Exam 3 Flashcards
1
Q
Pyelonephritis
A
Can be acute or chronic inflammation/infection of the renal pelvis
2
Q
Acute Pyelonephritis s/s
A
chills
fever
leukocytosis
bacteriuria
pyuria
low back pain
flank pain
NV
HA
malaise
painful urination
3
Q
Chronic Pyelonephritis s/s
A
Usually NO symptoms of infection unless an acute exacerbation occurs
Noticeable signs may include fatigue, HA, poor appetite, polyuria, excessive thirst and weght loss
4
Q
When is chronic pyelonephritis diagnosed
A
often incidentally when being evaluated for HTN
5
Q
What to look for on assessment for chronic pyelonephritis
A
poor urine concentrating ability
pyuria
azotemia
proteinuria
anemia
acidosis
6
Q
Azotemia
A
nitrogenous waste in urine
7
Q
When do we usually see s/s of pyelonephritis
A
usually only in acute exacerbations not so much chronic
8
Q
How is the extent of chronic pyelonephritis checked
A
usually by IV urogram and lab work (lab work includes creatinine clearance, BUN,, and creatinine levels)
9
Q
What is an important vital to check whenver a kidney issue is expected
A
Blood pressure - it is an important function of the kidneys
10
Q
Common Nursing Dx for pyelnoephritis
A
1 PAIN
Infection
Alterations in voiding patterns
Knowledge deficits r/t lack of understanding of tests and procedures
11
Q
Goals with Pyelonephritis
A
Pain reduction
Medication compliance
proper hygiene
12
Q
Patient education on pyelonephritis is focused on ___.
A
prevention
13
Q
Interventions for Pyelonephritis
A
Monitor VS, I&O, and Weight
Encourage fluids up to 3000 mL a day
Encourage adequate rest
Instruct on high calorie low protein diet
warm moist compresses to flank area
encourage warm baths (this one can cause infection though)
administer antibiotics analgesics antipyretics urinary antseptics and antiemetics as prescribed
monitor for signs of renal failure
education
14
Q
How much fluid should be given a day to dilute urine in pyelonephritis
A
3-4 L / 3000mL-4000mL
15
Q
What is an important sign of concerning I&O changes
A
increases or decreases in weight
16
Q
Education topics for pyelonephritis
A
prevent further infection by adequate fluid consumption and regular bladder emptying, perineal hygiene and taking meds as prescribed
keep follow up appointments
17
Q
Chronic Kidney Disease
A
Umbrella term to describe kidney damage or a decrease in the glomerular filtration rate for 3+ months
18
Q
Untreated CKD can result in…
A
ESRD and a need for kidney transplant or dialysis
19
Q
Risk Factors for CKD
A
Primary Cause: Diabetes
HTN
CV Disease
Obesity
20
Q
What is different between Acute Kidney Injury and CKD
A
Acute Kidney injury is one time and reversible if you ID and treat promptly before it damages the function of the kidneys
CKD is 3+ months of this and the kidneys may progress to CRF
21
Q
Stages of Chronic Renal Failure (CRF)
A
Stage 1: Slight Damage
- Mild Decrease in Fxn
- Moderate Decrease
- Severe Decrease
- ESRD
22
Q
What is the double sided issues with the gerontologic risk factors for renal disease
A
while they increase CKD incidence they also mask th s/s of it and make it harder to diagnose
23
Q
Why do diuretics need to be monitored carefully when given to elderly
A
We need to assess for dehydration that can further compromise renal function and contribute further to renal failure
24
Q
Conservative Gerontological management of CKD includes
A
nutritional therapy
fluid control
phosphate binders
25
Why are blood transfusions administered during dialysis
so excess K+ can be removed
26
When is peritoneal dialysis appropriate
for patients who cannot tolerate hemodialysis or have severe HTN, HF, and pulmonary edema that does not respond to hemodialysis
