urinary obstruction 2 Flashcards
Treat pain, infection and obstruction:
• Analgesia – NSAID then opioids (morphine)
• Tamsulosin – relaxes smooth muscle in ureter -
used to help stone pass
• Antiemetic – for nausea and vomiting
• Antibiotics – treat or prevent infection (may be
given before and after surgery)
• Infection – stone may need to be removed
surgically to control infection
NURSING
MANAGEMENT urinary obstruction
▪ Encourage adequate fluids ▪Pain management ▪ Encourage mobility ▪ Strain urine ▪Most stones 4mm pass
indications for intervention urinary obstruction
▪ Stones to large to pass > 7mm ▪ Stones causing infection ▪ Stones causing obstruction ▪ Causing impaired renal function ▪ Causing persistent pain/nausea ▪ Patients with only one kidney
procedures of urinary obstruction
▪Urethral stent ▪Nephrostomy tube ▪Ureteroscopy ▪ Lithotripsy ▪Open surgery
urethral stent
▪Inserted to relieve symptoms ▪Allows kidney to drain urine ▪Stretches ureter before surgery ▪Inserted after lithotripsy ▪Promotes drainage of fragments
stent complication
▪ Flank pain, spasms ▪Haematuria ▪Urgency and frequency ▪Burning when urinating ▪ Slipped position can cause incontinence ▪ String stents
nephrostomy tubes
▪ Type of catheter used when ureter is blocked completely ▪ Used temporarily to preserve renal function and reduce infection risk ▪ Inserted through small insertion in flank directly into kidney pelvis ▪ Attached to connecting tube to drain the urine
nephrostomy tube management
Catheter should not be kinked, compressed or clamped.
If pain around area or excessive urine drainage - check patency
If flush needed, aseptic technique, gently push no more than 5ml of sterile
saline to prevent overdistention and damage of the kidney.
Complications: infection, bleeding
ureteroscopy
▪ Inserted via cystoscope ▪ Removes stones from renal pelvis and upper urinary tract ▪ Ultrasonic or laser lithotripsy may be used ▪ Break up large stones
laser lithotripsy
▪ Laser beam is used to shatter stone into small pieces ▪ Extracted or passed in urine ▪ Minimally invasive procedure ▪ No other tissues affected ▪ Stone samples can be sent for stone analysis (Lithotripsy, n.d.). ▪ Most common procedure
lithotripsy complication
Haemorrhage Infection Abscess formation Moderate to severe colicky pain Ureteral stent is often placed after procedure This facilitates passage of shattered stone Removed within 2 weeks
extra-corporeal shockwave lthotripsy
ESWL: non-invasive ▪Ultra-sound waves used to shatter stone into small pieces. ▪ Excreted in the urine ▪Only suitable for a small number of patients
percutaneous nephrolithotomy
▪ Used for large stones > 20mm or staghorn ▪ For stones positioned in mid to distal ureter ▪ Scope inserted through small incision in back over kidney ▪ Stones fragmented by ultrasound or laser lithotripsy ▪ Stone fragments extracted
percutaneous nephrolithotomy complications
Haemorrhage Infection Urine extravasation Adjacent tissue and organ injury Nephrostomy tube is often placed after procedure This facilitates passage of shattered stone Removed within 2 week
nursing education urinary obstruction
Dietary and lifestyle
changes
Drink more water Dilutes urine to prevent
stone formation
