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Samenvatting Verpleegkundige Methodiek En Vaardigheden: urogenitaal
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samenvatting urogenitaal, VMV 4, vives Brugge, 2e jaar bachelor verpleegkunde
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Bachelor verpleegkunde: OLF 2VMV4: Urogenitale zorg
Urogenitale zorg 1
,Bachelor verpleegkunde: OLF 2
Inhoudsopgave
Anatomie en fysiologie ...................................................................................................................................... 6
Observaties ........................................................................................................................................................ 6
Diurese.......................................................................................................................................................................................... 6
Frequentie .................................................................................................................................................................................... 6
Bijzonderheden ............................................................................................................................................................................ 6
Helderheid van de urine ............................................................................................................................................................. 6
Kleur van de urine....................................................................................................................................................................... 6
Geur van de urine ....................................................................................................................................................................... 6
Urineonderzoek .................................................................................................................................................. 6
Algemeen ..................................................................................................................................................................................... 6
Urine teststroken ......................................................................................................................................................................... 7
Het urinesediment ................................................................................................................................................................. 7
Urinecultuur ............................................................................................................................................................................ 7
Hematurie..................................................................................................................................................................................... 7
Glucosurie .................................................................................................................................................................................... 7
Ketonurie ...................................................................................................................................................................................... 7
Proteïnurie.................................................................................................................................................................................... 7
Pyurie............................................................................................................................................................................................ 8
Cilinders en urinekristallen ......................................................................................................................................................... 8
Urineweginfecties en urosepsis.......................................................................................................................... 8
Cystitis (blaasontsteking) ........................................................................................................................................................... 8
Prostatitis (ontsteking prostaat) ............................................................................................................................................... 8
(Pyelo-)nefritis............................................................................................................................................................................. 8
Symptomen ............................................................................................................................................................................ 8
Behandeling ........................................................................................................................................................................... 9
Urine-incontinentie ............................................................................................................................................. 9
Fysiologie van urine-incontinentie............................................................................................................................................. 9
Diagnose ...................................................................................................................................................................................... 9
Anamnese en zorgvuldig klinisch onderzoek ................................................................................................................... 9
Labo ........................................................................................................................................................................................ 9
Verder onderzoek ................................................................................................................................................................ 9
Vormen ...................................................................................................................................................................................... 10
Urge-incontinentie of aandrangincontinentie ............................................................................................................... 10
Stressincontinentie of inspanningsincontinentie ............................................................................................................. 10
Mixed incontinentie ........................................................................................................................................................... 10
Overloopincontinentie ....................................................................................................................................................... 10
Therapie (algemeen) ............................................................................................................................................................... 10
Specifieke therapie bij aandrangincontinentie of urge-incontinentie ..................................................................... 10
Stressincontinentie (of inspanningsincontinentie)........................................................................................................... 10
Overloopincontinentie ....................................................................................................................................................... 10
Blaascarcinoom ................................................................................................................................................ 10
Urogenitale zorg 2
,Bachelor verpleegkunde: OLF 2
Aandoeningen van de prostaat ....................................................................................................................... 10
Benigne prostaathyperplasie (BPH) ...................................................................................................................................... 11
Diagnose.............................................................................................................................................................................. 11
Behandeling ........................................................................................................................................................................ 11
Prostaatcarcinoom ................................................................................................................................................................... 11
Diagnose.............................................................................................................................................................................. 11
Behandeling ........................................................................................................................................................................ 11
Eenmalige sondage .......................................................................................................................................... 11
Omschrijving............................................................................................................................................................................. 11
Indicaties ................................................................................................................................................................................... 11
De bladderscan ........................................................................................................................................................................ 12
Indicaties.............................................................................................................................................................................. 12
Voor- en nadelen............................................................................................................................................................... 12
Contra-indicaties ................................................................................................................................................................ 12
Procedure ............................................................................................................................................................................ 12
Uitvoering van de eenmalige sondage ................................................................................................................................. 12
Verblijfskatherisatie ......................................................................................................................................... 12
Omschrijving............................................................................................................................................................................. 12
Indicaties ................................................................................................................................................................................... 13
Contra-indicaties ...................................................................................................................................................................... 13
Materiaal .................................................................................................................................................................................. 13
Blaaskatheters of blaassonden ....................................................................................................................................... 13
Urine-opvangrecipiënten.................................................................................................................................................. 13
Uitvoering ................................................................................................................................................................................. 13
Het verwijderen van een verblijfskatheter ............................................................................................................................ 13
Het vernieuwen van een verblijfskatheter ............................................................................................................................. 13
Verpleegkundige zorgen bij een zorgontvanger met een verblijfskatheter .................................................................... 14
Hygiëne en steriliteit ......................................................................................................................................................... 14
Regelmatig nazicht van de urine-afvloei ...................................................................................................................... 14
Complicaties ............................................................................................................................................................................. 14
Infectie ................................................................................................................................................................................. 14
Trauma van de urethra..................................................................................................................................................... 14
Tijdelijke incontinentie ....................................................................................................................................................... 14
Bij mannen: drukwonden, abces, fistulisatie ter hoogte van penisscrotale hoek ................................................... 14
Genitale verwikkelingen: bijbalontsteking (epididymitis) en prostaatontsteking (prostatitis) ............................ 14
Steenvorming/vlokken ...................................................................................................................................................... 14
Suprapubische blaaskatherisatie...................................................................................................................... 14
Definitie ..................................................................................................................................................................................... 14
Indicaties ................................................................................................................................................................................... 14
Contra-indicaties ...................................................................................................................................................................... 14
Voordelen suprapubische sonde ............................................................................................................................................ 14
Nadelen van de suprapubische sonde ................................................................................................................................... 14
Vervangen van de suprapubische sonde .............................................................................................................................. 15
Vervanging door de verpleegkundige ......................................................................................................................... 15
Voorwaarden ..................................................................................................................................................................... 15
Urogenitale zorg 3
,Bachelor verpleegkunde: OLF 2
Wanneer en waarom vervangen? ................................................................................................................................. 15
Gebruikte materialen ....................................................................................................................................................... 15
Procedure vervanging ...................................................................................................................................................... 15
Problemen en aandachtspunten ............................................................................................................................................. 15
Algemene aandachtspunten ............................................................................................................................................ 15
Complicaties bij vervanging ............................................................................................................................................ 15
Verwikkelingen van de suprapubische sonde .............................................................................................................. 16
Frequentie van vervanging .............................................................................................................................................. 16
Steriel staal ....................................................................................................................................................... 16
Algemeen .................................................................................................................................................................................. 16
Middenstroom (midstream) via spontane mictie.................................................................................................................. 16
Indicaties.............................................................................................................................................................................. 16
Contra-indicaties ................................................................................................................................................................ 16
Aandachtspunten................................................................................................................................................................ 16
Staalopname ...................................................................................................................................................................... 16
Middelstroom (midstream) via éénmalige sondage............................................................................................................ 16
Via verblijfsonde ...................................................................................................................................................................... 16
Materiaal ............................................................................................................................................................................ 16
Uitvoering ............................................................................................................................................................................ 16
Via suprapubische blaaspunctie ..................................................................................................................................... 17
Blaasspoeling ................................................................................................................................................... 17
Omschrijving............................................................................................................................................................................. 17
Doel ........................................................................................................................................................................................... 17
Indicaties ................................................................................................................................................................................... 17
Spoelvloeistoffen ..................................................................................................................................................................... 17
Niet-voorverpakte spoelvloeistoffen ............................................................................................................................. 17
Voorverpakte spoelvloeistoffen ..................................................................................................................................... 17
Gewone of onderbroken blaasspoeling ................................................................................................................................ 17
Materiaal ............................................................................................................................................................................ 17
Uitvoering ............................................................................................................................................................................ 17
Continue blaasspoeling ........................................................................................................................................................... 18
Omschrijving........................................................................................................................................................................ 18
Uitvoering ............................................................................................................................................................................ 18
Mogelijke complicaties ..................................................................................................................................................... 18
Blaasinstillatie .................................................................................................................................................. 18
Omschrijving............................................................................................................................................................................. 18
Doel ........................................................................................................................................................................................... 18
Mogelijke aanwijzingen (indicaties) ...................................................................................................................................... 18
Instillatievloeistoffen................................................................................................................................................................ 18
Uitvoering van de blaasinstillatie met voorgeschreven instillatievloeistof ....................................................................... 19
Aandachtspunten................................................................................................................................................................ 19
Materiaal ............................................................................................................................................................................ 19
Uitvoering ............................................................................................................................................................................ 19
Instillatie met een uro-tainer................................................................................................................................................... 19
Gebruiksaanwijzing .......................................................................................................................................................... 19
Urostoma .......................................................................................................................................................... 19
Urogenitale zorg 4
,Bachelor verpleegkunde: OLF 2
Definitie ..................................................................................................................................................................................... 19
Indicaties ................................................................................................................................................................................... 19
Soorten urostoma .................................................................................................................................................................... 19
Incontinent urostoma .......................................................................................................................................................... 19
Continent urostoma ............................................................................................................................................................ 20
Verzorging van een incontinent urostoma ........................................................................................................................... 20
Materiaal ............................................................................................................................................................................ 20
Stomazorg ........................................................................................................................................................................... 20
Terugbetaling ........................................................................................................................................................................... 20
Mogelijke verwikkelingen ....................................................................................................................................................... 20
Praktische toepassing....................................................................................................................................... 20
Anatomie en fysiologie van het voorplantingsstelsel ..................................................................................... 21
Voortplantingsstelsel van de vrouw ...................................................................................................................................... 21
Voortplantingsstelsel van de man.......................................................................................................................................... 21
Diagnostische onderzoeken ............................................................................................................................. 21
Diagnostisch onderzoek bij de vrouw ................................................................................................................................... 21
Diagnostisch onderzoek bij de man ...................................................................................................................................... 21
Normale fysiologische veranderingen ............................................................................................................. 21
Fysiologische veranderingen bij de vrouw ........................................................................................................................... 21
Fysiologische veranderingen bij de man............................................................................................................................... 21
Aandoeningen.................................................................................................................................................. 21
Aandoeningen van de vrouwelijke geslachtsorganen ......................................................................................................... 21
Pelvic Inflammatory Disease (PID) .................................................................................................................................. 21
Cervixcarcinoom ................................................................................................................................................................ 22
Myomen ............................................................................................................................................................................... 22
Endometriose ...................................................................................................................................................................... 22
Uterusprolaps ..................................................................................................................................................................... 22
Mammacarcinoom.............................................................................................................................................................. 22
Goedaardige aandoeningen van de borst.................................................................................................................. 22
Aandoeningen van de mannelijke geslachtsorganen .......................................................................................................... 23
Prostatitis ............................................................................................................................................................................. 23
Epididymitis ......................................................................................................................................................................... 23
Orchitis ................................................................................................................................................................................. 23
Cryptorchisme ..................................................................................................................................................................... 23
Benigne prostaathyperplasie .......................................................................................................................................... 23
Prostaatkanker ................................................................................................................................................................... 23
Erectiele dysfunctie/ erectiestoornis/ impotentie ........................................................................................................ 23
Menopauze ...................................................................................................................................................... 23
Seksueel overdraagbare aandoeningen........................................................................................................... 23
Urethritis.................................................................................................................................................................................... 23
Gonorroe ............................................................................................................................................................................. 24
Chlamydia ........................................................................................................................................................................... 24
Chirurgische ingrepen ...................................................................................................................................... 24
Urogenitale zorg 5
, Bachelor verpleegkunde: OLF 2
Hysterectomie ........................................................................................................................................................................... 24
Anatomie en fysiologie
Observaties
Diurese Frequentie
• Gemiddelde urineproductie/urinedebiet per 24u bij een • 4 tot 6 maal per 24u met 200 à 300 ml per
volwassene = 1200 tot 1500 ml lozing
• Diurese is afhankelijk van: • Afwijking: pollakisurie à vermeerdering aantal
o Hoeveelheid vochtinname urinelozingen, zonder dat de hoeveelheid urine
o Hoeveelheid vochtuitscheiding langs andere wegen bv. per dag vermeerderd is à niet gelijk aan een
braken, diarree, transpiratie verhoogde diurese
o Geneesmiddelen (diuretica, opiumderivaten)
o Aandoeningen (hartaandoening, nierproblemen)
• Afwijkingen van de urineproductie:
Polyurie: verhoogde Anurie: <50ml/24u à
productie (>2l/24u) onvermogen
Oligurie: verminderde Nycturie: grotere productie ‘s
productie (<500ml/24u) nachts
Bijzonderheden Helderheid van de urine
• Dysurie: moeilijk kunnen urineren • Normaal helder zonder zichtbare bestanddelen
• Urineretentie: niet kunnen uitplassen à onvolledige blaaslediging à na lange bewaring lichte troebeling
na urinelozing • Afwijkingen: troebel door infectie (bacteriën) of
• Residu: urine die achterblijft in de blaas aanwezigheid van slijmen (vaginaal, sperma)
• Pijn, branderig gevoel bij het urineren
• Weinig kracht in de urinestaal, nadruppelen
• Enuresis: onwillekeurige urinelozing, bedplassen
Kleur van de urine Geur van de urine
• Afh. van de concentratie: lichtgeel, citroengeel • Bijna geurloos à na bepaalde tijd op
• Afwijkingen door voeding of medicatie kamertemperatuur ruikt het naar ammoniak
o Donkerbruin: hoog gehalte bilirubine in bloed • Afwijkingen: sterke ammoniakgeur bij infectie,
o Lichtgekleurd: lage concentratie urine bij hoge urineproductie zoete geur door glucosurie
o Roodbruin: bloed in urine (hematurie) à micro- of
macrohematurie
Urineonderzoek
Algemeen
• Het verkrijgen van een vers urinemonster dat goed bewaard wordt
• Gebruik maken van een zuiver (en/of steriel) recipiënt en het urinestaal koel bewaren
Urogenitale zorg 6
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