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Interventions for Clients with Renal Disorders

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... cavity into container Requires more time than hemo Complications Infection in peritoneal cavity Peritoneal Dialysis ESWL.Extracorporeal shock-wave lithotripsy ... – PowerPoint PPT presentation

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Title: Interventions for Clients with Renal Disorders


1
Interventions for Clients with Renal Disorders
2
Pyelonephritis
  • Bacterial infection in the kidney (upper urinary
    tract)
  • Key features include
  • Fever, chills, tachycardia, and tachypnea
  • Flank, back, or loin pain
  • Abdominal discomfort
  • Turning, nausea and vomiting, urgency, frequency,
    nocturia
  • General malaise or fatigue

3
Key Features of Chronic Pyelonephritis
  • Hypertension
  • Inability to conserve sodium
  • Decreased concentrating ability
  • Tendency to develop hyperkalemia and acidosis

4
Acute Pain Interventions
  • Pain management interventions
  • Lithotripsy
  • Percutaneous ultrasonic pyelolithotomy
  • Diet therapy
  • Drug therapy
  • Antibiotics
  • Urinary antiseptics

5
Surgical Management
  • Preoperative care
  • Antibiotics
  • Client education
  • Operative procedure pyelolithotomy, nephrectomy,
    ureteral diversion, ureter reimplantaton
  • Postoperative care for urologic surgery

6
Potential for Renal Failure
  • Interventions include
  • Use of specific antibiotics
  • Compliance with therapies and regular follow-up
  • Blood pressure control
  • Fluid therapy
  • Diet therapy
  • Other interventions

7
Potential for Renal Failure
  • Interventions include
  • Use of specific antibiotics
  • Compliance with therapies and regular follow-up
  • Blood pressure control
  • Fluid therapy
  • Diet therapy
  • Other interventions

8
Renal Abscess
  • A collection of fluid and cells caused by an
    inflammatory response to bacteria
  • Manifestations fever, flank pain, general
    malaise
  • Drainage by surgical incision or needle
    aspiration
  • Broad-spectrum antibiotics

9
Renal Tuberculosis
  • Diagnosis
  • Antitubercular therapy with rifampin, isoniazid,
    and pyrazinamide
  • Complications renal failure, kidney stones,
    obstruction, and bacterial superinfection of the
    urinary tract
  • Surgical excision possible

10
Acute Glomerulonephritis
  • Assessment
  • Management of infection
  • Prevention of complications
  • Diuretics
  • Sodium, water, potassium, and protein
    restrictions
  • Dialysis, plasmapheresis
  • Client education

11
Chronic Glomerulonephritis
  • Develops over a period of 20 to 30 years or
    longer
  • Assessment
  • Interventions include
  • Slowing the progression of the disease and
    preventing complications
  • Diet changes
  • (Continued)

12
Chronic Glomerulonephritis (Continued)
  • Fluid intake
  • Drug therapy
  • Dialysis, transplantation

13
Nephrotic Syndrome
  • Condition of increased glomerular permeability
    that allows larger molecules to pass through the
    membrane into the urine and be removed from the
    blood
  • Severe loss of protein into the urine
  • (Continued)

14
Nephrotic Syndrome (Continued
  • Treatment involves
  • Immunosuppressive agents
  • Angiotensin-converting enzyme inhibitors
  • Heparin
  • Diet changes
  • Mild diuretics

15
Nephrosclerosis
  • Thickening in the nephron blood vessels,
    resulting in narrowing of the vessel lumen
  • Occurs with all types of hypertension,
    atherosclerois, and diabetes mellitus
  • Collaborative management control high blood
    pressure and preserve renal function

16
Renovascular Disease
  • Profoundly reduces blood flow to the kidney
    tissue
  • Causes ischemia and atrophy of renal tissue
  • Diagnosis
  • Interventions drugs to control high blood
    pressure and procedures to restore the renal
    blood supply

17
Diabetic Nephropathy
  • Diabetic nephrophathy is a microvascular
    complication of either type 1 or type 2 diabetes.
  • First manifestation is persistent albuminuria.
  • Avoid nephrotoxic agents and dehydration.
  • Assess need for insulin.

18
Cysts and Benign Tumors
  • Thorough evaluation for cancer is needed.
  • Cyst can fill with fluid and cause local tissue
    damage as it enlarges.
  • Many cysts cause no symptoms.
  • Cysts are a structural birth defect that occur in
    fetal life.
  • Simple renal cysts are drained by percutaneous
    aspiration.

