GENITOURINARY MEDICATIONS

MEDICATIO CLASSIFICAT ACTION NURSING CARE TEACHING

N ION
Nitrofurantoi Urinary tract May interfere May cause stomach This medication is
n antibiotic with bacterial upset, diarrhea, loss best taken with food
(Macrodanti enzyme of appetite, nausea, or milk. Swallow the
n) systems and dizziness and capsules or tablets
cell-wall headache during the whole for maximum
formation; first few days as effect. Antibiotics
hinders growth your body adjusts to work best when the
of many the medication. If amount of medicine
common gram- these symptoms in your body is kept
positive and persist or become at a constant level.
gram-negative severe, inform your Do this by taking the
urinary doctor. May cause medication at evenly
pathogens urine to turn yellow- spaced intervals
including E. brown in color. This throughout the day
Coli, Staph is not harmful and and night. Continue
areaus, will disappear when to take this
enterococci, the drug is stopped. medication until the
Klebsiella, and Inform your doctor if full prescribed
Enterpobacter. you develop unusual amount is finished
weakness, tingling of even if symptoms
the hands or feet, disappear after a few
chills, muscle aches, days. Stopping the
cough or yellowing medication too early
of the eyes/skin. may allow bacteria to
continue to grow
resulting in a relapse
of the infection.
Co- Urinary tract Decreases This medication may This medication must
trimoxazole antibiotic bacterial folic cause stomach be administered as
(Bactrim) acid synthesis; upset, diarrhea, directed by your
inhibits nausea, headache or doctor. Antibiotics
susceptible vomiting. If any of work best when the
bacterial these effects persist amount of medicine
activity. This or become severe, in your body is kept
antibiotic is inform your doctor. at a constant level.
used to treat a Sulfonamides may Do this by using the
wide variety of increase sensitivity medication at evenly
infections to sunlight. Notify spaced intervals
including your doctor if you throughout the day
urinary tract, develop chills, fever and night. Continue
middle ear and or yellowing of eyes to use this
respiratory or skin. medication until the
tract full prescribed
infections. amount is finished
even if symptoms
disappear after a few
days. Stopping the
medication too early
may allow bacteria to
continue to grow
 resulting in a relapse
of the infection.
Phenozypyri Urinary Exerts local This medication may Take this with food or
dine HCL analgesic anesthetic cause stomach after meals to
(Pyridium) action on upset, headache, or prevent stomach
urinary dizziness. If any of upset. For urinary
mucosa; these effects persist tract infections, this
relieves or worsen, inform medication should be
urinary tract your doctor. This used for only 2 days
pain medication causes when used in
associated with urine to turn orange- combination with an
UTI or cystitis red in color. This is antibiotic drug.
not harmful. The Length of therapy for
color change will phenazopyridine
disappear when the alone is usually less
medication is than 15 days. Tell
stopped. Notify your your doctor your
doctor if you medical history,
experience especially of kidney
weakness. or liver disease, and
of any allergies you
may have. If this
medication makes
you dizzy, avoid
driving or taking part
in activities requiring
alertness.
Phenazopyridine may
cause staining of
contact lenses. Do
not wear contacts
while taking this
medication.
Chlorothiazi Thiazide Increases This drug may cause Because this drug
de (Diuril) diuretic and sodium and dizziness and increases urination, it
antihypertensi water lightheadedness is best taken early in
ve excretion by especially during the the day. This drug
inhibiting first few days as may be taken by
sodium your body adjusts to mouth with food or
reabsorption in it. Rise slowly from a milk to reduce
nephron’s seated or lying stomach upset. Tell
cortical diluting position to minimize your doctor your
site the dizziness or medical history
lightheadedness. especially if you have
Blurred vision, loss gout, diabetes, liver
of appetite, itching, problems, urinary
stomach upset, problems or any
headache and allergies especially to
weakness may also sulfa medications.
occur during initial Thiazide diuretics
therapy as your may increase
body adjusts to the sensitivity to
medication. If these sunlight. Avoid
effects persist or prolonged sun
 worsen, notify your exposure. If you
doctor promptly. become sun
Inform your doctor sensitive, use a
promptly if you sunscreen and wear
develop muscle protective clothing
cramps, weakness, when outdoors.
pain, nausea, or
vomiting while
taking this
medication.
Furosemide Loop diuretic; Inhibits sodium This drug may cause Tell your doctor if
(Lasix) antihypertensi and chloride dizziness and you have any pre-
ve reabsorption at lightheadedness existing liver or
proximal and especially during the kidney disease, gout,
distal tubules first few days as diabetes,
and ascending your body adjusts to pancreatitis, lupus, or
loop of Henle it. Rise slowly from a allergy to sulfa drugs.
to promote seated or lying Furosemide may
sodium and position. It may also make you more
water increase sensitivity sensitive to sunlight.
excretion to sunlight. Blurred Use a sunscreen and
vision, loss of wear protective
appetite, itching, clothing. If this
stomach upset, medication is used in
headache and the late afternoon or
weakness may also evening, you may
occur during initial need to get up during
therapy as your the night to urinate.
body adjusts to the Consult with your
medication. Inform doctor regarding
your doctor if you your dosing
develop muscle schedule. Alcohol
cramps, pain, may intensify side
nausea or vomiting effects. Limit your
while taking this alcohol intake.
medication. It may
be a sign of low
blood potassium.
Contact your doctor
if you experience dry
mouth, thirst,
unusual bleeding or
bruising, rash,
yellow eyes or skin,
severe nausea or
vomiting, or ringing
in ears. This
medication
increases urination.
Expect this effect. If
you notice other
effects not listed
above, contact your
doctor or
 pharmacist.

