Questions
A patient with severe ureter damage from chronic UTIs is concerned about her upcoming suprapubic catheterization. The doctor told her it can be permanent or temporary depending on how much function she regains. What does the doctor mean by regaining function? (i.e. once trauma is healed, what milestone does she have to pass to have the cath removed?)
she must establish a regular voiding pattern with less than 100 mL residual
Bladder cancer is the 4th most common cancer in men and 8th most common in women. The highest risk factor for cancer is smoking. What are some other risk factors associated with bladder cancer?
aromatic amine exposure from rubber and chemical industries, polycyclic aromatic hydrocarbon exposure from the coal and aluminum industries, chronic infection or inflammation from chronic catheter use, incomplete bladder emptying
What are the pros and cons of an orthotopic bladder bladder resectioning?
pros: no external pouch, most closely resembles "normal" urination
cons: requires bladder retraining, only 80% achieve full continence, higher risk of fluid and electrolyte imbalance
Surgical management of bladder cancer:
Invasive or metastatic cancer tumors require what kind of surgery and a permanent change to what?
full or partial cystectomy
permanent urinary diversion
A patient coming into PACU had a urinary diversion, what assessments would you perform?
monitor multiple drainage tubes, urine output, prevention of complications, pain control
What are some teaching points for a patient being sent home with kidney stones?
kidney stone prevention - adequate hydration, dietary restrictions, increase in dietary citrate, avoid foods high in oxalate (rhubarb, chocolate, tea, coffee, nuts)
Medicinal treatment of bladder cancer depends on the severity and spread of the tumors. What are the 3 types of tumors and the treatments of each?
Superficial tumor: topical therapy or instillation of chemotherapy kills actively growing cells
invasive tumors: systemic chemotherapy or immunotherapy
metastic tumors:target drug therapy, diagnostic drug testing, gene therapy
Urolithiasis - define the treatment
percutaneous nephrolithotomy
a nephroscope is passed through the lower back and into the kidney, where a grabber from the nephroscope can remove the stone.
Urolithiasis - define the treatment
Ureteroscopy
insertion of an cystoscope into the urethra to the bladder. if stone if located, a special grabber is inserted into tube of cystoscope and stone is removed
Depending on the type of urinary diversion performed, there are many interventions and patient education that needs done. What urinary diversion matches up with the care or education below (multiple answers for each)? (ileal, orthotopic, suprapubic, indiana)
emptying of tubes
stoma/skin care
bladder retraining
support groups
emptying of tubes - supra, indiana
stoma/skin care - supra, ileal, indiana
bladder retraining - supra, ortho
support groups - all of them
Patients with suprapubic catheters are at high risk of what?
CAUTIs
A patient diagnosed with a kidney stone is worried about surgery, what are some key points to educate your patient about kidney stones?
50% of stones less than 5mm pass spontaneously
if the stone is 5mm or less, there's minimal pain, no hydronephrosis or infection, trial passage is treatment of choice
NSAIDS, narcotics, and anti-emetics are prescribed during trial passage
flomax, cardura, or hytrin can be prescribed to relax musculature of lower ureters and aid in stone passage
if passage does not happen in 4-6 weeks, or renal colic develops, surgical intervention is required
Surgical management of bladder cancer:
A superficial or low-grade invasive cancer are excised using a.....
laser ablation or high frequency electrical current (fulguration)
bonus info: chemo and immunotherapy are used to shrink tumors prior to surgery
What are the pros and cons of an indiana pouch bladder resectioning?
pros: no external pouch, stoma is flush with skin below waist line
cons: stoma must be drained at regular intervals with catheter, strictures at skin level may occur
Painless hematuria is the most common presenting symptom of what bladder disorder?
bladder cancer
A doctor orders blood and urine tests to look for tumor markers in a patient suspected of bladder cancer. What might be ordered to rule out infections? What two diagnostic studies can be ordered to make a definitive diagnosis?
urine culture to rule out
cystoscopy and biopsy
Urolithiasis - define the treatment
ureteral stent
a cathether is passed from the bladder, through the ureter, into the kidney. The stent passes the stone in the ureter and allows urine to flow passed the blockage, into the bladder to be voided
T1 bladder cancer is non-muscle invasive cancer, meaning it only affect the inner lining. What is the inner lining called?
T2-T4 bladder cancer is muscle invasive cancer meaning is passes through the lining and into the muscle. What is the muscle called?
urothelium
detruser
Patient is staying on the floor due to extreme pain from kidney stones. What are some nursing interventions you can perform with/for the patient?
management of pain, help find a comfortable position (renal colic-severe pain with movement), increase PO fluids, anticipate orders for CBC, kidney function, serum chemistries, UA and culture, close monitoring of color, output, consistency (must use strainer)
Urolithiasis - define the treatment
extracorporeal shock wave lithotripsy
stones blocking the passage of urine from kidneys to ureters are broken up into small pieces by shock waves. smaller stone move through ureter and are passed naturally
What are the pros and cons of an ileal conduit bladder resectioning?
pros: simplest "tried and true" procedure, fewest complications
cons: external pouch, adhesives may cause skin irritation, lifelong equipment (pouch, drainage bag)
A male patient, 50yo, presents to the ER with extreme, sharp flank pain. He is nauseous and worried about vomiting. He says he's noticed a hint of red or pink in his urine the last couple days. What is the most likely diagnosis and what test will be ordered to perform to confirm?
diagnosis: urolithiasis (kidney stones)
tests:
non-contrast CT scan is test of choice
KUB for kidney stones formed from calcium, it cannot detect uric acid stones
Ultrasound is preferred diagnostic for children and pregnant women due to lack of radiation exposure
What are the 4 type of urinary diversion?
suprapubic catheter
ileal conduit
orthotopic neobladder
indiana pouch