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Care of The Patient With Renal and Urinary Disorders - Handout
Care of The Patient With Renal and Urinary Disorders - Handout
Classroom Objectives
Discuss the pathophysiology and clinical manifestations of renal failure Interpret the results of laboratory data & diagnostic tests associated with renal failure. Discuss three treatment modalities used in the collaborative management of chronic renal failure.
Continued
Use Maslows hierarchy to prioritize assessments in the patient with CRF undergoing various treatment modalities. State four nursing diagnoses (NANDA)commonly associated with a patient in end-stage renal disease.
Continued
Discuss the nursing management of the end-stage renal patient at home and the use of community resources
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Renal Function
Excretory function- urine formation Regulatory functions acid base balance Renal related endocrine functions
Regulatory Functions*
Partial control of acid-base balance Renal regulation of water Renal regulation of electrolytes- Na+ & K+
Slide 72.10
Slide 72.3
Renal Hormone Production and Hormones Influencing Renal bone Function Stimulates marrow to make red
blood cells Promotes absorption of calcium in the gastrointestinal tract Renal Raises blood Activated vitamin D parenchyma pressure as result of angiotensin Renin Juxtaglomerular (vasoconstriction) cells of and aldosterone the afferent and (volume expansion) efferent Prostaglandins secretion arterioles Regulate intrarenal blood flow by vaso Renal tissues Slide 72.2 dilation or constriction
Renal hormone Production Erythropoietin
Renal parenchyma
What questions should you ask regarding symptoms? What risk factors for development of CRF does the new admission have? What cardiac and respiratory manifestations might you find on physical exam?
Very ill new admission - Suspect CRF, 7 lb weight gain in 3 wks, Hx diabetes and HTN
Slide 72.6
Blood Chemistries*
BUN -greater than 20mg/dl - renal insufficiency normal =10-20mg/dl. Elderly sl. Higher Creatinine - 0.8 - 1.5 mg/dl Creatinine clearance - best indication of overall renal function- ave. 108- 120ml/min BUN/ Creatinine ratio: 10:1 to 20:1
Slide 75.6
Treatment is medical.
Stage III: Renal Failure - end-stage renal disease.* Excessive amounts of metabolic wastes such as urea and creatinine accumulate in the blood. The kidneys are unable to maintain homeostasis. Treatment is by dialysis or other renal replacement therapy.
Key Features of Uremia- Excessive amounts of Urea & Nitrogenous Wastes ( Azotemia)*
Metallic taste Anorexia Nausea Vomiting Muscle Cramps Itching
Electrolyte Imbalances*N.B!
K+ increases Phosphate increases Sodium - normal or decreased Magnesium increases Calcium decreases Metabolic acidosis
Slide 75.1
Focused Assessment for Care Clients with Chronic Renal Failure (Acute Care Too)*
Assess renal status, including Amount, frequency, and appearance of urine (anuric clients) Presence of bone pain Presence of hyperglycemia secondary to diabetes
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Assessment Continued*
Presence of edema (periorbital, pretibial, sacral) Jugular vein distension Presence of dyspnea Presence of crackles, beginning at the bases, and extending upward
Continued*
Assess hematologic status, including Presence of petechiae, purpura, ecchymoses Presence of fatigue or shortness of breath Assess gastrointestinal status, including Presence of stomatitis Presence of melena
Assessment Continued*
Assess integumentary status, including Skin integrity Presence of pruritis Presence of skin discoloration
Dietary Restrictions*
Fluid Protein on dialysis high quality protein not limited on hemodialysis Potassium 60-70 mEg./day Sodium Phosphorus
Outcomes Demonstrates improved nutritional status Consumes adequate nutrition Identifies nutritional requirements
NIC Interventions
Collaborate with dietician Teach family and client about prescribed diet Monitor and calculate food intake
NIC Interventions
Monitor location of edema Monitor daily weight Monitor vitals: decreased. BP, tachycardia, tachypnea. Monitors gallop rhythm Teach patient & family about sx. of both excess and deficient fluid volume.
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Slide 75.9
A Hemodialysis Circuit
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Slide 75.7
KB Dialysis at 10AM
Meds: Atacand, Lasix, Regular insullin, Digoxin, Tums What do you give? Other Nsg. Duties? Nausea, hypertensive,
Continued
Assess for symptoms of orthostatic hypotension. Assess the vascular access site. Observe for bleeding. Assess the client's level of consciousness and assess for headache, nausea, and vomiting.
Peritoneal Dialysis*
Osmosis Diffusion Dialysate Concentrations Dwell time
Slide 75.13
The used Dialysis Bags are 'Clinical Waste'. The Renal Unit will contact the local authority for you and arrange for free yellow coloured clinical waste bags to be delivered to your home (usually four a week. You will need only two bags but they need to be double wrapped). They will also arrange for a free weekly collection of the full bags. Flatten your cardboard boxes (see diagram on the box) and put out for your regular rubbish collection.
Please click on the links below for further CAPD info. Weight & Fluid Balance | Clean Procedures : Infection | General Info
Assess laboratory data, including BUN & Creatinine Creatinine clearance CBC Electrolyte Assess psychosocial status, including Presence of anxiety Presence of maladaptive behavior
Slide 75.20
Kidney Transplant*
Living Related Living Unrelated Cadaver United Network for Organ Sharing, Richmond Va. National kidney transplant waiting list - 38,760 First successful transplant -1954 - Dr. Jos. Murray, Brigham & Womens Hospital Boston MA.
Kidney Donor
Selection Process
Slide 75.16
Nursing Responsibilities
Post Transplant
Hyperacute Rejection*
Hyperacute Rejection
Onset Within 48 hr after surgery Clinical Manifestations Increased temperature Increased blood pressure Pain at transplant site Treatment Immediate removal of the transplanted kidney
BUN = blood urea nitrogen.
Slide 75.21
Acute Rejection*
Acute Rejection
Onset 1 wk to 2 yr postoperatively (most common in first 2 wk) Clinical Manifestations
Oliguria or anuria Temperature over 37.8 C (100 F) Increased blood pressure Enlarged, tender kidney Lethargy Elevated serum creatinine, Blood Urea Nitrogen, potassium levels Fluid retention
Treatment
Slide 75.22
Chronic Rejection*
Chronic Rejection
Onset Occurs gradually during a period of months to years Clinical Manifestations
Gradual increase in Blood Urea Nitrogen and serum creatinine levels Fluid retention Changes in serum electrolyte level Fatigue Treatment Conservative management until dialysis is required
Slide 75.23
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NURSING MANAGEMENT
Symptoms
Blood in the urine (slightly rusty to deep red in colour). Pain during urination. Frequent urination, or feeling the need to urinate without results.
Bladder Cancer
Bladder Tumors
Treatment Modalities*
Chemotherapy Radiation Surgery: Partial Cystectomy Total Cystectomy
TURP
Treatment Continued
Slide 73.9
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Slide 73.11
Slide 73.12
Hollister*
Sure-Fit Natura
Case Study
Patient with Ileal Conduit
Anatomy
Slide 79.12
Chemotherapy or Radiation
Cytoxan Adriamycin
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Slide 79.7
Perineal Prostatectomy
Slide 79.8
Effects of Surgery*
Client is STERILE Erective Dysfunction (if pudental nerve fx. Spared 3-6 mos of ED ( impotence) Urinary Incontinence if internal & external urinary sphincters involved.
Slide 79.11
Slide 79.11
Leg Bag
Potential Complications
Sexual dysfunction with radical perineal prostatectomy Urinary incontinence with radical prostatectomy
The End