19
Renal Cell Carcinoma
  • Paraneoplastic syndromes include anemia,
    erythrocytosis, hypercalcemia, liver dysfunction,
    hormonal effects, increased sedimentation rate,
    and hypertension.
  • (Continued)

20
Renal Cell Carcinoma (Continued)
  • Nonsurgical management includes
  • Radiofrequency ablation, although effect is not
    known
  • Chemotherapy limited effect
  • Biological response modifiers and tumor necrosis
    factor lengthen survival time

21
Surgical Management
  • Preoperative care
  • Operative procedure
  • Postoperative care monitoring, pain management,
    and prevention of complications

22
Renal Trauma
  • Minor injuries such as contusions, small
    lacerations
  • Major injuries such as lacerations to the cortex,
    medulla, or branches of the renal artery
  • Collaborative management
  • Nonsurgical management drug therapy and fluid
    therapy
  • Surgical management nephrectomy or partial
    nephrectomy

23
Polycystic Kidney Disease
  • Inherited disorder in which fluid-filled cysts
    develop in the nephrons
  • Key features include
  • Abdominal or flank pain
  • Hypertension
  • Nocturia
  • Increased abdominal girth

24
Polycystic Kidney Disease (Continued)
  • Constipation
  • Bloody or cloudy urine
  • Kidney stones

25
Interventions
  • Pain management
  • Bowel management
  • Medication management
  • Energy management
  • Fluid monitoring
  • Urinary retention care
  • Infection protection

26
Interventions/Complications
  • Acute and chronic pain
  • Constipation
  • Hypertension and renal failure
  • Nursing interventions to promote self-management
    and understanding
  • Fluid therapy
  • Drug therapy
  • Measure and record blood pressure
  • Diet therapy

27
Hydronephrosis, Hydroureter, and Urethral
Stricture
  • Provide privacy for elimination.
  • Conduct Credé maneuver as necessary.
  • Apply double-voiding technique.
  • Apply urinary catheter as appropriate.
  • Monitor degree of bladder distention.
  • (Continued

28
Hydronephrosis, Hydroureter, and Urethral
Stricture (Continued)
  • Catheterize for residual.
  • Intermittently catheterize as appropriate.
  • Follow infection protection measures.

29
Nephrostomy
  • Client preparation
  • Procedure
  • Follow-up care including
  • Assess for
  • amount of drainage.
  • type of urinary damage expected.
  • manifestations of infection.
  • Monitor nephrostomy site for leaking urine.

30
Interventions for Clients with Acute and
Chronic Renal Failure
31
Acute Renal Failure
  • Pathophysiology
  • Types of acute renal failure include
  • Prerenal
  • Intrarenal
  • Postrenal

32
Phases of Acute Renal Failure
  • Phases of rapid decrease in renal function lead
    to the collection of metabolic wastes in the
    body.
  • Phases include
  • Onset
  • Diuretic
  • Oliguric
  • Recovery
  • Acute syndrome may be reversible with prompt
    intervention.

33
Assessment
  • History
  • Clinical manifestations
  • Laboratory assessment
  • Radiographic assessment
  • Other diagnostic assessments such as renal biopsy

34
Drug Therapy
  • Cardioglycides
  • Vitamins and minerals
  • Biologic response modifiers
  • Phosphate binders
  • Stool softeners and laxatives
  • Monitor fluids
  • Diuretics
  • Calcium channel blockers

35
Treatment
  • Diet therapy
  • Dialysis therapies
  • Hemodialysis
  • Peritoneal dialysis

36
Continuous Renal Replacement Therapy
  • Standard treatment
  • Dialysate solution
  • Vascular access
  • Continuous arteriovenous hemofiltration
  • Continuous venovenous hemofiltration

37
Posthospital Care
  • If renal failure is resolving, follow-up care may
    be required.
  • There may be permanent renal damage and the need
    for chronic dialysis or even transplantation.
  • Temporary dialysis is appropriate for some
    clients.

