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Joanalain C.

Cortez, RN
Clinical Instructor
ANATOMY OF THE GUT SYSTEM
Diagnostic Tests
and Table of
Laboratory
Values
Serum Creatinine
measures effectiveness of
renal function.
end product of muscle
energy metabolism
Normal Value: 0.6 – 1.2 mg/dl (50
– 110 µmol/dL
Increased creatinine levels in the blood suggest diseases or conditions
that affect kidney function. These can include:

•Damage to or swelling of blood vessels in the kidneys


(glomerulonephritis) caused by, for example, infection or autoimmune
diseases
•Bacterial infection of the kidneys (pyelonephritis)
•Death of cells in the kidneys’ small tubes (acute tubular necrosis)
caused, for example, by drugs or toxins
•Prostate disease, kidney stone, or other causes of urinary tract
obstruction
•Reduced blood flow to the kidney due to shock, dehydration, congestive
heart failure,atherosclerosis, or complications of diabetes
•Creatinine blood levels can also increase temporarily as a result of
muscle injury and are generally slightly lower during pregnancy.
NOTE: The health care provider may tell you to stop
taking certain drugs that may affect the test. Such
drugs include:

•Aminoglycosides (for example, gentamicin)


•Bactrim
•Cimetidine
•Heavy metal chemotherapy drugs (for example,
Cisplatin)
•Nephrotoxic drugs such as cephalosporins (for
example, cefoxitin)
Blood Urea Nitrogen
(BUN)
Serves as index of renal function.
Urea is nitrogenous end product of protein
metabolism.
Test values are affected by protein intake,
tissue breakdown, and fluid volume changes.
Normal Value: 7-18 mg/dl, patients
over 60 years: 8-20 mg/dL
An increase in the BUN level is known as azotemia.
An elevated BUN may be caused by:
•Impaired renal function
•Congestive heart failure as a result of poor renal
perfusion
•Dehydration
•Shock
•Hemorrhage into the gastrointestinal tract
•Acute myocardial infarction
•Stress
•Excessive protein intake or protein catabolism
A decreased BUN may be seen in:
•Liver failure
•Malnutrition
•Anabolic steroid use
•Overhydration, Which can result from
prolonged intravenous fluids
•Pregnancy (due to increased plasma volume)
•Impaired nutrient absorption
•Syndrome of inappropriate anti-diuretic
secretion (SIADH)
NOTE: How to prepare for the test

Some drugs affect BUN levels. Before


having this test, make sure the health care
provider knows which medications you are
taking.

Drugs that can increase BUN


measurements include:
•Allopurinol •Guanethidine
•Aminoglycosides •High-dose aspirin
•Amphotericin B •Indomethacin
•Bacitracin •Methicillin
•Carbamazepine •Methotrexate
•Cephalosporins •Methyldopa
•Chloral hydrate •Neomycin
•Cisplatin •Penicillamine
•Colistin •Polymyxin B
•Furosemide •Probenecid
•Gentamicin •Propranolol
•Rifampin •Thiazide diuretics
•Spironolactone •Triamterene
Drugs that can decrease
BUN measurements include:
•Chloramphenicol
•Streptomycin
Urinalysis
The urinalysis provides important clinical
information on kidney function and helps
diagnose other diseases, such as diabetes.

Specific Gravity
Evaluates ability of kidneys to concentrate
solutes in urine.
Normal value: 1.010 – 1.025
NOTE: How to prepare for the test

•Your health care provider will instruct you, if


necessary, to discontinue drugs that may interfere
with the test. Drugs that can increase specific gravity
measurements include dextran and sucrose.
Receiving intravenous dye (contrast medium)
for an x-ray exam up to 3 days before the test can
also interfere with results.

•Eat a normal, balanced diet for several days before


the test.
Urine culture and Sensitivity
The urine culture determines if bacteria
are present in the urine, as well as their
strains and concentration.

Urine examination includes:


•Urine color
•Urine clarity and odor
•Urine pH and specific gravity
•Test to detect protein, glucose, and ketone
bodies in the urine (proteinuria,glycosuria,
and ketonuria)

•Microscopic examination of urine


sediment after centrifuging to detect
RBCs(hematuria), WBCs, casts
(cylindruria), crystals (crystalluria), pus
(pyuria), andbacteria (bacteriuria)
Creatinine Clearance
•the most accurate measurement of renal
function that does not require the injection
of dye or radiologic testing.

•It determines the glomerular filtration rate


and tubular excretion ability of the kidney.
•It is used to help evaluate the rate and efficiency of
kidney filtration.

•It is used to help detect kidney dysfunction and/or the


presence of decreased blood flow to the kidneys.

•In patients with chronic kidney disease or congestive


heart failure (which decreases the rate of blood flow),
the creatinine clearance test may be ordered to help
monitor the progress of the disease and evaluate its
severity.
Vanillylmandelic acid test
•A test for catecholamine-secreting tumors
(pheochromocytoma and neuroblastoma)

Procedure:
•Performed on a 24-hour urine specimen; it is based
on the finding that vanillylmandelic acid is the major
urinary metabolite of norepinephrine and epinephrine.

Nsg. responsibility
•The nurse should tell the patient to catch the
midstream flow of his/her urine
KUB (kidney, ureter, bladder)
•Demonstrates the size of kidney, ureter, and
bladder for presence of cysts, tumors,and
displacement or obstruction.

Nsg. responsibility
•Establish/maintain fluid and electrolyte balance
•Prevent complication
•Provide emotional support
•Provide information about s\disease
Uric acid
It is the increased urate excretion, fluid
depletion and a low urinary pH.
is used to learn whether the body might be
breaking down cells too quickly or not getting
rid of uric acid quickly enough.
is used to monitor levels of uric acid when
a patient has had chemotherapy or radiation
treatments.
What does the test result mean?

Higher than normal uric acid levels mean


that the body is not handling the
breakdown of purines well. The doctor
will have to learn whether the cause is the
over-production of uric acid, or if the
body is unable to clear away the uric
acid.
Procedure:
Urine is taken from the patient.

Nsg. responsibility
The nurse should tell the patient to
catch the midstream flow of his/her
urine
Bladder scanning
•This procedure is to inspect the bladder for any
obstruction, tumor etc.

