Genito-Urinary b.

Urine culture & sensitivity – microorganisms (esp pus in the

Anatomy and Physiology urine)
A. Urinary System c. BUN & creatinine – elevated? (40 – 50% Renal insufficiency
1. Kidney before it would have a POSITIVE result)
a. Structure d. Creatinine Clearance – evaluates GRF and sensitive indicator
i. cortex (outer layer): glomeruli, proximal and distal of Renal function
tubules e. Vascular studies – renal scan, renogram, arteriography,
ii. medulla (middle layer): about eight renal pyramids venography, radiography, ultrasound, CT, IVP, cystoscopy
formed by collecting ducts and tubules and biopsy
iii. renal pelvis (innermost layer): composed of calyces 4. Nursing Process
where papillae move urine into the ureter by  Impaired Urinary Elimination
peristalsis  Infection
iv. nephron: functional unit that filters, concentrates,  Acute Pain
reabsorbs and secretes to produce urine  Deficient Knowledge
v. glomerulus: filters fluid wastes out of the blood  Disturbed Sleep Pattern
(plural: glomeruli)  Hyperthermia
vi. tubules (proximal, Henle's loop, distal): here fluid  Risk for Decreased Cardiac Output
is made into urine  Risk for Ineffective Protection
b. Function  Disturbed Thought Process
i. fluid and electrolyte balance  Risk for Impaired Skin Integrity
ii. acid-base balance: HPO4 buffer system, NH3  Risk for Impaired Oral Mucous Membrane
buffer system  Deficient Knowledge
iii. to regulate arterial blood pressure: renin,  Excess Fluid Volume
aldosterone  Acute Pain
iv. to excrete waste products: urea, creatinine  Impaired Renal Tissue Perfusion
production of erythropoietin  Impaired Urinary Elimination
v. urine formation and micturition  Imbalanced Nutrition: Less than Body Requirements
 Activity Intolerance
2. Ureters  Disturbed Body Image
a. convey urine from pelvis of kidneys to bladder  Anticipatory Grieving
b. consists of smooth muscle, moves by peristalsis  Risk for Infection
3. Bladder – stores urine  Risk for Injury
4. Urethra – duct that transmits urine from the bladder to the  Urinary Retention
exterior of the body during urination.  Acute Pain
B. Reproductive: male  Risk for Deficient Fluid Volume
1. Testes: main male sex glands  Fear/Anxiety
2. Each testis is encased in a fibrous capsule which has partitions  Deficient Knowledge
into the inner gland 5. Planning, Implementation, Evaluation
3. Seminiferous tubules form spermatozoa a. Provide pain relief
4. Interstitial cells secrete testosterone b. Promote measure to prevent infection
5. Accessory glands c. Promote measures to ensure adequate urinary elimination
a. seminal vesicles d. Promote measures to maintain F & E balance
b. prostate gland e. Adequate nutrition
c. bulbourethral glands secrete lubrication prior to f. Maintain skin integrity
ejaculation g. Enhance activity tolerance
6. Ducts
a. epididymis conducts semen from testes to vas deferens Benign Prostatic Hypertrophy
b. vas deferens conduct semen from each epididymis to an  The prostate gland is found just below the bladder in men,
ejaculatory duct surrounding the urethra. As men age, the prostate enlarges, putting
c. ejaculatory ducts pressure on the surrounding structures and causing symptoms such
d. urethra as changes in urinary stream, frequent urination and urinary
7. Scrotum retention. The enlargement of the prostate causes narrowing of the
8. Penis urethra and upward pressure on the lower border of the bladder.
C. Reproductive System: female Urinary retention may develop, as the body has a harder time
1. Ovaries emptying the bladder. Hydronephrosis and dilation of the renal
a. consist of graafian follicles in which ova develop pelvis and ureter are complications of the urinary retention due to
b. functions of ovaries: overgrowth of the prostate.
