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Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without

immediate danger to survival. Butshould kidneys fail neither bone, muscle, nor brain could carry on. Homer Smith, PhD I. Anatomy and physiology Kidney(cortex,medulle and renal pelvis*small bladder) *renal clearanceNephron - million !enal "unction-serum crea #lomerlus and bo$man%s capsule, #&!'A((mean arterial pressure) )ubulointertitial part- proximal convoluted tubules,((*)) loop o" hele-concentrating abilty, distal convoluted tuble(+*)) ,ilum , vasa recta -ml.min urine production( urine is sterile) /reter- up0 and upv 1ladder 2 urgency, capacity. /rethra-bladder control. 3phincters (!43)A)5-inc in si6e due to conversion o" testosterone, drug- (!43*A! - main "x o" 7idney8 . excretion o" $aste urine "ormation ( glomerular "iltration, tubular reabsorption, tubu9ar excretion) -. ,omeostasis- hormone regulation o" acid base, and $ater and 1p - erythropoietin, ,-:;. <it d.. insulin degradation etc.. /rine composition-creatinine, urea, nitrogen, acidity, sp. gravity !egulation o" acid-bu""er(bicarbonates, protein) lungs "irst to react $hile 7idney can act on a prolonged period , ammonium binds $ith hydrogen=ammonia !egulation o" electrolytea nd $ater-Na and $ater reasorption !egulation o" bp-renin angiotensin system,aldosterone-na reapsortion 3cenarios lli7e decrease in #&! ( decrease 7idney per"usion) Ability o" 7idneys to autoregulate by vasodilatory e""ect, thru neural path$ays, AN( "rom myocardium by reabsorption o" Na and vasodialotry e""ect, prostaglandin synthesis(vasodialtory e""ect) !enal clearance-ability o" 7idney excrete $aste-1/N *!5A !A)I4.. 3)/+> Normal values glucose clearance rate=?, creatinine clearance rate= ??, urea=:?@ 3torage o" urine and voiding 1ladder- guarded by sphincters and unidirectional peristaltic movement ( in"ection and inc pressure) <oiding'uscle control (external urethral sphincter relaxes and detrusor muscle contracts.A 'I*)/!I)I4N Neural control 2 (N3 /rgency - :?ml 'aximum blader capacity *residual /rine- :? ml- ?? ml (gerontologic consideration) Assessment o" urinary "unction . **. 4nset -. Bocation. char and duration C. ,x o" /)I. stones D. &ever :. ,x o" +x testing. use o" device E. <oiding problems 2 "reFuency,urgency, dysuria,hesitancy, nocturia,incontinence, eneuresis, polyuria, oliguria, anuria, hematuria, proteinuria, pyuria;. G. &emale- ,x o" deliveryH In"ection, contraceptive I. 3)+ J. ,abit.vices ?. medication . #i symptoms -. (sych.socicultural.mental "unction. occupational C. evaluate pain anatomically

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D. (hysical assessment 2I((A IK. &luid and electrolyte Imbalance- revie$ normal values K. +iagnostic 5valuation . /rinalysis- *olor ($hat in"luences change in color- meds;etc), (h, 3p gravity, test "or *,4N, glucose, 'Icrocopic test 2 ,ematuria ( dip stic7) /!IN5 *4BB5*)I4N8 !AN+4' 3(5*I'5N * ideally in the morning midstream *B5AN *A)*, -D ,!- discard "irst voided collect until the -Dth hour in a sterile container immersed in ice or 7ept cold *A),5)5!- clamp or tie "irst to collect urine (at least : mins) disin"ect be"ore the > port then aspirate using a sterile syringe /!INA!> +I<5!3I4N3 +4/1B5 <4I+5+- "or 7etones and glucose -. !enal &unction )est C. K-rays L K/1 L/)M 1ladder ultrasonograhy 2 "ull bladder , pre and post voiding imaging ()!/(transrectal ut6 o" the prostate) L*).'!I- no metal L Nuclear scans-deprive pt "rom glucose L Intravenous urography-(excretory urogram)- iodine sensitivity, post chec7 "or adeFuate ouput L!etrograde pyelography-done during cystoscopy, image o" ureter;.ureteral catheter, contrast iodine. *omplication8 hematuria N per"oration o" ureter. L *ystography L <oiding cystourethrography-/ses a "luoroscopy machine to visuali6e the lo$er urinary tract and examine urine storage in the bladder. /sed as a diagnostic tool to identi"y vesicoureteral re"lux. /rethral catheter is inserted, and a contrast agent is instilled into the bladder.

