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NCM PPT Presentation in Urinary System
 

NCM PPT Presentation in Urinary System

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    NCM PPT Presentation in Urinary System NCM PPT Presentation in Urinary System Presentation Transcript

    • NCM 102- Group Activity PowerPoint Presentation February 23- 27, 2009
      • BSN 3- Fenwick
      • Group 1
      • 1.) Abool, Gretchen
      • 2.) Alayon, Marion Kaz
      • 3.) Baria, Charles Noel
      • 4.) Dellota, Luri John
      • 5.) Diomampo, Ma. Christina
      • 6.) Rotulo, Maureen Vi
      • 7.) Valbarez, Audrey
    • Urinary System
      • Consist of:
        • Kidneys
        • Ureters
        • Bladder
        • Urethra
      • General
      • Function :
      • Excretory
      • Regulatory
      • Secretory
      • Specific Function :
      • Urine formation
      • Excretion of waste products
      • Regulation of electrolyte excretion
      • Regulation of acid excretion
      • Regulation of water excretion
      • Auto regulation of blood pressure
      • Regulation of red blood cell production
      • Renal clearance
      • Vitamin D synthesis
      • Secretions of prostaglandins
      • Urine storage
      • Bladder emptying
    • Kidney
      • Bean-shaped, brownish-red structures.
      • Retroperitoneal, posterior wall of abdomen, 12 th thoracic vertebra.
      • Filter any products from the blood which has no use in the body.
    •  
      • Regions
        • Renal parenchyma
          • Cortex
            • Glomeruli, proximal and distal convoluted tubules, cortical collecting ducts, and adjacent peritubular capillaries.
          • Medulla
            • Pyramids
              • 8- 18 pyramids/ kidney
      • 2. Renal Pelvis
      • - it is the concave portion of the kidney through which the renal artery enters and the renal vein exits
      • - composed of afferent arteriole and efferent arteriole
      • Nephrons
        • - Functional units of kidney:
        • Glomerulus
        • Bowman’s capsule
        • Proximal tubule
        • Distal tubule
        • Loop of Henle
        • Collecting ducts
    •  
      • Calyx
        • Minor calyx- 4-13 minor calices
        • Major calyx- 2-3 major calices
      • Glomerulus
      • 3 filtering layers:
        • Capillary endothelium
        • Basement membrane
        • Epithelium
    • Ureters
      • Fibromuscular tube that connect each kidney to the bladder
      • Narrow, muscular tubes, 24-30 cm long
        • 3 narrowed areas:
          • Ureteropelvic junction
          • Ureteral segment
          • Ureterovesical junction
          • - prevents reflux of urine
    • Urinary Bladder
      • Muscular, hollow- sac located just behind the pubic bone
      • 300- 600 ml of urine
        • 4 layers of the urinary bladder:
        • Adventitia- outermost layer
        • Detrusor- beneath the adventitia
        • Lamina Propria- interface between detrusor and urethelium.
        • Urothelium- innermost layer
    • Urethra
      • Extends from the bladder to the urinary meatus
      • Exit passageway for urine
      • Lined with mucous membrane
      • In male, it serves as a passageway for both semen and urine
    • Acid- Base Regulation
      • Acid Base Balance
        • Homeostasis of the body fluids at a normal arterial blood pH ranging between 7.35- 7.45
      • Body fluids are slightly alkaline, metabolic processes of the body generally produced excess acid.
      • Maintained partially through the reabsorption of bicarbonate (HCO 3 - ) in the proximal tubule
      • Acids
        • release hydrogen ions (H + ) in solutions
          • Ex. Hydrochloric acid (HCl)- strong acid
            • Carbonic acid (H 2 CO 3 )- weak acid
      • Bases or alkalis
        • decrease hydrogen ion (H + ) concentration
        • accept H + in solutions
        • Ex: Sodium Hydroxide (NaOH) – strong base
        • Bicarbonate (HCO 3 ) – weak base
    • Regulation System
      • Buffer Regulation System
      • - chemicals which neutralizes excess acids and bases
      • a. bicarbonate buffer system
      • - controls the pH in ECF of the body
      • b. phosphate buffer system
      • - important ICF buffer system
      • c. protein buffer system
      • - largest buffer system of the body; includes Hgb in RBC, histone proteins and nucleic acids inside the cells.
      • Respiratory Regulation System
      • - excretes or retains CO 2 in the lungs
      • Renal Regulation System
      • - excretion or retention of Hydrogen ions (H + ) and bicarbonate ions (HCO 3 )
    • Acid Base Imbalances
      • Metabolic Acidosis (Base Bicarbonate Deficit)
      • Definition
      • - results because of high acid content of the blood, which also causes loss of sodium bicarbonate
      • - characterized by low pH and low plasma bicarbonate concentration
      • - 2 forms:
      • 1. high anion gap acidosis
      • 2. normal anion gap acidosis
      • Compensatory Mechanism
      • - increased ventilation and renal retention of bicarbonate
      • - lungs “blow off” CO 2 to raise pH and conserve HCO 3 -
      • Laboratory Findings (ABG)
      • - low plasma pH (below 7.35) or a normal pH (if compensated)
      • - normal PCO 2 or low if compensated in an attempt by the lungs to blow off more acid
      • - low plasma bicarbonate:
      • -below 21 mEq/L in adults
      • -below 20 mEq/L in children
      • - low urine pH (below 6)
      • Causes
      • -DKA or Diabetic Ketoacidosis with starvation
      • -Salicylate overdose
      • -Lactic Acidosis 2 o hypoperfusion
      • -Methanol and ethylene Glycol toxicity
      • -uremia
      • Medical and Nursing Management
      • 1. Correct metabolic defect
      • 2. If resulted from excessive intake of Chloride, eliminate the source of Chloride.
      • 3. Administer bicarbonate if pH < 7.1 and bicarbonate level < 10.
      • 4. Closely monitor serum potassium level
      • 5. Correct hypokalemia
      • 6. Give alkalizing agents, if serum bicarbonate level < 12meq/L
      • 7. Hemodialysis
      • 8. Peritoneal dialysis
      • Manifestations
      • A. Acute
      • - headache - drowsiness
      • - nausea and vomiting - confusion
      • - increased RR and depth - shock
      • - peripheral vasodilation - dysrhythmia
      • - cold and clammy skin - decreased BP
      • B. Chronic
      • -asymptomatic
      • Metabolic Alkalosis (Base Bicarbonate Excess)
      • Definition
      • - marked by the heavy loss of acid from the body or by increased level of bicarbonate
      • - characterized by increased pH and increased plasma bicarbonate.
      • Compensatory Mechanism
      • - decreased ventilation to conserve CO 2 and increase the PaCO 2
      • - lung retains CO 2 to lower pH
      • - kidney conserves H + to excrete HCO 3
      • Causes
      • - overzealous administration of sodium bicarbonate
      • - excessive or prolonged vomiting
      • - excessive diuresis
      • - gastric suction with loss of hydrogen and chloride ions
      • - pyloric stenosis
      • Laboratory Findings (ABG)
      • - high plasma pH (above 7.45)
      • - normal or high PCO 2 (above 45 mmHg) as a compensatory elevation
      • - high plasma bicarbonate:
      • - above 28 mEq/L in adults
      • - above 25 mEq/L in children
      • - high urine pH (above 7)
      - excessive diarrhea - hyperaldosteronism - Cushing’s syndrome - villous adenoma - cystic fibrosis - hypokalemia
      • E. Manifestations
      • a. Acute
      • - tingling of fingers and toes
      • - slow, shallow respiration (compensatory)
      • - hypertonic muscles
      • - tetany
      • - mental dullness
      • - dizziness
      • - respiratory depression
      • - atrial tachycardia may occur
      • - ventricular disturbances
      • - decreased motility and paralytic ileus
      • b. Chronic
      • - same with acute metabolic alkalosis
      • - PVC (premature ventricular contractions or U- waves seen in ECG)
      • F. Medical and Nursing Management:
      • 1. Sufficient chloride must be supplied.
      • 2. Restore normal fluid volume by administering sodium chloride fluids.
      • 3. In patient with hypokalemia, administer potassium as KCl.
      • 4. Administer H 2 -receptor antagonist such as Cimetidine (Tagamet) to reduce the production of gastric HCl, thereby decreasing the metabolic alkalosis associated with gastric suction.
      • 5. Carbonic anhydrase inhibitors are useful in patients who cannot tolerate rapid volume expansion.
      • 6. Monitor fluid intake and output.
      • 7. Correct the underlying acid-base disorder.
      • 3. Respiratory Acidosis (Carbonic Acid Excess)
      • A. Definition
      • - marked by an increased arterial CO 2 concentration (PaCO 2 ), increased carbonic acid, and increased hydrogen ion concentration (low pH)
      • - may be acute or chronic
      • - due to inadequate excretion of CO 2 with inadequate ventilation
      • B. Compensatory Mechanism
      • - excess hydrogen is excreted in the urine in exchange for bicarbonate ions
      • - kidney eliminate hydrogen ion and retain HCO 3
      • - kidney will retain increased amounts of HCO 3 to increase pH
      • C. Laboratory Findings (ABG)
      • - low plasma pH (below 7.35) or a normal pH (if compensated)
      • - increased PCO 2 (above 45 mmHg)
      • - normal or high plasma bicarbonate (HCO 3 ) if compensated
      • - above 28 mEq/L in adults
      • - above 25 mEq/L in children
      • D. Causes
      • - narcotic coma
      • - respiratory depression (drugs, CNS, trauma)
      • - pulmonary diseases (COPD, asthma, pneumonia)
      • - hypoventilation
      • - cardiac arrest/respiratory arrest
      • - head and spinal cord injury
      • - acute pulmonary edema
      • - aspiration of a foreign object
      • - atelectasis
      • - ventricular fibrillation (in anesthesized person)
      • - increased ICP
      • - papilledema
      • - dilated conjunctival blood vessels
      • - hyperkalemia
      • E. Manifestations
      • a. Acute
      • - increased RR, PR and BP
      • - mental cloudiness
      • - feeling of fullness in head
      • - hypoventilation, shallow respiration
      • - poor exhalation
      • - mental alertness and disorientation
      • - cerebrovascular vasodilation
      • - increased cerebral blood flow
      • b. Chronic
      • - cerebral vasodilation will increase ICP
      • - cyanosis and tachypnea will develop
      • - pneumothorax
      • - overdose of sedatives
      • - sleep apnea syndrome
      • - ARDS
      • - muscular dystrophy
      • - myasthenia gravis
      • - Guillain-Barre Syndrome
      • F. Medical and Nursing Management
      • 1. Improve ventilation
      • 2. Bronchodilators
      • 3. Antibiotics
      • 4. Thrombolytics
      • 5. Pulmonary hygiene measures
      • 6. Adequate hydration
      • 7. Supplemental oxygen PRN
      • 8. Mechanical ventilation, use appropriately
      • 9. Semi-Fowler’s position
      • 4. Respiratory Alkalosis (Carbonic Acid Deficit)
      • A. Definition
      • - marked by decreased PaCO 2 and increased pH
      • - clinical condition in which the arterial pH is greater than 7.45 and the PaCO 2 is less than 38 mmHg
      • - acute and chronic condition may occur
      • B. Compensatory Mechanism
      • - renal excretion of bicarbonate increase, and hydrogen ion is retained
      • - kidneys will excrete increased amounts of HCO 3 to lower pH
      • - kidneys conserve H + and excrete HCO 3
      • C. Laboratory Findings (ABG)
      • - high plasma pH (above 7.45)
      • - decreased PCO 2 (below 35 mmHg)
      • - decreased plasma bicarbonate as a compensatory measure
      • - below 21 mEq/L in adults
      • - below 20 mEq/L in children
      • - high urine pH (above 7)
      • D. Causes
      • - extreme anxiety
      • - “panic” attack
      • - hypoxemia
      • - early phase of salicylate intoxication
      • - gram-negative bacteremia
      • - inappropriate ventilator setting
      • - chronic respiratory alkalosis results from chronic hypercapnia
      • - low serum bicarbonate level
      • E. Manifestations
      • a. Acute
      • - lightheadedness
      • - inability to concentrate
      • - numbness and tingling from decreased calcium ionization
      • - tinnitus
      • - loss of consciousness at times
      • - tachycardia
      • - ventricular and atrial dysrhythmias
      • - deep or rapid breathing
      • - paresthesias
      • - mental restlessness and agitation progressing to hysteria
      • F. Medical and Nursing Management
      • 1. Instruct patient to breathe more slowly to allow CO 2 to accumulate or breathe into a close system (such as a paper bag)
      • 2. Sedative may be required
      • 3. Correct underlying problems
    • HYDRONEPHROSIS
      • Is distention of the renal pelvis and calices caused by an obstruction of normal urine flow.
    • Etiology
      • congenital or acquired
      • stricture from ulceration of the ureter, or may be due to a calculus.