URINARY DIAGNOSTIC PROCEDURES

TEST DEFINITION PROCEDURE DIAGNOSTIC NURSING CARE

VALUE
Intraveno An intravenous The patient will lie Reasons for The night before
us pyelogram is a on the x-ray table having an the test, the person
Pyelogra test that uses x- facing up. The intravenous will be asked to
m (IVP) rays to look at technologist will pyelogram take 8 ounces of
the structure and take a "scout" x- include: infection, citrate of magnesia.
function of the ray, which is an x- blood in the urine, He or she should
urinary system ray taken to pain in the mid or not eat within 4
The result is identify exactly lower back, pain in hours or drink
black and white where the kidneys the abdomen, within 2 hours of
images of interior and bladder are injury to the the exam. Upon
portions of the located. A large kidneys, suspicion reaching the
body. dose of iodinated of cancer, mass in hospital, the person
contrast material, the abdomen, high will need to remove
or dye, is injected blood pressure, or all jewelry and
into a vein in the postoperative metal objects.
arm. The order in follow-up. The x- Individuals are
which x-rays are ray pictures can required to sign a
taken will depend show: kidney consent form that
on the problem stones, abnormal asks about
being calcifications, or pregnancy and
investigated. Six hardening of allergies, especially
or seven pictures tissue because of to iodine. Right
are usually taken. calcium deposits before the test, the
These may be blockages person will empty
combined with tumors , either his or her bladder.
another imaging cancerous or non- Preparation may
technique that cancerous injuries, vary slightly from
views the kidney bladder place to place, so
in slices like bread, abnormalities an individual should
which is called a abnormalities of check with the
kidney tomogram. kidneys that are doctor or hospital
Toward the end of the source of high for specific
the session, the blood pressure, instructions.
person empties his structural
or her bladder. A abnormalities that
final picture is have been present
taken is taken from birth,
after urination. enlarged prostate,
and postoperative
follow up results.
Retrograd This is a test that Catheters are In addition to the The night before
e is similar to the introduced into the findings listed the test, the person
Pyelogra intravenous renal pelvis via a above, the will be asked to
m pyelogram; cystoscopic retrograde take 8 ounces of
however, it is procedure. pyelogram can citrate of magnesia.
used to visualize Contrast medium detect unlocated He or she should
structures that is injected into the stones and not eat within 4
are difficult to renal structures neoplasms that hours or drink
visualize on the via these cause obstructions within 2 hours of
IVP. catheters. The below the level of the exam.
procedure takes kidney. Individuals are
about 1 hour. required to sign a
consent form that
asks about
pregnancy and
allergies, especially
to iodine. Local or
general anesthesia
is used and care is
planned
accordingly.
Renal This is a The renal This test is used to The patient is
Angiograp procedure in arteriogram measure blood placed supine
hy which die is involves placing a flow dynamics, following the
introduced into catheter through renal vasculature, procedure with a
the femoral an artery in the and to pressure dressing
artery to visualize groin, which is differentiate cysts present on the
the renal arteries threaded up to the from tumors. This femoral artery.
and surrounding renal artery. Dye test is also used to Neurovascular
vasculature. is injected to allow confirm the checks are
the doctor to see presence of performed at least
the inside of the aneurysms and every hour to
artery. blood or assure that
cholesterol clots bleeding is not
present. Allergies
to dye are assessed
and the patient is
requested to sign a
permit.
Compute Computed The patient will lie A CT scan A person having
d tomography (CT) on a narrow table provides a direct the test will be
Tomograp is a computer- which will slide image of soft asked to refrain
hy (CT) aided x-ray through a machine tissue structures. from eating or
technique. A CT that looks like a CT is also good for drinking for 8 hours
scan produces doughnut. This is identifying and prior to the scan.
detailed cross- called the gantry. tracking large All jewelry and
sectional views of While in the abnormalities metal objects that
the body, similar gantry, an x-ray such as tumors. It may interfere with
to slices of tube travels is also useful for the exam need to
bread. around the detecting the be removed
The technology individual creating presence of blood beforehand, as
behind CT scans computer- in hollow cavities well. When used,
has advanced generated x-ray such as the the patient should
rapidly in recent images that are abdomen. be assessed for
 years. The image small cross- allergy to the
can be produced sections of the contrast medium.
in seconds. organ being
Newer scanners examined. Some
called spiral or types of exams
helical scanners require the
are so fast that indivudal to
they can scan the receive and
entire chest intravenous
during one held injection of
breath. These contrast, which is
devices can also a dye that makes
produce three- the tissues show
dimensional up better.
scans.
Renal A renal High frequency Abnormal results Usually there is no
Ultrasoun ultrasound is a sound waves pass will vary according preparation
d safe, noninvasive through the body to the initial needed, but a full
method of by the use of a suspected bladder may be
examining the transducer placed indications for required for an
kidney and on the abdomen. A performing the abdominal
surrounding soft liquid jelly is abdominal ultrasound. An
tissue structures. applied to the skin ultrasound. individual's
Ultrasound to transmit the Abnormal results healthcare provider
employs the use signal more of an abdominal will provide specific
of high-frequency efficiently through ultrasound in the instructions.
sound waves. A the transducer. non-pregnant
liquid jelly is The transducer is woman, such as a
applied to the connected to the pelvic mass,
skin to transmit computer with a fibroids, ovarian
the signal more display screen that mass or
efficiently. These will convert the gallstones, may
sound waves are signals into black warrant
emitted by a and white images. subsequent
transducer A Doppler testing and
placed on the ultrasound may possible surgery.
abdomen. The also be used to Results should be
ultrasonic waves check movement discussed with the
are reflected off in organs, such as healthcare
the tissue and blood flowing provider, as well
recorded onto a through blood as what potential
machine that vessels or the treatments may
creates an valves within the be necessary
image. The sound heart.
waves are
interpreted by a
computer into
black and white,
2-dimensional,
and recently 3-
dimensional,
images.
Renal This procedure Two different A renal biopsy is Complications are
Biopsy involves taking a biopsy methods often done when rare. Possible
 piece of tissue may be used: an abnormalities problems include
from the kidney. open biopsy or a have been bleeding, infection
needle biopsy. In discovered on and damage to
an open biopsy, a other non-invasive tissue of the
tumor or part of a tests as described kidney. Reaction to
tumor is cut out. A above. Other anesthesia is
small cut is made unexplained possible. Skin
in the skin and the kidney problems numbness may also
surgeon then cuts may require a occur in the area of
out the area that biopsy to the biopsy. Most
is of concern. The determine the biopsies are done
tissue is then sent cause. Most as outpatient
to the lab for biopsies are done procedures. Mild
analysis. The type to make sure pain is normal after
of pain control cancer is not the procedure and
depends on the present. can usually be
amount of tissue treated with mild
to be removed. pain relievers.
Local anesthesia Blood pressure
numbs the area. should be
General monitored for an
anesthesia may be increase or
used. For a needle decrease, observe
biopsy, the patient for tachycardia,
is placed in the flank pain or
prone position with shoulder pain,
a sandbag under dysuria, ureteral
the abdomen, the colic, or vague
skin over the area abdominal
is cleaned and discomfort. All of
injected with a these signs may
local anesthetic. indicate bleeding at
Another needle is the biopsy site. The
inserted, and patient should
tissue or fluid is remain on bedrest
removed for for 24 hours after
study. the procedure and
refrain fom heavy
lifting for at least 2
weeks.

