Management of Patients with Renal Disorders
Download
Report
Transcript Management of Patients with Renal Disorders
Management of
Patients with Renal
Disorders
Glomerular Diseases
Acute Glomerulonephritis
Chronic Glomerulonephritis
Nephrotic Syndrome
Glomerulonephritis
Acute Glomerulonephritis
Preceded (10 days) by an infection
Assess for:
Lesions
Signs of circulatory overload
Change in urine color and amount
Mild to moderate hypertension
Interventions:
Treat cause: antibiotics, corticosteroids, immunosuppressants
Restrict sodium, water, potassium, protein
Dialysis, plasmapheresis
Client education
Nursing ManagementAcute Glomerulonephritis
Patient assessment
Maintain fluid balance
Fluid and dietary restrictions
Patient education
Follow-up care
Chronic Glomerulonephritis
20-30+ years to develop
Diagnostics:
Causes:
Urine with fixed specific gravity, casts, and proteinuria
Electrolyte imbalances
hypoalbuminemia
Repeated episodes of acute glomerulonephritis,
hypertensive nephrosclerosis, hyperlipidemia,
Manifestations:
Mild proteinuria and hematuria, hypertension, and
occasional edema
Nursing Management:
Chronic Glomerulonephritis
Assessment
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Teaching self-care
Nephrotic Syndrome
Increased glomerular permeability
Severe loss of protein into urine
Treatment:
Immunosuppresive agents
ACE Inhibitors
Heparin
Diet changes
Mild diuretics
Nephrotic Syndrome
Nephrosclerosis
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
Renal Failure
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
Pathophysiology
Types of acute renal failure include:
Prerenal
Intrarenal
Postrenal
Phases of Acute Renal Failure
Phases of rapid decrease in renal function lead
to the collection of metabolic wastes in the
body.
Phases include:
Onset
Diuretic
Oliguric
Recovery
Acute syndrome may be reversible with prompt
intervention.
Assessment
History
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic assessments such as renal
biopsy
Drug Therapy
Cardioglycides
Vitamins and minerals
Biologic response modifiers
Phosphate binders
Stool softeners and laxatives
Monitor fluids
Diuretics
Calcium channel blockers
Treatment
Diet therapy
Dialysis therapies
Hemodialysis
Peritoneal dialysis
Renal Replacement Therapy
Standard treatment
Dialysate solution
Vascular access
Continuous arteriovenous hemofiltration
Continuous venovenous hemofiltration
Posthospital Care
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
Progressive, irreversible kidney injury; kidney
function does not recover
Azotemia
Uremia
Uremic syndrome
Stages of Chronic Renal Failure
Diminished renal reserve
Renal insufficiency
End-stage renal disease
Changes R/T CRF
•
•
Kidney
Metabolic
–
•
Electrolytes
–
–
•
•
Urea and creatinine
Sodium
Potassium
Acid-base balance
Calcium and phosphorus
(Continued)
Changes R/T CRF
(Continued)
•
Cardiac
–
–
–
–
•
•
Hypertension
Hyperlipidemia
Congestive heart failure
Uremic pericarditis
Hematologic
Gastrointestinal
Clinical Manifestations
Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin
Imbalanced Nutrition: Less Than
Body Requirements
Interventions include:
Dietary evaluation for:
Protein
Fluid
Potassium
Sodium
Phosphorus
Vitamin supplementation
Excess Fluid Volume
Interventions:
Monitor client’s intake and output.
Promote fluid balance.
Assess for manifestations of volume excess:
Crackles in the bases of the lungs
Edema
Distended neck veins
Drug therapy includes diuretics.
Decreased Cardiac Output
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.
Risk for Infection
Interventions include:
Meticulous skin care
Preventive skin care
Inspection of vascular access site for infection
Monitoring of vital signs for manifestations of
infection
Risk for Injury
Interventions include:
Drug therapy
Education to prevent fall or injury, pathologic
fractures, bleeding, and toxic effects of prescribed
drugs
Fatigue
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.
Anxiety
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
Potential for Pulmonary Edema
Interventions:
Assess the client for early signs of pulmonary
edema.
Monitor serum electrolyte levels, vital signs, oxygen
saturation levels, hypertension.
Hemodialysis
Client selection
Dialysis settings
Works using passive
transfer of toxins by
diffusion
Anticoagulation needed,
usually heparin treatment
Vascular Access
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
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.
Complications of Hemodialysis
Dialysis disequilibrium syndrome
Infectious diseases
Hepatitis B and C infections
HIV exposure—poses some risk for clients
undergoing dialysis
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
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.
Nursing Management of
Hospitalized Client on Dialysis
Protect vascular access
Monitor fluid balance
indicators
Monitor IV carefully
Assess for s/s uremia
Monitor
cardiopulmonary status
carefully
Monitor BP
Monitor medications
Address pain and
discomfort
Infection control
measures
Monitor dietary e-lytes
and fluids
Skin care
CAPD catheter care if
appropriate
Renal Transplantation
Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure
Postoperative Care
Assessment
all body systems
Pain
Fluid and electrolyte
status
Urologic management
Assessment of system
patency
Assessment of urine
output hourly for 48
hours.
Complications
Rejection
Acute tubular necrosis
Thrombosis
Renal artery stenosis
Other complications
Immunosuppressive drug
therapy
Psychosocial preparation
Post-transplantation Intervetions
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
Healthy kidney tissue damaged and replaced by
cancer cells
Paraneoplastic syndrome:
Anemia
Erythrocytosis
Hypercalcemia
Liver dysfuntion
Hormonal effects
Increased sedimentation rate
Hypertension
Renal Cell Carcinoma Management
Nonsurgical
Radiofrequency ablation
Chemotherapy
Biological response
modifiers and tumor
necrosis factor lengthen
survival time
Renal artery embolization
Surgical
Pre-op care
Nephrectomy
Post-op care:
Monitoring for
hemorrhage and
adrenal insufficiency
Pain management
Prevention of
complications
Renal Trauma
Minor injuries:
Major injuries:
Lacerations to cortex, medulla, or branches or renal
artery
Nonsurgical management:
Contusions, small lacerations
Drug and fluid therapy
Surgical management:
Nephrectomy or partial nephrectomy