Module 4B Continuous Bladder Irrigation exam |36 questions and answers.

Indications for continuous bladder irrigation -BPH -prostate cancer -before acute urinary retention what are some symptoms of BPH or prostate cancer and what are some complications? S&S: dec. force of urinary flow, dec. ability to initiate voiding, urgency, freq., nocturia, dysuria, urinary retention, or hematuria Complications: infection, retention, and renal colic possible complications of bladder irrigation? -hemorrhage and shock -infection -DVT -catheter obstruction -sexual dysfunction -urinary incontinence Relieving discomfort urinary obstruction -> admin analgesics monitor voiding patterns, eval. bladder distension, and assists w catheterization -> indwelling cath. is inserted is pt has continuing urinary retention of if lab test results indicate azotemia maintaining fluid balance with cont. bladder irrigation (CBI) prevent its obstruction by blood clots, fluid may be absorbed through the opening surgical site and retained, inc. the risk for excessive fluid retention ,fluid imbalance, and water intoxication (called TURP syndrome) monitor: amt fluid used for irrigation and urine output monitor: electrolyte imbalance (hyponatremia), rising BP, confusion, and resp. distress pain in flank area indicates? indicates kidney condition or bladder spasms bladder irritability can indicate bleeding and result in clot formation, leading to urinary retention bladder spasms pt note urgency to void, feeling pressure or fullness in bladder, and bleeding from urethra around cath. use anticholinergic meds (Ex. Oxybutynin), that relaxes smooth muscles easing spasms. warm compresses to pubis also relieve spasms Hemorrhage (symp.) bleeding may cause clots, which obstruct urine flow -urine drainage norm begins as reddish-pink then clears to light pink within 24hrs after surgery -bright- red bleeding w inc. viscosity and numerous clots indicates arterial bleeding -> arterial hemorrhage requires surgical intervention, whereas venous bleeding controlled by applying prescribed traction to cath. so balloon holding cath. applies pressure to prostatic fossa venous blood appears darker and less viscous Hemorrhage (interventions) Nursing interventions: · Admin meds · IV fluids · VS · Blood component therapy · Maintaining acuate record of I/O · Ensure adequate urine flow and patency of drainage system Infection (symp. and interventions) -change dressing on first post-op day -careful aseptic technique used as infection risk is high -Drgs held in place by double- tailed, T-binder bandage or paddled athletic support. each tail is drawn up on either -rectal thermometers, rectal tubes, and enemas are avoided bc of risk of injury to and bleeding in prostatic fossa -sitz bath used to promote healing -UTI and epididymitis are possible complications. Pt assessed for occurrence. if occur, then admin Abx. -educate pt family on S&S of infection Deep vein thrombosis -pt undergoing prostatectomy have a high incidence of DVT and pulmonary embolism -low dose heparin Obstructed Catheter -obstructed catheter produces distention of prostatic capsule and resultant hemorrhage -furosemide (lasix) may be used to promote urination and initiate postoperative diuresis monitor: lower abd. to ensure that cath. has not become blocked. an overdistended bladder presents a distinct, round swelling above the pubis monitor: drainage bag, drgs, and incisional site are examined for bleeding. Colour of urine is noted, change in colour from pink to amber indicates reduced bleeding -> BP, pulse, and resp/ monitored and compared with baseline preoperative BS to detect hypotension ->nurse observe pt for restlessness, cold sweats, pallor, and drop in BP and inc. HR how much fluid do you hand/open irrigate with? Process? cath. is irrigated with 30 - 60mL of irrigating fluid at one time. 1. always instill 60mL of NS as a cushion before withdrawing soln. to prevent damage to bladder wall 2. Draw up another 60mL NS and instill 3. Withdraw 60mL of bladder solution 4. continue until satisfied clots are removed and returns are clear or pending pt level of comfort