GENITOURINARY TRACT DISORDERS

DISORDER DEFINITION MANAGEMENT NURSING CARE
Urinary tract A disorder Mild cases of acute cystitis Cleanliness of the genital
infections invovling may disappear area may help reduce
(General) repeated or spontaneously without the chances of
prolonged treatment. However, because introducing bacteria
bacteria of the risk of the infection through the urethra. The
linfection of the spreading to the kidneys genitals should be
bladder or lower (complicated UTI), treatment cleaned and wiped from
 urinary tract. is usually recommended. front to back to reduce
Also, due to the high the chance of "dragging"
mortality rate in the elderly bacteria from the rectal
population, prompt treatment area to the urethra.
is recommended. Increasing the intake of
fluids may allow
MEDICATIONS: urination to "flush out"
Antibiotics may be used to the bacteria from the
control the bacterial bladder. Refraining from
infection. urinating for long periods
of time can give bacteria
time to multiply, so
those prone to urinary
tract infections, should
urinate frequently to
help reduce the risk of
developing cystitis.
Women who are prone to
urinary tract infections
should wear absorbent
cotton underwear. Long-
term use of prophylactic
(preventative) antibiotics
may be recommended
for some people who are
prone to chronic or
recurrent urinary tract
infections.
Cystitis A bacterial Mild cases of acute cystitis Keep the genital area
infection of the may disappear clean. Always clean and
bladder or lower spontaneously without wipe from front to back
urinary tract treatment. However, because to avoid dragging
of the risk of the infection bacteria from the rectal
spreading to the kidneys area to the urethra.
(complicated UTI), treatment Drink eight to ten
is recommended. Also, due to glasses of fluid a day.
the high mortality rate in the This helps to flush the
elderly population, prompt bacteria from the
treatment is recommended. bladder. Drink two
Antibiotics may be used to glasses of fluid before
control the bacterial infection and after sexual
intercourse. Urinate
immediately after sexual
intercourse. This helps
eliminate any bacteria
that may have entered
the bladder during
intercourse. Urinate
frequently (don't delay
urination). Long periods
of time between
urination may allow
bacteria time to multiply.
Urethritis An inflammation Antibiotics are prescribed for Some causes of urethritis
 of the urethra urethritis. Because of the may be avoided with
common association of good personal hygiene
sexually transmitted and by practicing safer
diseases, medications that sexual behaviors (such
will adequately treat as monogamy and the
Chlamydia and gonorrhea are use of condoms).
most frequently used.
Abstinence or use of
condoms should be
recommended throughout
the course of treatment.
Partners may be treated as
well. Avoiding the
precipitating factors treats
urethritis caused by trauma
or chemical irritants.
Analgesics (pain relievers)
and urinary tract-specific
analgesics (such as
phenazopyridine) may be
used as concurrent therapy
for urethritis of any cause.
Pyelonephritis An infection of The goals of treatment are Preventive measures
the kidney and control (cure) of the infection may reduce symptoms
the ducts that and reduction of symptoms. and prevent recurrence
carry urine Acute symptoms usually of infection. Keeping the
away from the persist longer than 48 hours genital area clean and
kidney (ureters) after treatment is begun. remembering to wipe
Also, due to the high from front to back may
mortality rate in the elderly reduce the chance of
population, and the risk of dragging E. coli bacteria
permanent kidney damage, from the rectal area to
prompt treatment is the urethra.
recommended. Initial therapy
usually consists of obtaining Urinating immediately
a urine culture to identify the after sexual intercourse
causative organism, and may help eliminate any
selecting appropriate bacteria that may have
antibiotics to treat that been introduced during
infection. However, it may intercourse. Refraining
take 3 to 5 days to receive from urinating for long
urine culture results. In the period of time may allow
interim, you will usually be bacteria time to multiply,
hospitalized to receive broad- so frequent urination
spectrum IV (intravenous) may reduce the risk of
antibiotics and monitoring of cystitis in those who are
kidney function. Intravenous prone to urinary tract
(IV) antibiotics may be used infections.
initially to control the DIET:
bacterial infection. In acute Increasing the intake of
cases of pyelonephritis, you fluids (2000 to 4000 cc
will receive a ten to fourteen- per day) encourages
