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. What would you like to do?
Calcium phosphate ( prelief
- Xray of kidneys ureters and bladder
- bowl prep maybe ordered
- Visualizes urinary tract after iv contrast
- Not for CRF patients because dye is nephrotoxic
- Iodine allergies?
- Bowel prep
- warn them that it will be warm
- seeing if there is a blockage, hydroonephrosis
- Opening of urethra neck
- bladder filled with contrast media
- 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
- IC, Pyelonephritis
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.
- Bacille Clamette-Guerin (BCG)
What should patients avoid with IC
- High potencty vitamins
- caffeine, alcohol. chocolate, juice, cheeses, peppers
- 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
- Fever, chills,
- Flank, back, groin pain
- Tender CVA
- 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
- taken bid
- 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
- Treats pyelonephritis
- 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
- Monitor I&Os
- Temperature management
- Assess labs- BUN/Creatinine/Specific gravity/WBC
- Compliance with medication- finish antibodics!
- FOLLOW UP
- Pain Management
Symptoms of BPH
- Hesitancy and Intermittency
- reduced force and size of stream
- post void dribbling
- hematuria (may have)
- Increase uti
- 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
- Direct extension
- Through lymph system
- Through bloodstream
- Prostate-specific antigen
- 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
- painful ejaculation
- 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?
- Urine output
- bladder patency (irrigation or flushes)
- bladder spasms
What would you like to do?
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