Transcript Unit_82

Renal Conditions
Unit 8
Part 2
Gordons Functional Health Pattern
Elimination Pattern
Do Case Studies from Critical Thinking Book Before Class!
1st CS on pg:327 Acute Renal Failure
2nd CS on pg:307 ESRD
3rd CS on pg:331 UTI
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Objectives
1. Discuss the anatomy and physiology of the renal system
2. Describe the effects of the aging on the G. U. system
3. Discuss the purpose, client preparation and nursing responsibilities of diagnostic procedures related to the renal system
4. Compare and contrast pyelonephritis, acute and chronic renal failure, their pathophysiology, clinical manifestations and
management
5. Compare and contrast the clinical course of renal failure including pre-renal, inter-renal and post-renal
6. Describe the pathophysiological process of acute renal failure
7. Define acute tubular necrosis
8. Discuss the medical and nursing management of acute renal failure
9. Describe the effects of renal failure on other body systems
10.Compare and contrast chronic renal failure with acute renal failure
11. Describe the management chronic renal failure and how it affects the various body systems due to alteration of tissue
perfusion
12. Define dialysis, describe the rational for dialysis and the methods of dialysis
13. Discuss the management of access ports used in dialysis
14. Describe expected outcomes of renal failure clients
15. Discuss medical and nursing management of the pre and post transplant client
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Required Reading
• Smeltzer & Bare: Chap 43, 44, 45
• Preusser: Case Studies indicated above
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Urinary Tract Infections (UTIs)
• The second most common reason for seeking health
care
• A common site of nosocomial infection
• Lower UTIs
– Cystitis
– Prostatitis
– Urethritis
• Upper UTIs
– Pyelonephritis: acute and chronic
– Interstitial nephritis
– Renal abscess and perirenal abscess
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Factors Contributing to UTI
• Function of glycosaminoglycan (GAG)
• Urethrovesical reflux
• Ureterovesical reflux
• Uropathogenic bacteria
• Shorter urethra in women
• Risk factors: see Charts 45-2 and 45-3
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Urethrovesical Reflux and
Ureterovesical Reflux
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Question
Tell whether the following statement is true or false.
The most common way in which bacteria enter the urethra
is through the bloodstream.
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Bladder Infection With
Long-Term Catherization
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Nursing Process—Assessment of the
Patient With a UTI
• Symptoms include pain and burning upon urination;
frequency; nocturia; incontinence; suprapubic, pelvic, or
back pain; hematuria; or change in urine or urinary
pattern
• About half of patients are asymptomatic
• Assess voiding patterns, association of symptoms with
sexual intercourse, contraceptive practices, and personal
hygiene
• Gerontologic considerations
• Assess urine, urinalysis, and urine cultures
• Other diagnostic tests
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Nursing Process—Diagnosis of the
Patient With a UTI
• Acute pain
• Deficient knowledge
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Collaborative Problems/Potential
Complications
• Sepsis
• Renal failure
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Nursing Process—Planning the Care of the
Patient With a UTI
• Major goals include relief of pain and discomfort,
increased knowledge of preventive measures
and treatment modalities, and absence of
complications
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Interventions
• Prevention: avoid indwelling catheters; exercise proper
care of catheters
• Exercise correct personal hygiene
• Take medications as prescribed: antibiotics, analgesics,
and antispasmodics
• Apply heat to the perineum to relieve pan and spasm
• Increase fluid intake
• Avoid urinary tract irritants such as coffee, tea, citrus,
spices, cola, and alcohol
• Frequent voiding
• Patient education: see Chart 45-4
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Question
Which medication classification is the ideal treatment for
urinary tract infection?
a. Antifungal
b. Antibacterial
c. Antihistamine
d. Antiviral
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Urinary Incontinence
• An underdiagnosed and underreported problem
that can significantly impact the quality of life
and decrease independence and may lead to
compromise of the upper urinary system
• Urinary incontinence is not a normal
consequence of aging
• Risk factors: see Chart 45-5
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Types of Urinary Incontinence
• Stress
• Urge
• Reflex
• Overflow
• Functional
• Iatrogenic
• Mixed incontinence
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Question
Which type of incontinence includes the involuntary loss of
urine associated with overdistention of the bladder?
a. Urge
b. Overflow
c. Stress
d. Functional
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Patient Teaching
• Urinary incontinence is not inevitable and is
treatable
• Management takes time (provide encouragement
and support)
• Develop and use a voiding log or diary
• Behavioral interventions: see Chart 45-7
• Medication teaching related to pharmacologic
therapy
• Strategies for promoting continence: see Chart 45-8
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Urinary Retention
• Inability of the bladder to empty completely
• Residual urine: amount of urine left in the bladder after
voiding
• Causes include age (50 to 100 mL in adults older than
age 60 due to decreased detrusor muscle activity),
diabetes, prostate enlargement, pregnancy, neurologic
disorders, and medications
• Assessment
• Nursing measures to promote voiding
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Urolithiasis and Nephrolithiasis
• Calculi (stones) in the urinary tract or kidney
• Pathophysiology
• Causes: may be unknown
• Manifestations
– Depend upon location and presence of obstruction
or infection
– Pain and hematuria
• Diagnosis: x-ray, blood chemistries, and stone analysis;
strain all urine and save stones
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Potential Sites of Urinary Calculi
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Methods of Treating Renal Stones
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Methods of Treating Renal Stones (cont.)
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Methods of Treating Renal Stones (cont.)
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Patient Teaching
• Signs and symptoms to report
• Follow-up care
• Urine pH monitoring
• Measures to prevent recurrent stones
• Importance of fluid intake
• Dietary teaching
• Medication teaching as needed
• See Chart 45-11
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Urinary Diversion
• Reasons: bladder cancer or other pelvic
malignancies, birth defects, trauma, strictures,
neurogenic bladder, chronic infection or intractable
cystitis; used as a last resort for incontinence
• Types:
– Cutaneous urinary diversion: ileal conduit,
cutaneous ureterostomy, vesicostomy, and
nephrostomy
– Continent urinary diversion: Indiana pouch,
Kock pouch, and ureterosigmoidostomy
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Cutaneous Urinary Diversions
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Continent Urinary Diversions
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Nursing Diagnoses—Preoperative
• Anxiety
• Imbalanced nutrition
• Deficient knowledge
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Nursing Diagnoses—Postoperative
• Risk for impaired skin integrity
• Acute pain
• Disturbed body image
• Potential for sexual dysfunction
• Deficient knowledge
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