38
Chronic Renal Failure
  • Progressive, irreversible kidney injury kidney
    function does not recover
  • Azotemia
  • Uremia
  • Uremic syndrome

39
Stages of Chronic Renal Failure
  • Diminished renal reserve
  • Renal insufficiency
  • End-stage renal disease

40
Stages of Chronic Renal Failure Changes
  • Kidney
  • Metabolic
  • Urea and creatinine
  • Electrolytes
  • Sodium
  • Potassium
  • Acid-base balance
  • Calcium and phosphorus

41
Stages of Chronic Renal FailureChanges
(Continued)
  • Cardiac
  • Hypertension
  • Hyperlipidemia
  • Congestive heart failure
  • Uremic pericarditis
  • Hematologic
  • Gastrointestinal

42
Clinical Manifestations
  • Neurologic
  • Cardiovascular
  • Respiratory
  • Hematologic
  • Gastrointestinal
  • Urinary
  • Skin

43
Hemodialysis
  • Client selection
  • Dialysis settings
  • Works using passive transfer of toxins by
    diffusion
  • Anticoagulation needed, usually heparin treatment

44
Hemodialysis Nursing Care
  • Postdialysis care
  • Monitor for complications such as hypotension,
    headache, nausea, malaise, vomiting, dizziness,
    and muscle cramps.
  • Monitor vital signs and weight.
  • Avoid invasive procedures 4 to 6 hours after
    dialysis.
  • Continually monitor for hemorrhage

45
Complications of Hemodialysis
  • Dialysis disequilibrium syndrome
  • Infectious diseases
  • Hepatitis B and C infections
  • HIV exposureposes some risk for clients
    undergoing dialysis

46
Peritoneal Dialysis
  • Procedure involves siliconized rubber catheter
    placed into the abdominal cavity for infusion of
    dialysate.
  • Types of peritoneal dialysis
  • Continuous ambulatory peritoneal
  • Automated peritoneal
  • Intermittent peritoneal
  • Continuous-cycle peritoneal

47
Complications
  • Peritonitis
  • Pain
  • Exit site and tunnel infections
  • Poor dialysate flow
  • Dialysate leakage
  • Other complications

48
Nursing Care During Peritoneal Dialysis
  • Before treating, evaluate baseline vital signs,
    weight, and laboratory tests.
  • Continually monitor the client for respiratory
    distress, pain, and discomfort.
  • Monitor prescribed dwell time and initiate
    outflow.
  • Observe the outflow amount and pattern of fluid.

49
Renal Transplantation
  • Candidate selection criteria
  • Donors
  • Preoperative care
  • Immunologic studies
  • Surgical team
  • Operative procedure

50
Postoperative Care
  • Urologic management
  • Assessment of urine output hourly for 48 hours.
  • Complications include
  • Rejection
  • Acute tubular necrosis

51
Postoperative Care
  • Thrombosis
  • Renal artery stenosis
  • Other complications
  • Immunosuppressive drug therapy
  • Psychosocial preparation

52
Interventions for Clients with Urinary Problems
53
Cystitis
  • Inflammation of the bladder
  • Most commonly caused by bacteria that move up the
    urinary tract from the external urethra to the
    bladder, viruses, fungi, or parasites
  • Catheter-related infections common during
    hospital stay

54
Incidence and Prevalence of Cystitis
  • Frequenct urge to urinate
  • Dysuria
  • Urgency
  • Urinalysis needed when testing for leukocyte
    esterase
  • Type of organism confirmed by urine culture
  • Other diagnostic assessments

55
Drug Therapy
  • Urinary antiseptics
  • Antibiotics
  • Analgesics
  • Antispasmodics
  • Antifungal agents
  • Long-term antibiotic therapy for chronic,
    recurring infections

56
Nonsurgical Management
  • Urinary elimination
  • Diet therapy includes all food groups, calorie
    increase due to increase in metabolism caused by
    the infection, fluids, possible intake of
    cranberry juice preventively
  • Other pain relief measures, such as warm sitz
    baths

57
Catheter
58
Urethritis
  • Inflammation of the urethra that causes symptoms
    similar to urinary tract infection
  • Caused by sexually transmitted infections treat
    with antibiotic therapy
  • Estrogen vaginal cream for postmenopausal women

59
Urethrala Strictures
  • Narrowing of the urethra
  • Most common symptomobstruction of urine flow
  • Surgical treatment by urethroplastybest chance
    of long-term cure
  • Dilation of the urethraa temporary measure
  • Urethroplasty

60
Urinary Incontinence
  • Five types of incontinence include
  • Stress
  • Urge
  • Mixed
  • Overflow
  • Functional

61
Collaborative Management
  • Assessment includes a thorough client history.
  • Clinical manifestations for urethral or uterine
    prolapse
  • Laboratory assessment by urinalysis
  • Radiographic assessment, especially before
    surgery
  • Other diagnostic assessments

62
Stress Urinary Incontinence
  • Interventions include
  • Keeping a diary, behavioral interventions, diet
    modification, and pelvic floor exercises
  • Drug therapy estrogen
  • Surgery
  • Collection devices and vaginal cone weights

63
Surgical Management
  • Preoperative care
  • Operative procedure
  • Postoperative care
  • Assess for and intervene to prevent or detect
    complications.
  • Secure urethral catheter.

