Transcript Renal Failure

Renal & Urologic
Problems
Nephrectomy
NUR 302
Post Op Care Nephrectomy
Flank incision, side lying position>muscle aches post op
 Monitor urine output- 30-50cc/hr
 Monitor resp status
 Medicate for pain
 Monitor for paralytic ileus
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Urinary Diversion
Incontinent urinary diversion
 Continent urinary diversion
 Orthotopic bladder substitution
 Pre-op info, assess readiness to learn,
involve family, enterostomal nurse
 Post-op complications- shock &
atelectesis
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Urinary Diversion
Prevent injury to stoma & good skin
care important
 Maintain urine output- mucous in urine
normal, hi fld intake
 Skin problems- alkaline encrustations
with dermatitis, yeast infections, product
allergies, sheering excoriations
 Properly fitting appliance
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Urinary Diversion
Address pt’s concerns- body image, offensive
odors, sexual, professional & activity
concerns
 Discharge- teach s/s infection & obstruction,
care of ostomy
 Fitted with appliance 7-10 days post-op &
may need to later be refitted
 Info where to buy supplies, emer phone #,
ostomy clubs, MD follow up
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Chronic Renal
Failure
Nur 302
Unit III
Chronic Renal Failure
Progressive, irreversible destruction
 Diminished renal reserve
 Renal insufficiency
 End-stage renal disease (ESRD)/uremia
 Common causes: diabetes, &
hypertension
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Clinical Manifestations
Renal insuff->polyuria
 Renal failure->oliguria then anuria
 Increased BUN & creatinine->n/v,
lethargy,fatigue, headache
 Altered CHO metabolism & elevated
triglycerides due to insulin resistance
 Metabolic acidosis, hyperkalemia, Ca,
phosphate Na & Mg alterations
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Clinical Manifestations
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Anemia, bleeding tendencies, infection
Increased incidence of cancer
Hypertension, CHF, arrhythmias
Uremic lung, dyspnea, pleural effusion
Stomatitis, uremic fetor
Neuro changes
Renal osteodystrophy, osteomalacia, osteitis
fibrosa, soft tissue calcification
Clinical Manifestations
Skin yellowish or pale, dry, scaly
 Pruritus esp when BUN very high
 Petechiae, ecchymosis, hair falls out
 Infertility & decreased libido
 Hypothyroidism
 Personality & behavior changes
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Drug Therapy
Hyperkalemia-> IV dextrose & insulin,
Kayexelate
 Hypertension-> Ca channel blockers &
ACE inhibitors, Na & fluid restriction
 Renal osteodystrophy->calcium
carbonate (Tums), vit D (calcitrol)
 Anemia-> erythropoietin
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Nursing Care
See Nursing Care Plan 47-1
 Health promotion – report changes in
urine appearance or volume, follow up
care to monitor renal function
 When conservative therapy ineffective,
explain choices clearly -peritoneal or
hemodialysis, transplant
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Dialysis: general principles
Diffusion
 Osmosis
 Ultra filtration
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Peritoneal Dialysis
Catheter placement in peritoneal cavity
 Dialysis soln with 1.5, 2.5, 4.25%
glucose & electrolytes
 Cycles – inflow, dwell, drain
 Complications– site infection, peritonitis,
Abd pain, outflow problems, hernias,
low back pain, bleeding pul. problems
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Hemodialysis
Access sites- internal arteriovenous
fistulas & grafts, temporary venous
access eg Quinton cath
 Complications- hypotension, muscle
cramps, blood loss, hepatitis, sepsis,
disequilibrium syndrome
 Adaptation to dialysis
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