may be tx of choice for those unwilling or unable to go to hemodialysis
27
Peritoneal Dialysis Procedure
sterile dialysate is introduced into the peritoneal cavity through an abdominal catheter at intervals
waste products move from an area of higher concentration (blood) to an area of lower concentration (dialysate) through a semi permeable membrane (peritoneum)
28
How much longer is peritoneal dialysis
pretty continuous - does what hemodialysis does in 6-8 hours over 36-48 hours
29
Types of Peritoneal Dialysis
Acute Intermittent Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis
Continuous Cyclic Peritoneal Dialysis
30
Acute Intermittent Peritoneal Dialysis
A nurse warms, spikes, and hangs each container of dialysate
Requires strict asepsis
If dialysate does not drain right, nurse will facilitate draining by turning patient from side to side or raising the head of the bed - NEVER push the catheter further into the peritoneal cavity
31
Common routine for acute intermittent peritoneal dialysis
hourly exchanges that involve 10 minute infusion, 30 minute dwell time and 20 minute drain time
32
Impotant assessments to be done with acute intermittent peritoneal dialysis
I&O
VS
Weight
Patient status
Skin turgor and mucous membranes to evaluate fluid status
presence of edema check
33
Continuous Ambulatory Dialysis (CAP)
2nd most common form
performed at home 4-5 times a day every day
Longer dwell time --> better results
managed by the patient or a trained caregiver
34
Continuous Cyclic Peritoneal Dialysis
uses a cycler machine and combines overnight intermitted PD with a prolonged dwell time during the day
lower infection rates since fewer bag changes and tubing disconnections occur
greater freedom to work
May need home visits by nurse or f/u calls or visits to outpatient settings to make sure dialysate is ok and BP is monitored carefully
35
Renal Calculi Cause what pain
RENAL COLIC - originating in lumbar region radiating around the side and down toward the testicle in mean and to the bladder in women
36
Ureteral Calculi cause what pain
UTERAL COLIC radiates toward the genitalia and thigh
37
s/s of Urinary Stone Disease
renal or ureteral colic
sharp severe sudden onset pain
dull aching kidneys
NV, pallor, diaphoresis during acute pain
urinary frequency with alternating retention
38
Signs of a UTI during Urinary Stone Disease
low grade fever
RBCs and WBCs and Bacteria in Urinalysis
Hematuria
39
Nursing Dx for Urinary Stone Disease
Pain - #1 until cause is eliminated
Risk for INfection
risk for inadequate renal function
Nutrition, risk for...
Patient specific dx
40
Nursing Goals with Urinary Stone Disease
relieve pain of renal colic
eradicate stone
determine stone type
prevent nephron destruction
control infection
relieve obstruction
41
Nursing interventions for Urinary Stone Disease
Monitor VS, I&O
Assess fever, chills, infection and Monitor for NVD
Force fluids to facilitate stone passage and prevent infection
Strain all urine and send stones for lab analysis
Provide warm baths and heat to flank area
Administer analgesics regularly to relieve pain and assess response to pain meds
Relaxation techniques to assist pain relief
Diet education based on stone composition
Maintain urinary pH depending on stone type
Turn and reposition
prep for surgeyr if needed
42
How many fluids sould be forced a day with urinary stones
3000 mL/ 3 L
43
What is the biggest concern with urinary stone disease regarding nursing dx
The pain
it can be so excruciating nothing seems to relieve it
44
If a patient has an Alkalytic Stone/Urine what diet should we discuss with them?
Acid Ash Diet
45
If a patient has an Acidic Stone/Urine what diet should we discuss with them?
