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Urologisch stelselTerminologie........................................................................................................................................12
Algemene termen.............................................................................................................................12
Termen i.v.m. diurese.......................................................................................................................12
Termen i.v.m. mictie.........................................................................................................................12
Termen i.v.m. urine..........................................................................................................................13
Termen i.v.m. blaas..........................................................................................................................13
Termen i.v.m. meatus, urethra en ureters........................................................................................14
Termen i.v.m. mannelijke geslachtsorganen....................................................................................14
Termen i.v.m. onderzoeken en behandelingen................................................................................15
Onderzoeken........................................................................................................................................16
Onderzoeken op urine......................................................................................................................16
Observatie verst geloosde urine (max 2u)....................................................................................16
Kleur.....................................................................................................................................................16
Geur......................................................................................................................................................16
Helderheid............................................................................................................................................16
Urine: volledig onderzoek.............................................................................................................16
Beoordeling..........................................................................................................................................16
Volledig duidt op verschillende onderzoeken die op staal worden genomen:.....................................16
Urinekultuur (uk)= bacteriologisch onderzoek.............................................................................17
Doel......................................................................................................................................................17
Bewaring...............................................................................................................................................17
Soorten.................................................................................................................................................17
Urinedebiet (UD)..........................................................................................................................17
Doel......................................................................................................................................................17
Onderzoeken van blaas- en sfincterfunctie......................................................................................18
Blaasresidubepaling......................................................................................................................18
Hoe.......................................................................................................................................................18
Urodynamisch onderzoek.....................................................................................................................18
Onderzoeken door middel van beeldvorming..............................................................................18
Onderzoeken door middel van endoscopie..................................................................................18
Celonderzoek................................................................................................................................18
Behandeling..........................................................................................................................................18
Cystostomie......................................................................................................................................19
Aanleg..........................................................................................................................................19
, lokale verdoving...........................................................................................................................19
Indicaties......................................................................................................................................19
Contraindicaties............................................................................................................................19
Aandachtspunten.........................................................................................................................19
Ureterostomie..................................................................................................................................19
Afvoering:.....................................................................................................................................19
Indicatie........................................................................................................................................20
Aandachtspunten.........................................................................................................................20
Nefrostomie......................................................................................................................................20
Therapeutische plaatsing..............................................................................................................20
Indicaties..............................................................................................................................................20
Diagnostische plaatsing................................................................................................................20
Indicaties..............................................................................................................................................20
Verpleegkundige aandachtspunten..............................................................................................20
Cystectomie met aanleg van een incontinent urostoma..................................................................21
Cystectomie met aanleg van een incontinent urostoma..............................................................21
Cystectomie met aanleg van een ureterocutaneostomie.............................................................21
Cystectomie met aanleg van een continent urostoma.....................................................................21
Cystectomie met aanleg van een continent urostoma volgens de Indiana techniek:...................21
Andere technieken met gelijkaardig doel.............................................................................................22
Cystectomie met aanleg van een orthotopische neoblaas...............................................................22
Blaaskanker......................................................................................................................................22
Factoren........................................................................................................................................22
Symptomen..................................................................................................................................22
Verpleegkundige zorgen aan het urinewegstelsel................................................................................23
Materiaal bespreking........................................................................................................................23
Keuze materiaal............................................................................................................................23
Niet invasieve handelingen...........................................................................................................23
Verschillen 1-delige en 2-delige stomasystemen..................................................................................23
Materiaal voor staalname:...................................................................................................................23
Materiaal voor aanbrengen condoomkatheter:...................................................................................24
Materiaal voor verzorging van incontinent urostoma (type Bricker of ureterocutaneostomie)...........24
Materiaal voor invasieve handelingen..........................................................................................24
Katheters..............................................................................................................................................24
Katheters voor eenmalige blaaskatheterisatie.....................................................................................24
Katheters voor verblijfskatheterisatie..................................................................................................25
,Katheters voor cystostomie..................................................................................................................25
Katheters voor plaatsing in de ureter...................................................................................................25
katheters voor plaatsing in de nier = nefrostomiekatheter..................................................................25
Vloeistoffen..........................................................................................................................................26
Glijmiddel en lokale verdoving.............................................................................................................26
Katheterisatieset..................................................................................................................................26
klem voor afvoerleiding van de urinecollector.....................................................................................26
Urinecollectoren...................................................................................................................................26
Materiaal voor blaasspoeling:..............................................................................................................27
Materiaal voor blaasinstillatie..............................................................................................................27
Materiaal voor continent urostoma (type Indiana)..............................................................................27
Verpleegkundige interventies op urologisch vlak.............................................................................27
Niet-invasieve interventies...........................................................................................................27
Staalname urine volledig (UV)..............................................................................................................27
Staalname voor urinekultuur (UK)........................................................................................................27
Specifieke aandachtspunten:................................................................................................................27
Urinedebiet:.........................................................................................................................................28
Specifieke aandachtspunten:................................................................................................................28
Gebruik van condoomkatheter.............................................................................................................28
Specifieke aandachtspunten.................................................................................................................28
Drainage van urine via een urostoma d.m.v. plaat en zakjes................................................................28
Indicaties:.............................................................................................................................................28
