Download Management of Patients with Renal Disorders

Management of
Patients with Renal
Disorders
Glomerular Diseases
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Acute Glomerulonephritis
Chronic Glomerulonephritis
Nephrotic Syndrome
Glomerulonephritis
Acute Glomerulonephritis
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Preceded (10 days) by an infection
Assess for:
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Lesions
Signs of circulatory overload
Change in urine color and amount
Mild to moderate hypertension
Interventions:
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Treat cause: antibiotics, corticosteroids, immunosuppressants
Restrict sodium, water, potassium, protein
Dialysis, plasmapheresis
Client education
Nursing ManagementAcute Glomerulonephritis
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Patient assessment
Maintain fluid balance
Fluid and dietary restrictions
Patient education
Follow-up care
Chronic Glomerulonephritis
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20-30+ years to develop
Diagnostics:
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Causes:
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Urine with fixed specific gravity, casts, and proteinuria
Electrolyte imbalances
hypoalbuminemia
Repeated episodes of acute glomerulonephritis,
hypertensive nephrosclerosis, hyperlipidemia,
Manifestations:
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Mild proteinuria and hematuria, hypertension, and
occasional edema
Nursing Management:
Chronic Glomerulonephritis
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Assessment
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Teaching self-care
Nephrotic Syndrome
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Increased glomerular permeability
Severe loss of protein into urine
Treatment:
Immunosuppresive agents
 ACE Inhibitors
 Heparin
 Diet changes
 Mild diuretics
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Nephrotic Syndrome
Nephrosclerosis
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Narrowing of vessel lumen from thickening in
blood vessels of the nephron
Occurs with hypertension, atherosclerosis and
diabetes mellitus
Collaborative management:
Control hypertension
 Preserve renal function
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Renal Failure
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Results when kidney’s cannot remove wastes or
perform regulatory functions
Systemic disorder resulting from many different
causes
Acute renal failure- reversible syndrome that
results in decreased GFR and oliguria
Chronic renal failure- progressive; irreversible
deterioration of renal function resulting in
azotemia
Acute Renal Failure
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Pathophysiology
Types of acute renal failure include:
Prerenal
 Intrarenal
 Postrenal
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Phases of Acute Renal Failure
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Phases of rapid decrease in renal function lead
to the collection of metabolic wastes in the
body.
Phases include:
Onset
 Diuretic
 Oliguric
 Recovery
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Acute syndrome may be reversible with prompt
intervention.
Assessment
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History
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic assessments such as renal
biopsy
Drug Therapy
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Cardioglycides
Vitamins and minerals
Biologic response modifiers
Phosphate binders
Stool softeners and laxatives
Monitor fluids
Diuretics
Calcium channel blockers
Treatment
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Diet therapy
Dialysis therapies
Hemodialysis
 Peritoneal dialysis
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Renal Replacement Therapy
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Standard treatment
Dialysate solution
Vascular access
Continuous arteriovenous hemofiltration
Continuous venovenous hemofiltration
Posthospital Care
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If renal failure is resolving, follow-up care may
be required.
There may be permanent renal damage and the
need for chronic dialysis or even transplantation.
Temporary dialysis is appropriate for some
clients.
Chronic Renal Failure
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Progressive, irreversible kidney injury; kidney
function does not recover
Azotemia
Uremia
Uremic syndrome
Stages of Chronic Renal Failure
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Diminished renal reserve
Renal insufficiency
End-stage renal disease
Changes R/T CRF
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Kidney
Metabolic
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Electrolytes
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Urea and creatinine
Sodium
Potassium
Acid-base balance
Calcium and phosphorus
(Continued)
Changes R/T CRF
(Continued)
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Cardiac
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Hypertension
Hyperlipidemia
Congestive heart failure
Uremic pericarditis
Hematologic
Gastrointestinal
Clinical Manifestations
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Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin
Imbalanced Nutrition: Less Than
Body Requirements
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Interventions include:
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Dietary evaluation for:
Protein
 Fluid
 Potassium
 Sodium
 Phosphorus
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Vitamin supplementation
Excess Fluid Volume
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Interventions:
Monitor client’s intake and output.
 Promote fluid balance.
 Assess for manifestations of volume excess:
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Crackles in the bases of the lungs
 Edema
 Distended neck veins
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Drug therapy includes diuretics.
