Medical-Surgical Nursing Final Notes
Urinary System & Post-Surgical Care
Types of Catheters:
1. Indwelling (Foley) Catheter – Left in place with an inflated balloon to prevent
removal.
2. Intermittent (Straight) Catheter – Inserted to drain urine and then removed
immediately.
3. Suprapubic Catheter – Surgically placed above the pubic bone into the bladder.
4. Three-Way Catheter (CBI - Continuous Bladder Irrigation) – Used
postoperatively to prevent clot formation (e.g., after prostatectomy).
5. External (Condom) Catheter – Applied externally for male patients with
incontinence.
Post-Operative Care for TURP (Transurethral Resection of Prostate)
Expected Findings: Hematuria.
Complications to Report: Fever, inability to urinate.
Urinary Catheter (CBI - Continuous Bladder Irrigation):
o Monitor for clots.
o Ensure output > input to prevent retention.
o Maintain strict intake & output documentation.
Three-Way Catheter (CBI - Continuous Bladder Irrigation)
• One lumen drains urine, one inflates the balloon, and one allows irrigation fluid.
• Minimum urine output: 30 ml/hr (deduct irrigation fluid input).
• Normal findings post-surgery:
Blood in urine initially.
Normal or slightly elevated output.
Catheter Care & Maintenance
• Daily Perineal Care: Clean with warm water and mild soap.
• Prevent Kinking: Ensure unobstructed urine flow.
• Monitor Urine Output: Check for color, clarity, and volume.
• Change Catheters as Needed: Avoid routine changes unless indicated (e.g.,
obstruction, infection).
• Encourage Hydration: Prevents crystal formation & catheter encrustation.
Post-Surgical Complications
• Notify provider if:
Fever (infection sign).
, Urine retention.
• Hemorrhage/shock indicators: Hypotension, tachycardia.
UTI Prevention
• Increase fluid intake.
• Wear cotton underwear and loose-fitting clothes.
• Complete full antibiotic course.
Key Nursing Considerations
• Use urinary catheters only when medically necessary.
• Adhere to infection control guidelines (CAUTI prevention bundle).
• Educate patients on catheter care & early UTI detection.
• Monitor urine output & overall renal function.
• Remove catheter as soon as possible to reduce infection risk.
Dialysis
• a life-sustaining treatment for patients with end-stage renal disease (ESRD) or
acute kidney injury (AKI). It helps remove waste products, excess fluids, and
toxins from the blood when the kidneys are unable to function adequately.
Types:
• Hemodialysis
s a procedure that filters blood through an artificial kidney (dialyzer) to
remove wastes, excess fluids, and electrolytes before returning the clean
blood to the patient.
• Indications for Hemodialysis:
End-stage renal disease (ESRD) (GFR < 15 mL/min)
Severe fluid overload unresponsive to diuretics
Severe electrolyte imbalances (e.g., hyperkalemia)
Toxin removal (e.g., drug overdose, acute poisoning)
Metabolic acidosis (pH < 7.1)
Uremic symptoms (nausea, vomiting, confusion, pruritus)
• Procedure:
, Blood is drawn from the patient and passed through a dialyzer.
A dialysis machine regulates blood flow, filtration, and fluid removal.
The filtered blood is returned to the patient.
• Complications of Hemodialysis:
Hypotension (due to rapid fluid removal)
Muscle cramps
Disequilibrium syndrome (headache, nausea, confusion)
Infection (sepsis)
Bleeding (heparin is used to prevent clotting)
• Peritoneal Dialysis
uses the peritoneal membrane in the abdomen as a natural filter to
remove wastes and excess fluids from the blood.
• Indications for Peritoneal Dialysis:
• Patient preference for home-based dialysis
• Hemodialysis access difficulties (e.g., poor vascular access)
• Severe cardiovascular disease (PD is gentler on the heart)
• Desire for greater mobility & flexibility
• Procedure:
1. Dialysate solution is infused into the peritoneal cavity.
2. Waste products and excess fluids diffuse across the peritoneal
membrane.
3. After a dwell time (4-6 hours), the solution is drained and replaced with
fresh dialysate.
Major complication: Peritonitis
• Signs of Peritonitis:
Abdominal pain, rebound tenderness.
Elevated WBC count.
If drainage output < input: Reposition patient.
