Health History Signs and Symptoms: Dyspnea Acute onset: pneumothorax, acute respiratory obstruction or ARDS.

. Post surgery dyspnea: pulmonary emboli. Cough Type, character and time: Dry irritative cough: URTI of viral origin Irritative high pitched cough : Laryngotracheitis Brassy cough: Tracheal lesions Severe changing cough: Bronchogenic CA Cough with pleuritic chest pain : pleural or chest wall involvement worsens in supine position: Sinusitis Coughing at night: Left CHF or bronchial asthma Morning cough with sputum: Bronchitis Coughing after food eating: Possible aspiration Health History Sputum Production: The presence of infection or disease and its causative microorganism can be determined by its amount, color and consistency: Purulent Sputum : Bacterial infection Increase amount over time : Chronic bronchitis or bronchiectasis Pink-tinged mucoid : Lung tumor Pink-tinged frothy : Pulmonary edema Foul smelling sputum : Lung abscess, bronchiectasis, infection Chest Pain: Pain related to pulmonary conditions: sharp, stabbing & intermittent or dull, aching and persistent. Occurs with pneumonia, pulmonary embolism with lung infarction & pleurisy. Late symptom of bronchogenic CA Wheezing Clubbing of the fingers Hemoptysis Cyanosis PHYSICAL EXAMINATION Upper & Lower Respiratory Structures: Nose & sinuses Pharynx & mouth Trachea Thorax Chest Configuration: Funnel chest (Pectus excavatum) Pigeon chest (Pectus carinatum) Barrel chest Kyphoscoliosis Breathing Pattern -Rate, regularity, depth Palpation -Chest excursion, tactile fremitus, chest wall pain, position of trachea

Thoracic Percussion: -Dull & flat : Consolidation / tumor -Hyperresonance : Trapped air Auscultation: Crackles Rhonchi Wheezes Diagnostic Evaluation Cultures Sputum Studies Pulmonary Function Test ABG Studies Radioisotope Diagnostic Procedures (Lung Scans) -Perfusion Scan -Ventilation Scan Endoscopic Procedures -Bronchoscopy -Thoracoscopy Thoracentesis Biopsy General Nursing Care for Patients with Respiratory Disorders Prevention of infection and spread of infection Maintain patent airway Promote comfort / provide comfort measures Promote communication Encourage fluid intake UPPER RESPIRATORY TRACT DISORDERS Common Cold -An afebrile, infectious, acute inflammation of nasal cavitys mucus membranes. Signs & symptoms: Nasal congestion, malaise Sore throat Sneezing, chills Teary, watery eyes Headache and muscle ache Management; Symptomatic treatment Increase fluid intake Warm salt water gargles for sore throat. Instruct patient to cover mouth & nose while sneezing & dispose tissue or solid articles properly. Sinusitis -Inflammation of sinuses as a result of URTI or allergic rhinitis. Signs & symptoms: Pressure & pain over sinus area. Purulent nasal secretions. Chronic hoarseness, headache and facial pain. Management: Antimicrobials & decongestants. *Give information about adverse effects of nasal decongestant sprays and rebound congestion.

UPPER RESPIRATORY TRACT DISORDERS Rhinitis Infectious, allergic, or non-allergic inflammation of the mucous membranes of the nose. Management: Antimicrobials, desensitizing immunizations, corticosteroids. Avoidance of causative substances. Pharyngitis -A febrile inflammation of the throat usually caused by group A streptococcus (Strep throat) Signs & symptoms: Fiery-red pharyngeal membrane & tonsils. Swollen & exudative lymphoid follicles. Enlarged and tender cervical lymphnodes. Fever, malaise, sore-throat, hoarseness, cough, rhinitis. Management: Antimicrobials, analgesics and antitussives. Ice packs to relieve sore throat. Upper Respiratory Tract Disorders Tonsilitis & Adenoiditis -Caused by group A streptococcus Signs and symptoms: Sore throat & fever Snoring, dysphagia Mouth breathing, earache, draining ears, frequesnt colds, noisy respiration, nasal obstruction. Management: Tonsillectomy / adenoidectomy Post-op: report if patient vomits large amount of bright red blood or shows signs of bleeding. Post-op: turn head to side to drain secretions from mouth & pharynx. Post-op: Observe for frequent swallowing. Give cold water & ice chips to help prevent bleeding. Laryngitis -Inflammation of larynx as a result of voice abuse or exposure to dust, chemicals, smoke & other pollutants. Signs & symptoms: Aphonia. Persistent hoarseness Management: Antibacterials & topical corticosteroids inhalation Rest voice, avoid irritants Maintain a well-humidified environment OBSTRUCTION & TRAUMA: UPPER AIRWAY Sleep Apnea Syndrome -Cessation of respiration during sleep Signs & symptoms: Excessive daytime sleepiness Morning headache Sore throat Snoring Impotence Intellectual deterioration Management: Avoid alcohol, lose weight CPAP or positive airway pressure therapy with supplemental O2 via nasal cannula.

Ovulopalatopharyngoplasty Tracheostomy if lifethreatening Protriptyline, medroxyprogesterone acetate, acetazolamide Education & psychological support Epistaxis -Nosebleeding Management: First aid: Apply direct pressure Silver Nitrate gelfoam, electrocautery Topical vasoconstrictors; Suction can remove excess blood & clots Nasal packs Antibiotics for risk of developing sinusitis & toxic shock syndrome Monitor vital signs Provide tissues & emesis basin. Reassurance & allay anxiety UPPER RESPIRATORY TRACT DISORDERS Nasal Obstruction -Caused by deviation of septum, hypertrophy of turbinate bones, or nasal polyps Signs & symptoms: Swelling within nose Deformity Pain in region of affected sinus Management: Removal of obstruction: endoscopic surgery, septoplasty, polyp clipping, astringent application for hypertrophied turbinates. Elevate head of bed to promote drainage. Oral hygiene Fractures of the Nose Diagnostics: X-ray Dipstick test for suspected fracture of cribform plate. Management: Cold compress for bleeding Ice packs 20 min. 4X a day to decrease swelling. Reduction of fractures 7-10 days after injury. Assess symmetry. Oral hygiene (mouth rinses). UPPER RESPIRATORY TRACT DISORDERS Laryngeal Obstruction -Swelling of larynx which may lead to suffocation. Causes: Acute laryngitis, urticaria, scarlet fever, foreign body aspiration. Signs & symptoms: Croupy cough Blood & mucus expectoration Labored breathing Signs of choking with foreign body aspiration Management: Edema; Epinephrine, corticosteroid, icepack Foreign body: manual removal or heimlich maneuver. LOWER RESPIRATORY TRACT DISORDER Chronic Obstructive Pulmonary Diseases (COPD):

Chronic Bronchitis Emphysema Asthma Predisposing factors: Cigarette smoking Air pollution Occupational exposure Heredity Infection & allergies Effects of aging Harmful drugs & chemicals Signs & symptoms: Dyspnea, cough Shallow, rapid respirations Activity intolerance Weight loss Signs of respiratory insufficiency Signs of infections Reduced VC & FEV Management: Inhaled bronchodilators O2 therapy (1-2 L) Pulmonary rehabilitation Smoking cessation Diaphragmatic breathing Pursed lip breathing Inspiratory muscle training CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic Bronchitis -Inflammation of the mucous membranes of the tracheo-bronchial tree. Signs & symptoms: Persistent productive cough for 3 months for two consecutive years. Reduced chest expansion Wheezing Fever / Dyspnea Diminished exercise tolerance Management: Bronchodilators / corticosteroids / antibiotics Postural drainage & chest percussion Provide comfort measures Encourage increased fluid intake Chronic Obstructive Pulmonary Disease Emphysema -Abnormal enlargement of air spaces distal to terminal bronchioles with destruction of alveolar walls Signs & symptoms: Dyspnea, cough, wheezing, occasional fever Tachypnea with prolonged expiration Barrel chest / pursed lip breathing Activity intolerance Hyperresonance & decreased fremitus Jugular vein distention Hypercapnia / hypoxemia Increased total lung capacity / residual volume Management: Bronchodilators

