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Urology and nephrology
 

Urology and nephrology

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  • Prerenal ARF – results from insufficient blood supply to the kidneys. 20 – 25% cardiac output goes to kidneys. Result in metabolic acidosis, hyperkalemia, and progress to renal ARF Renal ARF – Microangiopathy - Acute tubular necrosis Interstitial nephritis Postrenal ARF – obstruction stops removal of urine
  • Assessment – when was they last urination? Is there edema of face,hands,feet or torso? Results from fluid and Na retention. Any palpatations or irregular heart rate ? results from excess potassium. Elevated t wave indicates hyperkalemia. Is there a decrease in LOC? Result of metabolic acidosis. BUN/creatinine ratio
  • Management – because of metabolic disterbances, pay particular attention to ABCs, watch fluid input
  • hemodialysis – blood is passed through a machine that has an artificial mmbrane and dyalysate – osmosis. Complications include bleeding and thrombosis peritoneal dialysis – relys on peritoneal membrane as the semipermeable membrane. Complications include infection of catheter and peritonitis which occurs about once a year other complications include hypotension sob cp seizure

Urology and nephrology Urology and nephrology Presentation Transcript

  • Urology &Nephrology
  • Sections Anatomy and Physiology General Mechanisms of Nontraumatic Tissue Problems General Pathophysiology, Assessment, and Management Renal and Urologic Emergencies
  • Anatomy & Physiology The Urinary System  Female  Male Urology & Nephrology The Kidneys
  • Anatomy & Physiology The Kidneys  Hilum  Medulla  Pyramids  Papilla  Renal Pelvis
  • Anatomy & Physiology Nephrons  Glomerulus  Bowman’s capsule  Proximal Tubule  Loop of Henle  Distal Tubule  Collecting Duct
  • Anatomy & Physiology Functions of the Kidneys  Forming and Eliminating Urine  Maintaining blood volume with proper balance of water, electrolytes, and pH.  Retaining key compounds such as glucose, while excreting wastes such as urea.  Controlling Arterial Blood Pressure  Regulating Erythrocyte Development
  • Anatomy & Physiology Formation of Urine  Glomerular Filtration  GFR  Reabsorption & Secretion  Simple diffusion and osmosis  Facilitated diffusion • Active transport
  • Anatomy & Physiology Tubular Handling of Water and Electrolytes  Diuresis and Antidiuresis Tubular Handling of Glucose and Urea  BUN and Creatinine Control of Arterial Blood Pressure  The Renin-Angiotensin System Control of Erythrocyte Production  Erythropoietin
  • Anatomy & Physiology Ureters Urinary Bladder Urethra Testes Epididymus and Vas Deferens Prostate Gland Penis
  • General Mechanisms ofNontraumatic Tissue Problems Inflammatory or Immune-Mediated Disease Infectious Disease Physical Obstruction Hemorrhage
  • General Pathophysiology,Assessment and Management Differentiating GI and Urologic Complaints Pathophysiologic Basis of Pain  Causes of Pain  Types of Pain  Visceral pain  Referred pain
  • Assessment and Management Scene Size-up Initial Assessment Focused History  OPQRST History  Prior History of Similar Event  History of Nausea, Vomiting, and Weight Loss  Change in Bowel Habits and Stool  Last Oral Intake  Presence of Chest Pain
  • Assessment and Management Physical Exam  Appearance  Uncomfortable appearance.  Posture  Lying with knees drawn up.  Relief with walking.  Level of Consciousness  Determine if changes are acute or chronic.
  • Assessment and Management Apparent State of Health Skin Color Examination of the Abdomen  Inspection for distention, ecchymosis, or scarring  Pain associated with percussion of abdomen  Palpation • Normal or ectopic pregnancy • Masses Assessment Tools Vital Signs
  • Assessment and Management Management  Airway, Breathing Circulation  Pharmacologic Interventions  IV access and analgesics.  Nonpharmacological Interventions  Nothing by mouth (NPO).  Maintain position of comfort.  Reassess mental status and vital signs frequently.  Transport Considerations
  • Renal and Urologic Emergencies Risk Factors  Older Patients  History of Diabetes  History of Hypertension  Multiple Risk Factors Renal and Urologic Emergencies  Acute Renal Failure  Chronic Renal Failure  Renal Calculi  Urinary Tract Infection
  • Acute Renal Failure Pathophysiology  Prerenal Acute Renal Failure  Dysfunction before the level of kidneys • Most common and most easily reversible  Renal Acute Renal Failure  Dysfunction within the kidneys themselves  Postrenal Acute Renal Failure  Dysfunction distal to the kidneys
  • Acute Renal Failure
  • Acute Renal Failure Assessment  Focused History  Change in urine output  Swelling in face, hands, feet, or torso  Presence of heart palpitations or irregularity  Changes in mental function
  • Acute Renal Failure Physical Assessment  Altered mental status  Hypertension  Tachycardia  ECG indicative of hyperkalemia  Pale, cool, moist skin
  • Acute Renal Failure Physical Assessment  Edema of face, hands, or feet  Abdominal findings dependent on the cause of ARF
  • Acute Renal Failure Management  Airway, Breathing, Circulation  IV Access  Protect fluid volume.  Positioning and Transport
  • Chronic Renal Failure Chronic Renal Failure  Permanent Loss of Nephrons  End-Stage Renal Failure (ESRF) Pathophysiology  Similar to Renal ARF  Microangiopathy, glomerular injury  Tubular cell injury  Insterstitial injury
  • Chronic Renal Failure
  • Chronic Renal Failure Impairment of Kidney Functions  Maintenance of blood volume with proper balance of water, electrolytes, and pH • Increased sodium, water, and potassium retention  Retention of key compounds such as glucose with excretion of wastes such as urea • Loss of glucose and buildup of urea within the blood  Control of arterial blood pressure • Disruption of the renin-angiotensin loop resulting in HTN  Regulation of erythrocyte development • Development of chronic anemia
  • Chronic Renal Failure Assessment  Differentiate chronic and acute problems.  Focused history and physical exam.  Gastrointestinal complaints  Changes in mental status  Marked abnormalities during physical exam  Uremic frost
  • Chronic Renal Failure
  • Chronic Renal Failure Immediate Management  Monitor and support ABCs.  Establish IV access.  Regulate fluid volume.  Monitor vital signs and cardiac rhythm.  Expedite transport to an appropriate facility.
  • Chronic Renal Failure Long-Term Management  Renal Dialysis  Hemodialysis  Common complications
  • Chronic Renal Failure Long-Term Management  Renal Dialysis  Peritoneal dialysis  Common complications
  • Renal Calculi Pathophysiology  Results when “too much insoluble stuff” accumulates in the kidneys.  Stone types  Calcium salts  Struvite stones  Uric acid  Cystine
  • Renal Calculi Assessment  Focused History  Severe pain in one flank that increases in intensity and migrates from the flank to the groin  Painful, frequent urination with visible hematuria  Prior history of calculi  Physical Exam  Difficult due to patient discomfort  Tachycardia with pale, cool, and moist skin
  • Renal Calculi Management  Maintain ABCs.  Maintain position of comfort.  Establish IV access.  Fluid bolus may promote stone movement and urine formation.  Consider medication administration.  Parenteral narcotic analgesics may be indicated.
  • Urinary Tract Infection Pathophysiology  Risk Factors  Increased risk in female or catheterized patients  Sexual activity  Lower and Upper UTIs  Urethritis  Cystitis  Prostatitis  Pyelonephritis  Community-acquired vs. nosocomial infections
  • Urinary Tract Infection Assessment  Focused History  Abdominal pain  Frequent, painful urination  A “burning sensation” associated with urination  Difficulty beginning and continuing to void  Strong or foul-smelling urine  Similar past episodes
  • Urinary Tract Infection  Physical Exam  Restless, uncomfortable appearance.  Presence of a fever.  Vital signs vary with degree of pain. Management  Maintain ABCs.  Establish IV access.  Consider analgesics.  Transport to appropriate facility.
  • Urology and Nephrology Anatomy and Physiology General Mechanisms of Nontraumatic Tissue Problems General Pathophysiology, Assessment, and Management Renal and Urologic Emergencies