Nursing Management of the Adult Patient with Urologic Alterations - PowerPoint PPT Presentation

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Nursing Management of the Adult Patient with Urologic Alterations

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Function of the Kidneys. What are the functions of the kidneys? ... Renal angiogram. Cystoscopy. Renal biopsy. Assessment of the Renal System. Urodynamic testing ... – PowerPoint PPT presentation

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Title: Nursing Management of the Adult Patient with Urologic Alterations


1
Nursing Management of the Adult Patient with
Urologic Alterations
  • Donna Shepherd, MSN, RN, C
  • Spring 2009

2
Function of the Kidneys
  • What are the functions of the kidneys?

3
Urine Formation
  • Glomerular filtration
  • Tubular reabsorption
  • Tubular secretion

4
Assessment of the Renal System
  • Physical Assessment
  • Diagnostic Evaluation
  • UA
  • Renal function test
  • Serum Creatinine
  • BUN
  • Creatinine Clearance

5
Assessment of the Renal System
  • Other Diagnostic Tests / Procedures
  • KUB
  • IVP
  • Ultrasound
  • CT MRI
  • Renal angiogram
  • Cystoscopy
  • Renal biopsy

6
Assessment of the Renal System
  • Urodynamic testing

7
Tests of Renal Function
  • Creatinine 0.6 1.2 mg/dL
  • BUN 7 18 mg/dL
  • (gt 60 yrs) 8 20 mg/dL
  • BUN to Creatinine Ratio 101
  • Creatinine Clearance
  • 24 hour urine
  • Results by age, gender, ethnicity
  • Specific Gravity 1.010 1.025

8
Points to Ponder
  • What are the normal substances found in urine?
  • If found in urine, what substances warrant
    further investigation by the nurse?

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11
Nursing Interventions
  • Administer urinary tract antiseptics
  • Encourage medication compliance
  • Administer systemic antibiotics
  • Administer analgesics
  • Increase fluid intake to 1,500 mL (if normal
    renal / cardiac function)
  • Sitz bath for comfort

12
Nursing Interventions
  • Avoid irritants (coffee, tea, citrus fruits)
  • Teach toileting hygiene
  • Regular voiding
  • Monitor IO
  • Assess urine volume, color, cloudiness,
    specific gravity

13
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14
Surgery of the Kidney Preop. Care
  • Focus
  • Preparing patient
  • Minimizing / Preventing complications
  • Assessment
  • Lab Values
  • Reducing Anxiety
  • Teaching
  • Discharge Planning

15
Surgery of the Kidney Postop Care
  • Focus
  • Prevention / early detection of complications
  • Hemorrhage Shock
  • Atelectasis Pneumonia
  • Pneumothorax
  • Fluid Electrolyte imbalances
  • Abdominal distention Paralytic ileus
  • Infection
  • Thrombophlebitis
  • Pain

16
Post procedure Nursing Interventions
  • Key Thorough assessment of each body system
  • What measures should be implemented to prevent
    complications?
  • What education should be provided to the patient?

17
Post Surgery Nursing Plan of Care
  • Alleviate pain
  • Monitor urinary output
  • Detect spontaneous passage of stone (strain
    urine)
  • Ambulation
  • Force fluids (if not restricted)
  • Monitor IV fluids

18
Post Surgery Nursing Plan of Care
  • Monitor VS
  • Assess for s/s infection, sepsis, urinary
    obstruction
  • Education
  • Self-care
  • Continuing care
  • Prevention of recurrent stones

19
Nephrotic Syndrome
  • Characterized by
  • Proteinuria
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
  • Due to lack of albumin (a plasma protein) in urine

20
Nephrotic Syndrome
  • Contributing Causes
  • DM
  • SLE
  • Chronic glomerulitis
  • Renal vein thrombosis
  • Signs and Symptoms
  • Edema
  • Malaise Fatigue
  • HA
  • Irritability

21
Nephrotic Syndrome
  • Diagnostic Findings
  • Albumin exceeds 3 to 3.5 gm/day
  • ? WBC in urine
  • Needle biopsy (to confirm diagnosis)

22
Nephrotic Syndrome
  • Medical Management
  • Diuretics
  • ACE Inhibitors
  • Antineoplastic agents (Cytoxan)
  • Dietary Management
  • Low Na
  • Liberal K
  • Low fat
  • Protein 0.8 gm/kg/day

23
Nephrotic Syndrome
  • Nursing Management
  • As that of patient in chronic renal failure

24
Acute Renal Failure
  • Initiation Period
  • Period of Oliguria
  • Period of Diuresis
  • Period of Recovery

25
Chronic Renal Failure
  • Stages
  • Reduced renal reserve
  • Renal insufficiency
  • End Stage Renal Disease (ESRD)

26
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29
ESRD Dietary Management
  • Goals
  • Maintain body weight (age, height, build)
  • Maintain serum lab values within safe limits
  • Comply with dietary regimen

30
Dialysis
  • Hemodialysis
  • Continuous Renal Replacement Therapy (CRRT)
  • Peritoneal Dialysis
  • Continuous Ambulatory (CAPD)
  • Continuous Cycle (CCPD)

31
Dialysis Nursing Management
  • Protect vascular access
  • Monitor
  • Fluid balance
  • Electrolyte balance
  • Diet
  • BP
  • Assess for manifestations of
  • Uremia
  • Cardiac respiratory complications

32
Dialysis Nursing Management
  • Manage pain discomfort
  • Prevent infection
  • Knowledge deficiency regarding self care

33
Peritoneal Dialysis - Complications
  • Peritonitis
  • Leakage
  • Bleeding
  • Long term complications

34
Hemodialysis - Complications
  • Hypotension
  • Chest pain
  • Air embolism
  • Dialysis disequilibrium
  • Dysrhythmias

35
Hemodialysis - Complications
  • Exosanguination
  • CHF, CAD
  • CVA
  • Anemia
  • Fluid electrolyte imbalance

36
Hemodialysis - Complications
  • Osteodystrophy
  • Infection
  • GI problems
  • Diminished physical well-being
  • Diminished emotional well-being

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38
Urinary Diversions
  • Types
  • Cutaneous (Ileal Loop)
  • Continent (Indiana Pouch)
  • Ureterosigmoidostomy
  • Nursing Care
  • Dependent upon type of diversion performed during
    surgery
  • Common needs by patients

39
Urinary Diversions
  • Common Needs of Patients
  • Teaching needs
  • Anxiety reduction

40
Urinary Diversions Nursing Diagnoses
  • Preoperative
  • Anxiety
  • Altered nutrition
  • Knowledge deficient
  • Postoperative
  • Risk for impaired skin integrity
  • Pain
  • Body image disturbance
  • Altered pattern of urinary elimination

41
Urinary Diversions Nursing Management
  • Postoperative
  • Monitor urinary function
  • Assess skin prevent breakdown
  • Monitor fluid electrolytes
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