Alkaline Ash Diet
46
Acid Ash Diet
Drops pH
Cranberries
Plums
Grapes
Prunes
tomatoes
Eggs
Cheese
Whole Grain
Meat and Poultry
47
Alkaline Ash Diet
Raises pH
Legumes
Milk and Milk Product
Green Vegis
rhubarb
48
Calcium Stones
formed from high levels of calcium so avoid high calcium foods
49
What is the confusing recommendation regarding calcium stones
new research says avoiding calcium can be bad due to low bone density and osteoporosis and may not really change stone results much so its best to have a little calcium in the diet rather than non
50
High Calcium Foods
Milk and other dairy products
beans
lentils
dried fruits
flour
chocolate
cocoa
canned and smoked fish (NOT TUNA)
51
High Oxalate Foods to avoid when you have an oxalate stone
asparagus
beets
celery
cabbage
nuts
tea
fruits
tomatoes
green beans
chocolate
beer
colar
dark green leafy vegis
52
High Purine Foods to avoid when you have a purine stone (uracid stone)
organ meets
sardines
herring
venison
goose
53
What can cause increases in calcium and uric acid and lead to stones that you should discuss with the patient about decreasing
high protein and sodium diets
54
Stones that are how big usually are easier to pass
6 mm or less
55
Why is forcing fluids not going to help with ureteral stones and higher
because there is not enoguh peristalsis occurring for it to pass
56
Nephrostomy
A tube is placed to dilateand allow the stone and urine to come through
57
Urinary Diversion
a surgical procedure that diverst urine from the bladder into an exit site
58
Reasons for Doing a Urinary Diversion
Bladder cancer or other pelvic malignancies
birth defects
strictures
neurogenic bladder
chronic infection/intractable cystitis
59
What is the last resort for incontinence
urinary diversion
60
What are the3 types of urinary diversion
Indiana Pouch
Kock Pouch
Ureterosigmoidostomy
61
Nephrotic Syndrome
glomerular disease characterized by proteinuria, hypoalbuminemia, diffuse edema, high serum cholesterol, hyperlipidemia
basically any condition that seriously damages the glomerular membrane and increases the permeability to plasma proteins
62
Etiology of Nephrotic Syndrome
any renal condition that damages glomerular capillary membrane
salt and water retention contribute to edema
thromboemboli are common
prognosis is poor (<50% experience complete remission adn at least 30% develop ESRF)
63
Assessment for Nephrotic Syndrome
severe generalized edema - results in edema which is usually dependent edema (hands, feet, and sacrum)
symptoms of renal failure
loss of appetite and fatigue
may also see ascites
64
Potential Causes for Nephrotic Syndrome
Glomerular Nephritis
Diabetes
Lupus
Multiple Myeloma
Renal Vein Thrombosis
65
Therapeutic Management for Nephrotic Syndrome
Non specific but therapeutic management for RF, edema, etc
Med management and diet therapy
66
What is unique about nephrotic syndrome compared to other renal issues
because of the increase plasma protein permeability with this specific sydrome you have to talk to them about INCREASING PROTEINS IN THE DIET
67
Nursing Dx for Nephrotic Syndrome
Fluid overload
Fatigue
Insufficent Ability to Perform Usual Roles
68
Planning and Interventions for Nephrotic Syndrome
control edema
high protein diet
administer drug therapy as prescribed
bedrest
monitor laboratory and diagnostic tests
observe for s/s of pulmonary edema
I/O and weight
fluid restriction
immune system depression increase risk of infection
69
Client Education Topics for Nephrotic Syndrome
efforts to maintain general health
avoid infection
nutritious diet
medications
knowledge of renal function
70
Potential Complications due to Nephrotic Syndrome
Infection - deficient immune response
Thromboembolism - in renal vein
Could cause acute renal failure (d/t hypovolemia associated with nephrotic syndrome)
71
Structures of the Renal System
Kidneys and Nephrons x2
Ureters x2
Bladder
Urethra
Male Prostate
72
Nephrons ____
filter
73
Are the left and right kidneys perfectly symmetrical?
