urlnary dlverslon

nLroducLlon
W ulverslon of urlnary paLhway from lLs naLural paLh
W 1ypes
1emporary
ermanenL
ndlcaLlons of permanenL urlnary dlverslon
W When Lhe bladder has Lo be removed
W When Lhe sphlncLers of Lhe bladder Lhe deLrusor muscle have been
damaged or have losL Lhelr normal neurologlcal conLrol
W When Lhere ls lrremovable obsLrucLlon ln Lhe bladder dlsLal Lo LhaL
W LcLoplc veslcae
W ncurable veslco vaglna flsLula
1emporary urlnary dlverslon
W Suprapublc cysLosLomy
W yelosLomy or nephrosLomy or ureLhrosLomy (wlLh lndwelllng caLheLers)
llustration of suprapubic tube placed to aid bladder drainage
nephrostomy is a
surgical procedure by
which a tube, stent, or
catheter is inserted
through the skin and
into the kidney.
ermanenL urlnary dlverslon
W ureLero slgmoldosLomy
W leal condulL
W Colon condulL
W leocaecaecal segmenL
W Lowsley's operaLlon

1ypes of urlnary
dlverslons
CuLaneous urlnary
dlverslons
Wleal condulL (lleal loop)
WA 12 cm loop of lleum led ouL
Lhrough abdomlnal wall
WSLenLs used
W1he space aL cysLecLomy slLe
dralned by a dralnage sysLem
WAfLer surgery a skln barrler
and a LransparenL dlsposable
urlnary dralnage bag
WConsLanLly dralns
10
CompllcaLlons of lleal condulL
W Wound lnfecLlon
W Wound dehlscence
W urlnary leakage
W ureLeral obsLrucLlon
W Small bowel obsLrucLlon
W leus
W SLomal gangrene
W narrowlng of Lhe sLoma
W yelonephrlLls
W 8enal calcull
11
CuLaneous
ureLerosLomy
12
veslcosLomy
13
nephrosLomy
ureLero slgmoldosLomy
W CompllcaLlons
8eflux of urlne
Pyperchloraemlc acldosls
8enal lnfecLlon
SLrlcLure formaLlon
13
ConLlnenL urlnary ulverslons
W ConLlnenL leal urlnary 8eservolr
ndlana ouch
W MosL common conLlnenL urlnary dlverslon
W erlodlcally caLheLerlzed
koch ouch
CharlesLon ouch
ureLeroslgmoldosLomy
W voldlng occurs from recLum
16
17
1
koch
ouch
19
ureLeroslgmol
dosLomy
20
oLenLlal compllcaLlons
W erlLonlLls due Lo dlsrupLlon of anasLomosls
W SLomal lschaemla and necrosls due Lo
compromlsed blood supply Lo sLoma
W SLoma reLracLlon and separaLlon of
mucocuLaneous border due Lo Lenslon or
Lrauma
ladder reconsLrucLlon
8ecLo slgmold pouch
24
nurslng process 1he paLlenL undergolng urlnary dlverslon
surgery
reoperaLlve assessmenL
W Cardlopulmonary assessmenL
W nuLrlLlonal assessmenL
W Learnlng capclLy assessmenL
reoperaLlve nurslng dlagnosls
W AnxleLy
W knowledge deflclL
reoperaLlve plannlng and goals
W 8ellef of anxleLy
W Lnsurlng adequaLe nuLrlLlon
W Lxplalnlng surgery and lLs effecLs
23
nurslng ManagemenL
W n Lhe lmmedlaLe posLoperaLlve perlod urlne volumes are
monlLered hourly
W An ouLpuL below 30 ml/h dehydraLlon or obsLrucLlon
W romoLe urlne ouLpuL a caLheLer may be lnserLed Lhrough
urlnary condulL
W rovlde sLoma and skln care consulL wlLh enLerosLomal
LheraplsL
W Skln care speclallsL consulLed
W SLoma looked for color dark purpllsh blood supply