Corticosteroids Antimicrobials O2 therapy Pulmonary rehabilitation Smoking cessation Lung volume reduction surgery / Transplant Provide comfort & psychological support CHRONIC OBSTRUCTIVE PULMONARY DISEASE Asthma -Chronic, relapsing inflammatory disorder of the bronchial airway characterized by periods of bronchospasms with accompanying edema. Signs & symptoms: Orthopneic positon during attack Wheezing, non-productive cough, prolonged expiration, tachycardia, tachypnea Management: Corticosteroids, bronchodilators, leukotriene modifiers, anticholinergics Peak flow monitoring Instruct on oral hygiene after medication administrations Bronchiectasis -Chronic irreversible abnormal dilatation of bronchi with impaired drainage of bronchial secretions due to repeated damage to bronchial walls leading to persistent infection of the affected segment or lobes Signs & symptoms: Chronic, wet cough with abundant, foul-smelling purulent sputum Hemoptysis Recurrent fever & chills, fatigue, malaise Anemia, weight loss Occasional wheezing sound Dyspnea, sinusitis, clubbing of fingers Management: Anti-microbials, bronchodilators, beta-adrenergics Vaccination for influenza Atelectasis -Incomplete expansion or collapse of parts of or a whole lung. May be secondary to surgery, immobility, metastasis & chronic obstruction of airway. Signs & symptoms: Productive cough Dyspnea, tachycardia, tachypnea, pleural pain, central cyanosis Dyspnea in supine position Decreased breath sounds & crackles X-ray reveals patchy or consolidated areas Management: PEP & IPPB Nebulizer with bronchodilators Endotracheal intubation & mechanical ventilation Thoracentesis, bronchoscopy with cryotherapy or lazer therapy Encourage early ambulation post operatively Implement use of incentive spirometry Deep breathing & coughing exercises Cheat physiotherapy & turning q 2 hours Suction PRN

RESPIRATORY INFECTION Pulmonary Tuberculosis -Communicable disease caused by Mycobacterium tuberculosis. Transmitted through inhalation of airborne droplets. Signs & symptoms: Low grade fever, cough & night sweats. Fatigue, weight loss, non-productive cough, mucopurulent sputum Hemoptysis Chest x-ray lesions AFB (+) Management: Rifampicin, INH, PZA, ethambutol, streptomycin for 6-12 mos. Vitamin B6 Prevent transmission Instruct patient to take medications with empty stomach or 1 hour before meals Patients taking INH should avoid foods high in tyramine. Inform patient that rifampicin may turn body secretions dark yellow to orange. RESPIRATORY INFECTION Pneumonia -Inflammatory process of lung parenchyma associated with marked increase in interstitial and alveolar fluid caused by microorganisms. Signs & symptoms: Fever, chills, sweats, pleuritic chest pain Orthopnea, dyspnea Productive cough Headache or fatigue Crackling breath sounds Increased tactile fremitus over consolidated areas Chest X-ray reveals consolidations, infiltrates or pleural effusion Rapid tissue necrosis in lungs with cavity formation Management: Antibiotic therapy Antipyretic, antihistamines & decongestants Warm, moist inhalations Monitor ABG Monitor signs of hypoxia & hypercapnia Assess for signs of complications PLEURAL CONDITIONS Pleurisy (Pleuritis) -Inflammation of the pleura secondary to infection, injury or malignancy. May be dry or wet pleurisy. Signs & symptoms: Pleuritic pain Fever & chills, tachypnea Analgesics & antibiotics Intercostal nerve block Monitor for signs of pleural effusion Pleural Effusion -Accumulation of fluid in the pleural space between the visceral & parietal pleura. Signs & symptoms:

Dyspnea on exertion Dull or flat percussion Cough, fever, chills, pleuritic chest pains X-ray shows fluid in pleural space Management: Chemical pleurodesis, pleurectomy, thracocentesis, chest drainage, diuretic therapy. Manage pain, provide comfort & encourage to ambulate. Closed tube drainage when appropriate. PLEURAL CONDITIONS Empyema (Suppurative pleuritis) -Collection of pus in pleural cavity resulting in thickening of the pleura & restricting movement in the underlying lung. Signs & symptoms: Same as in acute respiratory infection or pneumonia. Management: Thoracentesis Tube thoracostomy Open chest drainage Antibiotics Deep breathing exercises Provide care & manage the drainage system Monitor signs of infection Pulmonary Edema -Life threatening condition characterized by abnormal accumulation of fluid in lung tissue or alveolar spaces. Signs & symptoms: Dyspnea Air hunger Cyanosis Pink frothy sputum Crackles at lung bases progressing to apices (NO SUCTIONING) Depressed pulse oximetry & respiratory acidosis Management: Vasodilators, inotropic medications, diuretics O2 therapy Morphine to control pain Upright position with feet dangling on bed Observe for adverse effects of Morphine (Narcan should be available) ACUTE RESPIRATORY DISORDERS Acute respiratory failure -PaO2 drops to less than 50 mmHg, PaCO2 - >50 mmHg, arterial pH < 7.35. Causes: Decreased drive, dysfunction of chest wall or lung parenchyma, respiratory deppression. Signs & symptoms: Restlessness, confusion, lethargy Tachycardia, fatigue, headache Dyspnea, tachypnea Air hunger, increased BP Diaphoresis, central cyanosis Decreased breath sounds Management: Intubation & or MV Assess respiratory status & VS

Prevent complications ARDS -Diffuse alveolar capillary damage leading to pulmonary edema, respiratory failure & hypoxemia Signs & symptoms: Acute stage alveolar damage Proliferative stage fibrosis of lung tissues, dyspnea 12 48 hrs. after initiating event -Labored breathing, tachypnea -Intercostal retractions & crackles Management: PEEP Pulmonary artery pressure monitoring Inotropic agents Prophylactic antibiotic Pulmonary Hypertension -Systolic pulmonary artery pressure exceeds 30 mmHg; mean pulmonary artery pressure exceeds 25 mmHg. Forms: Idiopathic Secondary Signs & symptoms: Dyspnea Substernal chest pain, fatigue, syncope Elvated pulmonary arterial pressure Peaked T & R waves, or ST segment deppression & T wave deppression, right ventricular hypertrophy. O2 therapy, Vasodilators Pulmonary Heart Disease (Cor Pulmonale) -Arise from sudden dilatation of right ventricle as a result of lung disorder affecting its vasculature. Signs & symptoms: Same as Right CHF Headache, confusion, somnolence due to hypercapnia Management: O2, bronchodilators Intubation & mechanical ventilation Diuretics, antibiotics, digitalis Assess respiratory & cardiac status Provide bed rest & sodium restriction Provide chest physiotherapy Pulmonary Embolism -Occlusion of the pulmonary artery by an embolus. Signs and symptoms: Sudden chest pain Dyspnea / tachypnea Cough, hemoptysis, crackles Tachycardia Fever, diaphoresis, syncope X-ray revealing atelectasis, elevation of diaphragmn, or pleural effusion Depression of PR interval Management: Morphine & dobutamine Anticoagulants / thrombolytic Surgical interventions

Monitor for Homans sign, cardiogenic shock, right ventricular failure Lung Cancer (Bronchogenic CA) Causes: Smoking, Radiation, Asbestos & other occupational substances Signs & symptoms: Chronic cough Wheezes / hemoptysis Chest / shoulder pain Hoarseness, dyspahagia, head and neck edema Weakness, anorexia, weight loss (+) sputum cytology X-ray reveals solitary nodule, atelectasis Management: Surgery, radiation therapy, chemotherapy, immunotherapy Promote comfort & rest Provide psychologic support Tumors of the Mediastinum Signs & symptoms: Cough, wheezes, dyspnea Anterior chest or neck pain Bulging of chest wall Heart palpitations & angina Dysphagia & weight loss X-ray reveals tumor Management: Radiation & chemotherapy Median sternotomy & thoracotomy Monitor injury to the phrenic or laryngeal nerve CHEST TRAUMA Blunt or Non-penetrating Trauma -Caused by sudden compression or positive pressure in chest wall. Signs & symptoms: Hypoxemia, hypovolemia, cardiac & respiratory failure Management: Initiate aggressive resuscitation Reestablish negative intrapleural pressure. Drain intrapleural fluid & blood. Sedatives & pain reliever Pneumothorax -Positive athmospheric pressure enters the parietal or visceral pleura or pleural space Traumatic pneumothorax Tension pneumothorax Signs & symptoms: Pain is abrupt & may be pleuritic Signs of ARDS Tympanic sound, absent of breath sounds & fremitus on affected side. Management: Reestablishing negative pressure of thorax Seal chest wound appropriately Sarcoidosis -Multisystem granulomatous disease Signs & symptoms:

Dyspnea Cough / Hemoptysis Congestion Respiratory difficulties Lymphadenopathy / hepatomegaly Nodular lesions in lungs Management: Corticoteroids OCCUPATIONAL LUNG DISEASES (Pneumoconioses) -Inhaled substances causes pulmonary fibrosis. Silicosis Asbestosis Black lung disease Management: Early diagnosis & management of complications Prevetive measures CARE MODALITIES Non-Invasisve Oxygen therapy Nebulizer therapy Postural drainage Breathing retraining Suctioning Invasive Water seal drainage Endotracheal Intubation Mechanical ventilation Thoracic surgeries: -Pneumonectory -Segmentectomy ASSESSMENT OF THE URINARY TRACT AND RENAL FUNCTION Urologic Health History: Location, character, duration of pain. History of UTI Previous urinary diagnostics Previous use of indewelling catheter Hematuria, nocturia, renal calculi Genital lesions / STDs Use of alcohol, tobacco, medications Female Patients: -deliveries -vaginal infection, irritation -contraceptives Signs & symptoms of urinary tract disease Pain / changes in voiding GIT symptoms Physical Assessment: Tenderness over costovertebral angle Bladder percussion / palpation Palpation of prostate gland Inspection / palpation of inguinal area Vulva, urethra, vagina assessed for women clients Edema & changes in body weight Diagnostic Evaluation Urinalysis Renal function Test

Ultrasonography Computed Tomography MRI Nuclear Scanning Intravenous Urography / IVP Retrograde pyelography Cystography Voiding cystourethrography Renal angiography Urologic endoscopic procedures Kidney Biopsy General Nursing Care Promote Urinary Elimination -Encourage voiding by providing stimulus & positioning -Program time & habit for voiding -Provide bedpan, urinal, sitz bath, warm shower or compress -Encourage increased fluid intake -Kegels exercises -Implement Credes method -Administer analgesics -Catheterization Monitor & Correct F&E Imbalances -Monitor I & O -Monitor for dehydration, edema, jugular vein distention -Implement restrictions & provide instructions -Monitor cardiac & musculoskeletal functions. -Monitor alterations in breath & heart sounds Prevent Infection -Asepsis -Empty collection bag when 2/3 full or at least every 8 hrs. -Perineal care -Monitor for signs of infection -Regular Handwashing Manage Pain & Discomfort -Administer drugs as prescribed -Keep skin clean and moisturized -Sitz bath & warm compress Provide Psychological Support / Education -Discuss disease process -Discuss therapies -Demonstrate procedures & evaluate by return demonstration NURSING PATIENT WITH DYSFUNCTIONAL VOIDING PATTERNS Urinary retention -Monitor urine output -promote urinary elimination Urinary Incontinence Types: Stress, Urge, Reflex, overflow -Behavioral therapy -Medications -Stabilizing the bladder & urethra -Sphincter implant -Pelvic floor electronic stimulation -Kegels exercises -Vaginal tone retention exercises Neurogenic Bladder -Causes urinary stasis

Types: Spastic or flaccid bladder. -Catheterization -Parasympathomimetics -Low calcium diet -Encourage mobility & ambulation -Perform catheter care -Educate & implement self catheterization DIALYSIS HEMODIALYSIS Complications: Hypotension, muscle cramping, exsanguination, dysrhytmias, air embolism, chest pain, Dialysis disequilibrium Management: Antihypertensive therapy Restrictions in diet, fluid, electrolytes Assess bruit / thrill every 8 hours Maintain asepsis Manage pain 5 Es: Encourage + attitude, education, exercise, employment, evaluation PERITONEAL DIALYSIS Complications: Peritonitis, leakage, bleeding, abdominal / hiatal hernia, hyperglyceridemia, low back pain, anorexia Management: Assure concentration of dialysate Maintain asepsis Dry heat the solution before administration Check characteristic of drainage *CONTINUOUS RENAL REPLACEMENT THERAPIES KIDNEY SURGERY Indications: To remove obstruction To drain kidney To remove one kidney Management: Antibiotics / heparin Fluid & blood transfusion Nephrostomy drainage / ureteral stents URINARY TRACT INFECTIONS: Lower Urinary Tract Infection Affects the bladder, although the urethra & ureters may also be involved. Signs & symptoms: Painful & burning voiding Frequency / urgency / nocturia Incontinence / hematuria Suprapubic / flank pain (CVA) Fever, chills, headache, malaise N&V (+) urine cultures Management: Antibiotic / analgesics Acid ash diet Manage pain and provide comfort Encourage fluid intake Upper Urinary Tract Infection

