Page 1300 - Saunders Comprehensive Review For NCLEX-RN

pelvic outlet into the urethra.
b. The client empties the neobladder by
relaxing the external sphincter and
creating abdominal pressure or by
intermittent self-catheterization.
8. Percutaneous nephrostomy or pyelostomy
a. These procedures are used to prevent or
treat obstruction.
b. The procedures involve a percutaneous
or surgical insertion of a nephrostomy
tube into the kidney for drainage.
c. Nursing interventions involve
stabilizing the tube to prevent
dislodgment and monitoring output.
9. Ureterostomy
a. Ureterostomy may be performed as a
palliative procedure if the ureters are
obstructed by the tumor.
b. The ureters are attached to the surface
of the abdomen, where the urine flows
directly into a drainage appliance
without a conduit.
c. Potential problems include infection,
skin irritation, and obstruction to
urinary flow as a result of strictures at
the opening.
10. Vesicostomy
a. The bladder is sutured to the abdomen,
and a stoma is created in the bladder
wall.
b. The bladder empties through the stoma.

F. Preoperative interventions

1. Instruct the client in preoperative, operative, and
postoperative management, including diet,
medications, nasogastric tube placement, IV lines,
NPO status, pain control, coughing and deep
breathing, leg exercises, and postoperative activity.
2. Demonstrate appliance application and use for those
clients who will have a stoma.
3. Arrange an enterostomal nurse consult and for a visit
with a person who has had urinary diversion.
4. Administer antimicrobials for bowel preparation as
prescribed.
5. Encourage discussion of feelings, including the effects
on sexual activities.
G. Postoperative interventions

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