“Renal Problems – Renal Calculi” plus 2 more nursing article(s): NursingCrib.com Updates
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| Renal Problems – Renal Calculi Posted: 09 Nov 2010 02:00 PM PST 
Renal Calculi also called kidney stones or renal lithiasis are found in the inner surfaces of the kidney, they usually contain mineral and acid salts.
Pathophysiology:
Renal stones are formed when the urine is not able to dissolve the minerals that comes along with the excretion of the body. Those minerals crystallizes and solidifies until it may block the passageway. Types of calculi based on composition:
1. Calcium stones – the most common form of renal stone, it is due to accumulation of oxalate that comes from the diet that’s rich in vitamin D. 2. Struvite Stone – this is common in women since they are more prone to have urinary tract infections. They are described as staghorn shaped because they usually collect themselves on the urine collecting space of the kidney. 3. Uric Acid Stone – this is the result of high-protein diet. 4. Cystine Stones – this is a genetic disorder wherein the kidneys excrete excessively high amounts of amino acids (cystinuria). Complications:
1. Kidney damage 2. Bleeding 3. Infection Clinical Manifestations: - acute, sharp, intermittent pain (ureteral colic)
- dull, tender ache in the flank
- nausea and vomiting accompanying severe pain
- fever and chills
- hematuria
- abdominal distention
- pyuria
Diagnostic Evaluation: - Kidneys, ureters and bladder radiography reveals visible calculi.
- Stone analysis detects mineral content calculi
- Intravenous pyelography determines size and location of the calculi
- Renal ultrasonography reveals obstructive changes, such as hydronephrosis.
Medical Management:
- For severe infections antibiotic therapy is indicated.
- Supportive therapy is given for fever, pain control and hydration.
Surgical Management: - Crucial decision in removing the kidney to relieve the obstruction.
- Nephrectomy
- Hand-assisted laparoscopic nephrectomy
Nursing Management: - Assess for ability to tolerate oral fluids and food.
- Obtain urologic history that could suggest recurrent infections or urinary tract infections
- Give prescribed analgesics to relieve pain
- Administer oral and intravenous fluids as ordered to reduce concentration of urinary crystalloids and ensure adequate urine output.
- Explain preventive measures including good fluid intake, personal hygiene measures and healthy voiding habits.
Photo credits: www.homeopathictreatment4u.com Related posts: - Nursing Care Plan – Renal Failure
- Acute Renal Failure
- Nursing Care Plan – Urinary Tract Infection (UTI)
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| Angioplasty Posted: 09 Nov 2010 12:00 PM PST 
 Angioplasty is a technique used to open an area of arterial blockage with the help of a catheter that has an inflatable small sausage-shaped balloon at its tip.
PTCA or Percutaneous Transluminal Coronary Angioplasty on the other hand involves introducing a balloon catheter through the groin, sometimes of the arm. It is placed within the blood vessel that is why it is medically called transluminal.
Procedure: - The doctor inserts a catheter into the artery usually at the groin area.
- The angiography shows the travel of the catheter as it is being inserted, the doctor inserts a smaller double lumen balloon catheter through the guide catheter and directs the balloon through the occlusion.
- The doctor inflates the balloon, causing arterial stretching and plaque fracture.
Nursing Management:
Before the Procedure: - Inform the patient that a catheter will pass through the artery and a vein in the groin area.
- Reassure the patient that the procedure lasts from one to four hours and he or she will lie flat on the operating table all the time.
- Advice deep breathing episodes during the procedure to provide ease with the process.
After the Procedure: - Inform the patient that he or she will spend ample time in the cardiac ICU or a certain facility wherein closer monitoring will be done until he or she is stable.
- Monitor the heparin effects and other intravenous medications.
- Asses for the peripheral pulses from time to time, there is a tendency that it will be impeded due to prolonged supine position.
Discharge Instructions: - When the patient goes home, emphasize that it he or she experienced complications such as bleeding or lack of sensation on the lower extremity, inform to call the attending physician immediately.
- Instruct that if chest pains happen there would be a tendency for the reinsertion of the catheter.
Photo credits: www.revolutionhealth.com Related posts: - Percutaneous Transluminal Coronary Angioplasty
- Balloon Valvuplasty
- Pelvic Laparoscopy
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| TURP (Transurethral Resection of the Prostate) Posted: 09 Nov 2010 10:00 AM PST 
TURP (Transurethral Resection of the Prostate) is the most common procedure used to treat BPH. It can be carried out through endoscopy. The surgical and optical instrument is introduced directly through the urethra to the prostate, which can then be viewed directly. The gland is removed in small chips with an electrical cutting loop.This procedure, which requires no incision, may be used for glands of varying size and is ideal for patients who have small glands and for those who are considered poor surgical risks.Newer technology uses bipolar electrosurgery and reduces the risk of TUR syndrome (hyponatremia, hypovolemia).TURP usually requires an overnight hospital stay. Urethral strictures are more frequent than with (non-trans-urethral procedures, and repeated procedures may be necessary because the residual prostatic tissue grows back. TURP rarely causes erectile dysfunction, but may trigger retrograde ejaculation because removal of the prostatic tissue at the bladder neck can cause seminal fluid to flow backward into the bladder rather forward through the urethra during ejaculation. Pre-operative Management: - Inform the patient about the procedure and the expected postoperative care, including catheter drainage, irrigation and monitoring of hematuria.
- Discuss the complications of surgery which include:
- Incontinence or dribbling of urine up to 1 year after surgery and that Kegel’s exercise will help alleviate this problem
- Retrograde ejaculation
- Bowel preparation is given.
- Optimal cardiac, respiratory and circulatory status should be achieved to decrease risk of complications.
- Prophylactic antibiotics are ordered.
Post-operative Management: - Urinary drainage is maintained and observed for signs of hemorrhage.
- Maintain patency of urethral catheter.
- Avoid overdistention of bladder, which could lead to hemorrhage.
- Administer anti-cholinergic medications to reduce bladder spasms.
- Maintain bed rest for the first 24 hours.
- Encourage early ambulation, thereafter to prevent embolism, thrombosis and pneumonia.
- Wound care is provided to prevent infection.
- Administer pain medications.
- Promote comfort through proper positioning.
- Administer stool softeners to prevent straining that can lead to hemorrhage.
- Reduce anxiety by providing realistic expectations about postoperative discomfort and overall progress.
- Encourage patient to express fears related to sexual dysfunctions and to discuss with partner.
- Teach measures to regain urinary control.
Photo credits: www.healthguide.howstuffworks.com Related posts: - What is Prostate Cancer
- Benign Prostatic Hypertrophy
- Anastomosis of Small Intestine (Small Bowel Resection)
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