Acute pyelopnephritis -Chills, fever, leukocytosis, pyuria, flank pain Chronic Pyelonephritis -Fatigue, headache, poor appetite, polyuria, excessive thirst & weight loss -A less common cause of end stage renal disease -Assess by IV urogram, creatinine clearance Management: Antimicrobials / analgesics Monitor I & O Encoureage increased fluid intake, regular bladder emptying & perineal hygiene Glomerulonephritis -Inflammation of glomerular capillaries caused by immunologic reaction. Signs & symptoms: Hematuria / proteinuria Hypoalbuminemia / edema Increased BUN, creatinine Anemia HPN, headache, malaise, flank pain Cardiomegaly, engorged neck veins, pulmonary edema Increased ASO or Anti Dnase B titer Hyperkalemia / m. acidosis Hyperphosphatemia, hypocalcemia, hypermagnesemia Impaired nerve conduction Management: Plasmaparesis Antibiotics Diuretics, antihypertensives, restrictions of sodium & H2O. Corticosteroids, immunosuppressive agents, anticoagulants, Dialysis. High CHO diet Strictly monitor I & O Implement fluid & dietary restrictions Monitor signs of complications Monitor F&E, neurologic & cardio-pulmonary status. Weigh daily-same time same amt. of clothing, same scale Protect skin integrity NEPHROTIC SYNDROME -Characterized by marked proteinuria, hypoalbuminemia, edema, hyperlipidemia. Signs & symptoms: Pitting edema, periorbital edema. Anasarca in children Malaise, headache irritability, fatigue. Management: Diuretics ACE inhibitors Antineoplastics, immunosuppressants, corticosteroids Same nursing management with glomerulonephritis & reanl failure RENAL FAILURE Acute Renal Failure -Abrupt loss of kidney function Phases: Oliguric anuric -Last 1-8 weeks

Diuretic phase -Glomerular filtration returns Recovery phase -Lasts 3-12 months Management: Dialysis Mannitol, furosemide, ethacrynic acid, ion exchange resin. Low dose dopamine Reduce metabolic rate Low protein, potassium. High calorie diet RENAL FAILURE Chronic Renal Failure -Progressive- irreversible reduction of functioning renal tissue leading to uremia & azotemia. Stages: Stage 1 (Reduced Renal Reserve) -40% - 70% loss of function Stage 2 (Renal insufficiency) -75% - 95% loss of function -Kidneys can not conc. urine -Increased Creatinine & BUN -Anemia, polyuria, nocturia Stage 3 (ESRD) -less than 10% nephron functioning -Elevated BUN & creatinine -Electrolyte imbalances very evident Signs & Symptoms: Cardiovascular Integumentary Gastrointestinal Neurologic Hematologic & Endocrine Musculoskeletal Management: Dialysis or Renal transplant Electrolyte replacement & fluid regulation Diuretics in early phase Sodium bicarbonate Antihypertensives Topical lotions Diet : High calorie, low protein, low Na & K. Monitor complications Kidney Transplant -Surgical implantation of human kidney as an intervention for irreversible kidney damage. Complications: Graft rejection Infection Urinary tract complications Non-infectious hepatitis Fluid & electrolyte imbalances Preoperative Care: Ensure all tests were done Post-operative Care: Immunosuppressive agents Assess for signs of rejections

Instruct client on need to take immunosuppressive agent lifetime and prevent infections

UROLITHIASIS -Stones in urinary tract caused by urinary stasis, retention & supersaturation with poorly soluble crystalloids. Signs & symptoms: Pyelonephritis, cystitis Chills, fever, dysuria Burning, frequency, urgency CVA pain Hematuria, pyuria, renal colic Management: Analgesics, NSAIDS, diuretics Increased fluid intake Percutaneous nephrostomy / nephrolithotomy Lithotripsy Chemolysis Instruct client to report unusual character of urine Strain urine Calcium stones: -Ammonium Cl, acetohydroxemic acid, cellulose sodium phosphate -Restriction on sodium, protein, calcium Uric acid stones -low purine diet, alkaline ash -Allopurinol Oxalate stones -Limit oxalate, Acid ash -Extracorporeal shock wave lithotripsy Renal Tumor -Adenocarcinoma accounts for 90% of kidney neoplasms Risk Factors: Gender, Obesity, tobacco use, chemicals, estrogen therapy. Signs & symptoms: Hematuria, flank pain, abdominal or flank mass Weight loss, fatigue, hematuria, anemia, abnormal serum liver profile. Hypercalcemia, elevated ESR Management: Radiotherapy, chemotherapy Nephrectomy Education / comfort measures Monitor for complications Cancer of the Bladder -Affects men more than women. Signs & symptoms: Painless hematuria, frequency, urgency, dysuria Back or pelvic pain Management: Transurethral resection Intravesical administration of BCG Intracavity radiation Cystectomy / ileal conduit

Maintain urethral catheter and bladder irrigation as appropriate Maintain continuous drainage from urethral & suprapubic catheters to prevent strain URINARY DIVERSION SURGERY Cutaneous Urinary Diversion: Ileal conduit / Ileal loop -ureter implanted to ileum Complications: -Wound infection, leakage, urethral obstruction, hyperchloremic acidosis, small bowel obstruction, stomal gangrene. Continent Urinary Diversions Indiana Pouch Kocks Pouch Ureterosigmoidostomy GENERAL NURSING MANAGEMENT Promotion of urinary output Provide stoma & skin care Maintain fluid & electrolyte imbalance Select appropriate ostomy appliance Provide education on ostomy care Nephrosclerosis -Hardening or sclerosis of arteries of the kidney due to prolonged hypertension Signs & symptoms; Blurring of vision & headaches Renal insufficiency Management: Aggressive anti-hypertensive therapy Hydronephrosis -Dilation of renal pelvis and calyces due to an obstruction of the ureter(s). Signs & symptoms: Flank & back pain. Dysuria, chills, fever, tenderness, pyuria. Hematuria Management: Antibiotic agents Sugical removal of obstruction Renal Abscess -Localized to renal cortex or extend into fatty tissue around the kidney. Signs & symptoms: Chills, fever, leukocytosis Dull ache or palpable mass in the flank Abdominal pain with guarding CVA tenderness Management: IV antibiotics Surgery for extensive perinephritic abscesses Interstitial Cystitis -Inflammation of the bladder wall that eventually causes disintegration of the lining & loss of bladder elasticity. Signs & symptoms: Irritable voiding symptoms Pain with bladder filling Frequency, urgency, suprapubic pressure. Markedly diminished bladder capacity.

Management: Antispasmodics Tricyclic anti-deppressants Intravesical heparin Urethritis -Inflammation of the urethra. Gonococcal urethritis -Burning urination, purulent discharge Non-gonococcal urethritis -Caused by C. trachomatis -Mild to severe dysuria -Scant to moderate urethral discharge Management; Antibiotics Tuberculosis of the Kidney -Caused by Mycobacterium tuberculosis Signs and symptoms: Afternoon fever, weight loss, night sweats, loss of appetite and malaise Hematuria & pyuria may be present Dysuria & urinary frequency due to bladder involvement Management: Combination of ethambutol, INH, Rifampin. Urethral Strictures -Narrowing of the lumen of the urethra as a result of scar tissue & contraction Prevention: Prompt treatment of infection. Avoidance of prolonged urethral catheter drainage. Signs & symptoms; Diminished force & volume of urinary stream Urinary retention & infection Management: Dilation of narrowed urethra Hot sitz bath / analgesics Internal urethrotomy Renal Cysts -Consists of abnormal fluid filled sacs that arise from the kidney tissue Signs & symptoms: Gradual enlargement of the kidneys Abdominal or lumbar pain Hematuria, hypertension, palpable renal masses and recurrent UTIs Management: Surgery Dialysis Genetic counseling