MEDICAL SURGICAL NURSING CARE
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The Urinary System Disorders
Dr Ibrahim Bashayreh, RN, PhD
22/12/2010
1
URINARY INCONTINENCE
22/12/2010
Involuntary urination
 Increased bladder pressure
 Lowered urethral resistance
 Pelvic muscle relaxation
 Impaired neural control
 Bladder problems
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URINARY INCONTINENCE
22/12/2010
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Types
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Stress
Urge
Overflow
Reflex
Functional
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URINARY INCONTINENCE - MANIFESTATIONS
22/12/2010
Uncontrolled urination
 Several types
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URINARY INCONTINENCE – DIAGNOSTIC
TESTS
22/12/2010
Postvoid residual urine
 Ultrasonic bladder scan
 Cystometrography (Measurement of bladder function, as
by a cystometer)
 Uroflowmetry (is a test that measures the volume of urine
released from the body, the speed with which it is
released, and how long the release takes)
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URINARY INCONTINENCE - TREATMENT
22/12/2010
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Medications
Inhibit detrusor muscle (is a layer of the urinary
bladder wall made of smooth muscle fibers arranged
in spiral, longitudinal, and circular bundles
contractions)
 Increase bladder capacity
 Estrogen therapy
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Surgery
Bladder neck suspension
 Prostatectomy
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URINARY INCONTINENCE – NURSING CARE
22/12/2010
Impaired Urinary Elimination
 Toileting Self-Care Deficit
 Social Isolation
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URINARY INCONTINENCE – NURSING CARE
22/12/2010
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Evaluating
Keep voiding diary
 Identify wetting episodes
 Assess willingness to participate in social activities
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Teaching
Home environment
 Voiding diary
 Therapies
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URINARY RETENTION
22/12/2010
Occurs when bladder cannot empty
 May be caused by obstructive or functional
problem
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Benign prostatic hypertrophy
Surgery
Drugs
Neurologic diseases
Trauma
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URINARY RETENTION - MANIFESTATIONS
Manifestations
Overflow voiding
 Incontinence
 Firm, distended bladder
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22/12/2010
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May be displaced
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URINARY RETENTION
Complications
Hydronephrosis
 Acute renal failure
 Urinary tract infection
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22/12/2010
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URINARY RETENTION – INTERDISCIPLINARY
CARE
Diagnostic tests
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Portable bladder scan
22/12/2010
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Treatment depends on cause
Surgery
 Medications
 Stimulation techniques
 Catheterization
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URINARY RETENTION - SURGERY
22/12/2010
Surgery (removal of obstuction, resection of
prostate)
 Catheterization after surgery helps prevent
overdistention
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URINARY RETENTION – NURSING CARE
22/12/2010
Identify clients
 Take measures to promote urination
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URINARY TRACT INFECTIONS
22/12/2010
Affect up to 20% of women
 Incidence increases with aging
 Healthcare-associated infections common
(catheter)
 Classified according to region and primary site
affected
 Cystitis is most common
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URINARY TRACT INFECTIONS
22/12/2010
Bacteria from intestines can infect area
 Changes in urinary tract with aging can increase
risk
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CYSTITIS - MANIFESTATIONS
22/12/2010
Bladder mucosa inflamed and congested with
blood
 Dysuria
 Frequency, urgency
 Hematuria
 Pyuria
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UTIS – DIAGNOSTIC TESTS
22/12/2010
Urinalysis
 Urine culture & sensitivity
 CBC with differential
 IVP
 Voiding cystourethrography
 Cystoscopy
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UTIS - MEDICATIONS
Antibiotics
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3 or 7 day treatment
22/12/2010
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UTIS – NURSING CARE
22/12/2010
Assessment
 Impaired Urinary Elimination
 Readiness for Enhanced Self Health
Management
 Teaching
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PYELONEPHRITIS
Inflammatory disorder of renal pelvis and
parenchyma
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Acute
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22/12/2010
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E. coli
Chronic
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Other disorders
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PYELONEPHRITIS - MANIFESTATIONS
Acute
Rapid onset
 Chills, fever
 Malaise, vomiting
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Flank pain, costovertebral tenderness (the angle
formed by the lower border of the12th, or bottom, rib
and the spine)
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22/12/2010
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Cystitis
Chronic
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Fibrosis, scarring, renal failure
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GLOMERULONEPHRITIS
22/12/2010
Inflammatory condition of glomerulus
 Acute or chronic
 Primary kidney disorder or secondary to systemic
disease
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GLOMERULONEPHRITIS
22/12/2010
Affects structure and function of glomerulus
 Damages capillary membrane

Blood cells and proteins escape into filtrate
 Hematuria, proteinuria, azotemia (increase BUN &
Creatinin)
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ACUTE GLOMERULONEPHRITIS MANIFESTATIONS
22/12/2010
Usually follows infection of group A betahemolytic Streptococcus
 Manifestations develop abruptly
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Hematuria, proteinuria, edema, hypertension,
fatigue,
 Anorexia, nausea, vomiting, headache
 Elevated BUN and serum creatinine
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ACUTE GLOMERULONEPHRITIS MANIFESTATIONS
22/12/2010
Older adults may show less characteristic
manifestations
 Symptoms may subside spontaneously
 Some may develop chronic glomerulonephritis