day course of antibiotics; frequent urination that
however, chronic flushes bacteria from the
 pyelonephritis may require
long-term antibiotic therapy.
It is imperative that you
finish taking the entire
course of prescribed
antibiotics. Commonly used
antibiotics include furidantin,
sulfa drugs, amoxicillin,
cephalosporins,
sulfisoxazole/trimethoprim,
doxycycline
Hydronephrosi The distention There is no separate
s of the pelvis treatment other than the
and calyces of treatment of the causative
both kidneys disorder. Renal insufficiency
or renal failure may develop
as a complication of many of
the disorders associated with
hydronephrosis.
Glomerulonep A group of Treatment varies depending
hritis kidney diseases on the cause of the disorder,
caused by and the type and severity of
inflammation symptoms. The primary
and gradual, treatment goal is control of
progressive symptoms. Hypertension
destruction of may be difficult to control,
the internal and it is generally the most
kidney important aspect of
structures treatment.
(glomeruli). Various antihypertensive
medications may be used to
attempt to control high blood
pressure. Corticosteroids,
immunosuppressives, or
other medications may be
used to treat some of the
causes of chronic
glomerulonephritis. Dietary
restrictions on salt, fluids,
protein, and other
substances may be
recommended to aid control
of hypertension or renal
failure. Dialysis or kidney
transplantation may be
necessary to control
symptoms of renal failure
and to sustain life.
Nephrotic A group of signs Treatment goals are to Nephrotic syndrome is a
Syndrome and symptoms relieve symptoms, to prevent group of signs and
bladder. Avoid fluids that
irritate the bladder, such
as alcohol, citrus juices,
and caffeine.
MONITORING:
Follow-up should include
a urine culture at the
completion of antibiotic
therapy to ensure that
bacteria are no longer
present in the urine.
Other causes of
obstruction such as
kidney stones, posterior
ureteral valves can be
diagnosed early if
individuals recognize
early warning signs of
obstruction and kidney
disease.
There is no specific
prevention for most
cases of chronic
glomerulonephritis.
Avoiding or limiting
exposure to organic
solvents, mercury, non-
steroidal anti-
inflammatory analgesics,
and HIV disease may
prevent some cases.
Joining support groups
where members share
common experiences
and problems can often
help the stress of illness.
 including complications, and to retard symptoms. It is caused
protein in the progressive kidney damage. by disorders that result
urine, low blood Treatment of the causative in some type of damage
protein, and disorder is necessary to to the kidney
swelling control nephrotic syndrome. glomerulus, leading to
(edema). The Treatment may be chronic. abnormal excretion of
urine may also Corticosteroid, protein in the urine. This
contain fat that immunosuppressive, may occur as a result of
is visible under antihypertensive, and infection, drug exposure,
the microscope, diuretic medications may malignancy, hereditary
and blood help control symptoms. disorders, or diseases
cholesterol rises Antibiotics may be needed to that affect multiple body
in many cases. control infections. If systems including
hypertension is present it diabetes mellitus (THE
must be treated vigorously. MOST COMMON CAUSE
Treatment of high blood IN ADULTS), systemic
cholesterol and triglyceride lupus erythematosus,
levels is recommended to multiple myeloma, and
reduce the development of amyloidosis. It may also
atherosclerosis. Dietary occur in disorders of the
limitation of cholesterol and kidney, including
saturated fats may be of little glomerulonephritis, focal
benefit, as the high levels and segmental
seem to be the result of glomerulosclerosis,
overproduction by the liver minimal change disease
rather than excessive intake (THE MOST COMMON
of fats. Medications to reduce CAUSE IN CHILDREN),
cholesterol and triglycerides membranous
may be recommended. High- glomerulonephritis, and
protein diets are of debatable mesangiocapillary
value. In many patients, glomerulonephritis.
reducing the amount of Nephrotic syndrome
protein in diet produces occurs in about 2 out of
decrease in urine protein. In 10,000 people. In
most cases, a moderate- children, the peak
protein diet (1 gram of incidence of nephrotic
protein per kilogram of body syndrome is in the
weight per day) is usually preschool years, usually
recommended. Sodium (salt) when the child is 2 to 3
may be restricted to help years old. There is a
control edema. Vitamin D slight male
may need to be replaced if predominance.
the nephrotic syndrome is
chronic and unresponsive to
therapy.