L !enal angiography- uses contrast agent. chec7 "or pulses on the a""ective site, chec7 dressing, sand bags D 5ndoscopy-cystoscopic exam :. 1iopsy-recommended i" there is chonuria, hematuria or elevated serum $aste IN&4!'5+ O!I))5N *4N35N) renal and uretral brush biopsy 7idney biopsy post op care- chec7 increasing pain, temp and dressing should be monitored closely, dec. 1( E. /rodynamic tests and voiding problem and urinar retention- normal bladder pressure( urecholine-produces normal bladder pressure) L /ro"lometry L*ystometrogram /rinary pressure 2 "lo$ study 5lectromyography <ideo "lourodynamic study /rethral pressure pro"ile <alsava%s lea7 point pressure test DRE- +I#I)AB !5*)AB 5KA' ((!I<A*>) PSA- *AN*5! )53)IN# Transrectal ultrasound and prostate biopsy * health teaching.care a"ter undergoing diagnostic tests8 !eport 9 -1loody urine - inability to urinate -&ever

- increasing pain at the biopsy site - "aintness and di66iness * #5!4N)4B4#I* *4N3I+5!A)I4N3 IN*!5A3IN# IN*I+5N*5 4& KI+5N> +I35A35 Nursing *are "ocused on . pain -. 7no$ledge de"icit C. anxiety and "ear KII. /rinary retention-syn9ischuria *ause8 +', 1(,, tumor in"ection, stones, trauma, cns disorder, preg, and meds (anticholinergics either inhibits contractility or increasing bladder outlet resistance), shy bladder syndrome(psychological) !53I+/AB /!IN5 (urecholine) 'gt8 catheteri6ation( "ocuses on the evacuation o" urine)- A)4NI* 1BA++5! KII urinary incontinence-stress,urge,re"lex,over"lo$ 'gt8 bladder training, habit training avoid +I/!5)I*3 post D (', avoid bladder irritant, avoid constipation, void regularly,pelvic "loor muscle exercises Neurogenic bladder 2urinary dys"unction that involves lesion in the cns )ypes8 . spastic 2upper -.&laccid-lo$er catheteri6ation retraining o" bladder lo$ calcium diet use o" urecholine mobility surgical Increase "luid inta7e management KIII. /)I )ypes8/pper Bo$er *omplicated /ncomplicated gonnococcaal and non gonnoccocal APN/CPN ( tubulointerstitial)-in"ection o" the tubulointertistial secondary to re"lux due to obstruction /)M- enlarged 7idneys, presence o" pus P'gt8 antibiotic, pain relievers, eliminate cause o" obstruction, GN- AN)I#5N AN)I14+> !5A*)I4N, usually post strep AH PE Renal abcess- pus (carbuncle ! perinenp"ric) #ret"ral stricture- narro$ed (bougies or internal urothrotomy) )/')- transurethral micro$ave therapy Renal trau%a &urinary diversion Renal cyst- (K+- Autosomal +ominant Autosomal recessive AcFuired -Sy%pto% 'uided %'t- pain and %ani(estations due to decreasin' ability o( )idney to e*crete and re'ulate - neprectomy, dialysis, 7idney transplant Hydronep"rosis-secondary to obstruction+,dilatation o( t"e renal pel-is ( due to obstruction distal ) Nep"rosclerosis- secondary to "pn . "ardenin' o( t"e arteries (beni'n ! %ali'nant) /nterstitial cystitis (pain(ul bladder syndro%e) hunner%s ulcer, thinning o" #A# patient sub0ected to K*B and distilled $ater installation patient $ithout I* $ill not be able to tell the di""erence T0 o( t"e 1idney- '. 1acterium tuberculli ( granulomatous nephritis) 2't8 the same as that $ith ()1, urine testing done (Ccatch) Renal stones(calculi . urolit". nep"rolit")2't 8 pain relievers, nphrostomy(percutaneousnephrolithotomy), 53OB (strain all urine) ; ston analysis *AB*I/' 3)4N53 Bo$ calcium diet ( D?? mg daily) Achieved by eliminating mil7.dairy products (rovide acid-ash diet to acidi"y urine *ranberry or prune 0uice - &ish - 'eat - #rapes - 5ggs - Ohole grains - (oultry

