Arianna Mabunga BSN-3B Urinary Diversion Deffinition

ARIANNA MABUNGA
BSN-3B
URINARY DIVERSION
Deffinition:
Urinary diversion is when the normal structures are bypassed and

an opening is made in the urinary system to bring the urine out
another way. This might need to be done if your bladder stops
working the right way or needs to be removed because of cancer
or an injury. The flow of urine is diverted to a replacement bladder
("neobladder") or through an opening in the abdominal wall (called
a "stoma"). Necessary for
Medical diagnosis: Nephrolithiasis (Kidney Stones)
 A kidney stone is a hard, crystalline mineral material formed within

the kidney or urinary tract. Kidney stones are a common cause of
blood in the urine (hematuria) and often severe pain in the
abdomen, flank, or groin. Kidney stones are sometimes called renal
calculi.
 A kidney stone is a hard, crystalline mineral material formed within
the kidney or urinary tract.
 Kidney stones form when there is a decrease in urine volume and/or
an excess of stone-forming substances in the urine.
Signs and Symptoms:
 Severe, sharp pain in the side and back, below the ribs
 Pain that radiates to the lower abdomen and groin
 Pain that comes in waves and fluctuates in intensity
 Pain or burning sensation while urinating
 Pink, red or brown urine
Foul-smelling urine
 A persistent need to urinate, urinating more often than usual or urinating in small amounts
 Nausea and vomiting
 Fever and chills if an infection is present
 Lower abdominal pain.
 Frequent urination.
 Difficulty urinating or interrupted urine flow.
 Blood in the urine.
 Cloudy or abnormally dark-colored urine
Pathophysiology
Laboratory
1. Urinalysis. Urinalysis involves a health care professional testing your urine sample. You will collect
a urine sample at a doctor’s office or at a lab, and a health care professional will test the sample.
Urinalysis can show whether your urine has blood in it and minerals that can form kidney stones.
White blood cells and bacteria in the urine mean you may have a urinary tract infection.
2. Blood tests. A health care professional may take a blood sample from you and send the sample to
a lab to test. The blood test can show if you have high levels of certain minerals in your blood that
can lead to kidney stones.
Diagnostic
1. Imaging. Imaging tests may show kidney stones in your urinary tract. High-speed or dual energy
computerized tomography (CT) may reveal even tiny stones. Simple abdominal X-rays are used
less frequently because this kind of imaging test can miss small kidney stones.
2. Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option to
diagnose kidney stones.
3. Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that
you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this
information to determine what's causing your kidney stones and to form a plan to prevent more
kidney stones.
Purpose
 Urinary diversion is a surgical procedure that reroutes the normal flow of urine out of the body
when urine flow is blocked. Urine flow may be blocked because of kidney stones.
 Urinary diversion reroutes the flow of urine for several days or weeks.
 Temporary urinary diversions drain urine until the cause of blockage is treated or after urinary
tract surgery. This type of urinary diversion includes a nephrostomy and urinary catheterization.
Nursing Diagnosis
1. Anxiety related to threat to self-concept, interaction patterns, or health status occurring with
urinary diversion surgery.
2. Impaired urinary elimination related to postoperative use of ureteral stents, catheters, or drains;
and related to urinary diversion surgery
3. Deficient knowledge about the surgical procedure and post-operative care
4. Acute pain related to surgical incision
5. Risk for impaired skin integrity related to problems in man-aging the urine collection appliance
Nursing Responsibility
Pre-Operative Nursing Responsibility
 Cardiopulmonary function assessments are performed be-cause patients undergoing cystectomy

(excision of the urinary bladder) are often older people who may not be able to tolerate a lengthy,
complex surgical procedure.
 A nutritional status assessment is important because of possible poor nutritional intake related
to underlying health problems.
 Aid to the patient’s learning needs are assessed to evaluate the patient’s and the family’s
understanding of the procedure and the changes in physical structure and function that result
from the surgery.
 Assist in identifying stoma site, avoiding folds of skin, bones, scar tissue, and the waistline or belt
area. Be sure to consider the client’s occupation and style of clothing
 Perform bowel-preparation activities as ordered.
Intra-Operative Nursing responsibility
 Monitor vital signs

 Inform Anesthesiologist of any significant changes to the patient’s vital signs, and document.
 Auscultate breaths sounds
Post-Operative Nursing responsibility
 Inspect incision line around the stoma. Observe and document wound drainage, note signs of
inflammation and signs of infection
 Change Dressing as needed.
 Monitor intake and output carefully, assessing urine output every hour for the first 24 hours, then
every 4 hours or as ordered. Call the physician if urine output is less than 30 mL per hour.
 Assess color and consistency of urine. Expect pink or bright red urine fading to pink and then
clearing by the third postoperative day.
 Irrigate the ileal diversion catheter with 30 to 60 mL of normal saline every 4 hours or as ordered
 Monitor serum electrolyte values, acid-base balance, and renal function tests such as BUN and
serum creatinine.
 Teach the client and family about stoma and urinary diversion care, including odor management,
skin care, increased fluid intake, pouch application and leakage prevention, self-catheterization
for clients with continent reservoirs, and signs of infection and other complications.
Discharge plan
 Educate the patient and significant others how to properly clean the wound.
 Educate the patient and significant others how to properly do the wound dressing.
 Teach the patient and the significant others about the importance of strictly complying the
medication treatment of the patient.
 Teach the patient the specific procedure to catheterize the continent cutaneous pouch or
reservoir. A simple stoma covering made from a feminine hygiene pad can be worn between
catheterizations.
 Stress the need for the patient to wear a medical ID bracelet.
 Instruct the patient on methods for performing Kegel exercises during and between voidings to
minimize incontinence. Suggest wearing incontinence pads until full control is achieved.
 Also instruct the patient on self-catheterization techniques in case the patient is unable to void.
Instruct patients where to obtain ostomy pouches, catheters, and other supplies. Teach the
patient how to clean and store catheters between use following the clean technique.
 Encourage the patient to wear nonrestrictive soft cotton clothing directly over the treatment area
and to protect the skin from sunlight and extreme cold.
 Stress the need to maintain the schedule for follow-up visits and disease surveillance as
recommended by the physician.
REFERENCES
Stöppler, M. C. (2016). Kidney stones: Pain, symptoms, causes, passing a kidney stone & treatment.
MedicineNet. https://www.medicinenet.com/kidney_stones/article.htm
National Institute of Diabetes and Digestive and Kidney Diseases. (2013, September 18). Urinary
diversion. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-diversion
Kidney stones - Symptoms and causes. (2020, May 5). Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/kidney-stones/symptoms-causes/syc-20355755

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ARIANNA MABUNGA

Urinary diversion is when the normal structures are bypassed and

Medical diagnosis: Nephrolithiasis (Kidney Stones)

 A kidney stone is a hard, crystalline mineral material formed within

Signs and Symptoms:

Pre-Operative Nursing Responsibility

 Cardiopulmonary function assessments are performed be-cause patients undergoing cystectomy

Intra-Operative Nursing responsibility

 Monitor vital signs

Post-Operative Nursing responsibility

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