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Urinary Tract Surgery Nursing Care
Urinary Tract Surgery Nursing Care
Urinary Tract Surgery Nursing Care
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Renal and Urinary Systems
• Function to maintain the body’s state of
homeostasis by regulating fluid and electrolytes,
removing wastes, and providing hormones involved
in red blood cell production, bone metabolism, and
control of blood pressure.
• Structures:
– Kidneys
– Ureters
– Bladder
– Urethra
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Kidneys, Ureters, and Bladder
Internal Structure of the Kidney
Nephron
Functions of the kidneys
1. Urine formation
2. Excretion of water products
3. Regulation of electrolytes
4. Regulation of acid-base balance
5. Regulation of water balance
6. Control of blood pressure
7. Renal clearance ( the ability of the kidneys to clear solutes from the plasma
8. Regulation of red blood cell production
9. Synthesis of vit.D to active form
10. Secretion of prostaglandins (PGE2) ( vasodilatation effect and maintaining
renal flow
Formation of urine
• Glomerular filtration
• Tubular reabsorption
• Tubular secretion
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Formation of urine
Terms Commonly Used to Describe Urinary
Dysfunction-1
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Physical examination
What is the normal daily urine output?
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Characteristics of urine: Color
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Characteristics of urine; Odor
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Characteristics of Urine; Turbidity
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Characteristics of Urine; pH
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Renal function tests; BUN
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Renal function tests; Creatinine clearance
• A creatinine clearance test measures the rate at which the
kidneys clear creatinine from the blood.
• Prevent complications.
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Cystoscopy
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IVP
Retrograde Pyelogram
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Renal Ultrasound
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Renal Biopsy
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Post Biopsy Patient assessment and nursing
care-1
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Surgical Terms-2
Parts of the urinary system may
be surgically removed
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Surgical Terms-3
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Total incontinence
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Stress incontinence
• Treatment: Catheterization
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Functional incontinence
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Surgical management of incontinence
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Nursing Management
• h fluids
• No diuretics after 4PM
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Ileal Conduit-1
• Disadvantages: surgical
procedure is complex. Must
wear an external collecting
device. Must care for stoma
and drainage bag. 64
Cutaneous ureterostomy
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Nephrostomy-1
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Nephrostomy
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Nursing Management-1
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Nursing Management-2
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Indications of TURP
• Obstructive uropathy related to benign prostatic
hypertrophy
• Acute urinary retention related to prostatic hypertrophy
• Recurrent urinary infections or febrile urinary infection
related to benign prostatic hypertrophy
• Recurrent bleeding from the prostate
• Bladder stones with prostate enlargement
• Increased pressure on the ureters and kidneys
(hydronephrosis) from urinary retention
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Complications
• TURP Syndrome
• Incontinence
• Retrograde ejaculation
• Thrombophlebitis
• Excessive bleeding
• Infection
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Preoperative nursing care
• Preoperative assessment
• Proper explanation of surgical procedure
• Proper explanation of the complications and risks
• Ensure that informed consent has been signed
• Notify physician for allergies
• Notify physician of all medications taken
• Notify for history of bleeding disorders
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Postoperative nursing care
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Indication of kydney transplantation
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Benefits
• Significantly reduced risk of mortality.
• Life expectancy can triple.
• Reduced risk of heart attack, stroke, heart
failure.
• Reduced infection-related hospitalization.
• Improved quality of life.
• More likely to stay employed.
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Risks
• Acute rejection or failure (less with current meds).
• Anti-rejection medication effects:
-Infection.
• Some malignancies, ex/skin cancer.
• Increased risk of diabetes, high blood pressure,
high cholesterol.
• Graft loss over time.
• Overall in eligible candidates, the benefits far
outweigh the risks.
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Classification
• Living donor
1. Genetically related
2. Non-related
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Living donors
• Evaluate donors on physical, medical and
psychological grounds.
• Assure the patient that there will be no long term
harm to donor.
• In some cases male living donor may develop a
hydrocele on the scrotum on the side of
nephrectomy.
• Live donor procedure are mostly laproscopic,hence
less painfull, less scarring and faster recovery.
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Deseased donors
• Brain dead donors.
• DONATION AFTER CARDIAC DEATH.
• BRAIN DEAD OR “ BEATING HEART” donors are
considered dead but the pumping heart
continues to perfuse the other organs.
• DONATION AFTER CARDIAC DEATH are elective
donation of organ by patient himself or the
relatives to withdraw life support as they have
slim chances of survival.
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Compatibility
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Postoperative nursing management
• Assessing the patient for transplant rejection
• Preventing infection
• Monitoring urinary function
• Addressing psychological concerns
• Monitoring and managing potential
complications
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Thank you…
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