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Renal & Urologic Problems

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 . Urinary Diversion. Incontinent urinary diversion

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Renal & Urologic Problems

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  1. Renal & Urologic Problems Nephrectomy NUR 302

  2. 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

  3. 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

  4. 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

  5. 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

  6. Chronic Renal Failure Nur 302 Unit III

  7. Chronic Renal Failure • Progressive, irreversible destruction • Diminished renal reserve • Renal insufficiency • End-stage renal disease (ESRD)/uremia • Common causes: diabetes, & hypertension

  8. 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

  9. Clinical Manifestations • 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

  10. 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

  11. 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

  12. 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

  13. Dialysis: general principles • Diffusion • Osmosis • Ultra filtration

  14. 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

  15. 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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