Complications of Peritoneal Dialysis:
Complication Signs & Symptoms Prevention
Urinary System & Post-Surgical Care
Types of Catheters:
1. Indwelling (Foley) Catheter – Left in place with an inflated balloon to prevent
removal.
2. Intermittent (Straight) Catheter – Inserted to drain urine and then removed
immediately.
3. Suprapubic Catheter – Surgically placed above the pubic bone into the bladder.
4. Three-Way Catheter (CBI - Continuous Bladder Irrigation) – Used
postoperatively to prevent clot formation (e.g., after prostatectomy).
5. External (Condom) Catheter – Applied externally for male patients with
incontinence.
Post-Operative Care for TURP (Transurethral Resection of Prostate)
Expected Findings: Hematuria.
Complications to Report: Fever, inability to urinate.
Urinary Catheter (CBI - Continuous Bladder Irrigation):
o Monitor for clots.
o Ensure output > input to prevent retention.
o Maintain strict intake & output documentation.
Three-Way Catheter (CBI - Continuous Bladder Irrigation)
• One lumen drains urine, one inflates the balloon, and one allows irrigation fluid.
• Minimum urine output: 30 ml/hr (deduct irrigation fluid input).
• Normal findings post-surgery:
Blood in urine initially.
Normal or slightly elevated output.
Catheter Care & Maintenance
• Daily Perineal Care: Clean with warm water and mild soap.
• Prevent Kinking: Ensure unobstructed urine flow.
• Monitor Urine Output: Check for color, clarity, and volume.
• Change Catheters as Needed: Avoid routine changes unless indicated (e.g.,
obstruction, infection).
• Encourage Hydration: Prevents crystal formation & catheter encrustation.
Post-Surgical Complications
• Notify provider if:
Fever (infection sign).
, Urine retention.
• Hemorrhage/shock indicators: Hypotension, tachycardia.
UTI Prevention
• Increase fluid intake.
• Wear cotton underwear and loose-fitting clothes.
• Complete full antibiotic course.
Key Nursing Considerations
• Use urinary catheters only when medically necessary.
• Adhere to infection control guidelines (CAUTI prevention bundle).
• Educate patients on catheter care & early UTI detection.
• Monitor urine output & overall renal function.
• Remove catheter as soon as possible to reduce infection risk.
Dialysis
• a life-sustaining treatment for patients with end-stage renal disease (ESRD) or
acute kidney injury (AKI). It helps remove waste products, excess fluids, and
toxins from the blood when the kidneys are unable to function adequately.
Types:
• Hemodialysis
s a procedure that filters blood through an artificial kidney (dialyzer) to
remove wastes, excess fluids, and electrolytes before returning the clean
blood to the patient.
• Indications for Hemodialysis:
End-stage renal disease (ESRD) (GFR < 15 mL/min)
Severe fluid overload unresponsive to diuretics
Severe electrolyte imbalances (e.g., hyperkalemia)
Toxin removal (e.g., drug overdose, acute poisoning)
Metabolic acidosis (pH < 7.1)
Uremic symptoms (nausea, vomiting, confusion, pruritus)
• Procedure:
, Blood is drawn from the patient and passed through a dialyzer.
A dialysis machine regulates blood flow, filtration, and fluid removal.
The filtered blood is returned to the patient.
• Complications of Hemodialysis:
Hypotension (due to rapid fluid removal)
Muscle cramps
Disequilibrium syndrome (headache, nausea, confusion)
Infection (sepsis)
Bleeding (heparin is used to prevent clotting)
• Peritoneal Dialysis
uses the peritoneal membrane in the abdomen as a natural filter to
remove wastes and excess fluids from the blood.
• Indications for Peritoneal Dialysis:
• Patient preference for home-based dialysis
• Hemodialysis access difficulties (e.g., poor vascular access)
• Severe cardiovascular disease (PD is gentler on the heart)
• Desire for greater mobility & flexibility
• Procedure:
1. Dialysate solution is infused into the peritoneal cavity.
2. Waste products and excess fluids diffuse across the peritoneal
membrane.
3. After a dwell time (4-6 hours), the solution is drained and replaced with
fresh dialysate.
Major complication: Peritonitis
• Signs of Peritonitis:
Abdominal pain, rebound tenderness.
Elevated WBC count.
If drainage output < input: Reposition patient.
Complications of Peritoneal Dialysis:
Complication Signs & Symptoms Prevention