Specifieke aandachtspunten.................................................................................................................28
Invasieve interventies...................................................................................................................28
Eenmalige katheterisatie:.....................................................................................................................28
Indicaties..............................................................................................................................................28
Werkwijze:............................................................................................................................................29
Specifieke aandachtspunten:................................................................................................................29
Verblijfskatheterisatie:.........................................................................................................................29
Indicaties..............................................................................................................................................29
Specifieke aandachtspunten:................................................................................................................29
Vervangen cystostomiesonde/suprapubische sonde...........................................................................29
Indicaties:.............................................................................................................................................29
Specifieke aandachtspunten:................................................................................................................29
Blaas- en katheterspoeling:..................................................................................................................30
Aandachtspunten discontinue spoeling:...............................................................................................30
,Blaasinstillatie.......................................................................................................................................30
Indicaties: lokale instillatie met............................................................................................................30
Aandachtspunten:................................................................................................................................30
Drainage van urine uit een urostoma d.m.v. katheterisatie.................................................................30
Indicaties..............................................................................................................................................30
Werkwijze.............................................................................................................................................30
Aandachtspunten.................................................................................................................................31
Verpleegkundige diagnostiek...............................................................................................................31
ProActive Nursing (PAN)...................................................................................................................31
Klinisch redeneren........................................................................................................................31
PAN-praktijkmodel.......................................................................................................................31
zakboek.............................................................................................................................................32
verpleegkundige diagnosen..........................................................................................................32
welzijnsdiagnosen.........................................................................................................................32
Multidisciplinaire problemen........................................................................................................32
Diagnostische clusters..................................................................................................................32
Pes(die)-methodiek..........................................................................................................................32
Verpleegdiagnostiek m.b.t. katheterisatie........................................................................................33
Problemen....................................................................................................................................33
Slechte afvloei stase en reflux..............................................................................................................33
Elke instrumentele manipulatie zoals retrograde van de urinewegen kan steriel matreaal niet steriel
maken...................................................................................................................................................33
Gevolg..................................................................................................................................................33
Risico op urineweg infectie (cystitis, pyelonefritis, nefritis)..........................................................33
Definitie:...............................................................................................................................................33
Etiologie................................................................................................................................................33
Symptomen:.........................................................................................................................................33
Interventies..........................................................................................................................................33
Risico op letsel..............................................................................................................................34
Definitie:...............................................................................................................................................34
Etiologie................................................................................................................................................34
Symptomen..........................................................................................................................................34
Interventies..........................................................................................................................................34
Acute pijn......................................................................................................................................34
Definitie................................................................................................................................................34
Etiologie................................................................................................................................................34
,Interventies..........................................................................................................................................35
Verpleegdiagnostiek m.b.t. mictie....................................................................................................35
Risico op acute retentie................................................................................................................35
Definitie................................................................................................................................................35
Etiologie................................................................................................................................................35
Symptomen..........................................................................................................................................35
Interventies..........................................................................................................................................35
Risico op chronische retentie........................................................................................................36
Definitie................................................................................................................................................36
Etiologie................................................................................................................................................36
Symptomen..........................................................................................................................................36
Interventies..........................................................................................................................................36
multifactoriële incontinentie........................................................................................................36
Volledige druppelincontinentie/ totale incontinentie..................................................................36
Definitie:...............................................................................................................................................36
Etiologie................................................................................................................................................36
Symptomen..........................................................................................................................................37
Interventies..........................................................................................................................................37
Functionele incontinentie.............................................................................................................37
Definitie................................................................................................................................................37
Etiologie................................................................................................................................................37
Symptomen..........................................................................................................................................37
Interventies..........................................................................................................................................37
Stressincontinentie.......................................................................................................................37
Definitie................................................................................................................................................37
Etiologie................................................................................................................................................37
Symptomen..........................................................................................................................................37
Interventies..........................................................................................................................................38
Urge-incontinentie........................................................................................................................38
Definitie................................................................................................................................................38
Etiologie................................................................................................................................................38
Symptomen..........................................................................................................................................38
Interventies..........................................................................................................................................38
Besluit...........................................................................................................................................38
Verpleegdiagnostiek met betrekking tot cystostomie, ureterostomie, nefrostomie........................38
Risico op letsel..............................................................................................................................38
,Definitie................................................................................................................................................38
