-
Obstructive Disorder:
- -Problems of urine outflow obstruction
- -RAPID DX IS ESSENTIAL
- -Damage can occur as early as 48 hours in some and after several weeks in others, depending on the patients underlying kidney health
- -Blood vessels and renal tubules can be damaged extensively
-
Assessment
- -Obtain a good hx
- -Inspect each flank to identify assymmetry
- -Gently palpate the abdomen to locate areas of tenderness
- -Palpate the bladder to asses distension (or use bladder scanner)
- -Gentle pressure on the bladder may cause urine leakage indicating an obstruction
- -UA may show baceteria or WBC if infection is present
-Blood creatinine and BUN increase w/ decreased GFR
-
Interventions: Urologic
- -If stone is causing the problem the obstruction the stone can be located and removed using a cystoscope
- -A stent may also need to be placed to increase urine flow in the area irritated by the stone- it will be removed a few weeks later by another cystoscopic procedure
-
Interventions: Radiologic
- -When hydronephrosis cannot be corrected by urologic procedures a nephrostomy is performed
- -This procedure diverts urine externally and prevents further damage to the kidney
- Pre-op:-If possible keep the pt NPO for 4 to 6 hours before the procedure
- -INR, PT, and PTT should be normal or correctied
- -Pt receives moderate sedation for the procedure
- Procedure:
- -Prone position
- -A needle is placed into the kidne, a soft tipped guidewire is placed through tht needle, and then a catheter is placed over the wire
- -The catheter tip remains in the renal pelvis and the external end is connected to a drainage bag
- -The procedure immediatley relieves pressure in the kidney system and prevents further damage
- -The nephrostomy tube remains in place until the obstruction is resolved
- Follow-Up Care:
- -Assess the amount of drainage in the collection bag
- -The amount of drainage depends on if a ureteral catheter is also being used
- -If the amount of drainage decreases and the patiend has back pain, the tube may be clogged or dislodged *Notify the physician ASAP
- -Monitor the nephrostomy site for leaking urine or blood *if either occurs notify the physician ASAP
- -Urine drainage may be red-tinged the first 12 to 24 hours and should gradually clear
- -Assess the pt for manifestations of infection, including fever or change in urine character
|
|
