INP 4 - Urology + CBI exam |33 questions and answers already graded A+

CBI indications bladder cancer - male or female benign prostatic hypertrophy or prostate cancer transurethral resection of the prostate (TURP) for BPH preferred method - fast recovery less complications removes inner portion of prostate via urethra with use of endoscope best for removal of small amounts of tissue spinal anesthesia CBI often follows the surgery prostate cancer requires radical surgery and radiation removal of prostate and adjacent tissues if tumour is invasive CBI may be indicated post-op bladder tumours common in 50-70 y/o may require TURP or cystotomy and resection of bladder CBI may be indicated postop How does a CBI help? continuous bladder irrigation prevents clot formation and prevents obstruction slows bleeding - d/t coolness and pressure from fluid influx often up to 24hrs post op - depending on color of returns CBI continuous bladder irrigation irrigates 0.9% NS through bladder via triple lumen catheter rate of flow runs according to returns - rapid (wide open), moderate or slow initially usually runs fast and then slows down as returns become lighter what happens if drainage is bright red? speed it up what happens if drainage is pinkish/clear? slow it down post op care for TURP HOB 30 degrees - until CBI d/c monitor returns for bleeding/clots and color of returns - ensure there is a constant flow VS, check CBCs, S&S of infection never allow bags to run dry check irrigation bags frequently may need to change bags q20-40 mins empty drainage freq check tubing for kinks ax bladder acute pain is abnormal relieve spasms with B&O supp why do you want the HOB at 30 degrees with CBI? easier fluid evacuation decreases clot buildup less pressure on operative site why should you never let the CBI bags run dry? risk for clot or obstruction what could acute pain indicate? potential catheter obstruction what could excessive bleeding indicate? hemorrhage clots post op teaching increase fluids AAT (activity as tolerated) ax urine flow, color avoid heavy lifting or prolonged sitting for 4-6 weeks - may cause increase bleeding mild burning when urinating - normal avoid constipation - high fibre and increase fluids call physician if fever, severe burning, difficulty voiding, bright red clots how long would it take for a 3000ml NS bag to completely run out if unclamped? 15 mins there is no drip factor - either clamped, slow, moderate or fully open catheter 16 french insert 30 cc of air the bigger the french the more air that needs to fill the balloon what do you do if drip chamber fills up? switch which bag is higher get the air out first turn it upside down and let fluids return to the bags Belladonna-opium suppositories treat bladder spasm in TURP procedure rectal suppositories unique med specifically for bladder pain and muscle spasms the CBI can cause muscle spasms what to do if there is a clot/occlusion with CBI? irrigate with syringe - RN scope apply hard pressure directly into catheter to try and get rid of occlusion manual hand irrigation 50-60 cc NS or water as protocol use catheter plug ^ ALL OUT OF OUR SCOPE LPN - slow down rate or stop CBI and call RN how to d/c CBI? check doctors order (not to mix with d/c catheter) returns should be clear clamp CBI ensure to have the 2 sterile caps clean gloves place blue pad underneath tubes disconnected/ maintain sterility cap catheter ensure returns stay clear for 24 hrs keep CBI outside of room for 3 hours incase returns show more bleeding/clots PSA prostate specific antigen test increases for BPH and even more for prostate cancer diagnostic tool BPH S&S dysuria freq/nocturia hesitancy urgency dribbling hematuria decreased force of stream UTIs