Procedure:
•The patient is scanned with the ultrasonography
machine
Nsg. responsibility
•The nurse should tell the patient to empty
bladder first before the procedure.
Computed Tomograpgy
Scan
Nursing responsibilities:
•Promote / maintain the client’s dignity
•Maintain the client’s sense of control
•Assist the client to become comfortable in
a new environment
Magnetic Resonance Imaging
Nursing responsibilities:
•Supply the MRI medical history questionnaire (S/N 1384) to
the patient for completion if the patient is coherent and an
accurate historian. Notify MRI personnel if the patient is
unconscious, unresponsive, cannot provide reliable history
and there is no family that can provide the information.
•The nursing staff is responsible for placement of an IV lock
and assuring that the MRI medical history questionnaire is
complete prior to transporting the patient to MRI.
•Nursing staff shall also key the order into the Invision
system following computer prompt.
Intravenous Pyelogram
(IVP)
An intravenous pyelogram (IVP) is an x-
ray examination of the kidneys, ureters and
urinary bladder that uses iodinated contrast
material injected into veins.
Renal Angiography
Angiography is the use of an x-ray to look at arteries
in order to detect blockage or narrowing of the
vessels.

How it works
A contrast dye injected via a catheter threaded into the
blood vessels of the kidneys makes them visible on a
x-ray, allowing detection of any abnormalities
affecting the blood supply to the kidneys.
Renal Scanning
A renal scan is a nuclear medicine exam in
which a small amount of radioactive material
(radioisotope) is used to measure the function
of the kidneys.

The specific type of scan may vary,


depending on the patient's specific needs. This
article provides a general overview.
Cystoscopy
is a test that looks at the inner lining
of the bladder and the tube from the
bladder to the outside of the body
(urethra).

The cystoscope is a thin, lighted


viewing tool that is put into the urethra
and moved into the bladder
RESULTS Normal
•The urethra, bladder, and ureters are normal.
•There are no polyps or other abnormal tissues,
swelling, bleeding, narrow areas (strictures), or
structural abnormalities.

RESULTS Abnormal
•There is welling or narrowing of the urethra
because of previous infections or an enlarged
prostate gland.
•There are bladder tumors (cancerous or
benign), polyps, ulcers, urinary stones, or
inflammation of the bladder walls.
•Abnormalities in the structure of the
urinary tract present since birth
(congenital) are seen.
•Pelvic organ prolapse is present in a
woman.
IMPORTANCE
A cystoscopy can check for stones, tumors,
bleeding, and infection. Cystoscopy can see areas
of the bladder and urethra that usually do not show
up well on X-rays. Tiny surgical instruments can be
put through the cystoscope to remove samples of
tissue (biopsy) or samples of urine. Cystoscopy also
can be used to treat some bladder problems, such as
removing small bladder stones and some small
growths.
Kidney Biopsy
A kidney biopsy is done using a long thin
needle put through the back (flank) into the
kidney. This is called a percutaneous kidney
biopsy. A tissue sample is taken and sent to a
lab. It is look at under a microscope. The
sample can help your doctor see how healthy
your kidney is and look for any problems.
RESULTS
Normal
•The structure and cells of the
kidney look normal. There are no
signs of inflammation, scar
tissue, infection, or cancer.
Abnormal
•The sample may show signs of scarring due
to infection, poor blood flow,
glomerulonephritis, a kidney infection
(pyelonephritis), or signs of other diseases
that affect the body, such as systemic lupus
erythematosus. Kidney tissue may show
tumors that were not expected, such as Wilms'
tumor (which occurs in early childhood) and
renal cell cancer (which is most common after
age 40).
Complete Blood Count (CBC)
CBC gives important information about the
kinds and numbers of cells in the blood,
especially red blood cells, white blood cells,
and platelets. A CBC helps your health
professional check any symptoms, such as
weakness, fatigue, or bruising, you may have.
A CBC also helps him or her diagnose
conditions, such as anemia, infection, and
many other disorders.
Erythropoietin Test
Alternative Names:
Serum erythropoietin; EPO

The erythropoietin test measures the amount of


a hormone called erythropoietin ((EPO) in blood.
The hormone acts on stem cells in the bone
marrow to increase the production of red blood
cells. It is made by cells in the kidney, which
release the hormone when oxygen levels are low.
Why the Test is Performed

This test may be used to help determine the


cause of anemia, polycythemia (high red
blood cells) or other bone marrow disorders.

A change in red blood cells will affect the


release of EPO. For example, persons with
anemia have too few red blood cells, so more
EPO is produced.
CT SCAN
Alternative Names
•CAT scan; Computed axial tomography
scan; Computed tomography scan

Computed tomography (CT) is an


imaging method that uses x-rays to create
cross-sectional pictures of the body.
Partial thromboplastin time
Alternative Names
•APTT; PTT; Activated partial
thromboplastin time

Partial thromboplastin time (PTT) is a


blood test that looks at how long it takes
for blood to clot. It can help tell if you
have bleeding or clotting problems
Normal Results
The normal value will vary between
laboratories. In general, clotting
should occur between 25 to 35
seconds. If the person is taking blood
thinners, clotting takes up to two and
a half times longer.
What Abnormal Results Mean
An abnormal (too long) PTT result may be due to:
•Cirrhosis
•Disseminated intravascular coagulation (DIC)
•Factor XII deficiency
•Hemophilia A
•Hemophilia B
•Hypofibrinogenemia
•Malabsorption
•Von Willebrand's disease
•Lupus anticoagulants
Prothrombin time
Prothrombin time (PT) is a blood test
that measures how long it takes blood to
clot. A prothrombin time test can be used
to check for bleeding problems. PT is also
used to check whether medicine to
prevent blood clots is working. The
normal range is 10 – 12 sec.
Renal Diseases
A. UTI
Urinary tract infection, (UTI) is an infection
of one or more of the structures in the urinary
tract. Most UTI’s happen from bowel
organisms, (E-coli). Women are more prone to
UTI’s because of the shortness of their urethra.
B.CYSTITIS
Infections of the lower urinary tract are
called cystitis. This is an inflammation of
the urinary bladder related to a superficial
infection that doesn’t extend to the
bladder mucosa, most often caused by
ascending infection from the urethra; it
can also be caused by sexual intercourse.
Causes
•Stagnation of urine in the bladder
•Obstruction of the urethra
•Sexual intercourse
•Incorrect aseptic technique during
catheterization
•Incorrect perineal care
•Kidney infection
•Radiation
•Diabetes mellitus
•Pregnancy
Other causes
•Cystitis is usually due to a bacterial infection of the
urine. Occasionally, in children it can be caused by
a virus.

•The infection is more common in women because a


woman's anatomy is designed in such a way that it
makes it easier for bacteria to enter the bladder.

•Sexual intercourse, using spermicidal creams, and


using diaphragms all increase the risk of developing
Bladder Infection.
•People who have a catheter in their bladder or
who have to periodically catheterize them have
a higher risk of developing bladder infection.

•People with Bladder Cancers or abnormal


connections between their bladder and
intestines also have a higher risk of developing
Bladder Infection.
Pathophysiology
•Bacterial infection from a second source
spreads to the bladder, causing an
inflammatory response.
•Cell destruction from trauma to the
bladder wall, particularly the trigone
area, initiates an acute inflammatory
response.
Complications
•Chronic cystitis (recurrent or
persistent inflammation of the
bladder)
•Urethritis (inflammation of the
urethra)
•Pyelenophritis (Infections of the
upper urinary tract)
Clinical manifestations
Any changes in the clients voiding habits
should be assessed as a possible UTI. The
most common clinical manifestation of cystitis
is burning pain of urination (dysuria),
Frequency, urgency, voiding in small amount,
inability to void, incomplete emptying of the
bladder, cloudy urine and hematuria ( blood in
urine). Asymptomatic bacteriuria (bacteria in
urine).
Nursing Diagnosis

•Impaired Urinary Elimination


The primary diagnosis when a client is experiencing
problems related to cystitis is Impaired Urinary
Elimination related to irritation of the bladder
mucosa.

•Acute Pain
Another common nursing diagnosis for clients with
cystitis is Acute Pain related to irritation and
inflammation of bladder and urethral mucosa.
Diagnostic test findings
•Urine culture and sensitivity: positive
identification of organisms (Escherichia
coli, Proteus vulgaris, Streptococcus
faecalis)
•Urine chemistry: hematuria, pyuria,;
increased protein, leukocytes, specific
gravity
Cytoscopy: obstruction or deformity
Assessment findings
•Frequency of urination
•Urgency of urination
•Burning or pain on urination
•Lower abdominal discomfort
•Dark, odoriferous urine
•Flank tenderness or suprapubic pain
•Nocturia (need to get up during the night in order to
urinate, thus interrupting sleep)
•Low-grade fever
•Urge to bear down during urination
•Dysuria (refers to painful urination)
•Dribbling
Medical management
•Diet: acid-ash diet with increased intake of fluids and
vitamin C
•Activity: as tolerated
•Monitoring: vital signs and intake and output
•Laboratory studies: specific gravity, urine culture and
sensitivity
•Treatment: Sitz baths
•Antibiotics: co- trimoxizole (Bactrim), cephalexin (Keflex)
•Analgesic: oxycodone (Tylox)
•Urinary antiseptic: Phenazopyridine (Pyridium)
•Antipyretic: acetaminophen (Tylenol)
Nursing interventions
•Maintain the patients diet
•Encourage fluids (cranberry or orange juice) to 3qt
(3L)/day
•Assess renal status
•Monitor and record vital signs, I/O, and laboratory
studies
•Administer medications, as prescribed
•Allay patient’s anxiety
•Maintain treatments: sitz baths, perineal care
•Encourage voiding every 2 to 3 hours
•Individualize home care instructions
Avoid coffee, tea, alcohol and cola
Increase fluid intake to 3 qt (3L)/ day using
orange juice and cranberry juice
Void every 2 to 3 hours and after
intercourse
Perform perineal care correctly
Avoid bubble baths, vaginal deodorants ant
tub baths
C.PYELENOPHRITIS
Infections of the upper urinary tract are called
pyelonephritis. This is an infection of renal pelvis,
tubules, (tubes), in the kidneys. The bacteria may
enter through the bladder via the ureters or through
blood stream. Pyelonephritis describes a syndrome
caused by the inflammation (irritation, swelling,
pain, damage) of the tubes (renal tubules) that carry
urine from the kidneys to the bladder (upper urinary
tract) and the renal (kidney) interstitium (tissue
surrounding the renal structures).
Pyelonephritis can be acute (sudden) or chronic
(prolonged) in nature.
•Acute pyelenophritis often occurs after bacterial
contamination of the urethra or after introduction of
an instrument, such as catheter or a cytoscope.
•Chronic pyelenophritis is more likely to occur
after chronic obstruction with reflux or chronic
disorders. It is slowly progressive and usually is
associated with recurrent acute attacks, although the
client may not have a history of acute
pyelenophritis.
Causes
•Enteric bacteria
•Ureterovesical reflux
•Urinary tract obstruction
•Pregnancy
•Trauma
•UTI
•Incorrect aseptic technique
•Diabetes mellitus
•Staphylococcal or streptococcal infections
Pathophysiology
•Bacterial infection from a second source
spreads to the renal pelvis, causing an
inflammatory response.
•Cell destruction from trauma to the renal
pelvis initiates an acute inflammatory
response.
Complications
•Chronic renal failure
•Hypertension
•Septicemia
Clinical manifestations
Characterized by enlarged kidney, focal parenchyma
abscesses and accumulation of polymorph nuclear
lymphocytes around and in the renal tubules

Nursing Diagnosis
•Risk for Deficient Fluid Volume. A common diagnosis is Risk for
Deficient Fluid Volume related to fever, nausea, vomiting, and
possible diarrhea.
•Acute Pain. Another common nursing diagnosis is acute pain related
to an inflammatory process in the kidney and possible colic.
•Readiness for Enhanced Self- Care. Client teaching is important to
promote self-care and to prevent recurrent teachings. Write the
diagnosis Readiness for Enhanced Self-Care to prevent recurrent
infections.
Diagnostic test findings
•Excretory urography (which consists of imaging the
kidneys and urinary tracts before and after the
administration of intravenous contrast material): atrophy,
blockage, or deformity of kidney
•Urine culture and sensitivity: bacteria
•Urine chemistry: pyuria, hematuria; leukocytes, WBCs,
and casts; specific gravity greater than 1.025; albiminuria
•Hematology( study of blood): increased WBCs
•24-hour urine collection: decrease creatinine clearance
Assessment findings
•Elevated temperature
•Chills
•Nausea and vomiting
•Flank pain
•Chronic fatigue
•Bladder irritability
•Hypertension
•Dysuria
•Burning on urination
•Frequency of urination
•Urgency of urination
•Headache
•Anorexia
•Weight loss
•Odoriferous, concentrated urine
Medical management
•Diet: soft, high-calorie, low protein
•IV therapy: saline lock, electrolyte and fluid replacement
•Activity: as tolerated
•Monitoring: vital signs, I/O, urine pH, and specific gravity
•Laboratory studies: WBCs, urine protein, and urine culture and
sensitivity
•Treatments: warm, moist compress to flank
•Fluid intake: 3qt (3L)/day
•Analgesic: meperidine (Demerol)
•Antibiotics: cefazolin (Ancef0, cefoxitin (Mefoxin), co- trimoxizole
(Bactrim)
•Urinary antiseptics: phenazopyridine (Pyridium)
•Antiemetic: prochlorperazine (Compazine)
•Alkalinizers: potassium acetate, sodium bicarbonate
•Sedative: oxazepam (Serax)
•Peritoneal dialysis and hemodialysis
Nursing interventions
•Maintain the patient’s diet
•Encourage fluids 3qt (3L)/ day
•Assess renal status and fluid balance
•Monitor and record vital signs, I/O, laboratory studies, daily weight, specific
gravity, and urine for blood, protein, and pH
•Administer medications, as prescribed
•Allay the patient’s anxiety
•Provide hot, moist compresses and warm baths
•Prevent chilling
•Provide rest periods
•Provide skin, mouth and perineal care
•Encourage frequent voiding
•Individualize home care instructions
Void frequently
Return to the physician immediately if symptoms reoccur
Take prescribed medications for entire duration of prescription
D.Glomerulonephritis
Glumerulonephritis is a disease that affects the
glumeruli of both kidneys. Etiologic factors are
many and varied; they include immunologic
reactions (lupus erythematosus, streptococcal
infection), vascular injury (hypertension), metabolic
disease (diabetes mellitus), and disseminated
intravascular coagulation (DIC). Glomerulonephritis
exists in acute, latent and chronic forms.
Acute glomerulonephritis
Acute glomerulonephritis is inflammation of
the glumerular capillary membrane. Acute
glumerulonephritis can result from systemic
diseases or primary glomerular diseases, but
acute postreptococcal glomerulonephritis (also
known as acute ploriferative
glomerulonephritis) is the most common form.
•Chronic Glumerulonephritis
Chronic Glumerulonephritis is typically the end stage of
other glomerular disorders such as RGPN, lupus nephritis,
or diabetic nephropathy. In many cases, however, no
previous glomerular disease has been identified.

Slow, progressive destruction of the glomeruli and a


gradual decline in renal function are characteristics of
chronic glomerulonephritis. The kidneys decrease in size
symmetrically, and their surfaces become granular or
roughened. Eventually entire nephrons are lost.
Causes or Risk Factors
•Diabetes
•Vasculitis
•High Blood Pressure
•Strep Throat
•Immune Disorders
•Genetic Disorders
•Heart Valve Disorders
•Family History of Glomerulonephritis
•Infections
Complications:
•Nephrotic Syndrome
•Sepsis
•High Blood Pressure
•Congestive Heart Failure
•Pulmonary Edema
•Nephritic syndrome
•Malignant Hypertension
•Chronic Kidney Failure
•End Stage Kidney Disease
Clinical Manifestations:
•Acute Glomerulonephritis:
Complaints commonly voiced by the patient include
shortness of breath, mild headache, weakness, anorexia,
and flank pain. The usual signs associated with acute
glumerulonephritis are the following:
1.Proteinuria
2.Hematuria
3.Increased urine specific gravit
4.Mild generalized edema
5.Elevated antistreptolysin O titer
6.Hypertension
7.Decreased urinary output
8.Elevated serum urea nitrogen
9.Elevated serum creatinine levels

Signs and symptoms reflect damage to the


glomeruli with leaking protein and red blood cells
into the urine, varying degrees of decreased
glomerular filtration with retention of metabolic
waste products, and fluid overloading of varying
severity.
Urinalysis provides important data such as the
presence of proteinuria, hematuria and cell debris.
•Chronic Glumerolunephritis
Symptoms:
•Headache especially in the morning
•Dyspnea on exertion
•Blurring of vision
•Lassitude
•Cola-colored or diluted iced-tea-colored urine from red
blood cells in your urine (hematuria)
•Foam in the toilet water from protein in your urine
(proteinuria)
•High blood pressure (hypertension)
•Fluid retention (edema) with swelling evident in your
face, hands, feet and abdomen
•Fatigue from anemia or kidney failure
•Less frequent urination than usual
Signs:
•Edema
•Nocturia
•Weight loss
•Urinalysis may show albumin, casts and blood,
despite normal renal function test
•Few nephrons remain intact
•Hematuria
•Proteinuria decrease
•Specific gravity of the urine becomes fixed at
1.010 (same as plasma)
•Nonprotein level in the blood increases
Treatment, Surgery and Medications:
Treatment:
•Bed rest may be ordered during the acute phase of post
streptococcal glomerulonephritis. When the edema of
nephritic syndrome is significant or the client is
hypertensive, sodium intake may be restricted.
•Dietary protein may be restricted if azotemia is present.
When proteins are restricted, those included in the diet
should be complete or high-value proteins. Complete
protein supply the essential amino acids required for growth
and tissue maintenance.
•Plasma exchange therapy (plasmapharesis), a procedure to
remove damaging antibodies from the plasma, is used in
conjunction with immunosuppressive therapy to treat
RPGN and Good pasture’s syndrome. Plasma and
glomerular-damaging antibodies are removed using a blood
cell separator. The RBCs are then returned to the client
along with albumin or human plasma removed. This
procedure is usually done in a series of treatments. Potential
complications of plasma exchange therapy include those
associated with IV catheters, fluid volume shifts, and
altered coagulation.
•Renal failure resulting from a
glomerular disorder may necessitate
dialysis to restore fluid and electrolyte
balance and remove waste products from
the body.
Medications:
•Although no drugs are available to cure glomerular
disorders, medications are used to treat underlying
disorder, reduce inflammation, and management
symptoms.
•Antibiotics are prescribed for the client with
poststreptococcal glomerulonephritis to eradicate
any remaining bacteria, removing the stimulus for
antibody production. Nephrotoxic antibiotics, such
as aminoglycoside antibiotics, streptomycin and
some cephalosporins, are avoided
•Aggressive immunosuppressive therapy is used to treat acute
inflammatory processes such as rapidly progressive
glumerulonephritis. When begun early, immunosuppressive therapy
significantly reduces the risk of end-stage renal disease and renal
failure.

•Predinosone, a glucocorticoid, is prescribed in relatively large doses


of 1 mg per kg of body weight per day (e.g., a 160 pound man would
receive 70 to 75 mg per day). Other immunosuppressive agents such
as cyclophosphamide (Cytoxan) or azathioprine (Imuran) are
prescribed in conjunction with corticosteroids. Corticosteroids use in
streptococcal glumerulonephritis may actually worsen the condition,
so is avoided.
•Oral glucocorticoids such as prednisone also are used in
high doses to induce remission of nephritic syndrome.
When glucocorticoids alone are ineffective, other
immunosuppressive agents such as cyclophosphamide or
Clorambucil (Leukeran) may be used to induce or maintain
remission.
•ACE inhibitors may be ordered to reduce protein loss
associated with nephritic syndrome. These drugs reduce
proteinuria and slow progression of renal failure. They have
a protective effect on the kidney in clients with diabetic
nephropathy. Nonsteroidal anti-inflammatory drugs
(NSAIDs) also reduce proteinuria ijn some clients, but can
increase salt and water retention.
•Antihypertensives may be prescribed to
maintain the blood pressure within normal
levels. BP management is important
because systemic and renal hypertensions
are associated with a poorer prognosisin
clients with glumerular disorders
Surgery:
Kidney Transplantation - Kidney
transplantation is a surgical procedure to
remove a healthy, functioning kidney from a
living or brain-dead donor and implant it into
a patient with nonfunctioning kidneys.
Purpose Kidney transplantation is performed
on patients with chronic kidney failure, or
end-stage renal disease (ESRD).
Nursing Responsibilities:
•Maintain patient's diet
•Monitor blood pressure, vital signs and laboratory findings
•Provide client a rest period
•Increased fluid intake
•Assist client on cutting back on protein and potassium
consumption may slow the buildup of wastes in the client's
blood.
•Teach client on how to restrict salt intake.This prevents or
minimize fluid retention, swelling and hypertension.
•If client has diabetes, nurse should take note that client should
maintain a healthy weight and control the client's blood sugar
levels and blood pressure as this may help slow kidney damage.
•Assist client in voiding.
E.RENAL FAILURE
•Renal Failure is the loss of function in both
kidneys.
•It has 5 stages that are based on the presence
or absence of symptoms and on progressively
decreasing GFR. The stages are as follow:

Stage 1: Kidney damage with normal or near


normal glomerular filtration rate, at or above
90mL/min
Stage 2: Glomerular filtration rate between 60 and
89mL/min, with evidence of kidney damage. This
stage is considered one of diminished renal reserve.
Remaining nephrons are highly susceptible to failing
themselves as their load becomes overwhelming.
Additional renal insults hasten the decline.

Stage 3: Glomerular filtration rate between 30 and


59mL/min. This stage is considered one of renal
insufficiency. Nephrons continue to die.
Stage 4: Glomerular filtration rate
between 15 and 29mL/min, with fewer
nephrons remaining.

Stage 5: End-stage renal failure;


glomerular filtration rate of less that
15mL/min. few functioning nephrons
remain. Scar tissue and tubular atrophy
are present throughout the kidneys
F.ACUTE RENAL FAILURE
Description
•Abrupt loss of kidney function over a period
of hours to a few days.
•Characterized by oliguria (daily output of
urine that between 100 and 400mL only) and
anuria (urine output of less than 100mL).
There is also a decrease in GFR and elevation
of the Serum Creatinine and BUN levels.
Cause or Risk Factor:
•Causes of acute renal failure have been
separated into three general categories:
prerenal, intrarenal, postrenal. Identification of
the cause of Renal Failure is important in the
management of the disease. Identification may
be accomplished by a study of the patient’s
history and the quantity and quality of his/her
urine.
Prerenal Causes:
•Most common cause of acute renal failure. Prerenal
failure occurs as a result of conditions unrelated to
the kidney but that damage the kidney by affecting
renal blood flow. Factors that contribute to
decreased renal blood flow are as follows:

Circulatory Volume Depletion, as may occur with


diarrhea, vomiting, hemorrhage, excessive use of
diuretics, burns, renal salt-wasting conditions
Volume Shifts, as from third-space sequestration
of fluid, vasodilation, or gram negative sepsis
Decreased cardiac output as during cardiac pump
failure, pericardial tamponade, or acute pulmonary
embolism.
Decreased peripheral vascular resistance as from
spinal anesthesia, septic shock, or anaphylaxis.
Vascular obstruction, such as bilateral renal
artery occlusion or dissecting aneurysm.
Intrarenal Causes:
•Occurs as a result of primary damage to the kidney tissue itself. It has
many causes including glomerulonephritis, acute pyelonephritis, and
myoglobinuria.

•Kidney cell damage usually occurs with as a result of tubular


ischemic tubular necrosis. It can result from a dec. renal blood flow or
a result of the direct action of nephrotoxic drugs, such as heavy metals
and organic solvents. Aminoglycoside antibiotics such as gentamicin,
are also nephrotoxic. Radiopaque contrast media use for viewing the
cardiac chambers or the GI tract can be nephrotoxic in susceptible
individuals. Ingestion of toxic amounts of analgesic mixtures,
especially codeine and caffeine, may lead to acute tubular necrosis.
Postrenal Cause
•Postrenal causes of ARF arise from a1n obstruction
in the urinary tract, anywhere from the tubules to
the urethral meatus. Common sources of obstruction
include prostatic hypertrophy, calculi, invading
tumors, surgical accidents, ureteral or urethral
strictures or stenosis and retroperitoneal fibrosis.
Spinal cord injury may lead to decreased bladder
emptying and a functional obstruction.
Complications
oFluid and electrolyte Imbalance
oAcidosis
oIncreased susceptibility to secondary infection
oAnemia
oPlatelet dysfunction
oGastrointestinal complications
oIncrease incidence of pericarditis
oUremic encephalopathy characterized by apathy,
defective recent memory, episodic obtundation,
dysarthria, tremors, convulsions and coma.
oImpaired wound healing.
Clinical Manifestations
Non-oliguric Renal Failure
•Urine excretion of 2L/day
•Low urine specific gravity
•Hypertension
•Tachypnea
•Dry Mucous Membranes
•Poor skin turgor
•Orthostatic Hypotension
Oliguric Renal Failure
•Urine production of less than 400mL/day
•High urine specific gravity
•Contains hyaline and granular casts
•Edema and weight gain
•Hemoptysis resulting from elevated left ventricular end-
diastolic pressure, weakness from anemia, and
hypertension.
•Anemia
•Hypertension
•High sodium concentration
•Definite proteinuria
•Hematuria, RBC and hemoglobin casts in the urine
•Elevated levels of creatinine, phosphokinase, potassium
Nursing Diagnosis
•Deficient fluid volume related to fluid loss from a variety
of causes
•Excess fluid volume related to inability of the kidneys to
produce urine secondary to ARF
•Imbalance Nutrition: Less than body requirements related
to anorexia and altered metabolic state secondary to renal
failure.
•Risk for impaired skin integrity related to poor cellular
nutrition and edema.
•Risk for infection related to lowered resistance
•Anxiety related to unknown outcome of disease process
Diagnostic Procedures
•Laboratory finding of azotemia (increased
nitrogenous compounds in the blood), and
elevated BUN and creatinine confirm
diagnosis
•Laboratory finding of hyperkalemia
(increased potassium in the blood) and
acidosis are common.
•Urinalysis shows casts
Treatment, Surgery and
Medication
Prevention of the oliguric phase results in a
better prognosis. Prevention of oliguria
involves:
•Aggressive plasma volume expansion
•Diuretics to increase urine production
•Vasodilators, especially dopamine, given to
increase renal blood flow.
•Dietary restrictions on potassium and protein
are often implemented in acute renal failure.
High-carbohydrate intake prevents the
metabolism of proteins and reduces
nitrogenous waste production. Give the patient
a high-calorie, low protein, sodium,
magnesium, phosphate, and potassium diet
should be given. Protein must be of high
biologic value, containing essential amino
acids to reduce nitrogenous waste products.
•The patient must undergo continuous renal
replacement therapy (CRRT)for:
Continuous arteriovenous
hemofiltration
Continuous venovenous hemofiltration
Continuous venovenous hemodialysis
Continuous arteriovenous ultrafiltration
Slow continuous ultra filtration
NOTE: CCRT removes plasma water
and dissolved contents from the patient’s
blood across a membrane. Slow
continuous removal of waste products and
water through CRRT is less stressful to
the client than shorter, more efficient
dialysis treatment.
•Antibiotic therapy to prevent or treat
infections may be necessary because of high
rate sepsis seen with acute renal failure.
•Continuous peritoneal dialysis is often
employed during the oliguric stage of
acute renal failure to give the kidneys
time to recover. Dialysis also prevents the
build up of nitrogenous wastes, stabilizes
electrolytes, and fluid overload.
•Cautious use of diuretics such as
furosemide and mannitol.
Nursing Responsibility
•Careful maintenance of electrolyte and fluid
balance
•Check vital signs, skin turgor, and mucous
membranes every 4 hours
•Obtain daily weight measurements using the same
scale at same time of the day
•Monitor for abnormalities in heart sounds, cardiac
output, breath sounds and mental status
•Give sodium bicarbonate, sodium lactate or sodium
acetate to correct metabolic acidosis
•Alleviate patients thirst with careful oral hygiene,
judicious use of ice chips, lip ointments and
appropriate diversionary techniques.
•Place allotted water in a spray bottle may help
spread out the amount taken
•Administer medication with meals to conserve fluid
for the client
•Work with the client and dietitian to plan a diet that
is acceptable. Provide a pleasant environment at
mealtime.
•Medications to alleviate the discomfort of nausea
and stomatitis may be useful.
•To prevent skin breakdown, meticulous skin care,
frequent turning and special mattresses are
important.
•Teach patient range of motion exercise to facilitate
movement and increase circulation
•Monitor patient carefully for infectious processes; if
these occur, they should be treated aggressively.
Give frequent careful explanations and provide
emotional and psychological support to the client
and family to relieve anxiety
Evaluation
•Fluid Balance must be maintained. If fluid volume excess
develops it is managed with dialysis or CRRT to reduce
body weight and to balance intake and output.
•Intact skin should be maintained
•The client and family will be less anxious and be able to
cope with the information provided.
•Clients with ARF recover within 4 to 10 weeks of
correction of the underlying problem.
•Renal function may continue to improve for up to 12
months after the onset of ARF. The client is particularly
vulnerable to additional renal injury during this time.
G.CHRONIC RENAL FAILURE
Description
•Chronic renal failure is the irreversible and
progressive reduction of functioning renal tissue.
When the remaining kidney mass can no longer
maintain the body’s internal environment renal
failure is the result.
•It also known as the end stage renal disease and
stage 5 CKD
•It can develop insidiously over many years or it
may result from an episode of ARF from which the
client has not recovered.
Cause or Risk Factor
•Chronic glomerulonephritis, ARF,
polycystic kidney disease, obstruction,
repeated episodes of pyelonephritis and
nephrotoxins.
•Systemic diseases such as diabetes
mellitus, hypertension, lupus
erythematosus, polyarteritis, sickle cell
disease, and amyloidosis
Complications
•Severe azotemia and uremia are present.
Metabolic acidosis worsens which
significantly stimulates respiratory rate.
•Hypertension, anemia, osteodystrophy,
hyperkalemia, uremic encephalopathy,
and pruritus are common complications,
•Decreased production of erythropoietin
may lead to cardiorenal anemia syndrome,
a self-perpetuating triad of anemia,
cardiovascular disease and renal disease
that ultimately leads to increased
morbidity and mortality.
•Congestive heart failure may develop
•Without treatment coma and death may
develop
Clinical Manifestations
•Increased BUN, serum creatinine
and uric acid
•Dilute Polyuria
•Dehydration
•Hyponatremia
•Decreased Libido
Infertility
•Delayed wound healing
•Infection
•Erratic Blood glucose levels
•Anemia, pallor
•Osteodystrophy
•Hypocalcemia
•Metabolic acidosis
•Hyperphosphatemia
•Hyperkalemia
•Hypertension
•Heart Failure
•Edema
•Peripheral Nerve Changes
•Pericarditis
•CNS changes
•Pruritus
•Bleeding tendencies
Altered taste
Nursing Diagnosis
•Deficient/ Excessive fluid volume related to
impaired renal function, fluid shifts between
dialysate and blood, and blood loss during
hemodialysis
•Imbalance Nutrition: Less than body
requirements related to anorexia and nausea
•Constipation related to medication, fluid and
dietary restrictions and decreased activity level
•Fatigue related to anemia and altered
metabolic state
•Risk for impaired skin integrity related to
edema dry skin and pruritus.
•Readiness for enhanced self care related
to learning to live with a chronic illness,
uncertain future, many stressors, role
reversal, and effects of long term dialysis.
Diagnostic Procedures
•Radiographs or ultrasound will show small,
atrophied kidneys
•Elevated BUN and Serum creatinine with a
decreased GFR
•Reduced hematocrit and hemoglobin
•Low plasma pH
Elevated respiratory rate indicates respiratory
compensation for metabolic acidosis.
Treatment, Surgery and Medications
•Renal Anemia Management Period (RAMP) is
defined as the following the time following the onset
of CRF when early diagnosis and treatment of
anemia will slow kidney disease progression, delay
cardiovascular complications, and improve quality
of life. Treatment of anemia is by administration of
recombinant human erythropoietin. This drug
improves the quality of life and reduces the need for
transfusions. It also significantly improves cardiac
function.
•Treatment is geared towards correcting fluid and
electrolyte imbalances
•Treatment includes dialysis or renal transplantation
Renal transplantation is the surgical implantation
of a human kidney from a compatible donor to a
recipient.
The kidney is surgically placed extraperitoneally
in the iliac fossa. The renal artery is anastamosed to
the recipient’s hypogastric internal or external iliac
artery and the renal vein is anastamosed to the
recipient’s iliac vein.
Selection of transplant recipients is based on
careful evaluation of the client’s medical,
immunologic, and psychosocial status. A
recipient must be:
Younger than 70 years old
Has an estimated life expectancy of 2 years or
more
Is expected to have an improved quality of
life after transplantation
Bilateral nephrectomy may be
performed before the transplantation
procedure for persistent or active
bacterial pyelonephritis, uncontrolled,
renin-mediated hypertension, polycystic
kidneys or rapidly progressive
glomerulonephritis
The source of kidneys for
transplantation is a living related donor
who matches the client closely. The donor
must have compatible:
•ABO blood group
•Tissue-specific antigen
•Human leukocyte histocompatibility
Contraindications of Renal
Transplantation
•Infection
•Active malignancy
•Liver disease
•Psychological disorders
•Advance atherosclerosis
•Hypertension
•Respiratory disease
•Gastrointestinal bleeding
Complications:
•Graft Rejection
•Spontaneous rupture of kidneys may occur
•Urinoma
•Reduced renal function
•Urinary, bladder, or pelvic leaks,
obstructions, reflux and lymphoceles
•Hypertension
•Dysrhytmias and heart Failure
•Pnuemonia, Pulmonary embolism,
pulmonary edema
Improve Renal Function by:
•Improving blood pressure by
medication, weight control and
diet
Protein restriction
Alleviate extrarenal manifestations as much as
possible by:
•Applying topical emollients and lotions, taking
antihistamines, intravenous lidocaine and ultraviolet
B light to alleviate pruritus.
•Treatment with epoetin alfa three times a week to
stimulate the production of RBC to treat anemia.
Supplemental iron, vitamin B12 and folic acid are
usually administered as well.
•Hyperlipidemia is treated with statins to minimize
the risk of myocardial infarction and stroke.
Elemental diets, enteral
feeding, or TPN may be
used instead of or in
addition to regular food
intake.
Nursing Responsibilities
•Fluid Status must be known and fluid intake carefully
regulated.
•Monitor fluid status by daily weight measurement,
orthostatic blood pressure, skin turgor, mucous membrane
moistness, and meticulous intake and output comparisons.
•Help the client follow the recommended fluid allowance.
Relieve thirst by moistening lips by using lip balms,
performing frequent oral hygiene, eating ice chips or using
spray bottles rather than drinking.
•During dialysis monitor the client’s vital signs
including postural blood pressure, pulse rate weight
and intake and output
•Help the client consume adequate nutrition while
minimizing uremic toxicity.
•Take measures to relieve nausea and vomiting,
stomatitis, and other gastrointestinal manifestations.
•Help the client select and prepare foods and learn
where to obtain special foods if necessary. Exercise
also improves appetite.
•Bran which is limited in potassium or phosphorus
can be used to alleviate constipation. Stool softeners
are often administered regularly can also alleviate
constipation
•Iron and erythropoietin therapy to increase energy
levels. Exercise is an important strategy to reduce
fatigue and improve quality of life.
•Moisturizing oils in the bath water or applied
directly to the skin help to correct dryness. Avoid
products that alcohol or perfume because they
increase dryness and pruritus.
•If edema is present avoid sustained pressure
on the area
•Observe for poor circulation and areas of
breakdown or infection
•Explain procedures and tests that are to be
done to alleviate anxiety.
•Closely monitor patients who have undergone
transplantation surgery for fluid and electrolyte
imbalance, infection, graft rejection and other
complications.
Evaluation
•The client is expected to improve physically and
mentally when dialysis begins.
•The clients weight and blood pressure should begin
to stabilize if dietary and fluid restrictions are
followed and as fluid balance stabilizes
•The client should report regular, normal bowel
movements.
•The client should report less fatigue and increased
energy and activity as hematocrit values approach
normal levels
•Skin should remain contact
•The client should understand and adapt to the
treatment regimen and be successfully
maintained with peritoneal dialysis or
hemodialysis.
•Clients having peritoneal dialysis should be
able to demonstrate successful performance of
the dialysis procedure and care of the vascular
access site or peritoneal catheter. The should
remain free from complications of dialysis
DIALYSIS
It is the diffusion of solutes and osmosis of
water through a passive, porous membrane
from the plasma to the dialysis solution and
vice-versa in response to a concentration or
pressure gradient.
Types of Dialysis
•Hemodialysis
•Peritoneal Dialysis
HEMODIALYSIS
•Involves shunting the patient’s blood from the
body through a machine in which diffusion,
osmosis and ultrafiltration occur and back into the
patient’s circulation.
•Used for clients with acute or irreversible renal
failure and fluid and electrolyte imbalances.
•It is usually the treatment of choice when toxic
agents, such as barbiturates after an overdose, need
to be removed from the body quickly.
ACCESS TO THE
BLOODSTREAM
A.External Arterio-venous
Cannula or Shunt
-Teflon cannula tips are placed in an artery
and nearby vein. These cannula tips are
connected by silicone rubber tubing and a
Teflon bridge to complete the shunt
-It ahs a short life-span (9 months) due to
clotting and infection
B. External Arterio-venous
Fistula
-anastomosing an artery directly to a vein (usually radial
artery and cephalic vein at the wrist)
-blood is shunted from the artery to the vein causing the
vein to enlarge (ripening) after a few weeks
-average life is 4 years; circumvented problems of infection,
clotting and possible hemorhhage
-disadvantages are painful venipuncture, formation of
aneurysms; achieving hemostatis post dialysis and ischemia
of the hand.
NURSING RESPONSIBILITIES
FOR HEMODIALYSIS
Before:
1. Measure and record baseline vital signs
as weight, temperature, pulse rate,
respiration, blood pressure.
2. Measure pre treatment result of BUN,
creatinine, Na, K levels and Hematocrit.
During:
1. Sterile techniques for needle and shunt connections.
2. Anchor connections securely.
3. Check equipments for readiness, safety and gauge settings.
4. Monitor vital signs every 15 minutes for 1 hour then every 30
minutes thereafter.
5. Watch out for rapid shifts in volume or electrolytes that may result
in hypovolemia, angina, dysrhythmias, nausea and muscle cramps due
to dialysis disequilibrium syndrome wherein the osmotic gradient
produced across the blood-brain barrier by the efficient removal of
urea from the blood but not from the brain tissues. Urea draws in
water from the ECF and can cause cerebral edema.
After:
1. Measure and record vital signs and weight.
2. Precautions against infection.
3. Routine care to shunt or fistula.
4. Avoid trauma to sites.
5. Do not use arm with shunt or fistula for
blood pressure taking and needlesticks.
6. Record BUN, creatinine Na, K levels to note
of treatment.
Between Treatments
1. Follow diet (Low Na, K, low protein) and fluid restrictions.
2. Take medications as ordered
3. Limit weight gain to 0.5 kg/ day between treatment
4. Care of access site:
a. No BP or IV punctures on arm with shunt / fistula.
b. Cleanse site aseptically with Peroxide.
c. Clean shunt with alcohol sponges from exist site.d.Cover with
dry sterile dressing
e. Avoid trauma to site, wear loose sleeves, avoid temperature
extremes, avoid lifting heavy objects, and avoid prolonged immersion
of arm in water.
POSSIBLE COMPLICATIONS OF
HEMODIALYSIS
1. Blood clots
-due to decreased blood flow which results from:
a. systemic hypotension
b. infection of shunt/fistula
c. compression of shunt/fistula
d. tight bandages/restrictive clothing
e. phlebitis from puncture of involved veins
f. prolonged inflation of BP cuff
-how do you detect clots:
a. absence of dark/separated blood in the tubing
2. Infection on site of cannula insertion
- signs of infection
a. redness
b. tenderness
c. swelling
d. excessive warmth of skin

Complication of Dialyzer Reuse


1.pyrogenic reactions
2..bacteremia
3. Membrane rapture
4. occlusion of hollow fibers
EVALUATION:
Successful achievement of patient outcomes for the patient
receiving hemodialysis is indicated by the following:
•lack of excessive fluid weight gain between dialysis
treatment
•states that no pain is present and that discomfort
experienced during dialysis is decreased
•participates in a program to maintain prescribed activity
level
•eats according to preference during therapy
•correctly explains dialysis, care of venous access, common
side effects and recommended work or activity schedule.
PERITONEAL DIALYSIS
A catheter is placed in the peritoneum cavity by
paracentesis. Two liters of sterile dialysis solution are
allowed to run into the peritoneal cavity through the catheter
for 10-20 minutes. Equilibrium between the dialysis fluid
and the highly vascular semi-permeable peritoneal
membrane takes place. The peritoneum acts as the semi-
permeable membrane. This is called the “dwell time” which
is generally 30-45 minutes. The fluid is then allowed to
drain by gravity into a closed, sterile connecting system.
Cycle is repeated successfully over a period of 1-2 days.
Types of Peritoneal Dialysis:
1. Continuous Cycling Peritoneal
Dialysis
-connecting the peritoneal catheter to an
automated peritoneal dialysis machine
that perform 3-5 cycles during the night
while patient sleeps; last bag of solution
remains in abdomen during daytime.
2. Continuous Ambulatory Peritoneal Dialysis
- a permanent dialysis catheter is inserted into the
abdomen; a connector joins the transfer set to the
bag of the fluid. Plastic bags are used; performs 3 -5
exchanges daily; last bag of solution remains in the
abdomen overnight.
3. Intermittent Peritoneal Dialysis
- connected for about 10 hour, with cycle changing
every 30 -60 minutes; abdomen is left “dry” between
sessions.
NURSING RESPONSIBILITIES IN PERITONEAL
DIALYSIS
Before:
1. Have patient empty the bladder to avoid puncturing it during
catheter insertions
2. Measure and record weight, abdominal girth, temperature, pulse,
respiration, blood pressure
3. Measure and record blood chemistry values like BUN, creatinine,
Na, K, Hematocrit
4. Sterile technique during insertion of catheter
5. After insertion of catheter, observe for perforation of bowel
(dialysate outflow stained with feces or blood) or bladder (pink or
blood tinged)
6. Warm dialysate up to 37°C before infusion
7. Flush tubing to remove air, connect to catheter, anchor connections
and tubings securely and be sure there are no kinks on the tubings
During:
1. Measure and record output, weight regularly and TPR, BP every 10
min. till stable then every 2-4 hours as ordered
2. Keep accurate record of dialysis cycles (inflow, dwell, outflow
times). Record strength of solutions used, additions made, and fluid
balance (amount retained or lost)
3. Observe for peritonitis (collect samples of dialysate for culture and
sensitivity tests whenever solution is turbid, bloody, or has an odor or
when routinely ordered).
4. Observe for respiratory embarrassment (dyspnea and rales) which
results from abdomen being too full of fluid or leakage of dialysate
into the thoracic cavity through defect in the diaphragm.
5. Have client change position frequently, do ROM exercises, and do
deep breathing.
After:
1. Determine fluid balance (measure
weight, TPR, BP, abdominal girth)
2. Check blood chemistry (BUN,
creatinine, Na, K)
3. Maintain adequate nutrition, adhering
to high protein diet which is needed to
replace those lost during the procedure
4. Facilitate learning
the teaching plan should include:
a. the process of dialysis and how the dialysis relates to the
patient’s own body needs
b. signs and symptoms of infection of eth peritoneal cavity or
catheter site and when to obtain care if these occur
c. appropriate care of the permanent peritoneal catheter
d. common side effects of treatment, means of controlling mild
symptoms and means of obtaining medical attention for severe or
persistent complications
e. changes in medication schedule required before and after
dialysis
f. a work and activity schedule as physical capabilities permit
with minimal interference from scheduled dialysis time.
Cycle-related problems:
1. Inflow problems- obstructed catheter (clots,
fibrin, omentum, catheter malposition),
leakage of fluid around catheter insertion site.
2. Dwell time problems- prolonged time may
cause water depletion or hyperglycemia
3. Outflow problems- kinks in tubing or
catheter, catheter occluded by loops of bowel,
constipation
COMPLICATIONS OF PERITONEAL DIALYSIS
COMPLICATIO SIGNS AND INTERVENTIONS
NS SYMPTOMS
1. Peritonitis Abdominal pain Aseptic technique
Elevated Culture and sensitivity of
temperature dialysate
Antibiotic treatment
Possible removal of catheter

2. Exit site Redness Assess response to cleansing


infection Swelling agents
Heat Continue thorough daily site
Pain care
Antibiotics as ordered
3.Abdominal If related to rapid inflow,
Pain decrease rate of infusion
during initial exchanges
4. Air in the Shoulder pain Prime new tubing carefully
peritoneal Distended Do not use vented system
cavity abdomen
5.Overheated Increased Drain solution
dialysate temperature Treat for hypothermia
Abdominal pain Evaluate warming
Cardiac procedure
disrythmias
6. Inadequately Hypothermia Drain solution
warm dialysate Treat for hypothermia
Evaluate warming procedure

7. Fluid overload Dyspnea Calculate fluid balance


Altered mental accurately
status Use a more hypertonic
Alteration in dialysate
breath sounds Limit fluid intake
Shorten dwell time
Correct catheter malfunction
Monitor weight, V.S and
cardio-respiratory status
frequently
8. Fuid Deficit Alteration in fluid Calculate fluid balance
and electrolytes accurately
Discontinue use of hypertonic
solution
Replace fluid and sodium
losses
Monitor V.S and weight closely
Lengthen dwell time

9. Hypokalemia Decreased level Monitor serum potassium


potassium Add potassium to dialysate for
clients with normal levels
Increase dietary intake of
Potassium if with chronic
problem
10. Drainage Inadequate Small amount of
of fluid outflow Heparin is added to the
dialysate
Turn patient from side
to side to reposition the
catheter in the
peritoneal cavity
Raise head of bed
Apply firm pressure to
the abdomen using
both hands
Thank you
and
Good Luck!!!

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