TYPES OF URINARY OSTOMIES

OSTOMY PURPOSE NURSING CARE
Ileal The Ileal Conduit is the most Permanent; low infection risk;
Conduit common type of urinary diversion. Ureteral stents are present 5-15 days;
E.M. Bricker first performed this used with bladder cancer and is the
procedure in the 1950’s and for that most common urinary diversion
reason is sometimes referred to as procedure.
"Brickers Loop". The ileal conduit is
created after the bladder has been
removed. A small piece of ileum is
removed from the small intestine
with its mesentery (blood supply)
and nerves intact. The small piece is
then sewn shut at one end. The two
ureters that carry urine from the
kidneys are then attached so they
will empty through the piece of
ileum. Then the open end of the
ileum piece is brought out through
the abdominal wall and a stoma is
created. The stoma looks like an
ileostomy because of the use of the
small piece of ileum, but it has an
output of urine.
Ureterosto A Ureterostomy is created when one May be temporary or permanent; low
my (single ureterostomy) or both infection risk; stoma is usually flush
(bilateral ureterostomy) of the with the patient’s skin and the
ureters are redirected from the appliance is placed immediately after
kidney through the abdominal wall. surgery. Used with advanced pelvis
A surgically created stoma is cancer and poor risk patients because
located on the patient's flank. it involves less surgery than some
other ostomies.
Cystostom A Cystostomy is formed when the Catheter patency maintained and
y flow of urine is diverted from the infection risk observed.
bladder to the abdominal wall. This
procedure requires the placement of
a tube through the abdominal wall
into the bladder. It is performed due
to blockage or stricture of the
urethra and can be temporary or
permanent.
Indiana The Indiana Pouch is constructed Continence of the Indiana Pouch is
Pouch using part of the terminal ileum maintained using the ileocecal valve.
(end portion) and the cecum. The The ileocecal valve is normally found
remaining ileum is first attached to between the ileum and the cecum,
the colon to maintain normal and it regulates the emptying of
digestive flow. A pouch is then waste into the large intestine. Similar
created from the removed cecum, to the ileal conduit, the two ureters
and the attached ileum is brought to are attached so they empty into the
the surface of the abdominal wall to internal pouch. The patient uses a
create a stoma. tube (flexible catheter) several times
a day to empty pouch. A continuous
external pouching system is not
necessary, but most patients will
wear a gauze pad or stoma cap
between emptying. Complications of

