Perioperative use in selected surgeries Assist healing of perineal and sacral

Perioperative use in selected surgeries assist

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Perioperative use in selected surgeries Assist healing of perineal and sacral wounds in incontinent patients Hospice/comfort/palliative care Required immobilization for trauma or surgery Chronic indwelling urinary catheter on admission Unacceptable Reasons 3
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Lecture Notes Urine output monitoring outside the ICU Incontinence without a sacral or perineal pressure sore Prolong postoperative use Morbid obesity Immobility Confusion/dementia Patient request Acute Pyelonephritis Inflammation of the renal parenchyma and collecting system Complications Urosepsis—Systemic bacterial infection Causative Organisms E. Coli—85% Proteus Klebsiella Urosepsis Bacteremia related to uncontrolled urinary tract infection Urosepsis: Assessment Fever Tachycardia Tachypnea Fever/Chills Change of mental status Positive urinalysis Positive bacterial culture (blood) Urosepsis: Management Antibiotic therapy 14-21 days Hemodynamic support Hypotensive due to shock state Respiratory support Hypoxemia Hypercapnia Metabolic support Normoglycemia Which statements by a female client indicate that instruction in ways to prevent urinary tract infection (UTI) was understood? Select all that apply. A. “I should avoid tub baths and take showers instead” B. “I should drink 8-10 glasses of fluid per day” C. “I should only wear nylon underpants” D. “I should void every 6 hours while I’m awake” 4
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Lecture Notes E. I should use powder or talc to aid in keeping the perineal skin dry” Obstructive Uropathies/Nephrolithiasis Causes Diet Geographic location Heredity Medications- diuretics Underlying medical conditions Common Causes Calcium oxalate/phosphate Uric acid- pt w/ gout higher risk Cystine Sturvite (Mg ammonium phosphate) Signs/Symptoms Renal Colic o Abdominal/flank o Groin, labia or testicular pain as stone moves Hematuria- gross vs microscopic Nausea/vomiting Frequency/dysuria o Stone in bladder Lithotripsy (Extracorporeal Shock Wave Lithotripsy ESWL) Use of sound, laser or dry shock waves to break up the stone Procedure Process: Continuous EKG monitoring o Waves are delivered on R wave Monitor for dysrhythmias Continuous fluoroscopy o Monitor for destruction of stone Post-Procedure Strain urine to monitor for fragments Monitor for bruising on affected side (may be normal) - BUT IF INCREASES- NOT GOOD Treatment Pain medication o Opiods--Morphine o NSAIDS—Ketorolac (IV motrin) o Spasmolytic—Ditropan/Pro-Banthine Lithotripsy Surgery 5
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Lecture Notes Nutritional considerations Strain all urine Surgical Procedures Stent placement o Stent place in ureter by ureteroscopy Retrograde ureteroscopy o Stone removed via ureteroscope Percutaneous ureterolithotomy o Physician inserts needle into collecting system of kidney and stone is removed through ultrasonic or laser lithotriptor Complication of Obstructions: Hydronephrosis/hydroureter Enlargement of the kidney or ureter due to obstruction of urinary flow out of
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  • Spring '16
  • Kim McCarron

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