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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

Renal & Urologic Problems

Nephrectomy

NUR 302

post op care nephrectomy
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
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
urinary diversion4
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
urinary diversion5
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
chronic renal failure

Chronic Renal Failure

Nur 302

Unit III

chronic renal failure7
Chronic Renal Failure
  • Progressive, irreversible destruction
  • Diminished renal reserve
  • Renal insufficiency
  • End-stage renal disease (ESRD)/uremia
  • Common causes: diabetes, & hypertension
clinical manifestations
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
clinical manifestations9
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
clinical manifestations10
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
drug therapy
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
nursing care
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
dialysis general principles
Dialysis: general principles
  • Diffusion
  • Osmosis
  • Ultra filtration
peritoneal dialysis
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
hemodialysis
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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