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Disorders of the Urinary System – Part 2

Disorders of the Urinary System – Part 2. Patty Maloney MSN/ Ed,RN Chapter 35. Renal System Trauma. Most common injury to the urinary system Injury may occur to kidneys, ureters & bladder Causes: motor vehicle accident, falls, stabbings, sports injuries, gunshot wounds

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Disorders of the Urinary System – Part 2

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  1. Disorders of the Urinary System – Part 2 Patty Maloney MSN/Ed,RN Chapter 35

  2. Renal System Trauma Most common injury to the urinary system Injury may occur to kidneys, ureters & bladder Causes: motor vehicle accident, falls, stabbings, sports injuries, gunshot wounds Kidneys are vascular, vulnerable to injury Young males at greatest risk

  3. Patient Assessment History of the injury Inspection of the abdomen and flank area (look for bruising, swelling, tenderness, bleeding) Diagnostic Tests – UA, IVP, US, CT, & MRI **Treatment – depends on extent of the injury (contusion, hematoma, laceration)

  4. Kidney Contusion

  5. Nursing Intervention Monitor vital signs Measure Intake and Output IV fluids Pain management

  6. Polycystic Kidney Disease Hereditary Disorder (strong family history) Affects men and women equally Formation of multiple cysts on the kidneys that eventually replace normal kidney structures Cysts are grapelike and contain serous fluid, blood or urine

  7. Polycystic Kidney Disease

  8. Polycystic Disease

  9. Polycystic Disease Initial symptoms – dull heaviness in the flank or lumbar region, hematuria Usually starts during adulthood Hypertension and urinary tract infections may occur later Patients with inherited type of the disease may experience aneurysms in the brain and diverticulosis in the colon

  10. Polycystic Disease Diagnosis – ultrasound imaging Treatment – no treatment to stop the progression Treatment – symptomatic ex. UTI-treat the symptoms of the UTI Hypertension - meds. and diet to decrease blood pressure

  11. Glomerulonephritis Inflammatory disease of the glomerulus Glomeruli can be injured in response to an auto-immune reaction to a pathogen, toxin or from systemic disease The resulting immune reaction in the glomerulus causes inflammation (from deposits of antigen-ab complexes) Inflammation causes the glomerulus to be porous, allowing proteins, WBC’s, & RBC’s to leak into the urine

  12. Acute Poststreptococcal GN Most commonly associated w/ group A beta-hemolytic streptococcal infection – following a strep infection of the throat or skin Most common in children and young adults Antibodies form complexes with the streptococcal antigen (Antigen-Ab complex), glomeruli become damaged and are unable to filter blood correctly, protein leaks into the urine

  13. Acute PoststreptococcalGlomerulonephritis Signs/Symptoms: Edema, oliguria, proteinuria & hypertension Develops 6 to 10 days after the preceding infection Onset is abrupt

  14. Glomerulonephritis Goodpasture’s Syndrome Glomerulonephritis that is caused by an auto-immune response For an unknown reason, antibodies form against the patients own glomerular membrane Progresses rapidly and often leads to renal failure

  15. Chronic Glomerulonephritis Occurs over years as a result of glomerular inflammatory disease Proteinuria and hematuria may have previously been diagnosed Lupus erythematosus and insulin-dependent diabetes mellitus may precede chronic glomerular injury

  16. Glomerulonephritis Signs/Symptoms: Fluid volume overload Hypertension Electrolyte imbalances (Na,K,Cl,CO2) Edema Periorbital edema Flank pain

  17. Glomerulonephritis Diagnostic Tests: Diagnosed with urinalysis, which shows protein, casts, RBC’s Urine is dark or cola colored, foamy urine from protein Creatinine, BUN elevated Renal Ultrasound Possible renal biopsy

  18. Periorbital Edema

  19. Cola Colored Urine

  20. Glomerulonephritis Treatment: Symptomatic Sodium and fluid restrictions Diuretics Antihypertensives Antibiotics, if associated with strep infection Dialysis, if fluid overload is severe May need to limit protein intake

  21. Glomerulonephritis • Acute GN: • In children, usually resolves spontaneously within 1 week, potentially can cause renal failure • In adults, more likely to progress to renal failure

  22. Importance of emptying your bladder!

  23. Renal Failure • Diagnosed when the kidneys are no longer functioning adequately to maintain normal body processes • BP control • Fluid & electrolyte balance • Production of RBC’s • Elimination of waste products • Results in dysfunction in almost all other parts of the body • Causes imbalances in fluids, electrolytes, and calcium levels, impaired RBC formation and decreased elimination of waste products • Can be either acute or chronic

  24. Acute Renal Failure (ARF)-sudden loss of the kidney’s ability to clear waste products and regulate fluid and electrolyte balance • Can occur in hours or days • Rapid damage to the kidneys causes waste products to accumulate in the blood stream • Elevated BUN and creatinine = AZOTEMIA

  25. Acute Renal Failure Causes: Hypotension Vascular obstruction Glomerular disease Acute tubular necrosis (from prolonged hypotension, from reaction to contrast media) ARF may be reversible with prompt diagnosis and treatment

  26. Signs/Symptoms Azotemia-rapid accumulation of toxic wastes from protein metabolism in the blood *elevated BUN and creatinine Oliguria-urine output decreased to less than 30mL/hr (less than 400 ml/24 hr)

  27. Acute Renal Failure Treatment : Directed toward correcting the cause Prevention of complications Possibility of requiring hemodialysis Approximately 50% of ARF patients die as a result of complications of infection, pneumonia, or septicemia

  28. Acute Renal Failure – 3 stages • OLIGURIC Produce less than 400 ml/24 hours Lasts 24 hr. – 7 days Fluid retained Electrolytes imbalanced Metabolic acidosis may develop

  29. Acute Renal Failure – 3 stages • DIURETIC Produce 1000-3000 ml urine per day Osmotic diuresis occurs due to increased urea levels in blood Kidneys cannot concentrate urine, dehydration becomes a concern Increasing BUN and creatinine Lasts 1-3 weeks

  30. Acute Renal Failure – 3 stages • RECOVERY GFR improves over a 2 week period Bun and creatinine decreased Recovery can take up to 1 year Without normal recovery, CRF occurs

  31. Classification of Renal Failure • 1. PRERENAL • Before the kidney • 55-60% of cases • Decreased blood supply to kidneys • Dehydration, hypotension, trauma, blockage in renal artery • Treatment: IV hydration, arteriogram w/ angioplasty, treat the cause (ie, low BP)

  32. Classification of Renal Failure • INTRARENAL Inside kidney damage to neprons Causes: nephrotoxins, infection, severe muscle injury (rhabdomyolysis), contrast media Treat the cause May need short term hemodialysis

  33. Classification of Renal Failure • 3. POSTRENAL • After the kidney • Associated with obstruction – blocks flow of urine out of kidneys – “back up” • 5% of ARF cases • Causes: stones, tumors, prostate, strictures • Diagnostics: US, cystoscopy • May require surgical intervention to correct problem

  34. Chronic Renal Failure (CRF) or (CKD) -affects approximately 26 million people in the United States Progressive, irreversible deterioration in renal function where the body is unable to maintain metabolic fluid and electrolyte balance Gradual decrease in kidney function over time Affects ALL body systems

  35. Chronic Renal Failure Causes: Diabetes mellitus resulting in diabetic nephropathy (#1 cause in US)) Chronic high blood pressure causing nephrosclerosis (#2 cause) Glomerulonephritis **DM & HTN account for 70% Autoimmune diseases of cases

  36. Chronic Renal Failure Pathophysiology: Nephrons are damaged or destroyed due to acute or chronic kidney disease and kidney failure occurs Progressive disease-silent in early stages Renal insufficiency occurs when 75% of nephron function is lost

  37. Chronic Renal Failure • End-stage renal disease (ESRD) occurs when 90% of the nephrons are lost • GFR less than 10% • Patients may make urine but not filter out waste or urine production may cease • Dialysis or kidney transplant is required to survive

  38. Chronic Renal Failure - Stages

  39. Chronic Renal Failure Signs/Symptoms: Hypertension Polyuria-large amounts of dilute urine Oliguria-small amounts of urine Anuria- no urine Hypernatremia-excessive sodium level Hyponatremia-low sodium level Hyperkalemia-can cause dysrhythmia and cardiac arrest Hyperphosphatemia – high phosphate level

  40. Chronic Renal Failure Renal failure can affect every system of the body Patients may c/o muscle weakness, abdominal cramping, and diarrhea Patient may be confused, lethargic, mental status changes

  41. Chronic Renal Failure Signs/Symptoms: Edema of the extremities, sacral area, and abdomen Shortness of breath, rales (crackles) due to fluid in the lungs Distended blood vessels in the neck (JVD)

  42. Chronic Renal Failure Symptoms Oral Cavity-stomatitis, bad taste in mouth (metallic) Cardiovascular-heart failure, hypertension, dysrhythmia GI-anorexia, appetite loss, N/V, GI bleeding, ulcers Neurological-fatigue, depression, headache, confusion, seizures, coma Respiratory-dyspnea, pulmonary edema, Renal system-anemia, oliguria, anuria

  43. Chronic Renal Failure Symptoms Reproductive-infertility, sexual dysfunction Musculoskeletal-prone to fractures Skin-pruritis, dry skin, uremic frost, yellowish skin, ecchymosis Fluid Volume-edema Asterixus – late symptom (hand flapping)

  44. Chronic Renal Failure Nursing Implications: Monitor serum potassium levels daily – normal level = 3.5-5.2 Potassium level above 7mEq/L may be life threatening Instruct patient to avoid food that are high in potassium such as: tomatoes, citrus fruits and juices, bananas, salt substitutes, sweet & white potatoes, chocolate, excessive dairy & meat

  45. Chronic Renal Failure Nursing Implications: Patients are prone to fractures due to low calcium and high phosphorus levels Encourage patient to ambulate to prevent further calcium loss from bone Avoid high phosphorus foods – colas, dairy, chocolate

  46. Chronic Renal Failure Treatment: • High calorie diet to maintain weight and energy needs • Diet will be individualized based on patient’s needs • May include potassium restriction, phosphorus restriction, protein restriction, increased calories, fluid restriction • Protein is usually restricted when patient’s kidneys are failing but increased when patient is treated with dialysis

  47. Chronic Renal Failure Treatment: Sodium may be restricted, depending on blood pressure, edema, or lab findings Potassium may be restricted for patients with oliguria Fluid restriction may be altered daily according to output (1000 ml per 24 hours)

  48. Chronic Renal Failure Medications: • Early-diuretics given to increase output (are ineffective in later stages of CRF) • ACE inhibitors, calcium channel blockers, or beta-blockers to control hypertension • Phosphate binders are given with meals to reduce phosphate levels (Tums, CaCO3,PhosLo,Renagel) • Calcium & vitamin D to raise calcium levels • Vit D – rx = Drisdol

  49. Chronic Renal Failure Medications: • Agents to lower potassium may be administered as necessary • Loop Diuretics: Lasix (furosemide), Demadex (torsemide) • Kayexalate: oral or via retention enema • Diabetic patient’s may require less insulin since insulin is no longer being broken down by the kidney

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