Date post: | 17-Jan-2016 |
Category: |
Documents |
Upload: | morris-cannon |
View: | 219 times |
Download: | 0 times |
RenalRenal
NURS 2016NURS 2016
Chapters: 44, 45Chapters: 44, 45
UrolithiasisUrolithiasis
Nephrolithiasis vs urolithiasisNephrolithiasis vs urolithiasisFactors favouring stone formation:Factors favouring stone formation: Infections Infections Urinary stasisUrinary stasis Periods of immobilityPeriods of immobility Altered calcium metabolismAltered calcium metabolismCauses:Causes: Conditions that promote increased Conditions that promote increased
Calcium in blood & urineCalcium in blood & urine
Clinical ManifestationsClinical Manifestations
ObstructionObstruction
InfectionInfection
EdemaEdema
Nursing AssessmentNursing Assessment
Pain: severity & locationPain: severity & location
Signs of UTISigns of UTI
Signs of obstructionSigns of obstruction
Stones in urineStones in urine
InterventionsInterventions
PainPain Opiates & NSAIDOpiates & NSAID Hot baths, moist heatHot baths, moist heat Fluid intake encouragedFluid intake encouraged
NutritionNutrition Fluids to ensure > 2L urine/dayFluids to ensure > 2L urine/day Protein < 60 mg/dayProtein < 60 mg/day
Nursing DiagnosesNursing Diagnoses Acute pain, Acute pain, as evidencedas evidenced by complaints, facial by complaints, facial
grimicing and restlessness, grimicing and restlessness, related torelated to irritation of irritation of stone and inadequate pain control or comfort measuresstone and inadequate pain control or comfort measures
Anxiety, Anxiety, as evidenced byas evidenced by expressions of concern about expressions of concern about future treatments, future treatments, related torelated to uncertain outcome and uncertain outcome and lack of knowledge regarding possible surgery.lack of knowledge regarding possible surgery.
Ineffective therapeutic regime management, Ineffective therapeutic regime management, as as evidenced byevidenced by questions that indicate inadequate questions that indicate inadequate knowledge of disorder, knowledge of disorder, related torelated to lack of knowledge lack of knowledge about prevention of recurrence, diet, fluid about prevention of recurrence, diet, fluid requirements, and symptoms of recurrence.requirements, and symptoms of recurrence.
Impaired urinary elimination, Impaired urinary elimination, as evidenced byas evidenced by decrease decrease in urinary output and blood urine, in urinary output and blood urine, related torelated to … …
Risk of infection, related to …Risk of infection, related to …
EducationEducation
High fluid intake (drink in evening & High fluid intake (drink in evening & night)night)
Discourage excessive intake of vitamins Discourage excessive intake of vitamins & minerals& minerals
Urine culture every 1-2 monthsUrine culture every 1-2 months Avoid excessive sweating & dehydrationAvoid excessive sweating & dehydration Avoid sudden increase in environments Avoid sudden increase in environments
temperature signs & symptoms of stone temperature signs & symptoms of stone formation, obstruction, S&S infectionformation, obstruction, S&S infection
Infections of the Urinary Infections of the Urinary TractTract
Lower UTILower UTI Cystitis: inflammation of the urinary Cystitis: inflammation of the urinary
bladderbladder Prostatitis: inflammation of the prostateProstatitis: inflammation of the prostate Urethritis: inflammation of the urethraUrethritis: inflammation of the urethra
Upper UTIUpper UTI Acute & chronic pyelonephitis: Acute & chronic pyelonephitis:
inflammation of the renal pelvisinflammation of the renal pelvis Interstitial Nephritis: inflammation of the Interstitial Nephritis: inflammation of the
kidneyskidneys
Urinary Tract InfectionUrinary Tract Infection
LowerLower UpperUpperPain, burningPain, burning FeverFeverFrequencyFrequency ChillsChillsUrgencyUrgency Flank or lower back Flank or lower back
painpainNocturiaNocturia Nausea & vomitingNausea & vomitingIncontinenceIncontinence Headache & malaiseHeadache & malaiseDysuriaDysuria Supra pubic, back or Supra pubic, back or Hematuria Hematuria pelvic painpelvic pain
