Term
| renal cysts and benign tumors |
|
Definition
| READ DIAGNOSIS & TREATMENT IN TEXTBOOK |
|
|
Term
| how are renal cysts and benign tumors found? |
|
Definition
by accident; many pts have no residual effects
*can drain or they go away |
|
|
Term
|
Definition
| malignant tumors of the kidney |
|
|
Term
| frequency of renal cell carcinoma |
|
Definition
| twice as frequent in men, age 50-70 |
|
|
Term
| most significant risk factor in renal cell CA |
|
Definition
cigarette smoking
*asbestos, gasoline, phosphate, lead, and cadmium exposure increase risk |
|
|
Term
| s/s of renal cell CA and when they occur |
|
Definition
occur late
*flank pain-dull, aching
*palpable renal mass
*gross hematuria (very late) bright red flecks, smoky cola colored
*generalized weakness, muscle wasting, poor nutrition, weight loss, |
|
|
Term
| telltale signs of renal cell CA |
|
Definition
palpable renal mass
gross hematuria that is smoky cola colored |
|
|
Term
| treatment of choice for renal cell CA |
|
Definition
|
|
Term
| treatments for renal cell CA |
|
Definition
#1 nephrectomy
also, radiation for metastasis or palliative
biological therapy |
|
|
Term
| does chemo help renal cell CA |
|
Definition
|
|
Term
| EXAMPLES OF BIOLOGICAL THERAPY for renal cell CA |
|
Definition
| interleukin 2 or alpha interferon |
|
|
Term
| review ROBSONS system of staging renal cell carcinoma in TEXTBOOK |
|
Definition
|
|
Term
|
Definition
the most common primary malignant renal tumor in infants and children
*autosomal dominant=inherited |
|
|
Term
| peak age of diagnosis of wilm's tumor |
|
Definition
| 3 years but can occur in adolescents and adults |
|
|
Term
| Why do children who have unknown wilm's tumor end up seeing the doctor? |
|
Definition
| abdominal swelling or mass found while bathing |
|
|
Term
| treatment for wilm's tumor |
|
Definition
start immediately
*central line for pre-surgical chemo
*nephrectomy then
*follow up chemoa (6-15 mo) |
|
|
Term
| TWO VERY IMP THINGS TO REMEMBER WITH WILMS TUMOR.... |
|
Definition
1. DO NOT PALPATE THE ABD OF A CHILD WITH WILMS TUMOR->SEEDING (stop palpating if find mass while assessing a child
2. PROTECT REMAINING KIDNEY = no contact sports, s/s of urinary problems |
|
|
Term
| when do you perform a nephrectomy |
|
Definition
| renal tumors, polycystic kidney disease, major renal trauma, organ donation |
|
|
Term
|
Definition
jack knife position=lateral, side lying position) *may be sore
*protect remaining kidney from trauma/infection |
|
|
Term
|
Definition
incision
*may remove 12th rib
*JP drain placed to drain |
|
|
Term
| what is removed with nephrectomy |
|
Definition
| kidney, adrenal gland, renal artery and vein, ureter, surrounding fat |
|
|
Term
| in a radical nephrectomy.... |
|
Definition
| surrounding lymph nodes are removed too |
|
|
Term
| postop care for nephrectomy |
|
Definition
hourly i&o
impaired breathing
abd distention
drain care
risk for infection
pain
risk for hypotension rt positioning, kidney removal |
|
|
Term
| how do you know if hypotension is from bleeding? |
|
Definition
| UOP will be immediately decreased |
|
|
Term
| nephrectomy can cause hemorrhage/adrenal insufficiency leading to what diagnosis |
|
Definition
|
|
Term
| how do you know if hypotension is from adrenal insufficiency? |
|
Definition
| large UOP followed by hypotension |
|
|
Term
| treatment for hypotension |
|
Definition
| steroid replacement therapy/replacement iv fluids |
|
|
Term
| do not....after nephrectomy |
|
Definition
| clamp or irrigate urinary catheter |
|
|
Term
| urine output and nephrectomy |
|
Definition
*assess uop every hour
*special care for 24-48 hours to monitor uop and adrenal problems |
|
|
Term
| why impaired breathing pattern with nephrectomy |
|
Definition
*cut through muscles; maybe removed rib
*painful to cough and deep breathe
*teach splinting and IS
*@risk for atelectasis and pneumonia |
|
|
Term
| what causes abdominal distention after nephrectom? |
|
Definition
paralytic ileus c/b manipulation and compression of bowel=no bs, vomiting bile
c/b internal bleeding= loc, decreased uop
*may bleed externally |
|
|
Term
| miscellaneous care for nephrectomy |
|
Definition
drain care=take care of skin
antibiotics=prophylaxis
pca or epidural for pain |
|
|
Term
|
Definition
can be used with organ donation
cant be used with diseased kidney
5 puncture sites |
|
|
Term
| what is needed for laparoscopic nephrectomy? |
|
Definition
| special OR suite and special training...don't want to damage kidney |
|
|
Term
|
Definition
| men 2-4x more often than women, age 60-70 |
|
|
Term
| risk factor for bladder tumors |
|
Definition
cigarettes a HUGE risk factor
*also dyes in rubber, cable, paint, electric, textile |
|
|
Term
| bladder tumors are a ____ ____ ____ |
|
Definition
| highly recurrent problem;long term surveillance is important |
|
|
Term
| how are bladder tumors staged? |
|
Definition
by depth of invasion of bladder wall=does it break thru wall and invade adjacent tissue
*stage determines the way it is treated |
|
|
Term
| classifcation system for bladder tumors |
|
Definition
| jewett-strong-marshall classification classifies bladder cancers as superficial, invasive, or metastatic |
|
|
Term
| assessment findings of bladder CA |
|
Definition
gross, painless hematuria=most common
*dyrsura, frequency, urgency if infection/obstruction
*cytology
*US, CT, MRI, IVP
*cystoscopy with biopsy to confirm and stage |
|
|
Term
|
Definition
| intravenous pyelogram-xray of kidneys, ureter, urinary bladder |
|
|
Term
|
Definition
radiation
chemo=rarely curative
intravesical therapy
surgical tx (depends on stage) |
|
|
Term
|
Definition
| for superficial CA; instill chemo agents into bladder with catheter; retain for 2 hours; reposition every 15 min |
|
|
Term
| surgical treatments of bladder CA |
|
Definition
*transurethral resection (TUR)
*laser photocoagulation
*open loop resection
*partial cystectomy
*complete cystectomy |
|
|
Term
|
Definition
transurethral resection with electrocautey
*destruction of the tissue by electrical current through electrodes placed in direct contact with growth. may need bladder irrigations |
|
|
Term
| continuous bladder irrigation |
|
Definition
|
|
Term
|
Definition
zap malignant tissue
used for superficial lesions no blood |
|
|
Term
| open loop resection with fulguration |
|
Definition
| snares the polyps and cauterize remaining tissue |
|
|
Term
| post op teaching for surgical treaments for bladder CA |
|
Definition
drink fluids, i&o, avoid etoh, pain control
teach routine cystoscopies to detect regrowth of tumors |
|
|
Term
| segmental/partial cystectomy |
|
Definition
only portion ofbladder with tumor is removed
take up to 1/2
60 mL after surgery but stretches to 20-400 in a few mos |
|
|
Term
| problem with segmental cystectomy |
|
Definition
| bladder distention with leaking/rupture of bladder |
|
|
Term
|
Definition
used for invasive tumors or tumors near ureters
requires urinary diversion |
|
|
Term
|
Definition
remove bladder, prostae, seminal vesicles in men
remove uterus, cervix, urethra, ovaries, fallopian tubes in women |
|
|
Term
| complete cystectomy care (pre, intra, post) |
|
Definition
preop=ET nurse, help with pt teaching about stoma care
INTRAOP=entire bladder removed, ureters diverted
post op=care of diversion, post op care after major surgery
complications ususally big (surgery is 5-7 hours)=gut,clots,skin,breathing |
|
|
Term
|
Definition
*ileal conduit
*kock pouch
*orhotopic bladder substitutions
*nephrostomy tubes
*ureterostomy |
|
|
Term
| most commonly performed incontinent urinary diversion |
|
Definition
|
|
Term
|
Definition
*most common incontinent urinary diversion
*segment of intestine used to construct a system in which urine is imptied through stoma
*usually section of terminal ileum
bowel anastomosized
*ureters are implanted into ileal segment, urine expelled by peristalsis
APPLIANCE REQUIRED |
|
|
Term
| complications of ileal conduits |
|
Definition
obstruction or ureter and ileal anastomosis
phelonephritis
stenosis
leakage
hydronephrosis
calculi
peristomal hernia or skin problems |
|
|
Term
|
Definition
*maintain urine output (lots of fluid)
*stoma care=red and moist, urine asap
*mucus in urine(secreted by intestines bc of irritation) |
|
|
Term
| ph of urine in ileal conduit |
|
Definition
| urine is alkaline and can create amonia salt encrustations...KEEP URINE ACID, KEEP APPLIANCE IN PLACE |
|
|
Term
| review care of ileal conduit in textbook |
|
Definition
know how to care for and change appliance
table 46-24 in text |
|
|
Term
|
Definition
continent reservoir for the urine so patient does not need an appliance
*created from segment of ileum and ascending colon
ureters implanted
patient must catheterize and irrigate reservoir on rigid schedule |
|
|
Term
| complications of koch pouch |
|
Definition
obstruction
difficulty cathing
urinary reflux
bateriuria
stones |
|
|
Term
| what could happen if patient does not adhere to cath schedule in koch pouch |
|
Definition
|
|
Term
| orthotopic bladder substitution |
|
Definition
aka neobladder
*portion of intestine is used to create a new bladder
*ureters and urethra are attached to it
"relax sphincter, contract abs" |
|
|
Term
| complications from neobladder |
|
Definition
urinary incontinence from urethra or sphincter problems
*if can not empty bladder, may need to do self catheter |
|
|
Term
|
Definition
catheter inserted into renal pelvis and allows urine to drain from kidney to collection device
*treat like foley cath =no kinds, DONT CLAMP,
*IRRIGATE with sterile saline nor more than 5 mL
**picture person with tubes down back of legs |
|
|
Term
|
Definition
ureters are attached to surface of the abd where the urine flows directly into a drainage appliace
NO CONDUIT
infection,obstruction, skin probs
*wear appliance with this |
|
|
Term
|
Definition
stents extend through ureters and through rservoir, conduit, or neobldder
TO KEEP PATENT |
|
|
