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

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

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

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

6. Potential for Renal Failure • Interventions include: • Use of specific antibiotics • Compliance with therapies and regular follow-up • Blood pressure control • Fluid therapy • Diet therapy • Other interventions

7. Potential for Renal Failure • Interventions include: • Use of specific antibiotics • Compliance with therapies and regular follow-up • Blood pressure control • Fluid therapy • Diet therapy • Other interventions

8. 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

9. 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

10. 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 (Continued)

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

13. Nephrotic Syndrome • Condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and be removed from the blood • Severe loss of protein into the urine (Continued)

14. Nephrotic Syndrome(Continued • Treatment involves: • Immunosuppressive agents • Angiotensin-converting enzyme inhibitors • Heparin • Diet changes • Mild diuretics

15. Nephrosclerosis • Thickening in the nephron blood vessels, resulting in narrowing of the vessel lumen • Occurs with all types of hypertension, atherosclerois, and diabetes mellitus • Collaborative management: control high blood pressure and preserve renal function

16. Renovascular Disease • Profoundly reduces blood flow to the kidney tissue • Causes ischemia and atrophy of renal tissue • Diagnosis • Interventions: drugs to control high blood pressure and procedures to restore the renal blood supply

17. Diabetic Nephropathy • Diabetic nephrophathy is a microvascular complication of either type 1 or type 2 diabetes. • First manifestation is persistent albuminuria. • Avoid nephrotoxic agents and dehydration. • Assess need for insulin.

18. Cysts and Benign Tumors • Thorough evaluation for cancer is needed. • Cyst can fill with fluid and cause local tissue damage as it enlarges. • Many cysts cause no symptoms. • Cysts are a structural birth defect that occur in fetal life. • Simple renal cysts are drained by percutaneous aspiration.

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. Surgical Management • Preoperative care • Operative procedure • Postoperative care: monitoring, pain management, and prevention of complications

22. 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. Interventions • Pain management • Bowel management • Medication management • Energy management • Fluid monitoring • Urinary retention care • Infection protection

26. Interventions/Complications • Acute and chronic pain • Constipation • Hypertension and renal failure • Nursing interventions to promote self-management and understanding • Fluid therapy • Drug therapy • Measure and record blood pressure • Diet therapy

27. 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

28. 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.

30. Interventions for Clients with Acute and Chronic Renal Failure

31. Acute Renal Failure • Pathophysiology • Types of acute renal failure include: • Prerenal • Intrarenal • Postrenal

32. 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.

33. Assessment • History • Clinical manifestations • Laboratory assessment • Radiographic assessment • Other diagnostic assessments such as renal biopsy

34. Drug Therapy • Cardioglycides • Vitamins and minerals • Biologic response modifiers • Phosphate binders • Stool softeners and laxatives • Monitor fluids • Diuretics • Calcium channel blockers

35. Treatment • Diet therapy • Dialysis therapies • Hemodialysis • Peritoneal dialysis

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

37. Posthospital Care • If renal failure is resolving, follow-up care may be required. • There may be permanent renal damage and the need for chronic dialysis or even transplantation. • Temporary dialysis is appropriate for some clients.

38. Chronic Renal Failure • Progressive, irreversible kidney injury; kidney function does not recover • Azotemia • Uremia • Uremic syndrome

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

40. Stages of Chronic Renal FailureChanges • Kidney • Metabolic • Urea and creatinine • Electrolytes • Sodium • Potassium • Acid-base balance • Calcium and phosphorus

41. Stages of Chronic Renal FailureChanges (Continued) • Cardiac • Hypertension • Hyperlipidemia • Congestive heart failure • Uremic pericarditis • Hematologic • Gastrointestinal

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

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

44. Hemodialysis Nursing Care • Postdialysis care: • Monitor for complications such as hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps. • Monitor vital signs and weight. • Avoid invasive procedures 4 to 6 hours after dialysis. • Continually monitor for hemorrhage

45. Complications of Hemodialysis • Dialysis disequilibrium syndrome • Infectious diseases • Hepatitis B and C infections • HIV exposure—poses some risk for clients undergoing dialysis

46. 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

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

48. 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.

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

50. Postoperative Care • Urologic management • Assessment of urine output hourly for 48 hours. • Complications include: • Rejection • Acute tubular necrosis