Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Mrs. Barbara Streisand, a 70-year-old woman, awoke in the middle of the night having a sudden urge to urinate and abdominal pain. While trying to void, she felt intense pain (dysuria) and could only manage to void little drops of urine. She also noticed that she had voided blood along with her urine (hematuria). Her husband rushed her to the hospital where she was diagnosed with Ureteropelvic Junction Obstruction (UPJ). She reported other symptoms such as back and flank pain. She has a history of multiple UTI exacerbations, depression and angina. She underwent Cystoscopy, Insertion of a Left Ureteral stent and Laparoscopic Left Pyeloplasty. The patient remains stable (BP 109/70, P 80/min, O2 sats 97%, R 16/min,
T 36.5) and is being monitored for signs of infection, bleeding, hernia, tissue/organ injury and urinary retention (post-op day #1-2). Jackson-Pratt and urinary catheter have been removed.
(http://urology.jhu.edu/MIS/lap_pyeloplasty.php#risks)
-Provide and clarify information on procedure
-Asses emotional and psychological state,reinforce coping strategies
-Reduce fear,anxiety,stress,pain,and vomiting
-Establish baseline data (vital signs)
-Identify any medication and herbs taken or any allergies to meds.
-Note if problems voiding and inform operative team
-Leg and foot exercises to avoid DVT
-Deep breathing and coughing (incentive spirometer)
-inform about drains,tubes,and catheter (bright red blood)
-Food and fluid restrictions (NPO)
-Shower and grooming night before
-Safety
-Positioning in bed
-Consent for surgery (POA)
By: Jannice Evangelista
Goodridge, D., Lewis, S. M., Goldsworthy, S., Barry, M., & Lewis, S. M. (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems. Toronto: Elsevier Canada.
A radiological bladder procedure in which material is instilled into the bladder. The purpose is to inspect the interior of the bladder and evaluate the vesicoureteral reflux (backward flow of urine from bladder into the kidneys) with a tubular lighted endoscope called a cystoscope.
The James Buchanan Brady Urological Institute
http://urology.jhu.edu/MIS/lap_pyeloplasty.php
-Monitor pain (question about the degree and characteristics, 0-10 scale)
-Pain medication via IV,PCA,or injection. (oral meds: moderate-severe eg.morphine)
-Shoulder pain (1-2 days) related to the carbon dioxide gas used to inflate abdomen during the laparoscopic surgery
-Airway,breathing,circulation (ABC)
-Check vital signs
-Assess surgical site (turn pt check for bleeding)
-Drains (prevent blood and fluid from building up around the kidney and pyeloplasty repair.drainage typically appears blood-tinged)
-Neurological assessment (LOC,PERLA)
-Coping strategies
-Asses catheter for patency (input and output)
-Deep breathing and coughing (incentive spirometer)
-Ambulation.Compression stockings (leg and foot exercises)
-Safety (side rails up,secure IV lines, drains)
-Positioning in bed (rewarming)
-Nausea and vomiting due to abdominal surgery
-Diet (clear liquids,ice chips, regular diet advance as tolerated)
-Constipation/Gas cramps (encourage to walk,suppositories,stool softeners)
-Fatigue for a few days after surgery
-Discharge:Pain control,showering,activity,follow up apt,stent follow up
- 70-year-old female
- Feeling depressed and fearful of her surgery
- Requires assistance with ADLs
-Rates 8/10 on a pain scale
- Abdominal, back and flank pain
- Excruciating pain while voiding
- History of multiple UTI exacerbation,depression and angina
Thin, flexible tube threaded into ureter to help urine drain from kidney to the bladder
Infection r/t
Surgical wound
- Alert, oriented x4, responds to questions appropriately but has slight latency in response
-Vitals: BP 109/70, P 80/min, O2 sats 97%, R 16/min, T 36.5
- Left upper abdominal dressing intact (saturated with serrou-sanguinous drainage)
-Tests done prior to surgery CBC,PT/PTT (Blood coagulation profile,Urinalysis
- Jackson-Pratt and urinary catheter have been removed.
Urinary Retention r/t Left Urethral trauma
Hello Dr. Castellano. My name is Jannice Evangelista. I am the LPN caring for Mrs. Streisand on 6North, Room 27, bed 4.
I am calling about her post-op urinary status. She seems to be retaining her urine as her output was 15cc in the last 2 hours.
Mrs. Streisand had a Cystoscopy, Insertion of a left Ureteral stent and Laparoscopic left Pyeloplasty yesterday afternoon. She is 70-years-old with a history of depression, angina and UTI. She is alert and oriented x4. She complains of feeling full and having the urge to void.
Vitals: BP 109/70, P 80/min, O2 sats 97%, R 16/min, T 36.5
Output: 15mL / 2 hours
Post-Void Residual: 600cc
I would like you to make an order for a Foley catheter in order to drain her bladder and for patient to be seen now.
Let me repeat back what you have said...
- Foley catheter
- Bladder scan
- You will be up to see the patients in 15 mins.
An operation used to correct a blockage or narrowing of the ureter where it leaves the kidney
Resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes identical to that of the open procedure.