No, the left kidney is higher than the right one because of the location of the liver
74
As a risk factor, childhood diseases can lead to what possible renal/urologic disorder
chronic kidney disease
75
As a risk factor, advanced age can lead to what possible renal/urologic disorder
incomplete bladder emptying, etc
76
As a risk factor, cystoscopy or catheterization can lead to what possible renal/urologic disorder
UTI or incontinence
77
As a risk factor, immobilization can lead to what possible renal/kidney disorder
kidney stone formation
78
As a risk factor, diabetes can lead to what possible renal/urologic disorder
Chronic Kidney Disease (CKD)
Neurogenic Bladder
79
As a risk factor, HTN can lead to what possible renal/urologic disorder
renal insufficiency
CRF
80
As a risk factor, multiple sclerosis can lead to what renal/urologic disorder
incontinence
neruogenic bladder
81
As a risk factor, Parkinsons Disease can lead to what renal/urologic disorder
incontinence
82
As a risk factor, Gout, Chrohns, and Hyperparathyroidism can lead to what renal/urologic disorder
Kidney stones
83
As a risk factor, BPH can lead to what renal/urologic disorder
obstruction
84
What information should be taken upon reanl/urologic assessment in the health history
Chief Complaint
Pain (Reason, pattern, intensity, what makes it worse or better etc)
Past health history (hx of UTi, tests, renal angiograms, caths, STDs, etc)
Family Hx
Social Hx (Habits and behaviors)
Voiding Patterns (when is normal, how much, smell, at night a lot?)
Medications (What is taken, what may affect UO/micturation/renal toxicity)
85
What is an important bit of information to teach elderly patients about their renal function
to drink plenty of water everyday even if they are not thirsty as it is good for their renal function
86
When is a lot of renal/urologic issues and diagnoses found
they tend to be found when clients are seeking care for other symptoms like for a cold
87
Urinary Frequency
voiding more than every 3 hours
88
Urinary Urgency
Having a strong desire to void
89
Dysuria
Painful urination
90
Urinary Hesitancy
delay in initiation
91
Nocturia
excessive urination at nightr
92
Incontinence
Involuntary loss of urine
93
Enuresis
Bed wetting
94
Polyuria
increased volume of urine
95
Oliguria
UO less than 500 mL a day
96
Anuria
Less than 50 mL of UO a day
97
When are oliguria and anuria most common
chronic renal failure
98
Hematuria
RBC in urine
99
Proteinuria
Protein in urine (should not be there)
100
The most accurate indicator of fluid loss or gain in patients who are acutely ill is ___
weight
101
Areas of Emphasis for the Renal/Urologic Physical Exam
Abdomen
Suprapubic Region
Genitalia
Lower Back
Lower Extremities
KIDNEYS - Not always palpable
Bladder percussion
Areas of Edema
Checking DTRs and Gait
102
Renal dysfunction may produce tenderness...
at the CVA (can very rarely palpate the kidney here too)
103
Why are DTRs and Gait checked with renal physical exams
Because the peripheral nerve innervating the bladder also innervates the lower extremities
104
It is important to document ____ and ____ of urine
color and amount
105
What are some urinary diagnostic tests commonly seen
Urinalysis and Urine Culture
Renal Fxn Tests: Specific Gravity and 24 hour Urine Test
Serum Tests: Creatinine, BUN, BUN:Creatinine
Biopsy
106
Another name for 24 hour urine test is...
creatinine clearance test
107
What is normal urine specific gravity
1.010 - 1.025
108
Urine C&S is often used for suspected ___
UTIs
109
Normal BUN:Creatinien ratio
10:1
110
What is the process of urine collection/clean catch (midstream)
1. Nurse has pt wash genitals and perineal area prior w/ soap and water
2. Males: Void directly into container; Females - Hold container between legs
3. Begin voiding, then place specimen container in stream of urine and collect 30-60 mL
111
How should males clean their genitals prior to a clean catch
clean the meatus and head of penis with a circular motion
Use each towelette (3 total) once
112
How should females clean their genitals prior to a clean catch
front to back
use each towelette (3 total) once
113
What is the gold standard of urine collection for determining renal fxn
24 hour urine collection
114
How does a 24 hour urine collection work
A special orange speciment container with a preservative is obtained from the lab in order to collect urine (unless the pt has an indwelling catheter)
Signs are posted in the client room, chat, and bathroom regarding all urine needing to be collected in the next 24 hours
Client will void and discard the first urination at the start of the 24 hour period and then begin collecting everything after that