Percutaneo A Nephrostomy is created when the
us flow of urine is diverted directly
Nephrosto from the kidneys to the abdominal
my wall. Tubes are placed within the
kidney to collect the urine as it is
manufactured and transported to
the abdominal wall. The purpose of
the percutaneous nephrostomy is to
serve as an external drainage route
for the patient following kidney
surgery or when obstruction is
present that will not allow for
adequate renal drainage. Other
purposes include serving as a route
to insert a stent, dissolve renal
calculi, dilate strictures, close
fistulas, administer medications and
provide a route for biopsy. This
procedure is usually temporary,
however, if cancer is present, it can
be permanent.
an Indiana Pouch include valve
incompetence (leakage),
inflammation of the pouch, bleeding
and fistula formation.
Postoperatively, the patient must be
monitored for tube patency (clear
passageway), since the kidney has a
very small capacity for storage. A
blockage could very quickly result in
pain and infection. Do not irrigate. Do
not clamp. Notify the MD
immediately if tube becomes
dislodged. Follow-up assessment
includes monitoring for bleeding,
urinary stones and the passage of
debris, fistula formation, and
infection. The patient is required to
consume at least 3000cc of fluids per
day and keep the urine acidic. If two
tubes are present, I and O is kept
separately.

ALTERATIONS IN URINARY FUNCTION

ETIOLOGY PATHOPHYSIOL CLINICAL MANAGEMEN NURSING CARE
OGY MANIFESTATIO T
NS
UROLITHIAS  Formed when  Depends on  Pain relief is  Discharge
IS: urinary the presence of achieved by MS teaching should
 May be concentrations of obstruction, or Demerol, hot include
found substances in the infection, and baths and moist information about
anywhere urinary tract such edema heat tot he diet, increasing
from the as calcium  Stones in the flank, and fluids to 3000-
kidney to the oxalate, calcium renal pelvis are increasing 4000cc per day to
bladder phosphate, and characterized by fluids increase
 Vary in uric acid increase. deep, intense  Stone hydrostatic
size from  Deficiency of ache in the removal is pressure,
minute substances that costovertebral accomplished increasing fluids
granular normally prevent region, hematuria, by ESWL, in the evening,
deposits to precipitation such pyuria, pain percutaneous avoidance of
stones the as citrate radiating down nephrolithotom sweating and
size of an  Alkaline urine toward the y, ureteroscopy dehydration, and
orange. pH promotes stone bladder in the with stent, seeking prompt
 Stone formation female and chemolytic medical attention
formation is  Dehydration toward the testes agents to at the first sign of
favored in favors stone in the male and dissolve stone, a UTI
infections, formation renal colic. and surgical  When a stone
urinary  Stones lodged removal in rare is suspected, or
stasis, and in the ureter are cases following ESWL,
periods of characterized by  Nutrition instruct the
immobility acute, wavelike and medication patient to strain
excruciating pain therapy all urine to
radiating down considerations determine
the thigh and to include spontaneous
the genitalia, the increasing passage of stones
desire to void, fluids to 8
urinary retention, glasses per
and hematuria day, avoidance
 Stones lodged of certain foods
in the bladder are in the diet that
characterized by make up the
irritation, main ingredient
symptoms of of the stone,
infection, urinary acidification of
retention, and the urine with
sepsis meds
RENAL  The most  Many tumors  The goal of  Nursing care
CANCER: common type is produce no treatment is to is directed toward
 Accounts renal cell symptoms and eradicate the supportive care
for 2% of all carcinoma or renal are discovered on tumor before  Assessing
cancers adenoma routine physical metastasis remaining renal
 Affects  ¼ to ½ of the exam as a occurs function
men 2X more patients will have painless mass in  Radical  Aftercare for
than women advanced disease the abdomen nephrectomy is the patient with
 at the time of  The classic performed renal surgery
Associated diagnosis triad of symptoms  Other which includes
with tobacco which occur late treatments monitoring for:
use, chemical in the disease include  - hemorrhage
exposure, include chemotherapy, and shock
obesity, hematuria, pain, radiation,
and mass in the
 - paralytic
dialysis hormonal ileus
 flank therapy,
 Painless immunotherapy
 - abdominal
Metastasizes distention
early to hematuria is the  Renal artery
lungs, bone, usual sign that embolization is
 Administering
first calls antibiotics
liver, brain, done when
and attention to the metastasis has  Providing
contralateral tumor occurred to the heparin
kidney  Other bladder prophylaxis
symptoms, that  Reduces the  Providing
occur late, blood supply to appropriate care
include dull back the tumor for the
pain, colicky pain making the nephrostomy or
when clot is nephrectomy ureteral stents
present, easier, reduces  Assessment of
 unexplained the chance of respiratory status,
weight loss, seeding, and circulatory status,
anemia, increased reduces the pain management
weakness blood supply to and patency of
 Diagnosis the tumor urinary drainage
occurs with IVP,  Post- devices is also
cystoscopic exam, infarction important
nephrotomagram, syndrome lasts  Post-operative
renal arteriogram, 2 to 3 days and teaching includes
ultrasound, CT, consists of local drainage system
and biopsy flank and care, SS of
abdominal pain, infection, SS of
increased obstruction, and
temperature, monitoring of fluid
and GI distress intake and output.
BLADDER  Can be  Painless   Nursing care
CANCER: superficial or hematuria Chemotherapy involves care of
 Accounts invasive in nature  Change in  TUR bladder the urinary
for 1:25  Made up of voiding pattern  Intravesical diversion that is
cancers transitional or  Metastatic chemotherapy created as a
diagnosed in squamous cell result of the
the US
disease leads to  Radiation surgery.
carcinoma pelvis and back
 3X more  Simple or  The diversion
 Associated pain radical
common in with chemical can be
cystectomy
men than exposure, ureterocutaneous
women recurrent or
 In males in which the
 Seen radical intestines are
chronic bladder
cystectomy involved in the
more in infections,
involves diversion or
people 50 smoking, coffee
removal of the cutaneous where
years and drinking, and
bladder, the stoma is
older parasitic bladder
prostate, diverted directly
infections
seminal to the skin.
 Tumors are vesicles, and
graded and staged  See chart on
perivescial
according to urinary diversion
tissue
severity for more about
 In females a nursing care
radical
cystectomy
involves
removal of the
bladder, ureter,
uterus,
Fallopian tubes,
ovaries,
anterior vagina,
and urethra
URETHRAL  Associated  Force and size   Following
STRICTURE with scar tissue of urinary stream Management is dilatation the
S: contraction is diminished palliative or patient is
 Narrowing  Results from  Urinary surgical instructed to use
of the lumen injury to the retention  Palliative sitz baths to
of the urethra urethra  Symptoms of management promote comfort
  May also be persistent urinary involves  Non-narcotic
congenital in tract infection progressive analgesics are
nature dilatation of the used to manage
narrowed area pain
via a  Antimicrobials
Cystoscopy are prescribed for
 Surgical several days to
dilatation minimize the risk
involves direct of infection
visualization of
the constricted
area with repair
 In severe
cases, surgical
excision or
urethroplasty is
required