Etiologie................................................................................................................................................38
Interventies..........................................................................................................................................39
Risico op uittrekken..............................................................................................................................39
Risico op bloeding.................................................................................................................................39
Risico op verstopping:..........................................................................................................................39
Irritatie van de huid..............................................................................................................................39
Verpleegdiagnostiek m.b.t. urostomie na blaasresectie...................................................................39
Risico op letsel..............................................................................................................................39
Risico op opstijgende infectie.......................................................................................................39
Verpleegdiagnostiek m.b.t. het psycho-sociaal functioneren van de patiënt...................................40
Psycho-sociale problematiek m.b.t. katheterisatie.......................................................................40
Psychosociale problematiek m.b.t. mictie....................................................................................40
incontinentie........................................................................................................................................40
geeft vaak aanleiding tot......................................................................................................................40
hulpmiddelen.......................................................................................................................................40
Psychosociale problematiek m.b.t. urostoma...............................................................................40
hulpmiddelen.......................................................................................................................................41
Terminologie........................................................................................................................................41
Algemene termen.............................................................................................................................41
Termen slokdarm..............................................................................................................................41
Termen maag....................................................................................................................................42
Termen dunne darm.........................................................................................................................42
Termen dikke darm..........................................................................................................................43
Termen endeldarm en anus..............................................................................................................43
Termen lever en galwegen...............................................................................................................44
Andere termen.................................................................................................................................44
Onderzoeken........................................................................................................................................45
Observatie........................................................................................................................................45
Braaksel........................................................................................................................................45
Samenstelling en kleur.........................................................................................................................45
Hoeveelheid:........................................................................................................................................45
Geur:.....................................................................................................................................................45
Braken..........................................................................................................................................45
Tijdstip:.................................................................................................................................................45
Wijze van braken:.................................................................................................................................46
, Stoelgang......................................................................................................................................46
Normale stoelgang...............................................................................................................................46
Kleur van abnormale stoelgang:...........................................................................................................46
Geur van abnormale stoelgang:...........................................................................................................46
abnormale samenstelling en consistentie:...........................................................................................47
Stoelgangspatroon........................................................................................................................47
Maagdarmstelsel..........................................................................................................................47
Medische beeldvorming...................................................................................................................48
Röntgenonderzoek.......................................................................................................................48
door......................................................................................................................................................48
Echografie.....................................................................................................................................48
werking.................................................................................................................................................48
Kenmerken...........................................................................................................................................48
CT-scan: ComputerTomografie.....................................................................................................49
Nucleaire scan..............................................................................................................................49
PET-scan= Position-Emission-Tomografie.............................................................................................49
Gebruik.................................................................................................................................................49
MRI: magnetic resonance imaging................................................................................................49
Endoscopisch onderzoek..............................................................................................................50
Een endoscopie....................................................................................................................................50
Indeling.................................................................................................................................................50
Endoscopen..........................................................................................................................................50
Functie-onderzoek............................................................................................................................51
Slikonderzoek= slikfoto.................................................................................................................51
Maagvulling en –lediging..............................................................................................................51
Coloninloop..................................................................................................................................51
Labo..................................................................................................................................................52
Behandelingen......................................................................................................................................52
Niet invasief......................................................................................................................................52
De toediening van medicatie........................................................................................................52
Therapeutisch.......................................................................................................................................52
Diagnostisch.........................................................................................................................................52
voeding.........................................................................................................................................52
Sondevoeding: plaatsen van een voedingssonde.........................................................................53
Defenitie...............................................................................................................................................53
Indicaties..............................................................................................................................................53
,Toedieningswijzen sondevoeding.........................................................................................................53
Sondevoeding via sonde langs de neus................................................................................................53
Sondevoeding via sonde langs de mond...............................................................................................53
Voorwaarden voor een goede sondevoeding.......................................................................................53
Methoden voor toedienen van de sondevoeding................................................................................53
Invasief.............................................................................................................................................54
Plaatsing van percutane voedingssonde.......................................................................................54
PEG-sonde:...........................................................................................................................................54
Gastrostomiesonde:.............................................................................................................................54
Jejunostomiesonde= Enterostomiesonde............................................................................................54
Aanleggen van een gastro-intestinaal stoma................................................................................55
Fysieke gevolgen...................................................................................................................................55
Soorten stomata volgens duur: tijdelijk stoma gedurende weken of maanden...................................55
Doelstelling...........................................................................................................................................55
Indicaties:.............................................................................................................................................55
Soorten stomata volgens duur: blijvend/permanent...........................................................................55
Doelstelling:..........................................................................................................................................55
Indicaties:.............................................................................................................................................56
Soorten stomata volgens lokalisatie.....................................................................................................56