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CHRONIC GLOMERULONEPHRITIS MANIFESTATIONS
22/12/2010
Symptoms develop slowly caused by progressive
destruction of glomeruli and loss of nephrons
 Signs of renal failure may be reason to seek diagnosis
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GLOMERULONEPHRITIS –
DIAGNOSTIC TESTS
Serum electrolytes
 Urinalysis
 KUB x-ray
 Kidney scan or biopsy
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22/12/2010
ASO titer (anti
streptolysine O)
 ESR
 BUN
 Serum creatinine
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GLOMERULONEPHRITIS – INTERDISCIPLINARY
CARE
22/12/2010
Focus is on identifying and treating underlying
disease process and preserving kidney function
 Often no specific treatment
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GLOMERULONEPHRITIS –
TREATMENT
22/12/2010
Medications
 Plasma exchange therapy
 Dietary management
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GLOMERULONEPHRITIS –
NURSING CARE
22/12/2010
Assessment
 Diagnosing, Planning, and Implementing
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Excess Fluid Volume
 Fatigue
 Risk for Infection
 Ineffective Role Performance
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NEPHROTIC SYNDROME - MANIFESTATIONS
22/12/2010
Significant proteinuria
 Low serum albumin levels
 High blood lipids
 Edema
 Thromboemboli
 Usually resolves without long-term effects
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HYDRONEPHROSIS
22/12/2010
Abnormal dilation of renal pelvis and calyces
 Results from urinary tract obstructions or
backflow of urine
 Manifestations depend on how rapidly it develops
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HYDRONEPHROSIS - MANIFESTATIONS
22/12/2010
Acute (colicky flank pain, hematuria, pyuria, fever,
nausea and vomiting, abdominal pain
 Chronic (intermittent dull flank pain, hematuria,
pyuria, fever, palpable mass)
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HYDRONEPHROSIS – INTERDISCIPLINARY
CARE
Diagnosis
Ultrasound
 CT scan
 Cystoscopy
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22/12/2010
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Treatment
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Stents
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HYDRONEPHROSIS - SURGERY
Stents positioned during suergery or cystoscopy
Pig-tail or J-shaped
 Temporary or long-term
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22/12/2010
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HYDRONEPHROSIS – NURSING CARE
22/12/2010
Focuses on ensuring urinary drainage
 Monitor I&O
 Irrigate tubes only as ordered
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POLYCYSTIC KIDNEY DISEASE
22/12/2010
Hereditary
 Cyst formation and massive kidney enlargement
 Relatively common
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POLYCYSTIC KIDNEY DISEASE
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22/12/2010
Renal cysts develop in nephron
 Cysts fill, enlarge and multiply
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Causes kidneys to enlarge
Gradual destruction of functional kidney tissue
 Slowly progressive
 Flank pain, hematuria, proteinuria, polyuria,
nocturia
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A POLYCYSTIC KIDNEY AND A NORMAL
STOCK PHOTOS, INC.)
KIDNEY FOR COMPARISON.
(SOURCE: NMSB, CUSTOM MEDICAL
22/12/2010
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POLYCYSTIC KIDNEY DISEASE MANIFESTATIONS
22/12/2010
Enlarged kidneys
 Flank pain, hematuria, proteinuria, polyuria,
nocturia
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POLYCYSTIC KIDNEY DISEASE –
INTERDISCIPLINARY CARE
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22/12/2010
Management is supportive
 Renal ultrasound to diagnose
 Fluids
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Medications
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POLYCYSTIC KIDNEY DISEASE –
NURSING CARE
Diagnosing, Planning, and Implementing
Excess Fluid Volume
 Grieving
 Ineffective Self Health Management
 Ineffective Coping
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22/12/2010
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CANCER OF THE URINARY TRACT
22/12/2010
Bladder cancer
 Kidney tumors
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BLADDER CANCER
Bladder cancer is 10th leading cause of cancer
deaths
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22/12/2010
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Major risk factors
Carcinogens in urine related to a history of
smoking (probably because of the excretion of
carcinogens such as 4-aminobiphenyl),
 which increases the risk about four-fold.
 Chronic inflammation or infection of bladder
mucosa
 Smoking
 Chemicals in environment
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BLADDER CANCER - MANIFESTATIONS
22/12/2010
Painless hematuria
 Frequency
 Urgency
 Dysuria
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BLADDER CANCER – INTERDISCIPLINARY
CARE
Diagnostic tests
Bladder ultrasound
 Urinalysis
 Urine cytology
 Cystoscopy
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22/12/2010
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Treatment
Medications
 Surgery
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47
KIDNEY TUMORS
22/12/2010
Uncommon
 Renal cell carcinoma most common primary
tumor
 Risk factors
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Smoking
 Obesity
 Renal calculi
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KIDNEY TUMORS
22/12/2010
Most arise from tubular epithelium
 Can occur anywhere
 Often metastasize
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KIDNEY TUMORS - MANIFESTATIONS
22/12/2010
May be silent
 Flank pain
 Palpable mass
 Fever, fatigue
 Weight loss, anemia, polycythemia
 Hypercalcemia, hypertension, or hyperglycemia
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KIDNEY TUMORS – INTERDISCIPLINARY CARE
Diagnostic tests
Renal ultrasound
 CT scan
 Kidney biopsy
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22/12/2010
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Treatment
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Radical nephrectomy
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BLADDER AND KIDNEY CANCER –
NURSING CARE
22/12/2010
Assessment
 Diagnosing, Planning, and Implementing

Impaired Urinary Elimination
 Risk for Impaired Skin Integrity
 Disturbed Body Image
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52
BLADDER AND KIDNEY TUMORS –
NURSING CARE
Diagnosing, Planning, and Implementing
Acute Pain
 Ineffective Breathing Pattern
 Disturbed Body Image
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22/12/2010
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