Interventions for Clients with Renal Disorders

1. Interventions for Clients with Renal Disorders

2. Pyelonephritis • Bacterial infection in the kidney (upper urinary tract) • Key features include: • Fever, chills, tachycardia, and tachypnea • Flank, back, or loin pain • Abdominal discomfort • Turning, nausea and vomiting, urgency, frequency, nocturia • General malaise or fatigue

4. Key Features of Chronic Pyelonephritis • Hypertension • Inability to conserve sodium • Decreased concentrating ability • Tendency to develop hyperkalemia and acidosis

5. Acute Pain Interventions • Pain management interventions • Lithotripsy • Percutaneous ultrasonic pyelolithotomy • Diet therapy • Drug therapy • Antibiotics • Urinary antiseptics

6. Surgical Management • Preoperative care • Antibiotics • Client education • Operative procedure: pyelolithotomy, nephrectomy, ureteral diversion, ureter reimplantaton • Postoperative care for urologic surgery

7. Renal Abscess • A collection of fluid and cells caused by an inflammatory response to bacteria • Manifestations: fever, flank pain, general malaise • Drainage by surgical incision or needle aspiration • Broad-spectrum antibiotics

8. Renal Tuberculosis • Diagnosis • Antitubercular therapy with rifampin, isoniazid, and pyrazinamide • Complications renal failure, kidney stones, obstruction, and bacterial superinfection of the urinary tract • Surgical excision possible

9. Acute Glomerulonephritis • Assessment • Management of infection • Prevention of complications • Diuretics • Sodium, water, potassium, and protein restrictions • Dialysis, plasmapheresis • Client education

11. Chronic Glomerulonephritis • Develops over a period of 20 to 30 years or longer • Assessment • Interventions include: • Slowing the progression of the disease and preventing complications • Diet changes

12. Chronic Glomerulonephritis(Continued) • Fluid intake • Drug therapy • Dialysis, transplantation

14. Nephrotic Syndrome

15. Nephrosclerosis

16. Renovascular Disease

17. Diabetic Nephropathy

18. Cysts and Benign Tumors

19. Renal Cell Carcinoma • Paraneoplastic syndromes include anemia, erythrocytosis, hypercalcemia, liver dysfunction, hormonal effects, increased sedimentation rate, and hypertension. (Continued)

20. Renal Cell Carcinoma(Continued) • Nonsurgical management includes: • Radiofrequency ablation, although effect is not known • Chemotherapy: limited effect • Biological response modifiers and tumor necrosis factor: lengthen survival time

21. Renal Trauma • Minor injuries such as contusions, small lacerations • Major injuries such as lacerations to the cortex, medulla, or branches of the renal artery • Collaborative management • Nonsurgical management: drug therapy and fluid therapy • Surgical management: nephrectomy or partial nephrectomy

23. Polycystic Kidney Disease • Inherited disorder in which fluid-filled cysts develop in the nephrons • Key features include: • Abdominal or flank pain • Hypertension • Nocturia • Increased abdominal girth

24. Polycystic Kidney Disease(Continued) • Constipation • Bloody or cloudy urine • Kidney stones

25. Hydronephrosis, Hydroureter, and Urethral Stricture • Provide privacy for elimination. • Conduct Credé maneuver as necessary. • Apply double-voiding technique. • Apply urinary catheter as appropriate. • Monitor degree of bladder distention. (Continued

27. Hydronephrosis, Hydroureter, and Urethral Stricture(Continued) • Catheterize for residual. • Intermittently catheterize as appropriate. • Follow infection protection measures.

29. Nephrostomy • Client preparation • Procedure • Follow-up care including: • Assess for • amount of drainage. • type of urinary damage expected. • manifestations of infection. • Monitor nephrostomy site for leaking urine.

31. Interventions for Clients with Acute and Chronic Renal Failure

32. Acute Renal Failure

33. 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.

34. Continuous Renal Replacement Therapy • Standard treatment • Dialysate solution • Vascular access • Continuous arteriovenous hemofiltration • Continuous venovenous hemofiltration

35. Chronic Renal Failure

36. Stages of Chronic Renal Failure • Diminished renal reserve • Renal insufficiency • End-stage renal disease

37. Clinical Manifestations • Neurologic • Cardiovascular • Respiratory • Hematologic • Gastrointestinal • Urinary • Skin

38. Hemodialysis • Client selection • Dialysis settings • Works using passive transfer of toxins by diffusion • Anticoagulation needed, usually heparin treatment

39. 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

40. Complications • Peritonitis • Pain • Exit site and tunnel infections • Poor dialysate flow • Dialysate leakage • Other complications

41. 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.

42. Renal Transplantation • Candidate selection criteria • Donors • Preoperative care • Immunologic studies • Surgical team • Operative procedure