Structural Disorders Of the Uterus and Vagina

DISORDE SYMPTOM NURSING MANAGEME
PATHO TEACHING
R S CARE NT
Vaginal Abnormal - UTI - Douches - Heal Low residue
Fistula opening between - Feces and - Enemas spontaneously diet; Warm
two internal flatus in the - Rest perineal
hollow organs or vagina - Antibiotics - If not—treat irrigations; Keep
between the - - Low residue surgically area clean;
hollow organ and Excoriation diet - Fecal Proper nutrition;
the outside of the - - Warm diversion if Frequent sitz
body. Usually Leukorrhea perineal large baths; Bland
between vagina with bad irrigations - Follow up creams or corn
and ureter and odor - Heat lamp with starch to
vagina and treatment treatment for protect skin
rectum. - Indwelling 2 years to
catheter assure doesn’t
- Bladder & recur
vaginal
irrigation

Cystocele Downward - Pelvic - Perineal - Surgery if - Use of pessary

displacement of pressure exercises severe
the bladder and pain - Teach use - Pessary - Kegal
toward the vagina - Fatigue of pessary - Kegal exercises
due to weakness - exercises
Incontinenc
e
- Frequency
 - Urgency
- Back pain
Rectocele Rectum pooches - Post-op Surgery - Avoid lifting
downward, Constipatio management post-op until
pushing the n of abdominal clear with MD
posterior wall of - surgery - Keep area
the vagina with it. Incontinenc clean and dry
e of gas or
feces
Enterocele Intestinal wall - Same as Surgery Same as above
protrudes into the Constipatio above
vagain n
-
Incontinenc
e
-
Sometimes
obstruction

Displacem Change in normal - - Explain use - - Prevent

ent of the position of uterus Retroversio of pessary Hysterectomy infection by
Uterus associated with n causes and pads to (removal of wound care and
weak muscles or back and reduce uterus and avoiding
anatomical pelvis pain wetting with accessory intercourse until
variations. - Prolapse stress organs) cleared by MD
causes incontinence - Vaginal
stress douches of
incontinenc - Kegal sterile saline
e and exercises - Heat lamp BID
retention - Limit lifting and hair dryer
and avoid to dry wound
prolonged area
sitting after - HOB and
surgery knees slightly
- No elevated for
menstruatio comfort
n after
surgery
- Watch for
urinary
retention
after surgery
due to
bladder
atony
- Observe for
ileus
- Major risk
of
hemorrhage
and infection
 TUMORS OF THE UTERUS AND OVARIES

