Nursing 4 Lecture 4 Hydronephrosis

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  1. Obstructive Disorder:
    • -Problems of urine outflow obstruction
    • -Damage can occur as early as 48 hours in some and after several weeks in others, depending on the patients underlying kidney health
    • -Blood vessels and renal tubules can be damaged extensively
  2. Assessment
    • -Obtain a good hx
    • -Inspect each flank to identify assymmetry
    • -Gently palpate the abdomen to locate areas of tenderness
    • -Palpate the bladder to asses distension (or use bladder scanner)
    • -Gentle pressure on the bladder may cause urine leakage indicating an obstruction
    • -UA may show baceteria or WBC if infection is present

    -Blood creatinine and BUN increase w/ decreased GFR
  3. Interventions: Urologic
    • -If stone is causing the problem the obstruction the stone can be located and removed using a cystoscope
    • -A stent may also need to be placed to increase urine flow in the area irritated by the stone- it will be removed a few weeks later by another cystoscopic procedure
  4. Interventions: Radiologic
    • -When hydronephrosis cannot be corrected by urologic procedures a nephrostomy is performed
    • -This procedure diverts urine externally and prevents further damage to the kidney

    • Pre-op:
    • -If possible keep the pt NPO for 4 to 6 hours before the procedure
    • -INR, PT, and PTT should be normal or correctied
    • -Pt receives moderate sedation for the procedure

    • Procedure:
    • -Prone position
    • -A needle is placed into the kidne, a soft tipped guidewire is placed through tht needle, and then a catheter is placed over the wire
    • -The catheter tip remains in the renal pelvis and the external end is connected to a drainage bag
    • -The procedure immediatley relieves pressure in the kidney system and prevents further damage
    • -The nephrostomy tube remains in place until the obstruction is resolved

    • Follow-Up Care:
    • -Assess the amount of drainage in the collection bag
    • -The amount of drainage depends on if a ureteral catheter is also being used
    • -If the amount of drainage decreases and the patiend has back pain, the tube may be clogged or dislodged *Notify the physician ASAP
    • -Monitor the nephrostomy site for leaking urine or blood *if either occurs notify the physician ASAP
    • -Urine drainage may be red-tinged the first 12 to 24 hours and should gradually clear
    • -Assess the pt for manifestations of infection, including fever or change in urine character
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Nursing 4 Lecture 4 Hydronephrosis
2012-02-03 06:46:03

Nursing 4 Lecture 4 Hydronephrosis
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