Once 24 hours is up container is put on ice and the client should void one last time to collect that urine before being sent to the lab
115
Urinary Retention
Inadequate bladder emptying disorder
Residual urine stays in the bladder after voiding and can result in overflow incontinence
116
Results of Urinary Retention
Overflow Incontinence
Urinary Stasis --> Bacterial Growth --> Infection/Stones
117
If urinary retention is left untreated what will happen
A UTI will begin or possible stone formation
118
S/Sx of Urinary Retention
Difficulty starting to urinate
Difficulty fully emptying the bladder
Weak dribble/stream of urine
Leaking throughout the day
Inability to feel when the bladder is full
Lack of urge to urinate
Increased abdominal pressure
119
Interventions for Urinary Retention
Privacy
Warm Sitz Bath
Normal Standing or Sitting Position to Void
Faucets and Warm Water
Bedside Commode or Toilet
Analgesia after surgical interventions
Catheterizations
Establish normal voiding and evaluate outcomes
120
Urinary Incontinence
Involuntary loss of urine caused by functional issues, neurogenic issues, etc
121
What are the 5 main types of incontinence
Stress
Urge
Functional
Iatrogenic
Mixed
122
Stress Incontinence
Involuntary loss of urine as a result of sneezing, coughing, laughing, multiple child births
123
Urge Incontinence
Involuntary loss of urine alongside a strong urge to void that cannot be suppressed
Need to void but cannot reach the toilet in time
124
Functional Incontinence
Instances in which lower urinary function is intact but other factors (cognition) make it difficult
125
Iatrogenic Incontinence
Involuntary loss of urine d/t extrinsic factors and medical factors -
*Primarily medications*
126
Mixed Incontinence
Empasses several types of urinary incontinence, is involuntary leakage associated with urgency and also exertion, sneeze, or cough
127
Urinary Tract Infections
Infections of the urinary tract that can be acute, chronic, uncomplicated, complicated, lower or upper
128
Examples of lower UTIs
Cystitis
Urethritis
Prostatitis
129
Examples of Upper UTIs
pyelonephritis
interstitial nephritis
renal abscesses
130
Cystitis
lower UTI of the bladder
131
Urethritis
lower UTI of the urethra
132
Prostatitis
lower UTI of the prostate gland
133
Pyelonephritis
Inflammation of the renal pelvis
Upper UTI
134
Interstitial Nephritis
Inflammation of the kidney
Upper UTI
135
Clinical Manifestatiosn of Uncomplicated UTIs
Burning on urination
Frequency, urgency, nocturia, incontinence
Suprapubic or pelvic pain
Hematuria and back pain
136
Clinical manifestations of complicated UTIs
can range from asymptomatic to Gram Negative sepsis with chock (aka urosepsis)
have a lower response rate to treatment
tend to reoccur
137
Major Goal for UTIs
Controlling Pain
Teach and educate patients and make sure they know when to come to the hospital
138
What are some potential complications from UTIs
Urosepsis
Acute kidney injury and/or chronic kidney disease
139
Risk Factors for UTIs
Female Gender
Diabetes
Pregnancy
Neurologic Disorders
Gout
Altered States caused by incomplete emptying of the bladder and urinary stasis
Decreased natural host defenses or immunosuppression
Inability or failure to empty the bladder completely
Inflammation or abrasion of the urethral mucosa
Instrumentation of the urinary tract (cath, cytoscopic, procedure)
Obstructed Urinary flow from:
congenital abnormalities, urethral strictures, contractures of bladder neck, bladder tumors, calculi, and compression of ureters
140
Why are females more likely to get a UTI
they have a shorter urethra/anatomy
141
What are some area of education to provide the patient to prevent recurrent UTI
Hygiene - showering rather than bathing, cleaning area front to back each bowel movement
Fluid intake - flush the system and bacteria
Voiding habits - every 2-3 hours to prevent bacteria buildup
Absorbic acid or other treatments as prescribed like probiotics
142
Urosepsis
Gram negative bacteremia originating in urinary tract
It is an infection from the urinary tract spreading into the blood leading to systemic infection
143
The most common organism cause of Urosepsis is ___
E. Coli
144
the most common cause of urosepsis is
Presence of indwelling catheter or untreated UTI in medically compromised patients
145
What is the 2 major problems regarding urosepsis
1. Bacterium ability to develop resistant straints
2. Urosepsis can lead to septic shock if not treated aggressively
146
The most common s/sx of urosepsis are
FEVER - most common and earliest
Perfuse/Sweat more than normal
Different Vitals
C&S Results from Urine
147
Interventions for urosepsis are done...
