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Transcript
The Urinary System and
Dialysis
Kidney Blood Flow
Kidneys
• Role is to maintain body fluid volume and
composition, filter waste products for
elimination.
• Regulate blood pressure
• Participate in acid-base balance
• Produce erythropoietin for RBC synthesis
• Metabolize vitamin D to an active form
Kidneys
Regulatory functions:
Control fluid, electrolyte and acid base
balance
Hormonal functions:
Control red blood cell formation, blood
pressure and vitamin D activation
Hormonal
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Renin
Prostaglandins
Bradykinin
Erythropoietin
Vitamin D activation
Ureters
• Each kidney has a single ureter-connects
renal pelvis with urinary bladder.
• ½ inch diameter
• 12 to 18 inches in length
Urethra
• Narrow tube- mucous membranes and
epithelial cells
• Men- 6 to 10 inches
• Women- 1 to 1.5 inches
• Tube for eliminating urine from the body.
Urination removes bacteria from the
urethra.
Renal changes in older adult
• Changes occur as part of the aging
process.
• Kidney smaller by 80 yr/old
• Function decreases with aging.
• Decreased bladder capacity
• Reduced ability to retain urine.
Patient history
• Family history for risk
• Personal history- age, previous renal
problems, prescription drugs, OTC’s, work
exposure
• Diet history- intake or appetite changes
• Changes in urination pattern or continence
Physical assessment
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Inspection
Auscultation
Palpation
Percussion
Lab tests
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Serum creatinine
Blood urea nitrogen
Urine culture and sensitivity
24 hr urine
Urine- Creatinine clearance
UA Strip
Urinalysis
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Color, odor, turbidity
Specific gravity
pH
Glucose
Ketones
Protein
Leukoesterase
Nitrites
Sediment
Radiology
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Kidney, Ureter, Bladder x-rays
Intravenous urography (IVP)
CT, US
VCUG
Renal scan
Cystoscopy
IVP
Renal biopsy
• Determine cause for renal dysfunction and
direct treatment
• Percutaneous with US or CT
• Monitor for bleeding, vital signs,
hematuria, increasing pain or discomfort
• Bed rest 2-6hrs
Urolithiasis
• Calculi in the urinary tract
• Nephrolithiasis- stones in the kidney
• Ureterolithiasis- stones in the ureter
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Hypercalcemia
Hyperoxaluria
Hyperuricemia
Struvite
cystinuria
Kidney Stones
Kidney Stones
Kidney Stones
Physical assessment
• Renal colic
• Pain most intense when stone moving or
ureter obstructed
• Nausea, vomiting, pallor, diaphoresis
• Obstruction is emergency
• KUB or CT to determine
Interventions
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PAIN RELIEF
Lithotripsy
Hydration
Strain urine-to determine cause of stone
• Surgical- if too large
• Stent
• Percutaneous nephrolithotomy
Lithotripsy
Chronic renal failure
• Progressive, irreversible kidney injury
• No return of kidney function
• ESRD- kidney function too poor to sustain
life
• Stage I- diminished renal reserve
• Stage II- renal insufficiency
• Stage III- end stage renal disease
Body changes
• Elevates blood pressure
• Increased triglycerides, total cholesterol
and LDL levels
• Heart failure
• Anemia
• GI upset
Patient education for prevention
• Observe for changes in urine- color,
amount, discomfort
• Adequate amount of fluids
• Know family history
• Control DM, HTN
• Take medication as prescribed
Interventions
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Nutrition therapy
Protein restriction
Sodium restriction
Potassium restriction
Vitamin supplementation
Drug therapy
Fluid restriction
Dialysis
Hemo vs peritoneal dialysis
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More efficient clearance
Shorter treatment time
Muscle cramps
Hemodynamic changes
Vascular access route
Specially trained nurses
Vascular access care
Restricted diet
• Easy access
• Few hemodynamic
complications
• Hyperglycemia
• Bowel perforation
• Peritoneal adhesions
• Intra-abdominal catheter
• Simple
• Less complex training
• More flexible diet
HD system
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Dialyzer
Dialysate
Vascular access route
HD machine
Anticoagulation
Types of access for HD
• AV fistula
• AV graft
• Tunneled catheter
• Hemo catheter
• AV shunt
• Subcutaneous device
Care of the access
• NO !!!! Blood pressure readings,
venipunctures or IV lines in extremity with
access
• Assess for bruit and thrill frequently
• Evaluate extremity for CMS and ROM
• No heavy lifting with accessed arm
• Observe for infection
Care of HD patient
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May hold medications until after treatment
Monitor for side effects of treatment
Weigh before and after treatment
Assess access before and after treatment
Observe access for bleeding after
treatment
Peritoneal dialysis
• Occurs in the peritoneal cavity
• Slower than HD- more time needed for
same effect
• For hemodynamically unstable and cannot
tolerate anticoagulation
• Not if pt. has abdominal adhesions or
extensive intra-abdominal surgery
• Diffusion and osmosis across
semipermeable membrane and capillaries.
• Solutes and water move from area of
higher concentration in the blood to an
area of lower concentration in the dialyzing
fluid (diffusion)
• Dialysate prescribed based on patient's
fluid status
• Heparin to tube to prevent clotting
• Potassium and antibiotics in Dialysate
Care of PD patient
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Mask self and patient
Sterile gloves
Observe Dialysate for color
Frequent vital signs
Weigh before and after treatment
Strict I/O
Kidney Transplant
Kidney transplant
• Treatment for ESRD
• Candidates selected based on medical
problems and risks
• Donors- living related, living non-related,
cadaveric
• Immunosupressive medications long term
Post operative
• Ongoing physical and renal assessment
• I/O strict
Complications:
• Rejection
• Thrombosis
• Infection
• Urinary tract complication
Rejection
Hyperacute:
• Within 48 hrs of surgery
• Increased temp
• Increased BP
• Immediate removal of kidney
Acute rejection:
• 1wk to 2 yr
• Oliguria or anuria
• Temp over 100F
• Increased BP
• Elevated creat, BUN, K+
• Increased doses of immunosuppressive
drugs
Chronic rejection:
• Gradual over months to years
• Fluid retention
• Changes in electrolytes
• Conservative treatment until dialysis
needed
Thank you