-
Ureterostomies
divert urine directly to the skin surface through a ureteral skin opening (stoma); must wear a pouch
-
Cutaneous
one ureter one stoma
-
Cutaneous ureteroureterostomy
one kidney joined to the other and one stoma
-
Bilateral cutaneous ureterostomy
two ureters, two stomas
-
Conduits
collect urine in a portion of the intestine which is then opened onto the skin as a stoma; must wear pouch
-
Ileal conduit
at the top of small/lg intestine; oldest and most common
-
Colon conduit
more down towards large intestine
-
Sigmoidostomies
divert urine to the lg intestine so no stoma; excretes urine with poop and bowel incontinence may result
-
Ileal reservoirs
divert urine into a surgically created pouch that functions as a bladder; stoma is continent; client removes urine by regular self cath
-
Pt education prior to surgery for ileal conduit
select stoma site; make sure pt understands there will be stoma
-
Complications or ileal conduit
wound infection, wound dehiscence, urinary leakage, ureteral obstruction, small bowel obstruction, ileus, stomal gangrene
-
Nursing considerations for ileal conduit
promote urine output, stoma care, ostomy and skin care, encouraging fluids, relieving anxiety, teaching stoma and appliance care
-
Urinary diversions nursing considerations
monitor drains for patency, amount and type of drainage, skin integrity, body image, sexuality issues, monitoring for potential complications, post up similar to ileal conduit
-
Incisional approaches
flank, lumbar, thoracoabdominal
-
Renal transplant
treatment of choice for ESRD; elective-not emergency; success rate increases survival with a living related donor before dialysis is initiated
-
Renal transplant contraindications for candidate selection
active or chronic infection, severe irreversible extra-renal disease, recent malignancy, autoimmune disease, morbid obesity, current ETOH abuse, HX of nonadherence, severe psychosocial problems
-
Donor selection
matched on tissue type, blood type, antibody screening; absence of systemic disease or infection; no history of cancer; no HTN or kidney disease; adequate renal functioning
-
Kidney transplantation
adrenal gland remains intact; renal artery and vein tied off; donor kidney cradled in ilium; renal artery sutured to iliac artery and renal vein sutured to iliac vein; ureter sutured
-
Complications of renal transplant
organ rejection (most common and most serious); infection; bleeding, DVT, thrombosis of major renal vessels
-
Immunosuppressive drug therapy
glucocorticoids, cyclosporine, Tacrolimus (Prograf-100 times more potent than cyclosporine), Sirolimus (Rapamune)
-
Post op nursing management for renal transplant-assessment
all body systems, pain, fluid and electrolyte, patency and adequacy of urinary drainage system
-
Potential nursing dx post renal transplant
ineffective airway, ineffective breathing, acute pain, fear and anxiety, impaired urinary elimination, risk for fluid imbalance
-
Post operative renal transplant interventions
pain relief, promote airway clearance and effective breathing pattern, monitor urine output and maintain patency of urinary drainage systems; strict asepsis with catheter, s/s of bleeding, leg exercises and early ambulation to prevent DVT
-
Renal transplant education post op
pt and family, drainage care system, strategies to prevent complications, s/s of complications, follow up care, fluid intake, health promotion and screening
|
|