64
Urge Urinary Incontinence
  • Interventions include
  • Drugs anticholinergics, possibly antihistamines,
    others
  • Diet therapy avoid caffeine and alcohol
  • Behavioral interventions exercises, bladder
    training, habit training, electrical stimulation

65
Reflux Urinary Incontinence
  • Interventions include
  • Surgery to relieve the obstruction
  • Intermittent catheterization
  • Bladder compression and intermittent
    self-catheterization
  • Drug therapy
  • Behavioral interventions

66
Functional Urinary Incontinence
  • Interventions include
  • Treatment of reversible causes
  • If incontinence is not reversible, urinary habit
    training
  • Final strategycontainment of urine and
    protection of the clients skin
  • Applied devices
  • Urinary catheterization

67
Urolithiasis
  • Presence of calculi (stones) in the urinary tract
  • Collaborative management
  • History of urologic stones
  • Clinical manifestations
  • Laboratory assessment
  • Radiographic assessment
  • Other diagnostic tests

68
IVP (Intravenous Pyelography)
69
Interventions
  • Drug therapy
  • Opioid analgesicsoften used to control pain
  • Nonsteroidal anti-inflammatory drugs
  • Pain medications at regular intervals
  • Constant delivery system
  • Spasmolytic drugsimportant for relief of pain
  • Complementary and alternative therapy

70
Lithotripsy
  • Extracorporeal shock wave lithotripsy uses
    sound, laser, or dry shock wave energy to break
    the stone into small fragments.
  • Client undergoes conscious sedation
  • Topical anesthetic cream is applied to skin site
    of stone.
  • Continuous monitoring is by electrocardiography

71
Surgical Management
  • Minimally invasive surgical procedures
  • Stenting
  • Retrograde ureteroscopy
  • Percutaneous ureterolithotomy and nephrolithotomy
  • Open surgical procedures
  • Preoperative care
  • Operative procedure

72
Postoperative Care
  • Routine postoperative care procedures for
    assessment of bleeding, urine, and adequate fluid
    intake
  • Strained urine
  • Infection prevention
  • Drug therapy
  • Diet therapy
  • Prevention of obstruction

73
Drug Therapy
  • Drug selection to prevent obstruction depends on
    what is forming the stone
  • Calcium
  • Oxalate
  • Uric acid
  • Cystine

74
Urothelial Cancer
  • Collaborative management
  • Assessment
  • Diagnostic assessment
  • Nonsurgical management
  • Prophylactic immunotherapy
  • Chemotherapy
  • Radiation therapy

75
Surgical Management
  • Preoperative care
  • Operative procedures
  • Postoperative care includes
  • Collaboration with enterostomal therapist
  • Kocks pouch
  • Neobladder

76
Bladder Trauma
  • Causes may be due to injury to the lower abdomen
    or stabbing or gunshot wounds.
  • Surgical intervention is required.
  • Fractures should be stabilized before bladder
    repair.

77
Hemodialysis
  • Hospital, dialysis center
  • Pts blood moves from implanted shunt in arm
    artery ? tube ? machine ? exchange of wastes,
    fluids, electrolytes
  • Semipermeable membrane separates pts blood from
    dialysis fluid

78
Hemodialysis
  • Constituents move between the 2 compartments
  • Ex wastes in blood ? dialysate
  • bicarbonate in dialysate ? blood
  • Blood cells, proteins remain in blood
  • Movement by ultrafiltration, diffusion, osmosis
  • ? Blood to pt vein

79
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80
Peritoneal Dialysis
  • Administered in unit or at home
  • At night or continuously
  • CAPD (continuous ambulatory peritoneal dialysis)
  • Peritoneal membrane serves as semipermeable
    membrane
  • Catheter w/ entry and exit points implanted
  • Dialyzing fluid instilled in catheter into cavity

81
Peritoneal Dialysis
  • Remains there
  • Allows exchange of wastes and electrolytes to
    occur
  • Dialysate drained from by gravity from cavity
    into container
  • Requires more time than hemo
  • Complications
  • Infection in peritoneal cavity

82
Peritoneal Dialysis
83
ESWL.Extracorporeal shock-wave lithotripsy (ESWL)
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