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Nursing Care of Individual with Genitourinary Disorders:
Renal Trauma Renal Vascular Problems Acute Renal Failure • • • • • • • • • • • • • • I. A&P of the Kidney a. Fibrous capsule b. Renal cortex c. Renal medulla d. Pyramids e. Papillae f. Minor calyx g. Major calyx h. Renal pelvis i. Ureter Review: Renal A & P II. Functions of the Kidneys Elimination of _______ & _________ • • Can you name some of these substances? __________________________
Regulates fluid & electrolyte balance thru
processes of: __________, _________, and _____________. Name a few of these F&Es regulated by kidneys __________________ • • • Functions of the Kidneys (continued) Name a few of these Fluid and Electrolyes regulated by kidneys __________________
Distal tubule . Bowman’s capsule • • • c. The Nephron Why is it called the functional unit of the Kidney??? Label the Nephron’s Parts a. what will happen to the patient’s serum calcium level? __________________ • • • • • III. Proximal tubule d.• • • • __________________ __________________ Functions of the Kidneys (cont) Regulates acid-base balance • HCO3 and H+ • Hormonal (endocrine) functions: • Renin Release • • Functions of the Kidneys (cont) Erythropoietin Release • If a patient has chronic kidney disease or chronic renal failure. Glomerulus b. Loop of Henle e. If a patient has renal failure. what condition will occur and WHY??? • • Functions of the Kidneys (cont) Activated Vitamin D • Necessary to absorb Calcium in the GI tract.
impalement injury. Monitor for S & S of what??? ____________________ . knife/gunshot wounds. renal ultrasound. renal arteriogram What serum levels can be useful? _________________________ • • • Renal Trauma-Interventions Bedrest and close observation.youtube. rib fractures • • Renal Trauma Common Manifestations: • • • • • Microscopic to gross hematuria Flank or abdominal pain Oliguria or anuria Localized swelling. MVA. sports injuries. tenderness.• • • • f. ecchymosis flank area Turner’s sign=bluish discoloration flank area due to retroperitoneal bleeding • • Renal Trauma What are some diagnostic tests used in renal trauma? • • • IVP.com/watch?v=glu0dzK4dbU Renal Trauma • • Renal Trauma Etiology: • Blunt force from falls. CT scan. Collecting duct How the Kidney Works http://www.
TCDB & incentive spirometry • Incision in flank area. What should u.• Embolization or open surgery to stop bleeding or repair • • • Partial or total Nephrectomy Renal Surgery-Nephrectomy Indications for Nephrectomy: • • • • • • Renal tumor Massive Trauma Polycystic Kidney Disease Donating a Healthy kidney Renal Surgery-Nephrectomy Post Op Nursing Management • Strict I & O • • • • Urine output should be at least _____. Observe ACC of urine. 12th rib removed • • Medicate for pain as ordered Renal Vascular Problems • I.o. be if patient had bilateral nephrectomy? ______. Hypertension & Nephrosclerosis • • Sustained elevation of the systemic blood pressure can result from or cause kidney disease---How? Patho of HTN-Nephrosclerosis • ↓ Development of arterio sclerotic lesions in the arterioles and glomerular capillaries .
Common Manifestations: • • • • Uncontrollable HTN Critical thinking question… How could a renal artery stenosis result in HTN? Renal Artery Stenosis • Treatment/Collaborative Care • • • Anti-hypertensive Medications Dilation of renal artery by Percutaneous Transluminal Angioplasy Bypass Graft of Renal Artery • Renal Artery Stenosis • • Treatment/Collaborative Care Renal Vascular Problems: III.Decreased blood flow which leads to ischemia and patchy necrosis ↓ Destruction of glomeruli ↓ Decrease in GFR • Renal Vascular Problems II. Renal Vein Thrombosis • Renal Vein Occlusion • • Definition: Blockage or obstruction of Renal Vein by a thrombus. Risk Factors: • • Nephrotic syndrome Use of Birth control pills . Renal Artery Stenosis • • Definition: Narrowing of one or both renal arteries due to atherosclerosis or structural abnormalities.
• • Certain Malignancies Vascular Disorders of the Kidney Renal Vein Occlusion • Treatment/Collaborative Care • • Thrombolytic drugs such as streptokinase or tPA Anticoagulant therapy to prevent further clot formation • • Acute Renal Failure Definition: rapid decline in renal function that leads to accumulation of nitrogenous wastes (azotemia) • Etiology of ARF: • • • • • • • • • Pre-renal Intra-renal Post renal Compare & Contrast… What is missing from the ARF definition? What is the difference between uremia and azotemia??? ____________________________ Etiology of Acute Renal Failure Pre-renal List causes of “pre-renal” ARF failure-all related to decreased blood flow to the kidneys • • • Hypovolemia: dehydration. arrythmias Renal vascular obstruction: renal artery stenosis. shock. or renal artery blockage. burns Decreased cardiac output: CHF. . MI.
destruction tubular epithelium . (such as antibiotics). damaged muscle tissue and blocks tubules (rhabdomylosis)(ATN) Nephrotoxic drugs/chemicals (ATN) • • • Aminoglycosides* Radiographic contrast agents Arsenic. hemoglobin released from hemolyzed red blood cells. lead. potentially reversible Hemolytic blood transfusion (ATN) Trauma (crushing injuries which release myoglobin. nephrotoxins. carbon tetachloride • • • Acute glomerulonephritis/pyelonephritis Systemic lupus Causes of Acute Renal Failure (ATN) • Renal ischemia • Disruption basement membrane.• • • • Etiology of Acute Renal Failure Intra-renal Direct injury to the kidneys Conditions causing direct insult to renal tissue causing damage to nephrons List causes of “intra renal” ARF failure: • • Causes of Intrarenal Failure Primary renal disease: acute glomeulonephritis and acute pyelonephritis • ATN (Acute tubular necrosis) most common causes • Result from ischemia. ischemia). or myoglobin released from necrotic muscle cells • • • • • Frequent causes of “intra-renal” failure ATN: acute tubular necrosis of tubular cells which slough and plug tubules (nephrotoxicity.
decreased in_________. • • Question… Which of the following urinary symptoms is the most common initial manifestations of ARF? a-dysuria b-anuria c-hematuria d-oliguria • Question… .• Nephrotoxic agents • Necrosis tubular epithelium… plug tubules. basement membrane intact. measurement of amount of urea in blood What is urea?_____ BUN fluctuates BUN elevated in______. urine backs up into renal pelvis) • BPH (Benign Prostatic Hypertrophy) • Calculi − Trauma – Prostate cancer • • Diagnostic Tests in Acute Renal Failure: BUN (blood urea nitrogen) • • • • Normal = 10-30 mg/dl. • Potentially reversible IF • Basement not destroyed and tubular epithelium regenerates • • Etiology of Acute Renal Failure Post-renal Identify three causes of “post-renal failure” (mechanical obstruction of urinary outflow.
2 BUN 16 12 • • Diagnostic Tests in Acute Renal Failure: Creatinine clearance • • • • Most accurate indicator of Renal Function Reflects GFR Involves a 24 hr urine/serum creatinine Formula: Amount of urine creatinine X urine V serum creatinine .5 mg/dl Directly related to GFR 2 X normal (3.• The client’s BUN is elevated in ARF.0) = 50% nephron fx loss 10 X normal (15) = 90% nephron fx loss MORE ACCURATE INDICATOR of RENAL FUNCTION THAN BUN • BUN. What is the likely cause of this finding? • • • • a-fluid retention b-hemolysis of red blood cells c-below normal protein intake d-reduced renal blood flow • • Diagnostic Tests in Acute Renal Failure: Serum Creatinine: end product of muscle and protein metabolism. excreted by the kidneys at a constant rate • • • • • Normal = 0.5-1. Creatinine ratio Normal= 10:1 Creatinine 1.6 1.
5-5.030 Will be fixed a 1.010 usually in ARF due to kidneys losing ability to concentrate urine • Serum Electrolytes Normal= 135-145 1.Serum Sodium • • • sodium • • 2↑ May be high. low.003-1.5mg/dl Phosphorus is a product of protein . or normal High in Volume deficit (dehydration) Low due to damaged tubules not conserving Diagnostic Tests in Acute Renal Failure: Serum Electrolytes Serum K+ • • • • Normal= 3.0. treatment initiated to prevent ______________________ • Diagnostic Tests in Acute Renal Failure: • 3↑ Serum Electrolytes Serum Phosphorus Normal= 2.• • Normal= 100-135ml/minute Diagnostic Tests in Acute Renal Failure: • Urine Specific Gravity • • Normal= 1.0 meq/l Almost always increased WHY? Kidneys excrete 80-90% of our K+ If K+> 6.8-4.
bicarb levels due to bicarb being used up to buffer excess H+ ions.0-11. Vitamin D needed to absorb calcium from GI tract What other process is occurring to decrease serum calcium??? __________________ • Diagnostic Tests in Acute Renal Failure: • ABGs • • pH Metabolic acidosis due to excrete acid metabolites ability of kidneys to (uric acid.0 mg/dl due to ↓ production of activated Vitamin D. • Also.breakdown excreted by the kidneys What other process is occurring to phosphorus??? __________________ • Diagnostic Tests in Acute Renal Failure: • Serum Electrolytes increase serum 4 . • • Initiating Phase of ARF: What stage? • • Initiating Phase Onset: begins at time of insult . ammonia) so the pH will be __________.↓ Serum Calcium Normal= 9.
casts.• • • • Duration: hours to days Urine output: <20ml/h or 100-400 ml/24 hours or CAN HAVE NORMAL URINE OUTPUT! What Signs and Symptoms to Anticipate? • • Urine less that 400 ml in 24 hours Urine possibly with RBC’s. PO4 excess • • Diuretic Phase of ARF: What stage? • • • • Diuretic Phase Onset: days to weeks Duration: 10 days (1-3 weeks) Urine output:1-3 liters/day .010 in oliguria in intra renal failure Fluid overload Urine with RBCs. WBCs Elevated BUN and serum creatinine K likely to be elevated Ca deficit. WBC’s depending on the causative agent • • Oliguric Phase of ARF: What stage? • • • • Oliguric Phase Onset: 1-7 days Duration: 10-14 days Urine output: Less than 400 ml/24 hours in 50% of patients • What Signs and Symptoms to Anticipate? • • • • • • • Urine less that 400 ml in 24 hours Specific gravity fixed at 1.
Acute Renal Failure: Management of…. Acute Renal Failure: Management of…. spasms of the renal arteries B. Your patient develops acute renal failure after being on Amphotericin for 1 week: The patient’s ARF is primarily related to: • • A.• What Signs and Symptoms to Anticipate? • • • • Fluid Volume Overload or Fluid Volume Deficit??? Elevated BUN and serum creatinine K likely to be elevated or decreased??? Hyponatremia and hypotension • • Recovery Phase of ARF: What stage? • • • • Recovery Phase Onset: When BUN and Creatinine are stablized Duration: 4-12 months Urine output: Normal • What Signs and Symptoms to Anticipate? • Continue to monitor for signs and symptoms of F & E imbalances • • • • • • • • • • All body systems for effects of fluid volume changes Treatment During: Oliguric/Non-Oliguric Phase Treatment During: Oliguric/Non-Oliguric Phase Acute Renal Failure: Management of…. blood clots in the loops of Henle . Acute Renal Failure: Management of Potassium Levels Acute Renal Failure: Management of….
acute tubular necrosis Your patient’s K+ level is elevated. releases hydrogen ions for sodium ions C. exchanges sodium for potassium in the colon . The physician orders Kayexalate because it: A. low cardiac output D. increases calcium absorption in the colon D.• • • • • • • C. increases sodium excretion from the colon B.
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