DISORDER CLINICAL MANAGEMENT NURSING

MANIFESTATIONS CARE
Ovarian Cysts - Mass Surgical removal Care for a
Pathologic enlargement of - Acute or chronic lower patient
the ovarties and associated abdominal pain undergoing
structures associated with - Swelling abdominal
overgrowth of ovarian - Pressure surgery
eipthelium which may be
hormone related.
Leiomyomas - Asymptomatic usually - Palliative if - Abdominal
Fibroid tumors of the uterus - Metorrhagia minor surgery
which arise from muscle - Pain - Hysterectomy if - Side effect
tissue and other tissues - Backache severe management
within the uterus, - Urinary urgency - Hormone of hormone
depending on size manipulation therapy
Endometriosis - Dysmenorrhea - Observation - Abdominal
Uterine tissue which grows - Pain 1 to 2 days period - Palliative surgery
outside the uterus. May be menstrual period lasting 2 - Hormonal - Side effect
associated with to 3 days after therapy management
transplantation of cells - Nausea - Pregnancy with hormone
druing surgery or retained - Diarrhea - Surgery therapy
fragments of embryonic
tissue
Cervical Cancer - Early detection with PAP - Follow-up - Supportive
Squamous cell carcinoma smears - Cryosurgery care for
or adenocarcinoma. Risk - Class I: OK - Laser terminal
factors include sexual - Classes II, III, IV: - Conization illness
activity before age 25, abnormal; test needs to - Hysterectomy - Abdominal
multiple partners and be repeated for late cancer surgery
chronic cervical infections - Class V: Cancer - Chemotherapy if - Outpatient
- Irregular bleeding or advanced management
discharge for other
- Usually asymptomatic procedures
Endometrial Cancer - Post menopausal - Hysterectomy - Abdominal
Adenocarcinoma of the bleeding (about 2/3 of (removal of surgery
uterine lining associated women with post- uterus and - Care of
with obesity, uopposed menopausal bleeding accessory radiation
estrogen, nulliparity, late have some type of organs) therapy
menopause, caucasion gynecological cancer) - Intracavitary patient
decent, diabetes mellitus radiation - Supportive
- External pelvic care
radiation
Vulva Cancer - Long-standing pruritis - Wide excision of -
Epidermoid cancer of the - Bleeding (late sign) lesion Psychosocial
external vulva, labia - Foul-smelling discharge - Laser support
majoria, and labia minora - Ulcerated cauliflower - Radiation - Drains
associated wtih growth - Vulvectomy present
menopause, advanced age - Regional lymph - Daily peri
(44-61 highest group), HTN, node dissection care with
DM, obesity, and chronic warm NS
vulvar irritation - Heat lamp
- Use mirror
to inspect
incision
- NO sitz
baths
- Low
Fowler’s
position
Ovarian Cancer - No screening - TAH with BSO - Emotional
Squamous cell carcinoma mechanisms - Radiation support
AKA "silent killer" - Irregular menses therapy - Care with
associated with advanced - Vague abdominal pain - Chemotherapy chemo and
age (50-59 highest group), - GI distress over several - Hormone radiation
high fat diet, nulliparity, years regulation - Care of
and infertility abdominal
surgery
patient

NURSING CONSIDERATIONS FOR THE HYSTERECTOMY PATIENT

NURSING CARE:

• Relief of anxiety
• Acceptance of body image changes
• Control pain
• Increase knowledge of self care

PRE-OPERATIVE CONSIDERATIONS:

• Prep 1/2 of the abdomen and pubic region

• Intestinal tract and bladder are emptied
• Enema and douche administered PM before surgery
• Sedation administered PM before surgery to reduce anxiety
• Usual pre-op meds are given

POST-OPERATIVE CONSIDERATIONS:
 • Anti embolism hose are in place
• Major risk for infection and hemorrhage
• Voiding difficulties are monitored for
• Edema and nerve damage can cause temporary bladder atony
• Observe for ileus
• early ambulation after vaginal hysterectomy: may take longer with abdominal
• Abdominal hysterectomy patient may have NG tube, food, and fluid restriction
• Rectal tube can be used for flatus--ambulation works best

DISCHARGE TEACHING:

• Limitations and restriction as with abdominal surgeries--avoid lifting, etc.

• No menstruation
• In ovaries are removed--symptoms of menopause will occur
• Avoid prolonged sitting--blood pools in the pelvis leading to increased risk of
thrombus
• Showers reduce risk of infection
• Avoid sexual intercourse and driving until MD clears it
• Report foul vaginal odor, discharge, excessive bleeding and elevated temperature