Interventions for Clients with Renal Disorders

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Interventions for Clients with Renal Disorders
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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

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Key Features of Chronic Pyelonephritis

• Hypertension
• Inability to conserve sodium
• Decreased concentrating ability
• Tendency to develop hyperkalemia and acidosis

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Acute Pain Interventions

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

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Surgical Management

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

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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

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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

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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

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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

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Acute Glomerulonephritis

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

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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)

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Chronic Glomerulonephritis (Continued)

• Fluid intake
• Drug therapy
• Dialysis, transplantation

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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)

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Nephrotic Syndrome (Continued

• Treatment involves
• Immunosuppressive agents
• Angiotensin-converting enzyme inhibitors
• Heparin
• Diet changes
• Mild diuretics

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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

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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

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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.

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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.

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Renal Cell Carcinoma

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

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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

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Surgical Management

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

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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

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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

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Polycystic Kidney Disease (Continued)

• Constipation
• Bloody or cloudy urine
• Kidney stones

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Interventions

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

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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

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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

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Hydronephrosis, Hydroureter, and Urethral
Stricture (Continued)

• Catheterize for residual.
• Intermittently catheterize as appropriate.
• Follow infection protection measures.

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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.

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Interventions for Clients with Acute and
Chronic Renal Failure
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Acute Renal Failure

• Pathophysiology
• Types of acute renal failure include
• Prerenal
• Intrarenal
• Postrenal

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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.

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Assessment

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

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Drug Therapy

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

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Treatment

• Diet therapy
• Dialysis therapies
• Hemodialysis
• Peritoneal dialysis

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Continuous Renal Replacement Therapy

• Standard treatment
• Dialysate solution
• Vascular access
• Continuous arteriovenous hemofiltration
• Continuous venovenous hemofiltration

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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.

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Chronic Renal Failure

• Progressive, irreversible kidney injury kidney
  function does not recover
• Azotemia
• Uremia
• Uremic syndrome

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Stages of Chronic Renal Failure

• Diminished renal reserve
• Renal insufficiency
• End-stage renal disease

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Stages of Chronic Renal Failure Changes

• Kidney
• Metabolic
• Urea and creatinine
• Electrolytes
• Sodium
• Potassium
• Acid-base balance
• Calcium and phosphorus

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Stages of Chronic Renal FailureChanges
(Continued)

• Cardiac
• Hypertension
• Hyperlipidemia
• Congestive heart failure
• Uremic pericarditis
• Hematologic
• Gastrointestinal

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Clinical Manifestations

• Neurologic
• Cardiovascular
• Respiratory
• Hematologic
• Gastrointestinal
• Urinary
• Skin

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Hemodialysis

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

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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

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Complications of Hemodialysis

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

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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

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Complications

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

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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.

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Renal Transplantation

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

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Postoperative Care

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

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Postoperative Care

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