Treatment & PreventionTreatment & Prevention
PharmacologyPharmacology Septra, Bactrim, Azithromycin Septra, Bactrim, Azithromycin
(Zithromax)(Zithromax) NitrofurantoinNitrofurantoin
HygieneHygiene Voiding habitsVoiding habits
Fluid intakeFluid intake
Neurogenic BladderNeurogenic Bladder
Spastic (reflex)Spastic (reflex) Upper motor neuron lesionUpper motor neuron lesion Loss of conscious sensation & Loss of conscious sensation &
cerebral motor controlcerebral motor control
FlaccidFlaccid Lower motor neuron lesionLower motor neuron lesion Bladder fills, distends, overflowsBladder fills, distends, overflows
Management GoalsManagement Goals
Prevent over distention of bladderPrevent over distention of bladder Empty bladder regularly & Empty bladder regularly &
completelycompletely Maintain sterility of urinary systemMaintain sterility of urinary system Maintain adequate bladder capacity Maintain adequate bladder capacity
without refluxwithout reflux UrecholineUrecholine
CatheterizationCatheterization
ContinuousContinuous
IntermittentIntermittent
SuprapubicSuprapubic
Nephrostomy TubeNephrostomy Tube
Temporary or permanent urinary Temporary or permanent urinary diversiondiversion
Inserted through skin & into renal Inserted through skin & into renal pelvispelvis
Prophylactic antibioticProphylactic antibiotic
Care of Nephrostomy Care of Nephrostomy TubeTube
Assess possible complicationsAssess possible complications Ensure unobstructed drainageEnsure unobstructed drainage Notify surgeon immediately if tube Notify surgeon immediately if tube
dislodgesdislodges Never clampNever clamp Never irrigateNever irrigate Encourage fluid intakeEncourage fluid intake Measure & record I & O accuratelyMeasure & record I & O accurately
Renal FailureRenal Failure
Systemic diseaseSystemic disease
Kidneys unable to remove body’s Kidneys unable to remove body’s metabolic wastesmetabolic wastes
Progressive & irreversibleProgressive & irreversible
Clinical ManifestationsClinical Manifestations
CardiovascularCardiovascular IntegumentaryIntegumentary PulmonaryPulmonary GastrointestinalGastrointestinal Neurological MusculosketalNeurological Musculosketal ReproductiveReproductive HematologicHematologic
StagesStages
Reduced renal reserveReduced renal reserve 40-70% loss of nephron function40-70% loss of nephron function asymptomaticasymptomatic
Renal insufficiencyRenal insufficiency 75-90% loss of nephron function75-90% loss of nephron function Increased creatinine & BUN – polyuri, Increased creatinine & BUN – polyuri,
nocturianocturia End stage renal diseaseEnd stage renal disease
Less than 10% nephron functionLess than 10% nephron function UremiaUremia
ManagementManagement
PharmacologicalPharmacological
DialysisDialysis
DietDiet
DialysisDialysis Dialysis cleans the blood, either by passing Dialysis cleans the blood, either by passing
it through an artificial kidney machine or by it through an artificial kidney machine or by filtering it within the abdomen. Wastes & filtering it within the abdomen. Wastes & excess water are removed during treatmentexcess water are removed during treatment
HemodialysisHemodialysismost commonmost commonblood is pumped through a dialyzer blood is pumped through a dialyzer
Peritoneal dialysisPeritoneal dialysisthe peritoneal cavity is filled with dialysatethe peritoneal cavity is filled with dialysate
Clinical CaseClinical Case 48 year old husband, 48 year old husband,
fatherfather Acute kidney failure – Acute kidney failure –
progressed to chronicprogressed to chronic Hemodialysis started 1 Hemodialysis started 1
wk ago (3x/wk)wk ago (3x/wk) c/o weakness, dry skin, c/o weakness, dry skin,
nauseanausea Dependent edema, Dependent edema,
tenacious sputum, tenacious sputum, serum K+highserum K+high
Quiet, moodyQuiet, moody
Planning Care: Mind Planning Care: Mind MappingMapping
Octogon: Octogon: assessment dataassessment data
Oval: nursing Oval: nursing diagnosisdiagnosis
Triangle: expected Triangle: expected outcomeoutcome
Rectangle: nursing Rectangle: nursing interventionintervention