after the culture and sensitivity
148
Interventions for Urosepsis
Administer IV antibiotics as prescribed - usually until afebrile for 3-5 days
Use of oral antibiotics
Secure, smallest, and aseptic catheterization only when needed
Great perineal care
149
Bacteriuria increases with ___ and ___
age and disability
150
What is the most common cause of bacterial sepsis in those 65+
UTIs
151
What is the mortality rate like for older patients with UTIs
>50%
152
S/S of UTI in Older Populations
Fatigue (most common and subjective complaint in this gorup)
Altered confusion, cognition
153
Factors that contribute to UTIs in older adults
cognitive impairment
frequent use of antimicrobial agents
high incidence of multiple chronic medical conditions
immunocompromise
immobility and incomplete bladder emptying
obstructed flow of urine
indwelling catheters
154
Clinical Manifestations of Cystitis
*R/t actual inflammatory response*
Frequency, urgency, and voiding in small amounts
Burning upon urination and inability to void
incomplete bladder emptying and spasm
lower abdominal or back discomfort
cloudy, dark foul smelling urine
hematuria
malaise, chills, fever, n/v
nocturia
incontinence
suprapubic, pelvic, or back pain
confudion in older populations
155
What does hematuria indicate in cystitis
infection and inflammation spreading up toward the kidneys (also cloudy dark foul smelling urine)
156
Education for Cystitis Patient
Pharmacological Therapy
Prevent recurrence
Deficient knowledge gaps
157
Interventions for Cystitits
Collect urine for C&S - ID bacteria
Instruct to force fluids - especially if taking a sulfonamide
Use strict aseptic technique when inserting a urinary catheter and provide meticulous perineal care
Maintain closed urinary drainage systems for clients with indwelling catheters
administer prescribed meds
education
158
How many fluids should be forced a day for cystitis
3000 mL/day or 10 oz/hr x 10 hour
159
Why is it particularly important to force fluids if a patient is on a sulfonamide (Bactrim)
They can form crystals in concentrated urine
160
Education Points for Cystitis
acid ash diet - discourage caffeine products and avoid alcohol
heat to abdomen or sitz bath for c/o discomfort
avoid bubble baths and perfumed hygiene products
avoid tight fitting clothing and nylon undergarments
follow up urine culture following treatment
Medications (Analgesic, antiseptic, antispasmodic, antibiotic, antimicrobial)
161
What is the msot frequent cause of Urethritis in men
gonorrhea and chlamydia
162
What is the most frequent cause of Urethritis in women
feminine hygiene sprays
perfumed toilet paper and sanitary napkins
spermicidal jellies
UTIs and change in vaginal mucosa lining
163
BPH - Benign Prostatic Hyperplasia
hyperplastic process - increased number of cells - of the prostate gland in men
a NON CANCEROUS enlargement
164
The most common disease or condition in aging men is...
BPH (51% of men have it with no clear cause known)
165
S/S of BPH
frequency
urgency
nocturia
difficulty initiating
when they do have a stream feels like nothing empties fully - hard to fully empty
dribbling
person QOL decrease
sleep patterns change
166
Complications from BPH
Stasis
Retention
UTI
Obstruction
167
Treament for BPH is tailored toward...
