Nursing Management: Renal and Urologic Problems Chapter 46 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc

Nursing Management:Nursing Management:

Renal and Urologic Problems Renal and Urologic Problems

Chapter 46 OverviewChapter 46 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Infectious and Inflammatory Infectious and Inflammatory Disorders of Urinary SystemDisorders of Urinary System

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Urinary Tract Infection Urinary Tract Infection

• ClassificationClassification




Fig. 46-1. Sites of infectious processes in the upper and lower urinary tracts.


• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies• Collaborative Care and Drug Collaborative Care and Drug

TherapyTherapy


Nursing Management:Nursing Management:Urinary Tract Infection Urinary Tract Infection

• Nursing Assessment Nursing Assessment • Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing Implementation Nursing Implementation

Health promotion Health promotion Acute intervention Acute intervention Ambulatory and home careAmbulatory and home care

• EvaluationEvaluation


Acute Pyelonephritis Acute Pyelonephritis

• Etiology and PathophysiologyEtiology and Pathophysiology




Fig. 46-2. Acute pyelonephritis. Cortical surface shows grayish white areas of inflammation and abscessformation (arrow).


• Clinical Manifestations and Clinical Manifestations and Diagnostic StudiesDiagnostic Studies

• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy


Nursing Management: Nursing Management: Acute Pyelonephritis Acute Pyelonephritis

• Nursing AssessmentNursing Assessment• Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing ImplementationNursing Implementation

Health promotion Health promotion Acute intervention and home and Acute intervention and home and

ambulatory careambulatory care• EvaluationEvaluation


Chronic Pyelonephritis Chronic Pyelonephritis


Urethritis Urethritis


Urethral Diverticula Urethral Diverticula


Interstitial Cystitis/Painful Interstitial Cystitis/Painful Bladder Syndrome Bladder Syndrome

• Collaborative Care and Drug Collaborative Care and Drug TherapyTherapy


Nursing Management: Nursing Management: Interstitial Cystitis/Painful Bladder Syndrome Interstitial Cystitis/Painful Bladder Syndrome


Renal Tuberculosis Renal Tuberculosis


Immunologic Disorders of Immunologic Disorders of KidneyKidney


Glomerulonephritis Glomerulonephritis

• Etiology and PathophysiologyEtiology and Pathophysiology• Clinical ManifestationsClinical Manifestations


Acute Poststreptococcal Acute Poststreptococcal Glomerulonephritis Glomerulonephritis

• Clinical Manifestations and Clinical Manifestations and ComplicationsComplications

• Diagnostic StudiesDiagnostic Studies


Nursing and Collaborative Management: Nursing and Collaborative Management: Acute Poststreptococcal GlomerulonephritisAcute Poststreptococcal Glomerulonephritis


Goodpasture Syndrome Goodpasture Syndrome


Nursing and Collaborative Management: Nursing and Collaborative Management:

Goodpasture Syndrome Goodpasture Syndrome


Rapidly Progressive Rapidly Progressive Glomerulonephritis Glomerulonephritis


Chronic Glomerulonephritis Chronic Glomerulonephritis


Nephrotic Syndrome Nephrotic Syndrome

• Etiology and Clinical ManifestationsEtiology and Clinical Manifestations



Nephrotic Syndrome Nephrotic Syndrome


Obstructive Uropathies Obstructive Uropathies


Fig. 46-3. Sites and causes of upper and lower urinary tract obstruction.

Obstructive Uropathies Obstructive Uropathies


Fig. 46-4. Hydronephrosis of the kidney. Note the marked dilation of the pelvis and calycesand thinning of the renal parenchyma.

Urinary Tract Calculi Urinary Tract Calculi

• Etiology and PathophysiologyEtiology and Pathophysiology




Fig. 46-5. A, Renal staghorn calculus. The renal pelvis is filled with a large calculus that is shaped to itscontours, resembling the horns of a stag (S). B, Imbedded staghorn calculus (yellow arrow) inhydronephrotic, infected, nonfunctioning kidney.


• TypesTypes• Clinical ManifestationsClinical Manifestations• Diagnostic StudiesDiagnostic Studies



• Collaborative CareCollaborative Care Endourologic proceduresEndourologic procedures




Fig. 46-6. A, Calcium oxalate stones. B, Plain abdominal x-ray showing large bladder calculus.