Decreased Cardiac Output
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Interventions:
Control hypertension with calcium channel blockers,
ACE inhibitors, alpha- and beta-adrenergic blockers,
and vasodilators.
 Instruct client and family to monitor blood pressure,
client’s weight, diet, and drug therapy.
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Risk for Infection
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Interventions include:
Meticulous skin care
 Preventive skin care
 Inspection of vascular access site for infection
 Monitoring of vital signs for manifestations of
infection
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Risk for Injury
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Interventions include:
Drug therapy
 Education to prevent fall or injury, pathologic
fractures, bleeding, and toxic effects of prescribed
drugs
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Fatigue
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Interventions:
Assess for vitamin deficiency, anemia, and buildup
of urea.
 Administer vitamin and mineral supplements.
 Administer erythropoietin therapy for bone marrow
production.
 Give iron supplements as needed.
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Anxiety
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Interventions include:
Health care team involvement
 Client and family education
 Continuity of care
 Encouragement of client to ask questions and
discuss fears about the diagnosis of renal failure
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Potential for Pulmonary Edema
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Interventions:
Assess the client for early signs of pulmonary
edema.
 Monitor serum electrolyte levels, vital signs, oxygen
saturation levels, hypertension.
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Hemodialysis
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Client selection
Dialysis settings
Works using passive
transfer of toxins by
diffusion
Anticoagulation needed,
usually heparin treatment
Vascular Access
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Arteriovenous fistula, or arteriovenous graft for
long-term permanent access
Hemodialysis catheter, dual or triple lumen, or
arteriovenous shunt for temporary access
Precautions
Complications
Permanent Vascular Access
Hemodialysis Nursing Care
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Postdialysis care:
Monitor for complications such as hypotension,
headache, nausea, malaise, vomiting, dizziness, and
muscle cramps.
 Monitor vital signs and weight.
 Avoid invasive procedures 4 to 6 hours after dialysis.
 Continually monitor for hemorrhage.
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Complications of Hemodialysis
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Dialysis disequilibrium syndrome
Infectious diseases
Hepatitis B and C infections
HIV exposure—poses some risk for clients
undergoing dialysis
Peritoneal Dialysis
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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
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Complications
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Peritonitis
Pain
Exit site and tunnel infections
Poor dialysate flow
Dialysate leakage
Other complications
Nursing Care During Peritoneal
Dialysis
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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.
Nursing Management of
Hospitalized Client on Dialysis
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Protect vascular access
Monitor fluid balance
indicators
Monitor IV carefully
Assess for s/s uremia
Monitor
cardiopulmonary status
carefully
Monitor BP
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Monitor medications
Address pain and
discomfort
Infection control
measures
Monitor dietary e-lytes
and fluids
Skin care
CAPD catheter care if
appropriate
Renal Transplantation
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Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure
Postoperative Care
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Assessment
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all body systems
Pain
Fluid and electrolyte
status
Urologic management
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Assessment of system
patency
Assessment of urine
output hourly for 48
hours.
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Complications
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Rejection
Acute tubular necrosis
Thrombosis
Renal artery stenosis
Other complications
Immunosuppressive drug
therapy
Psychosocial preparation
Post-transplantation Intervetions
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Pain relief measures and analgesics
Promote airway clearance and effective
breathing pattern
Strict asepsis
Monitor for signs/symptoms of bleeding
Encourage leg exercises, early ambulation, and
monitor for signs of DVT
Renal Cell Carcinoma
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Healthy kidney tissue damaged and replaced by
cancer cells
Paraneoplastic syndrome:
Anemia
 Erythrocytosis
 Hypercalcemia
 Liver dysfuntion
 Hormonal effects
 Increased sedimentation rate
 Hypertension
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Renal Cell Carcinoma Management
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Nonsurgical
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Radiofrequency ablation
Chemotherapy
Biological response
modifiers and tumor
necrosis factor lengthen
survival time
Renal artery embolization
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Surgical
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Pre-op care
Nephrectomy
Post-op care:
 Monitoring for
hemorrhage and
adrenal insufficiency
 Pain management
 Prevention of
complications
Renal Trauma
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Minor injuries:
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Major injuries:
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Lacerations to cortex, medulla, or branches or renal
artery
Nonsurgical management:
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Contusions, small lacerations
Drug and fluid therapy
Surgical management:
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Nephrectomy or partial nephrectomy