostomy tube, which may be attached to a drainage bag, for a
continuous flow of urine.
 Do not irrigate the nephrostomy or bladder catheters unless specifically
prescribed.
 Encourage fluid intake to ensure a urine output of 2500 to 3000 mL/day or more
as prescribed.
Benign Prostatic Hyperplasia
 Enlargement or hypertrophy of prostate (sometimes called hypertrophy of the
prostate.
 Benign prostatic hyperplasia (BPH) tends to occur in men over 40 years of age.
 Intervention is required when symptoms of obstruction occur.
 There are three treatment approaches: active surveillance (watchful waiting)
drug therapy with 5-alpha-reductase inhibitors such as finasteride (Proscar) and
alpha-adrenergic receptor blockers (tamsulosin), or surgery.
 The most common treatment is transurethral resection of the prostate gland
(TURP). The prostate is removed by endoscopy (no surgical incisions made),
allowing for a shorter hospital stay.
Nursing Assessment
 Increased frequency of voiding, with a decrease
 in amount of each voiding
 Nocturia
 Hesitancy
 Terminal dribbling
 Decrease in size and force of stream
 Acute urinary retention
 Bladder distention
 Recurrent UTI
Nursing interventions

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 Preoperative teaching: include information concerning pain from bladder spasms

that occurs postoperatively.
 Maintain patent urinary drainage system (large three-way indwelling catheter
with a 30-mL balloon) to decrease the spasms.
 Provide pain relief as prescribed: analgesics, narcotics, and antispasmodics (e.g.
Alpha-adrenergic blockers - TeraZ@SIN, doxaZOSIN,, tamsUZOSIN)
 Maintain gentle traction on urinary catheter.
 Check the urinary drainage system for clots.
 Irrigate bladder as prescribed (may be continuous or rarely intermittent).
 The catheter may cause a continuous sensation of bladder fullness. The client
should not try to void around the catheter because bladder spasms may occur.
 Client can request medication to reduce or prevent spasms.
 Observe the color and content of urinary output.
o Normal drainage after prostate surgery is reddish pink, clearing to llight
pink within 24 hours after surgery. Some small to medium-size blood clots
may be present.
o Monitor for bright-red bleeding with targe clots and increased viscosity.
 Monitor vital signs frequently for indication of hemorrhagic or hypovolemic shock
(circulatory collapse).
 Monitor hemoglobin (Hgb) and hematocrit (hct)) for pattern of decreasing values
that indicates bleeding.
 After catheter is removed:
o Monitor amount and number of times client voids.
o Encourage fluids.
o Have the client use urine cups to provide a specimen with each
voiding.
o Observe for hematuria after each voiding (urine should progress to
clear yellow color by the fourth day).
 Inform client that burning on urination and urinary frequency are usually
experienced during the first postoperative week.
 Generally, the client is not impotent after surgery, but sterility may occur.
 Instruct client to report any frank bleeding to physician immediately.
 Monitor for signs of urethral stricture: straining, dysuria, weak urinary stream.
 Administer antispasmodics as ordered.
 Ambulate first pastop day, if possible.
 Instruct client to increase fluid intake to 3000 mL/day.
 Prepare client for discharge with instructions to:
o Continue to drink 12 to 14 glasses of water a day.
o Avoid constipation, straining
o Avoid strenuous activity, lifting, intercourse, and engaging in sports during
the first 3 to 4 weeks after surgery.
o Schedule a follow=up appointment.

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 Instillation of hypertonic or hypotonic solution into a body cavity will cause a shift
in
 cellular fluid.
 Use only sterile saline for bladder irrigation after TURP because the irrigation
must be
 isotonic to prevent fluid and electrolyte imbalance.
 Clients with Foley catheters require perineal care and actual catheter care twice
per day.
 Inform the client before discharge that some bleeding is expected after TURP.
 Large amounts of blood or frank bright bleeding should be reported.
 However, it is normal for the client to pass small amounts of blood, as well as
small clots, during the healing process
 He should rest quietly and continue drinking large amounts of fluid.

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 DE ASIS, K.J BSN 3-B MS

Renal Carcinoma
 Kidney tumors may be benign or malignant, bilateral or unilateral.
 Common sites of metastasis of malignant tumors include bone, lungs, liver,
spleen and the other kidney.
 The exact cause of renal carcinoma is unknown

Nursing Assessment
 Dull flank pain  Painless gross hematuria
 Palpable renal mass
Surgical Management
Radial Nephrectomy
 Surgical removal of the entire kidney, adjacent adrenal gland and renal artery
and vein.
 Radiation therapy and possible chemotherapy may follow radical nephrectomy.
 Before surgery, radiation may be used to e mobilize (occlude) the arteries
supplying the kidney to reduce bleeding during nephrectomy.
Post- operative interventions:
 Monitor Vital signs for signs of bleeding (hypotension’s and tachycardia).
 Monitor for abdominal distention, decreases in urinary output and alterations in
level of consciousness as signs of bleeding Check the bed linens under the client
for bleeding.
 Monitor for any signs of adrenal insufficiency, which include a large urinary
output followed by hypotension and subsequent oliguria.
 Administer fluids and packed red blood cells intravenously as prescribed.
 Monitor intake and output and daily weight.
 Monitor for any urinary output of 30 to 50mL/hr to ensure adequate renal
functions.
 Maintain the client in a semi-Fowler’s position.
 If a nephrostomy tube is in place, do not irrigate (unless specifically prescribed)
or manipulate the tube.

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