Fluroscopic films are taken, patient pees then another film to look for residual. Can detect abnormailities of the lower urinary tract , uretheral stenosis, bladder neck obstruction, prostatic enlargement
Checking for reflex
inspects interior of bladder with tubular lighted scope
complications include urinary retention, urinary tract hemmorrage, bladder infect. and perforation of the bladder
Inoffice steril procedure, monitor urine output and will have some blood tinged urine for 24 hour peird, orthostatic hypotention is normal so risk of falls
Invasive, informed consent, no dye
Loop of henley decreases what electroylte
If someone has diabetes or hypertention, what does that mean for the kidneys?
Not getting adequate blood supply, will have deterioration
Normal PH of the urine
3 or \4
What is the one symptom that diferentiates interstital cystitis from uti?
pain relieved by urination
What antidepressant is used for ic?
Elavil is the most common
What 3 types of medications are instilled for treatment of ic?
DMSO- desensitizes pain receptors
Heperin and hyluronic acid- use linocain before, inhances protective properties.
Make sure they are compliant because they will be in pain
Classic symptom of pyelonephritis
Involves interstitial inflammation, tubular cell necrosis, and possible abscess formation
Ingection is scattered in the kidney
fibrosisi AND SCARE TISSURE DEVELOP
calices thicken and scars develop in interstitial tissure
What would constitute as a positive urinalysis?
Greater that 100,000 colonies of bacteria
What is the usual type of bacteria infecting the kidneys
Gram neg rods, which is endotoxic and can lead to ureasepsis
Symptoms of pyelonephritits
Flank, back, groin pain
Nausea, and vomiting
general malaise, fatigue
burning, urgency, frequency (not always)
Symptoms of pyelonephritits
Inability to conserve sodium
Medical management of pyelonephritis
Asses the cause first
Antibiotics- oral or iv
long term urinary antiseptics
surgical intervention -possible reflux fix
fluid therapy: acute phase- large amount, they can get dehydrated
Diet therapy- stones
used to treat inital or uncomplicated pyelonephritits
e. coli resistance to tmp-smx
sulfer based: MUST make sure they are not allergic! and MUST drink tons of fluids because will crystallized in the blood
three or 4 times a day
long-term use pulmonary fibrosis and neuropaties
Treat uncomplicated uti's
soothes the urintary tract
urine is reddish orange
used to relieve uti symptoms
blue to green urine
If on long term antibiodics what do you need to keep in mind?
What BUN and creatinine
Nursing interventions with pyelonephritis
Assess labs- BUN/Creatinine/Specific gravity/WBC
Compliance with medication- finish antibodics!
Symptoms of BPH
Hesitancy and Intermittency
reduced force and size of stream
post void dribbling
hematuria (may have)
nontender enlargement by digital exam
feeling of bladder fullness
Diagnosics of BPH
Digital rectal exam
psa and acid phosphatase- rule out cancer
flowmetrics via cystoscope-how much blockage
Conservative treatment for BPH
Proscar (shrinks prostate)
Hytrin and Flomax: alpha-adrenergic blockers (constricts prostate, improve urine flow)
Hormonal agents: estogens and androgens
Surgical treatment for BPH
TURP: closed surgical procedure using scope. rotorudder the prostate, huge catheter after procedure (30french) with 30 ml ballon. 2 ports, flush bladder- prevents clots and reduces the bleeding.
Patient will have decrease hematocrit, hemoglobin
MUST Have a CBI (CONTINOUS BLADDER IRRIGATION)
Dr may use traction
If clots will be in severe pain, bright red pee, you need to speed up the irrigation flow.
medication to stop bladder spasms
For paralysed people, massaging the bladder down to help pee
What 3 routes does prostate cancer spread
Through lymph system
Elevated level indicate prostatic pathology-not definative diagnosis of cancer
Marker of tumor volume when cancer exists
Also used to montior treatment
Digitial rectal exam
abnormal prostate finding include hard, nodular, and asmmetric prostate.
Elevated levels of PAP(prostatic acid phosphatase) indicateds what
What test shall be done to definatively diagnose prostate cancer
Bone scan, CT, MRI with endorectal probe and TRUS(transrectal ultrasound)
Signs and Symptoms of prostate cancer
frequent urination, esp. at night
difficult starting urination, or holding back urine
Weak or inturrupted flow of urine
painful or buring urination
difficultiy haveing an erection
blood in urine and semen
frequent pain or stiffness in the lower back, hips, or upper thighs
Watchful waiting when life expectancy is less that 10years
resence of significant co morbid disease
Presense of low-grade, low stage tumor
Most widely used method of ratdiation for prostate cancer
Used to treat cance confined to prostate and or surrounding tissures
side effects can be acute or delayed
Implantation of radioactive seed into the prostate gland
Spares surrounding tissure
placement guided by transrectal ultrasound
best suited for stage Aor B
irritative or obstructive urinary problems are common side effects
What is the primary therapeutic approach to homornal therapy in prostate cancer?
Luteinizing hormone- most common? Side effects?
Lupron most common
hot flashes, gynecomastia, loss of libido, ed
Androgen receptor blocker- Most common? se
Casodex very common
loss of libedo, ed, hot flashes, breast pain, gynecomastia
Chemotherapy- First drug to produce some increased survival rates for prostate cancer, but very expensive. What is also used?
Removal of entire prostate gland, Seminal vesicals, and part of bladder neck are moved?
Surgical technique that destroys cancer cells by freezing the tissure. Initial and second line treatment after ratdiation fails
What should you monitor post op for major surgury of prostate?