Soorten stomata volgens uiterlijke vorm..............................................................................................56
Enkelloops- of eindstandig stoma.........................................................................................................56
Dubbelloops-stoma..............................................................................................................................57
Soorten stomata volgens continentie...................................................................................................57
Incontinent stoma................................................................................................................................57
Continent stoma:..................................................................................................................................57
Voorbereiding van de patiënt op het krijgen van een stoma...............................................................57
Fysieke voorbereiding...........................................................................................................................57
Psychische voorbereiding.....................................................................................................................58
Verpleegkundige zorgen van het maagdarmstelsel..............................................................................59
Materiaalbespreking.........................................................................................................................59
Materiaal voor staalname.............................................................................................................59
Staalpotje voor stoelgang.....................................................................................................................59
Faecale wisser......................................................................................................................................59
FOB-test................................................................................................................................................59
Diepvriestoilet......................................................................................................................................59
Sondes voor plaatsing in de maag/duodenum.............................................................................59
,Indeling naargelang hardheid...............................................................................................................59
Slappe sondes.......................................................................................................................................59
Semi- rigide sondes..............................................................................................................................59
Indeling naargelang maat van de sonde:..............................................................................................60
Indeling volgens uiterlijke kenmerken..................................................................................................60
Sonde van Levin....................................................................................................................................60
Sumptube.............................................................................................................................................60
Sonde van Faucher...............................................................................................................................60
Microsonde:.........................................................................................................................................60
P.E.G.-sonde: percutane endoscopische gastrostomiesonde...............................................................61
Intestinale sonde..................................................................................................................................61
Materialen voor sondevoeding.....................................................................................................61
Sondes en materialen voor rectaal gebruik..................................................................................61
Rectale sonde.......................................................................................................................................61
Lavementen..........................................................................................................................................61
5-10ml lavement..................................................................................................................................61
125 ml lavement...................................................................................................................................61
Disposable 1l lavement.........................................................................................................................61
Niet disposable irrigator.......................................................................................................................62
Materiaal voor stomagebruik.......................................................................................................62
Stomazakjes en platen..........................................................................................................................62
Colostomie...........................................................................................................................................62
Ileostomie.............................................................................................................................................62
Tweedelige systemen...........................................................................................................................62
Eéndelige systemen..............................................................................................................................62
Eisen.....................................................................................................................................................62
Bijkomende (hulp)middelen.................................................................................................................62
verpleegkundige interventies...........................................................................................................63
Stoelgang staalname.....................................................................................................................63
Indicaties..............................................................................................................................................63
Werkwijze:............................................................................................................................................63
Aandachtspunten.................................................................................................................................63
Hulp bij gastro oesophagale reflux (psyrosis/heartburn)..............................................................63
Indicaties..............................................................................................................................................63
werkwijze.............................................................................................................................................64
Aandachtspunten.................................................................................................................................64
, Maagtubage..................................................................................................................................64
Indicaties:.............................................................................................................................................64
Aandachtspunten:................................................................................................................................64
Toedienen van sondevoeding.......................................................................................................65
Aandachtspunten bij toediening..........................................................................................................65
Hulp bij defecatie..........................................................................................................................67
Indicaties..............................................................................................................................................67
Werkwijze: verwijderen van faecalomen:............................................................................................67
Aandachtspunten:................................................................................................................................67
Hulp bij flatus (=winderigheid= scheten)......................................................................................67
Indicaties:.............................................................................................................................................67
Werkwijze:............................................................................................................................................67
Aandachtspunten:................................................................................................................................67
Toedienen van lavementen of clysmata.......................................................................................68
Indicatie................................................................................................................................................68
Aandachtspunten:................................................................................................................................68
Stomazorg.....................................................................................................................................68
Indicaties..............................................................................................................................................68
Aandachtspunten:................................................................................................................................68
FYSIEKE AANDACHTSPUNTEN...............................................................................................................68
PSYCHOSOCIALE AANDACHTSPUNTEN.................................................................................................71
PATIENTENEDUCATIE...........................................................................................................................72
De stomaverpleegkundige....................................................................................................................73
Algemeen.............................................................................................................................................73
Functie..................................................................................................................................................73
Functieprofiel:......................................................................................................................................73
Organisatie...........................................................................................................................................73
Praktische zorgtoepassing....................................................................................................................73
Thuisverpleging en stomazorg..............................................................................................................74
Profiel stoma- thuisverpleegkundige....................................................................................................74
Nog enkele praktische tips bij de begeleiding van stomapatiënten......................................................74
Colonirrigatie................................................................................................................................75
definitie................................................................................................................................................75
Indicatie:...............................................................................................................................................75
Werkwijze.............................................................................................................................................75
Aandachtspunten.................................................................................................................................75
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