improving patient QOL - we want to make sure we improve urine output, relieve obstruction, and prevent further progression of the disease
168
Treatments for BPH
encouraging fluids
catheterization in severe PH (or urology has to do it if its too large and needs a metal cath)
medications - PROSCAR + Hytrin/Cardua/Flomax (Proscar shrinks gland)
Surgery
169
Which prostate surgical procedure requires no incisions
TURP - Transurethral resection
(Technically ablation too)
170
Transurethral Resection (TURP)
Prostatic tissue is removed through the urethra by optical instruments
Used for glands of various sizes and ideal for those who are at surgical risk
171
Advantages of TURP
avoids abdominal incision
safer for surgical risk pateints
shorter length of stay in hospital and recovery periods
lower morbidity rates
causes less pain
can be used as a palliative approach with hx of radiation therapy
172
Disadvantages of TURP
requires a highly skilled surgeon
recurrent obstruction, urethral trauma, and strictures can develop
delayed bleeding can occur
173
Important Nursing Consideration Post Op with TURP
monitor for hemorrhage
observe for symptoms or urethral stricture such as dysuria, straining, weak urinary stream
CBI - cont. bladder irradiation
give antispasmodics
174
Nursing Interventions Post TURP
Assess for bleeding
Assess and treat pain
Infection
DVT Prevention/prophylaxis - get them walking ASAP
Obstruction monitoring
Antispasmodics as prescribed
Teach exercises for sphincter control
Continuous Bladder Irrigation (CBI)
175
What bleeding may be normal at first following TURP
Bleeding should be red/pink for 24 hours after and then turn a more tea like color
but if color remains bright red or has clots in it, then it is abnormal bleeding and indicates arterial bleeding - contact the provider
176
Continuous Bladder Irrigation
a 3 way (lumen) irrigation system to decrease bleeding and keep the bladder free from clots
Its a bag putting fluid into the stomach and it continuously allows bladder irrigation to prevent clot buildup and keep things moving
177
What is one major potential complication that can occur from CBI
TURP Syndrome
178
TURP Syndrome
A syndrome caused by CBI caused by neurologic, lyte, and cardiac imbalance from too much absorption of the irrigated fluid
179
S/S of TURP Syndrome
HTN
NV
Confusion
Cardiac Issues
180
What should be done if you suspect TURP syndrome
stop CBI and let the provider know
181
What are the 3 lumens on CBI used for
1 is for inflating a balloon (30 mL) to hold it in place
1 is for outflow
and 1 is for instillation (inflow)
182
How much fluid should be given to Post Op TURP Patients
2400-3000 mL/d if possible
183
When can you begin ambulating a post op TURP patient
ASAP - so as soon as the urine is more clear (not when pink/red)
184
What does ARTERIAL bleeding appear like post TURP and what should be done if this occurs
bright red urine with numerous clots --> If this occurs increase CBI and notify physicial immediately
185
What does VENOUS bleeding appear like Post TURP and what should be done if this occurs
burgundy colored UO --> If this occurs inform MD who may apply traction on catheter
186
Important rule to CBI
What is put in must come out - so what is instilled better be in bag outflow or else something is wrong like tube kinking, urinary retention etc which can cause over distention leading to secondary hemorrhage
187
Catheter Traction
Maintaining tautness to the catheter (straight leg not bent) taped to the abd/thigh which is done by the MD
Never released without MD order - usually after bright red/burgundy colored drainage diminished
Important to Post TURP Care
188
What should be run through the CBI
Normal Saline (or glycine) to prevent water intoxication
189
At what rate should CBI be run
at a rate to keep the urine pink
If bright red or has clots than run it faster (40 gtt/minute once bright red clears)
190
What should be done if the CBI catheter is obstructed
Turn off CBI, irrigate catheter with 30-50 mL NS and notify MD if obstruction is unresolved
191
What two things are important to watch for when using CBI / post TURP
Turp Syndrome
Severe Hyponatremia (Water intoxication)
(Both caused by excessive CBI absorption)
192
Important TURP Post Op Care Considerations
Expect red-light pink urine 24 hours - then amber for 3 days
Continuous feelings of urge to void is normal
Avoid attempts to void around catheter - causes bladder spasms
Antibitoics, Analgesics, Stool Softeners, and AntiSpasmodics as prescriped
Monitor 3 way foley cath: 30-45 mL retention balloon
Maintain CBI with NS
Educate on post op diet, s/s to watch for
Control pain
Stress importance of doctor follow up