compromlsed
W Skln lnspecLed for lrrlLaLlon
W leedlng
W Wound lnfecLlons
26
osLoperaLlve nurslng lnLervenLlons
W MonlLor urlnary funcLlon
W revenL compllcaLlons
lnfecLlon sepsls resplraLory compllcaLlons fluld and
elecLrolyLe lmbalances flsLula formaLlon
W 8yle's Lube asplraLlon
W AmbulaLe qulckly
W MalnLaln perlsLomal lnLegrlLy
W 8elleve paln
W mprove body lmage
W Lxplorlng sexuallLy lssues
W 1reaL perlLonlLls
W Look for sLomal lschaemla and necrosls
W Look for sLomal reLracLlon and separaLlon
27
W neomycln kanamycln
W mmedlaLely afLer operaLlon caLheLer ln recLum Lo prevenL
reflux lnLo ureLers and lnfecLlon of Lhe newly formed ureLerlc
openlng lnLo Lhe lnLesLlnes
W MonlLorlng fluld and elecLrolyLes lnLesLlnal mucosa absorb
urlne waLer and elecLrolyLes dlarrhoea due Lo poLasslum and
magneslum malnLaln Lhe balance L advlsed Lo empLy Lhe
recLum every 2 hours Lo bulld up of pressure and Lhereby Lhe
absorpLlon of urlnary salLs
W 8eLraln Lhe recLum speclal sphlncLerlc exerclses learn Lhe
dlfferenLlaLe beLween Lhe need Lo defaecaLe and Lhe need Lo
urlnaLe
2
W romoLlng dleLary measures avold chewlng gum
smoklng
W SalL lnLake resLrlcLed Lo prevenL hyperchloremlc
acldosls oLasslum lncreased Lo make up for
poLasslum losL ln acldosls
W MonlLorlng and managlng poLenLlal compllcaLlons
pyelonephrlLls due Lo reflux of bacLerla from recLum
long Lerm anLlbloLlcs laLe compllcaLlon due Lo
lrrlLaLlon adenocarclnoma
29
Managlng osLomy appllance
W LmpLy Lhe pouch when 1/3 full Lo prevenL welghL pulllng
down
W A small amounL of urlne ls lefL Lo prevenL collapse of Lhe
bag agalnsL lLself
W 1he collecLlng boLLle and Lublng ls rlnsed wlLh cold waLer
dally and once ln a week wlLh a 31 soluLlon of waLer and
whlLe vlnegar
W ConLlnulng care look for meLasLases
30
W Look for leakage of urlne from Lhe appllance
W urlne pP ls kepL below 63 by admlnlsLraLlon of ascorblc acld
W Appllance Lo be flLLed properly Lo prevenL skln from geLLlng
lrrlLaLed by urlne
W f Lhe urlne ls foul smelllng CS done
W leal condulL mucosa mucus produced urlne geLs mlxed
wlLh mucus paLlenL encouraged Lo Lake loL of fluld Lo wash
ouL Lhe mucus
W Appllances reusable or dlsposable
W Skln barrler used Lo proLecL skln from urlne
31
romoLlng home and communlLy care
W 1each paLlenLs self care
W ConLrol odour food LhaL glves odour Lo urlne avolded eg Cheese eggs
W ueodorlzers or dlluLe whlLe vlnegar lnLroduced lnLo Lhe dralnage bag
W Ascorblc acldlfles suppresses odour
W Asplrln lnLroduced lnLo bag Lo deodorlze may cause ulceraLlon of Lhe sLoma
32
W Pome and communlLy care
W 1eachlng self care
W ConLlnulng care
uLure aspecLs
1 More Lhan 40 varlanLs of conLlnenL
dlverslon no slngle besL Lechnlque
2 Whlch bowel segmenL ?
3 Whlch conLlnenL Lechnlque ?
4 Whlch anLlreflux Lechnlque ?
Ooly looq tetm follow op coo ooswet tbese
poestloos