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PREOPERATIVE
CONSIDERATIONS
Evaluasi
fungsi ginjal
Meningkatkan asupan cairan
mengeluarkan toksin sebelum
pembedahan
Jika terjadi infeksi ginjal antibiotik
spektrum luas
Laboratorium koagulasi: prothrombin
time, partial thromboplastin time,
platelet count
Education
Kecemasan
Membangun
PERIOPERATIVE
CONCERNS
Posisi
Selama
pembedahan
rencanakan untuk
manajemen
drainase urin
rencana: insersi
nefrostomi atau
selang drainase
atau ureteral
stents
POSTOPERATIVE
MANAGEMENT
Hemorrhage
and shock
Fluid and blood component replacement is
frequently necessary in the immediate
postoperative period to treat intraoperative
blood loss
Abdominal distention and paralytic ileus
If infection occurs, antibiotic agents are
prescribed after a culture reveals the causative
organism
Low-dose heparin therapy may be initiated
postoperatively to prevent thromboembolism in
patients who had any type of urologic surgery
Drainage Tubes
Almost
All
patent
must be kept
Nephrostomy Drainage
Nephrostomy
Jenis
Percutaneous
Nephrostomy Tube
(PNT)
PNT adalah sistem pengeluaran
urine dengan kateter yang
dimasukkan dalam ginjal (nephron).
Pemasangan PNT dilakukan secara
invasif diruang operasi.
Nephro-Uretero Stent (NES)
NES adalah sistem pengeluaran
urine dengan menggunakan kateter
Percutaneous Nephrostomy
Tube
Nephro-Uretero Stent
Permanent
nephrostomy tubes ,
..seharusnya
diganti setiap 3
bulan
Before procedure
Broadspectrum
antibiotic mencegah
infeksi
Koreksi: hipertensi dan adanya resiko
perdarahan
Anticoagulant agents dan aspirin harus
dihentikan dan pemeriksaan prothrombin
time, partial thromboplastin time, platelet
count harus dalam kondisi normal /
menurun untuk mencegah perirenal
hematoma atau renal hemorrhage.
Procedure
Anastesi
area kulit
Minta pasien tarik nafas dalam ketika jarum
ditusukkan dalam renal pelvis
Aspirasi urin untuk kultur dan suntikan
kontras ke dalam pyelocalyceal system.
Kateter angiographic wire memandu jarum
untuk masuk dalam ginjal
Selang neprostomi masuk dalam ginjal atau
ureter
Fiksasi dengan cara jahit kulit dan terhubung
dengan sistem drainase tertutup
Ureteral Stents
A
The
Indikasi
Relief
Procedure
Under
Stent Removal:
Remove
The
Jenis stent
Double pigtail
Assessment
assessment of all body systems
respiratory and circulatory status
pain level
fluid and electrolyte status
patency and adequacy of urinary
drainage systems
RESPIRATORY STATUS
risk of respiratory
complications
Respiratory status is assessed by monitoring
the rate, depth, and pattern of respirations.
The location of the incision frequently causes
pain on inspiration and coughing; therefore,
the
patient tends to splint the chest wall and
take shallow respirations.
Auscultation is performed to assess normal
and adventitious breath sounds
Anesthesia
PAIN
Postoperative
URINARY DRAINAGE
Urine
NURSING DIAGNOSES
Ineffective
COLLABORATIVE PROBLEMS/
POTENTIAL COMPLICATIONS
Bleeding
Pneumonia
Infection
Fluid
heat
Analgesic medications provide relief.
Patient-controlled analgesia may be
effective in controlling pain and
enabling the patient to ambulate,
cough, and breathe deeply
Strict
Bleeding
The
Bleeding
Pneumonia
Incentive
Fluid imbalanced
Fluid
Evaluasi
Achieves effective airway clearance
Exhibits
Reports progressive
decrease in pain
Requires
analgesic medications at
less frequent intervals
Turns, coughs, and takes deep
breaths as suggested
Ambulates progressively
Tubes
Exhibits
Experiences no complications
Demonstrates