i. oogenesis Prognosis
ii. ovulation  The symptoms of benign prostatic hypertrophy (BPH) are the same
iii. secretion of progesterone and estrogen as those for prostate cancer. Important for the patients to have
2. Fallopian tubes – conduct ova from ovaries to uterus regular checkups to evaluate for risk of prostate cancer and conduct
3. Uterus functions in menstruation and pregnancy periodic screenings for prostate cancer. Renal function may be
4. Vagina – temporarily affected by hydronephrosis secondary to urinary
5. Vulva - retention.
Hallmark Signs and Symptoms
 Urinary hesitancy – difficulty initiating stream of urine due to
pressure on urethra and bladder neck
 Urinary frequency – need to urinate frequently owing to pressure
on bladder
 Urinary urgency – need to get to bathroom quickly to urinate
because of pressure on bladder
Nursing Process Overview  Nocturia – need to get up at night to urinate due to pressure on
1. Assessment – dysuria, hesitancy, flank pain, discharge, hematuria, bladder
incontinence, nocturia, and enuresis  Decrease in force of urinary stream
2. Physical Examination  Intermittent stream of urination or dribbling
3. Diagnostic Findings  Hematuria may be visible or microscopic
a. Urinalysis –color, opacity, odor, specific gravity, ketones, Common Test Results
(NO glucose, proteins, blood, and microbes)  Urography shows high  of post-void residual urine.
  Prostate-specific antigen (PSA) is usually elevated. It is Treatment
concerning if the PSA level increases by doubling (or greater)  Monitor renal function.
within a year.  Monitor electrolyte levels.
 Prostate ultrasound shows hypertrophy.  Monitor vital signs.
 Digital rectal exam reveals fullness of prostate and loss of median  Administer diuretics to remove excess fluids.
sulcus (midline groove between the two lateral lobes of the  Administer antihypertensive medication to control blood pressure.
prostate).  Monitor urinary output.
 Urinalysis may show microscopic hematuria.  Restrict fluid intake—measure output, intake should match 24-
 BUN & crea levels may , if renal function is impaired. hour output plus 500 cc.
Treatment  Dietary restriction of sodium (salt), fluids, potassium.
 Administer alpha1-blockers for symptom relief.  Plasmapheresis if due to autoimmune cause.
o doxazosin Nursing Diagnosis
o tamsulosin 1. Impaired urinary elimination
o terazosin 2. Excess fluid volume
 Monitor blood pressure; hypotension may be side effect of some Nursing Interventions
alpha1-blockers. 1. Monitor vital signs.
 Administer finasteride to relieve symptoms by shrinking prostate 2. Monitor intake and output.
gland. 3. Weigh daily.
 Monitor PSA levels periodically. Typical monitoring timeframe is 4. Assess respiratory system for lung sounds, difficulty breathing,
annual, more frequent if elevation is noted. crackles in lungs suggesting fluid overload.
 Monitor renal function. 5. Assess cardiovascular status, heart rate, heart sounds, or presence
 Surgical removal of portion of prostate tissue to relieve pressure. of S3 suggesting fluid overload.
 Continuous bladder irrigation postoperatively. 6. Assess extremities for edema.
 Administer antispasmodics for patients experiencing bladder 7. Explain to the patient: medications, disease process.
spasms.
Nursing Diagnosis Kidney Stones
1. Risk for impaired urinary elimination  also known as renal calculi or nephrolithiasis, occur within the
2. Urinary retention kidneys. Stones can also form elsewhere within the urinary tract.
3. Risk for urge urinary incontinence The patient may not have any symptoms from kidney stones until
Nursing Interventions the stone attempts to move down the ureter toward the bladder.
1. Maintain the three-port catheter postoperatively. One port is for Patients develop crystals within the urine. A slow flow of urine
irrigation, another is for drainage, and the third to inflate a balloon gives the crystals time to form a stone. Crystals may be formed
that holds the catheter in position from calcium, uric acid, cystine, or struvite. Medications such as
2. Monitor intake and output. thiazide diuretics can increase the risk of kidney stone formation in
3. Monitor vital signs for changes. some patients.
4. Monitor postoperative patient’s bladder irrigation: Prognosis
5. Monitor the amount of fluid instilled and returned and subtract the  A stone may lodge in the ureter blocking the flow of urine.
amount of fluid instilled from the amount returned to determine Hydronephrosis and swelling of the ureter may follow. Kidney
the actual urine output. stones typically recur, especially in those with a family history of
6. Document color of urine postoperatively; the greatest risk of nephrolithiasis.
hemorrhage is the first day after the operation. Hallmark Signs and Symptoms
7. Monitor for bladder spasms which may indicate blocked catheter  Hematuria
drainage postoperatively.  Unilateral spasms of pain in the flank area (renal colic). Pain may
8. Explain to the patient: be severe.
9. Avoid caffeine, alcohol, decongestants, anticholinergics which  Pain may radiate to lower abdomen, groin, scrotum, or labia
may increase symptoms of BPH.  Nausea, vomiting, and sweating associated with occurrence of
10. Proper home care of urinary catheter. pain
11. Monitor for signs of urinary tract infection.  Elevated blood pressure with pain
Common Test Results
 Urinalysis shows RBCs.
Acute Glomerulonephritis
 Ultrasound shows stones.
 also known as acute nephritic syndrome, is typically preceded by
 X-ray of kidneys, ureters, and bladder (KUB) shows stones.
an ascending infection or occurs secondary to another systemic
 CT scan shows stones.
disorder. Infectious causes include group A beta hemolytic
 MRI shows stones.
Streptococcus, measles, mumps, cytomegalovirus, varicella,
Treatment
coxsackievirus, pneumonia due to mycoplasma, Chlamydia psittaci,
 Provide pain relief.
or pneumococcal infection. Systemic disorders include systemic
 narcotics such as morphine
lupus erythematosus, viral hepatitis B or C, thrombotic
 non-narcotics such as ketorolac, a nonsteroidal anti-inflammatory
thrombocytopenic purpura, or multiple myeloma. Exposure to
drug (NSAID)
hydrocarbon solvents increases the risk of developing
 Administer antispasmodics as adjuncts for pain control.
glomerulonephritis.
 Increase fluid intake to 3 liters or more per day to flush through
Prognosis
the urinary tract.
 Depending on cause, acute episode may completely resolve.
 Lithotripsy—shock waves are used to break the stone into very
Patients should be monitored during the occurrence; signs of renal
small pieces that can pass more easily.
function need to be checked.
 Stent placement to allow free flow of urine and passage of small
Hallmark Signs and Symptoms
stones or stone pieces.
 Hematuria (urine may be dark, rust colored, or tea colored)
 Surgical removal of stone.
 Peripheral edema
Nursing Diagnosis
 Elevated Blood Pressure
1. Risk of impaired urinary elimination
 Oliguria
2. Acute pain
 N/V, Anorexia as renal function declines
Nursing Interventions
 Malaise, fatigue, anorexia, muscle aches
1. Monitor intake and output.
Common Test Results
2. Monitor pain level and response to pain medications.
 Urinalysis shows protein, RBCs, and red blood cell casts.
3. Strain urine to obtain stone for analysis in laboratory.
 Glomerular filtration rate will be decreased.
4. Explain to the patient:
 24-hour urine collection for protein will be elevated.
o Adequate fluid intake.
 BUN level will be increased.
o Medications used to reduce chance of recurrence.
 Serum albumin will be decreased.
 Renal biopsy to determine cause. o Dietary modifications needed based on content of stone.
 Pyelonephritis  In acute, kidneys start working following intensive treatment and
 an infection involving the kidneys. Inflammation of the tissue rectifying the underlying condition that caused the problem. In
accompanies the infectious process. The most common bacteria are chronic renal failure, the patient can die as a result complication of
Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, the disease.
and Staphylococcus saprophyticus. Typically, the infection begins Hallmark Signs and Symptoms
in the lower urinary tract and ascends upward. Identification of  Azotemia—elevated BUN and creatinine
infections and initiation of treatment is important to prevent the  If hypovolemic (prerenal), tachycardia, orthostatic hypotension,
infection from getting worse. dry skin,and mucous membranes
Prognosis  Weight loss owing to chronic disease
 Older patients and patients with co-morbidities have a greater  Abdominal bruit renal artery stenosis which may result in
chance of complications from pyelonephritis. Impaired renal ischemic nephropathy
function may complicate recovery in some patients. Septic shock  Peripheral edema with third spacing of fluids
may occur.  Decreased urinary output
Hallmark Signs and Symptoms  Uremic pruritis—see excoriations from scratching
 Flank pain (unilateral)  Anemia of chronic disease—kidneys produce erythropoietin
 Fever and chills due to infection Common Test Results
 Frequency, urgency, dysuria owing to urinary tract infection  Creatinine elevated.
 Nausea, vomiting, and diarrhea because of infection  BUN/creatinine ratio elevated.
 Increased heart rate due to fever  Urinalysis may show casts (hyaline or granular in acute prerenal;
 Costovertebral angle (CVA) tenderness RBC, WBC in renal), proteinuria.
Common Test Results  Glomerular filtration rate decreases in chronic disease. May not be
 Urinalysis shows leukocytes, bacteria, nitrites, and RBCs; may see symptomatic until GFR drops to below 70 ml per minute.
white blood cell (WBC) casts.  Creatinine clearance decreases.
Treatment  Renal ultrasound shows decrease in renal size in chronic renal
 Administer antibiotics to treat infection—intravenous or oral failure; dilation & fluid buildup in postrenal failure.
depending on severity of infection and co-morbidities of patient. Treatment – needs to address the underlying disease process. What will
o nitrofurantoin correct one cause may make another cause worse.
o ciprofloxacin  Administer intravenous fluids to correct hypovolemia.
o levofloxacin  Administer inotropic agents for CHF: cardiac output.
o ofloxacin  Administer antibiotics for pyelonephritis.
o trimethoprim-sulfamethoxazole  Stent placement or catheter (urethral, suprapubic, nephrostomy) to
o ampicillin allow for drainage of urine if blockage present.
 Dialysis.
o amoxicillin
 Administer erythropoietin to treat anemia.
 Administer antipyretics for fever.
 Restrict K, phosphate, sodium, and protein in diet.
 Administer fluids for dehydration dt vomiting & diarrhea.
 Administer phosphate binders:  phosphate levels.
 Administer phenazopyridine: relief of dysuria symptoms.
 Administer sodium polystyrene sulfonate to reduce potassium
 Repeat urine culture after complete antibiotic course.
levels.
Nursing Diagnosis
 Monitor electrolyte levels.
1. Impaired urinary elimination
 Control blood pressure.
2. Nausea
 Control blood glucose levels.
3. Hyperthermia
Nursing Diagnosis
Nursing Interventions
1. Impaired urinary elimination
1. Monitor vital signs.
2. Ineffective tissue perfusion (renal)
2. Monitor intake and output.
3. Fear
3. Assess abdomen for signs of bladder distention due to urinary
Nursing Interventions
retention.
1. Monitor VS for changes in heart rate or blood pressure.
4. Assess for pain in back.
2. Monitor intake and output.
5. Assess skin for signs of redness or breakdown if undergoing
3. Assess intravenous site for redness, swelling, or pain.
radiation treatments.
4. Check dialysis access site for signs of infection.
6. Assess for side effects of medication.
5. Check arteriovenous shunt (AV shunt) for thrill (palpable
7. Explain
turbulence of blood flow; gently feel for flow of blood through
8. Monitor for side effects of medications.
shunt) and bruit (audible turbulence of blood flow; listen with
9. Urine culture identifies organism.
stethoscope for sound of blood flow through shunt).
10. Sensitivity shows which antibiotics the organism is most
6. No contrast dye tests.
responsive to.
7. No nephrotoxic medication.
11. CBC shows leukocytosis.
8. Monitor patient very closely.
Renal Failure
Urinary Tract Infection
 A decrease in renal function can occur in an acute (sudden) or a
 occurs when an infecting organism, typically gram-negative
chronic (progressive) manner. Acute renal failure can be broken
bacteria such as E coli, enters the urinary tract. Inflammation of the
down into:
local area occurs, followed by infection as the organism
o Prerenal: result from diminished renal perfusion.
reproduces. Often the bacteria are present on the skin in the genital
 Hypovolemia due to blood or fluid losses
area and enter the urinary tract through the urethral opening. The
 diuretic use
organism can also be introduced during sexual contact. The
 third-spacing of fluids,
infection occurs as an uncomplicated, community-acquired
 reduced renal perfusion owing to NSAID use or CHF can
infection in this setting. Patients with a urinary catheter in place
cause prerenal failure
may also develop an infection due to the presence of the catheter
o Renal:
which allows a pathway for the bacteria to enter the bladder.
 acute care patients most commonly result from acute tubular Instrumentation of the urinary tract, e.g. cystoscopy, also allows a
necrosis. pathway for bacteria to enter the bladder. Some of the instruments
 Drug-related reactions, particularly to antibiotics, may cause are not completely sterilized between patients; they are treated with
an allergic interstitial nephritis. a high-level disinfectant due to fiberoptics and lenses within
 Pyelonephritis or glomerulonephritis may also cause renal because they would not withstand the high temperatures needed to
failure. sterilize. These infections would be considered nosocomial.
o Postrenal: due to some type of urinary tract obstruction, bladder Prognosis
outlet obstruction, stone, prostate hypertrophy, or compression of  Urinary tract infections that are identified are typically treated and
ureter because of abdominal mass. resolve. Some bacteria have become resistant to certain antibiotics,
Prognosis so testing the urine to be sure the infection has cleared after
 treatment is a good idea. Infections that are left untreated can  Cryosurgery – freezing of tissue w/ ultrasound guidance
progress and travel upward through the urinary tract to involve the  Watchful waiting—monitoring PSA and ultrasound depending on
kidneys or become a systemic infection or sepsis, especially in patient’s age and cell type of cancer and any co-morbidities
elderly or infirm patients.  Hormonal treatment to suppress natural androgen production
Hallmark Signs and Symptoms o leuprolide
 Frequency due to irritation of bladder muscles o goserelin
 Urgency owing to irritation of bladder muscles o estrogen
 Dysuria because of irritation of mucosal lining  Orchiectomy to reduce natural androgen production
 Feeling of fullness in suprapubic area Nursing Diagnosis
 Low back pain 1. Fear
Common Test Results 2. Impaired urinary elimination
 Urinalysis shows leukocytes, nitrites, and RBCs. 3. Pain
 Urine culture and sensitivity indicate the infecting organism and Nursing Interventions
the appropriate antibiotic to treat the infection. 1. Monitor VS, intake and output.
Treatment 2. Monitor pain level and response to pain medications.
 Administer antibiotics. 3. Strain urine to obtain stone for analysis in laboratory.
o nitrofurantoin 4. Assess abdomen for signs of bladder distention due to urinary
o ciprofloxacin retention.
o levofloxacin 5. Assess for pain in back.
o ofloxacin 6. Assess skin for signs of redness or breakdown if undergoing
o trimethoprim-sulfamethoxazole radiation treatments.
o ampicillin 7. Monitor for side effects of medications.
o amoxicillin 8. Explain to the patient:
 Encourage fluids, to make urine less concentrated. 9. Adequate fluid intake.
 Administer phenazopyridine for symptoms of dysuria. 10. Medications used to reduce chance of recurrence.
 Repeat urine testing after antibiotics are completed. 11. Dietary modifictns needed based on content of stone.
Nursing Diagnosis 12. Hematuria
1. Risk of impaired urinary elimination 13. Palpable nodule on digital rectal exam
2. Risk of urge urinary incontinence 14. Urinary retention owing to enlargement of the tumor blocking
Nursing Interventions flow of urine
1. Monitor intake and output. 15. Back pain as a result of metastasis
2. Monitor vital signs for changes, signs of fever.
3. Encourage fluid intake. Kidney Cancer
4. Encourage cranberry juice to acidify urine.  Occurs when cancer cells create a tumor within the kidney.
5. Explain to the patient: Exposure to chemicals, lead, and smoking all increase the risk of
6. Phenazopyridine will cause orange-colored urine. developing kidney cancer.
Prognosis
Prostate Cancer  Identification of renal cancer is integral to a favorable outcome.
 Cancer of the prostate typically is found in the peripheral area of Patients often have vague symptoms & may not seek health care
the prostate gland. Nodules may be palpable on digital rectal exam. until later in disease when cancer is well developed. Metastatic
There is a greater incidence as men age. Routine screening for disease has worst prognosis.
prostate cancer typically begins when males reach the age of 50. Hallmark Signs and Symptoms
African-American males and those with a family history of the  Weight loss (unintentional)
disease have a higher risk for prostate cancer and should begin  Anemia due to altered erythropoetin production
screening at an earlier age. The symptoms of prostate cancer are the  Hematuria (may be microscopic)
same as those of benign prostatic hypertrophy.   blood pressure owing to increase in renin production
Prognosis  Flank pain, dull or aching, occurs in less # of patients
 It is the most common cancer found in American males, and the Common Test Results
second leading cancer-related cause of death. The number of cases  CBC may show either anemia or erythrocytosis.
of prostate cancer found on autopsy is even higher than those found  Urinalysis shows RBCs.
clinically. Screening for prostate cancer has increased the number  Erythrocyte sedimentation rate (ESR) may be elevated.
of cases identified.  Ultrasound shows renal mass.
Hallmark Signs and Symptoms  CT scan with contrast shows renal mass.
 Urinary hesitancy—difficulty initiating stream of urine due to  MRI shows renal mass.
pressure on urethra and bladder neck  Assess respiratory system for lung sounds, difficulty breathing,
 Urinary frequency—need to urinate frequently owing to pressure crackles in lungs suggesting fluid overload.
on bladder  Assess cardiovascular status, heart rate, heart sounds, or presence
 Urinary urgency—need to get to bathroom quickly to urinate of S3 suggesting fluid overload.
because of pressure on bladder  Assess extremities for edema.
 Nocturia—need to get up at night to urinate due to pressure on  Explain to the patient:
bladder  About medications, disease process.