- )a7e vitamin A N *, &olic acid supplements and !ibo"lavin 4KABA)5 3)4N53 Avoid excess inta7e o" "oods."luids high in oxalate )ea - !hubarb - *hocolate - 3pinach 'aintain al7aline-ash diet to al7alini6e urine - 'il7 - <egetables - &ruits except prunes, cranberries and plums /!I* A*I+ 3)4N53 /ric acid is a metabolic product o" purines !educe "oods high in purine - Biver, brains, 7idneys, venison, shell"ish, meat soups, gravies, legumes and $hole grains 'aintain al7aline urine - Al7aline-ash diet *>3)IN5 3)4N53 (rare) Bo$ methionine - 'ethionine is the essential amino acid "rom $hich the non- essential amino acid cystine is "ormed Bimit protein "oods - 'eat, mil7, eggs, cheese 'aintain al7aline-ash diet KI<.#B4'5!/B4N5(,!I)I3-1eta 3taphyloccocus ( post streptococcl in"ection), antigen antibody reaction that leads to decrease in #&! A6otemia ,ematuria 4liguria (roteinuria 5dema, ,(N *<A tenderness, pain* may also have anemia Acute !apidly progressive( cresentric glomerulonephritis) *hronic #oodpasteur%s syndrome(primarily attac7s !53(I!A4!> 3>3)5') K<. !enal "ailure Acute- reversible, initiation, oliguric, diuretic(concentrating abilitycompromised), recovery phases. Kayexelate, sorbitol, lo$ dose dopamine, bicarbonate( hyperkalemia) (rerenal(be"ore the 7idney,decrease in the supply o" blood to renal artery) , intrarenal (7idney itsel" A)N-acute tubular necrosis,nephrotoxi6 drugs), post renal( a"ter the 7idney, obstrusction) *ategories . causes based on anatomical possition *hronic- reduced renal reserved,renal insu""iciency, esrd ( stage -: brunners)irreversible 3.3x8 multi system( /!5'IA) 5x8 +erma- uremic "rost /remic "etor ,ema- anemia Neuro- encephalopathy, increase ammonia level 4rtho- renal osteodystrophy , amyloidosis '#)8 antibiotic, dialysis, 7idney transplantation +iet8 ,1< lo$ *,4N,high *,4, lo$ Na ( - gm), K( D?-E? meF.day) K<I +ialysis- /se o" dialysate, through "iltration, osmosis, di""usion, reverse osmosis He%odialysis.- A< shunt acts on high pressure D-E hour --C x a $ee7( maybe substituted $ith *!!), "inancial details to be considered) *hec7 shunt "or pulsations;.. ,ealth teaching on ho$ to ta7e care o" access; such as don%t bump, don%t sleep on a""ected side,arm precaution, don%t li"t heavy ob0ects;

Oeigh patient be"ore and a"ter di""erence =urine output (atient may experience 8 hypovolemis shoc7, dialysis diseFuilibrium syndrome peritoneal dialysis- peritoneum serves as exchange site, uses tench7o"" catheter, "or (+ access, -D hours cycle "or C days average( IN&/35 4! IN&B4O, +O5BB, +!AIN- time, type and 7ind o" dialysate determined by physician) common problem8 lea7, obstruction complication8(5!I)4NI)3 respiratory di""iculty secondary to "luid retention K<I- )ransplantation-patient preparation, psychological, Immunosuppresion ( steroids and anti neoplastic drugs)-patient on reverse isolation, donor types ( living related, living unrelated, cadaver) ABB4#!A&) (5!&/3I4N( organ preservation allo$s 7idney "or -D-DI hours), candidates and non candidates ( AI+3, uncontrollable *AN*5!) Incision site lo$er inguinal- recipient anastomosed near to !. artery, *<A(lateral, side)- donor )ype o" re0ection8 ,yperacute, acute, chronic *4''4N !5A34N o" re0ection in"ection ( (A)I5N) I''/N4 *4'(!4'I35+) !outine chec7 2 increase incidence o" bone degradation ( *a supplements), routine blood serum level +4N4! may su""er "rom 34BI)A!> KI+N5> 3>N+!4'5 +onor and recipient incision site. K<II 1(,- surgical mgt )/!(, )/I(, non surgical )/NA,)/')(medications (!43*A!, inhibits production o" testosterone responsible "or increasing si6e o" prostate; usually a"ter D? years old);.. K<III renal trauma- urethral,bladder, ureter,7idney 1lunt or penetrating, may also use stents KIK urinary diversion- 7idneys are still "unctional )ypes(Ileal *onduit /rinary +iversion *Indiana (ouch !eservoir *Neobladder to /rethra +iversion) KK. !enal tumor.cancer KKI. congenital anomalies8 treatment i" necessary- i" the condition does not pose any medical problem treatment is not an option.. KKII. ta7ing care o" patients $ith ind$elling catheter; *ondom catheter- change everyday ( clean everyday) "oley catheter-change every G days or depending on type o" catherter;. +o let urine bag to touch the "loor (erineal care everyday /rine bag should be hanging "reely *atheter attachment "or male patient H "or "emale patient H ,o$ to do bladder trainingH ---- clamp "or at least D hours then release, instruct patient to in"orm nurse should there be urgency even be"ore the Dth hour.. *ollection o" urine via "oley catheter "or urinalysis---- clamp ;, then aspirate urine using a sterile syringe be"ore the y port a"ter disin"ecting.

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