• Collaborative Care, continued Collaborative Care, continued LithotripsyLithotripsy Surgical therapySurgical therapy Nutritional therapyNutritional therapy


Nursing Management:Nursing Management:Urinary Tract Calculi Urinary Tract Calculi

• Nursing AssessmentNursing Assessment• Nursing DiagnosesNursing Diagnoses• PlanningPlanning• Nursing ImplementationNursing Implementation• EvaluationEvaluation


Strictures Strictures

• Ureteral StricturesUreteral Strictures• Urethral StrictureUrethral Stricture


Renal Trauma Renal Trauma


Renal Vascular Problems Renal Vascular Problems


Nephrosclerosis Nephrosclerosis


Renal Artery Stenosis Renal Artery Stenosis


Renal Vein Thrombosis Renal Vein Thrombosis


Hereditary Renal Diseases Hereditary Renal Diseases


Polycystic Kidney Disease Polycystic Kidney Disease


Fig. 46-7. A, Comparison of polycystic kidney with normal kidney. B, Cysts in the liver.

Nursing and Collaborative Management:Nursing and Collaborative Management:

Polycystic Kidney DiseasePolycystic Kidney Disease


Medullary Cystic Disease Medullary Cystic Disease


Alport Syndrome Alport Syndrome


Renal Involvement in Metabolic Renal Involvement in Metabolic and Connective Tissue Diseasesand Connective Tissue Diseases


Urinary Tract TumorsUrinary Tract Tumors


Kidney CancerKidney Cancer


Fig. 46-8. Cross section of kidney with renal cell carcinoma. The carcinoma (blue arrow) is on the pole ofthe kidney. Note that the renal vein is involved and thrombosed (yellow arrow).







Table 46-15. Robson's System of Staging Renal Carcinoma.

Bladder CancerBladder Cancer


Fig. 46-9. A, Papillary transitional cell carcinoma (T) seen arising from the dome of the bladder as acauliflower-like lesion (blue arrow). B, Opened bladder showing a bladder cancer at an advanced stage.Yellow areas represent ulcerations and necrosis (yellow arrow).




Nursing and Collaborative Management:Nursing and Collaborative Management:


• Surgical TherapySurgical Therapy• Radiation Therapy and Radiation Therapy and

ChemotherapyChemotherapy• Intravesical TherapyIntravesical Therapy


Urinary Incontinence and Urinary Incontinence and Retention Retention

• Diagnostic StudiesDiagnostic Studies• Collaborative Care: Urinary Collaborative Care: Urinary

IncontinenceIncontinence Drug TherapyDrug Therapy Surgical TherapySurgical Therapy


Nursing Management: Nursing Management: Urinary Incontinence Urinary Incontinence

• Collaborative Care: Urinary Collaborative Care: Urinary RetentionRetention Drug therapyDrug therapy Surgical therapySurgical therapy


Nursing Management: Nursing Management: Urinary Retention Urinary Retention


Instrumentation Instrumentation


Fig. 46-10. Types of urinary catheters. A, Simple urethral catheter. B, Mushroom-tip de Pezzer catheter (canbe for suprapubic catheterization). C, Wing-tip Malecot catheter. D, Indwelling urethral catheter with inflatedballoon. E, Indwelling Tiemann catheter with coudé tip–inflated balloon. F, Three-way indwelling catheter(third lumen can be used for irrigation).

Instrumentation Instrumentation

• Urethral CatheterizationUrethral Catheterization• Ureteral CathetersUreteral Catheters• Suprapubic CathetersSuprapubic Catheters• Nephrostomy TubesNephrostomy Tubes• Intermittent CatheterizationIntermittent Catheterization


Surgery of the Urinary TractSurgery of the Urinary Tract


Renal and Ureteral Surgery Renal and Ureteral Surgery

• Preoperative ManagementPreoperative Management• Postoperative ManagementPostoperative Management

Urine outputUrine output Respiratory statusRespiratory status Abdominal distentionAbdominal distention

• Laparoscopic NephrectomyLaparoscopic Nephrectomy


Urinary Diversion Urinary Diversion


Fig. 46-11. Methods of urinary diversion. A, Ureteroileosigmoidostomy. B, Ileal loop (ileal conduit).C, Ureterostomy (transcutaneous ureterostomy and bilateral cutaneous ureterostomies). D, Nephrostomy.


• Incontinent Urinary DiversionIncontinent Urinary Diversion




Fig. 46-12. Urinary stoma. Symmetric, no skin breakdown, protrudes about 1.5 cm; mucosa is healthy red. This configuration is flat when the patient is upright or supine.


• Continent Urinary DiversionsContinent Urinary Diversions




Fig. 46-13. Creation of a Kock pouch with implantation of ureters into one intussuscepted portion of the pouch and creation of a stoma with the other intussuscepted portion.


• Orthotopic Bladder ReconstructionOrthotopic Bladder Reconstruction


Nursing Management: Nursing Management: Urinary Diversion Urinary Diversion

• Preoperative ManagementPreoperative Management• Postoperative ManagementPostoperative Management




Fig. 46-14. Ammonia salt encrustation secondary to alkaline urine.



Fig. 46-15. Retracted urinary stoma with pressure sore from faceplate above stoma (arrow).

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Nursing Management: Renal and Urologic Problems Chapter 46 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc