Download 10. Interventions for clients with renal and urinary problems

Interventions for
Clients with
Renal Disorders
Pyelonephritis
 Bacterial infection in the kidney (upper
urinary tract)
 Key features include:
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Fever, chills, tachycardia, and tachypnea
Flank, back, or loin pain
Abdominal discomfort
Turning, nausea and vomiting, urgency,
frequency, nocturia
 General malaise or fatigue
Key Features of Chronic
Pyelonephritis
 Hypertension
 Inability to conserve
sodium
 Decreased
concentrating ability
 Tendency to develop
hyperkalemia and
acidosis
Acute Pain Interventions
 Pain management interventions
 Lithotripsy
 Percutaneous ultrasonic
pyelolithotomy
 Diet therapy
 Drug therapy
 Antibiotics
 Urinary antiseptics
Surgical Management
 Preoperative care
 Antibiotics
 Client education
 Operative procedure:
pyelolithotomy,
nephrectomy, ureteral
diversion, ureter
reimplantaton
 Postoperative care for
urologic surgery
Renal Abscess
 A collection of fluid and
cells caused by an
inflammatory response to
bacteria
 Manifestations: fever,
flank pain, general
malaise
 Drainage by surgical
incision or needle
aspiration
 Broad-spectrum
antibiotics
Renal Tuberculosis
 Diagnosis
 Antitubercular therapy
with rifampin, isoniazid,
and pyrazinamide
 Complications renal
failure, kidney stones,
obstruction, and
bacterial superinfection
of the urinary tract
 Surgical excision
possible
Acute Glomerulonephritis
 Assessment
 Management of infection
 Prevention of complications
 Diuretics
 Sodium, water, potassium, and protein
restrictions
 Dialysis, plasmapheresis
 Client education
Chronic
Glomerulonephritis
 Develops over a period of
20 to 30 years or longer
 Assessment
 Interventions include:
 Slowing the progression
of the disease and
preventing
complications
 Diet changes
Chronic Glomerulonephritis
(Continued)
 Fluid intake
 Drug therapy
 Dialysis, transplantation
Nephrotic Syndrome
Nephrosclerosis
Renovascular Disease
Diabetic Nephropathy
Cysts and Benign Tumors
Renal Cell Carcinoma
 Paraneoplastic syndromes include
anemia, erythrocytosis,
hypercalcemia, liver dysfunction,
hormonal effects, increased
sedimentation rate, and hypertension.
(Continued)
Renal Cell Carcinoma
(Continued)
 Nonsurgical management includes:
 Radiofrequency ablation, although effect is not known
 Chemotherapy: limited effect
 Biological response modifiers and tumor necrosis
factor: lengthen survival time
Renal Trauma
 Minor injuries such as contusions, small
lacerations
 Major injuries such as lacerations to the
cortex, medulla, or branches of the renal
artery
 Collaborative management
 Nonsurgical management: drug therapy and
fluid therapy
 Surgical management: nephrectomy or
partial nephrectomy
Polycystic Kidney Disease
 Inherited disorder in which fluid-filled cysts
develop in the nephrons
 Key features include:
 Abdominal or flank pain
 Hypertension
 Nocturia
 Increased abdominal girth
Polycystic Kidney Disease
(Continued)
 Constipation
 Bloody or cloudy urine
 Kidney stones
Hydronephrosis, Hydroureter,
and Urethral Stricture
 Provide privacy for elimination.
 Conduct Credé maneuver as
necessary.
 Apply double-voiding technique.
 Apply urinary catheter as appropriate.
 Monitor degree of bladder distention.
(Continued
Hydronephrosis, Hydroureter,
and Urethral Stricture
(Continued)
 Catheterize for residual.
 Intermittently catheterize as
appropriate.
 Follow infection protection measures.
Nephrostomy
 Client preparation
 Procedure
 Follow-up care including:
 Assess for
 amount of drainage.
 type of urinary damage expected.
 manifestations of infection.
 Monitor nephrostomy site for leaking
urine.
Interventions for Clients
with Acute and Chronic
Renal Failure
Acute Renal Failure
Phases of Acute Renal
Failure
 Phases of rapid decrease in renal function
lead to the collection of metabolic wastes in
the body.
 Phases include:
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Onset
Diuretic
Oliguric
Recovery
 Acute syndrome may be reversible with
prompt intervention.
Continuous Renal
Replacement Therapy
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Standard treatment
Dialysate solution
Vascular access
Continuous arteriovenous
hemofiltration
 Continuous venovenous
hemofiltration
Chronic Renal Failure
Stages of Chronic Renal
Failure
 Diminished renal reserve
 Renal insufficiency
 End-stage renal disease
Clinical Manifestations
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Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin
Hemodialysis
 Client selection
 Dialysis settings
 Works using passive transfer of toxins by
diffusion
 Anticoagulation needed, usually heparin
treatment
Peritoneal Dialysis
 Procedure involves siliconized rubber catheter
placed into the abdominal cavity for infusion of
dialysate.
 Types of peritoneal dialysis:
 Continuous ambulatory peritoneal
 Automated peritoneal
 Intermittent peritoneal
 Continuous-cycle peritoneal
Complications
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Peritonitis
Pain
Exit site and tunnel infections
Poor dialysate flow
Dialysate leakage
Other complications
Nursing Care During
Peritoneal Dialysis
 Before treating, evaluate baseline vital
signs, weight, and laboratory tests.
 Continually monitor the client for
respiratory distress, pain, and discomfort.
 Monitor prescribed dwell time and initiate
outflow.
 Observe the outflow amount and pattern of
fluid.
Renal Transplantation
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Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure