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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 $aste-1/N *!5A !A)I4.. 3)/+> Normal values glucose clearance rate=?, creatinine clearance rate= ??, urea=:?@ 3torage o" urine and voiding 1ladder- guarded by sphincters and unidirectional peristaltic movement ( in"ection and inc pressure) <oiding'uscle control (external urethral sphincter relaxes and detrusor muscle contracts.A 'I*)/!I)I4N Neural control 2 (N3 /rgency - :?ml 'aximum blader capacity *residual /rine- :? ml- ?? ml (gerontologic consideration) Assessment o" urinary "unction . **. 4nset -. Bocation. char and duration C. ,x o" /)I. stones D. &ever :. ,x o" +x testing. use o" device E. <oiding problems 2 "reFuency,urgency, dysuria,hesitancy, nocturia,incontinence, eneuresis, polyuria, oliguria, anuria, hematuria, proteinuria, pyuria;. G. &emale- ,x o" deliveryH In"ection, contraceptive I. 3)+ J. ,abit.vices ?. medication . #i symptoms -. (sych.socicultural.mental "unction. occupational C. evaluate pain anatomically
<III.
D. (hysical assessment 2I((A IK. &luid and electrolyte Imbalance- revie$ 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.