 Decrease in force of urinary stream Treatment
 Intermittent stream of urination  Surgical removal by nephrectomy
Common Test Results  Tumor destruction by radiofrequency ablation
 PSA elevates as tumor size increases.  Chemotherapy
 Digital rectal exam may reveal nodule. Nursing Diagnosis
 Transrectal ultrasound used to identify prostate cancer and 1. Fear
determine the stage. 2. Impaired skin integrity
 MRI to identify prostate lesions and involvement of surrounding 3. Risk of impaired urinary elimination
tissue or lymph nodes. Nursing Interventions
 Biopsy to identify cell type. 1. Monitor vital signs for changes.
 Alkaline phosphatase elevates with metastasis to bone. 2. Monitor intake and output.
Treatment 3. Monitor operative site for redness, swelling, and bleeding.
 Radiation therapy 4. Monitor pain level postoperatively.
 External beam 5. Hourly urine output monitoring for first 24 to 48 hours
 Brachytherapy – insert radioactive subs to prostate postoperatively. If bedside drainage bag is present, follow the
 Surgery—radical prostatectomy tubing up to see the site as multiple different drainage tubes can
 Chemotherapy drain urine (nephrostomy, urethral, suprapubic).
6. Monitor hemoglobin and hematocrit as scheduled.
 7. Monitor for signs of infection postoperatively.
Bladder Cancer
 Typically, a nonaggressive cancer that occurs in transitional cell
layer of the bladder. It is recurrent in nature. Less, bladder cancer is
found invading deeper layers of the bladder tissue. In these cases,
the cancer tends to be more aggressive. Exposure to industrial
chemicals (paints, textiles), history of cyclophosphamide use,
family history of nonpolyposis colorectal cancer, smoking,
advanced age, smoking and potentially the use of pioglitazone
increases the risks for bladder cancer.
Prognosis
 The more aggressive the cancer cell type, the greater the risk of
metastasis of the disease. Patients may have advanced disease at the
time of diagnosis. The
Hallmark Signs and Symptoms
 Fatigue – due to chronic process
 Hematuria – blood in urine, may be microscopic
 Change in urinary pattern – color, frequency, or amount
 Urinary urgency, dribbling
Common Test Results
 Urinalysis shows RBCs in urine.
 Cystoscopy to identify tumor site and obtain biopsy.
 Bladder biopsy shows cancer cell type.
 Urine cytology may show abnormal cells.
 CT scan shows metastasis or invasion of tumor.
Treatment
 Surgical removal of tumor.
 May be removal of superficial tumor from bladder wall with
transurethral approach; removal of part or entirity.
 If the entire bladder is removed, a stoma is created on the surface
of the abdomen or an ileal reservoir is created internally to collect
the urine.
 Instillation of bacilli Calmette-Guérin (BCG) into bladder to
decrease chance of recurrence.
 Radiation therapy.
 Chemotherapy.
Nursing Diagnosis
1. Risk of impaired urinary elimination
2. Disturbed body image
3. Fear
4. Powerlessness
Nursing Interventions
1. Monitor vital signs.
2. Monitor intake and output.
3. Document amount and color of drainage from all drains. If there is
a bedside drainage bag (or possibly two) follow the tubing to see
if it is urethral, suprapubic, or nephrostomy drainage. Record each
drainage source separately.
4. Monitor stoma for color, check adequate BF to tissue.
5. Mntr abdomen for bowel sounds, pain, and distention.
6. Monitor skin for signs of breakdown, redness.
7. Monitor for side effects of medications.
8. Maintain the three-port catheter postoperatively. One port is for
irrigation, another is for drainage, and the third to inflate a balloon
that holds the catheter in position
9. Monitor postoperative patient’s bladder irrigation.
10. Monitor the amount of fluid instilled and returned and subtract the
amount of fluid instilled from the amount returned to determine
the actual urine output.
11. Document color urine postoperatively; the greatest risk of
hemorrhage is the first day after the operation.
12. Monitor for bladder spasms which may indicate blocked catheter
drainage postoperatively.
13. Explain to the patient:
o Proper skin care postoperatively.
o Catheterization of ileal reservoir if needed.
o Avoid caffeine, alcohol, decongestants, anticholinergics: may
increase symptoms of BPH.
o Proper home care of urinary catheter.
o Monitor for signs of urinary tract infection. more advanced
the disease at the time of diagnosis and the more aggressive
the tumor, the greater the risk of death for the patient.