      • thickening of the bladder walls from cystitis
      • enlarged prostate
      • urethral stricture
      • Pressure from a pregnant or displaced uterus
      • ovarian tumors
    • PRESENCE OF CALCULUS, TUMORS, SCAR TISSUE, CONGENITAL DEFECTS, KINK IN THE URETER URINE FLOW OBSTRUCTION URINE ACCUMULATION & STASIS PRESSURE IN THE KIDNEY WALLS DISTENTION OF THE KIDNEYS SUSTAINED/INTERMITTENT INCREASE PRESSURE IRREVERSIBLE NEPHRON DESTRUCTION Pathophysiology
    • Assessment
      • Acute
      • Renal colic
      • Severe back pain
      • Chronic
      • Dull, aching discomfort in the flank on the affected side
      • Painful hydronephrosis that occurs intermittently
      • General
      • Vague intestinal symptoms such as:
        • nausea
        • vomiting
        • abdominal pain
      • Pain in the sides
      • Abdominal mass
      • Nausea and vomiting
      • Very high Fever
      • Dysuria (Painful urination)
      • Increased urinary frequency
      • Hematuria (blood in the urine)
      • High number of white blood cells in the urine
      • Feel fatigued
      • Appear pale
      • Diarrhea
      • Respiratory distress
      • Foam in the toilet water, which may be caused by excess protein in your urine
      • Weight gain due to excess fluid retention
      • High blood pressure
      • Thromboembolism
        • • severe pain and swelling in arm or leg • changes in color or temperature of arm or leg
    • Diagnostics:
      • Ultrasonography
        • Intravenous pyelogram (IVP )
      • Abdominal magnetic resonance imaging (MRI)
      • Urine tests
      • Blood Test
      • Endoscopy
      • Kidney (Renal) Scan
      • Bladder catheterization (insertion of a hollow, flexible tube through the urethra
    • Complications
      • kidney infection (pyelonephritis)
      • urinary tract infection
    • Nursing Diagnosis
      • Excess Fluid Volume related to Sodium Retention
      • Impaired Urinary Elimination related to Inflammation
      • Risk for Infection
      • Pain related to infection
      • Deficient Knowledge related to Factors of Development of the Disease
    • INTERVENTION
      • Pain relief
      • Analgesics
      • Antispasmodic
      • Antibiotics administration
      Medical
      • Pyeloplasty
      • Pre operative
      • ensure optimal renal function
      • encourage to recognize and express feelings of anxiety
      • Post operative
      • VS
      • permit oral fluids after passage of flatus
      • maintain sterility of nephrostomy tube
      • ensure unobstruction in the nephrostomy tube or catheter
      • never clamp nephrostomy tube
      • MIO
      • In case of ureteral stent
      • Monitor for bleeding
      • MIO
      • Assess for signs of UTI
      • monitor colicky pain & decrease urine output (stent displacement)
      Surgical
    • NEPHROTIC SYNDROME
      • Is a set of clinical manifestations caused by protein wasting secondary to diffuse glomerular damage.
    • ETIOLOGY
      • Nephrotic syndrome is a protein wasting disease
      • Caused by:
        • glomerulonephritis
        • diabetes mellitus
        • Lupus erythematosus
        • Amylodidosis
        • Carcinoma
    • Pathophysiology Membranous glomerulonephritis Glomerular basement membrane damage Glomerular permeability to plasma protein Albumin depletion in the blood Alteration in osmotic pressure in the vessels Fluid moves to interstitial spaces Increase synthesis of LDL, HDL in the liver with decrease lipid catabolism Decreased plasma volume Stimulates aldosterone secretion Sodium & water retention Decreased glomerular filtration rate edema edema Hyperlipidemia lipiduria proteinuria hypoalbuminemia
    • Assessment
      • Proteinuria
      • Hypoalbuminemia (low level of albumin in the blood)
      • Edema (swelling)
      • Hypercholesterolemia (high level of cholesterol in the blood)
      • High blood pressure
      • Susceptibility to infections
      • Oliguria
      • Hematuria
    • Diagnostics:
      • Complete medical history and physical examination
      • Urinalysis
      • Blood analysis
      • Kidney biopsy
    • Complications
      • kidney infection (pyelonephritis)
      • urinary tract infection
      • Blood clots
      • High blood cholesterol and elevated blood triglycerides
      • Poor nutrition
      • High blood pressure
      • Acute kidney failure
      • Chronic kidney failure
    • Nursing Diagnosis
      • Altered Nutrition: Less Than Body Requirements related to Increased Metabolic Demands
      • Fluid Volume Excess related to Reduced Urine Output
      • Potential Impairment of Skin Integrity related to Edema
      • Fatigue related to Increased Metabolic Demands
      • Risk for Infection Related to Altered Immune Response Secondary to Treatment
    • URINARY TRACT INFECTION
      • Inflammation of the bladder or the urethra caused by gram-negative bacteria, with Escherichia coli causing most cases.
    • Etiology
      • Caused by gram-negative bacteria
        • Escherichia coli
        • Kleibshiella
        • Proteus
        • Pseudomonas
      • Obstruction of the urine flow
      • Benign Prostatic Hyperplasia
    • Assessment
      • Lower Urinary Tract Infection (Cystitis)
      • - pain on urination
      • - Frequent urination
      • - Nocturia
      • - Incontenence
      • - Suprapubic pain
      • - Hematuria
      • ` - dysuria
      • - foul-smelling urine
      • - increased WBC, pus and bacteria in urine
      • Upper Urinary Tract Infection (Pyelonephritis)
      • - Fever
      • - Chills
      • - Flank or Low Back Pain
      • - Nausea and Vomiting
      • - Headache
      • - Malaise
      • - Painful Urination
    • Diagnostics:
      • Antibiogram
      • Urinalysis
      • Urine culture and Sensitivity
      • Nitrate testing
      • Intravenous pyelography
      • Computed tomography (CT Scan)
      • Ultrasonography (Ultrasound)
      • Retrograde Urethrogram (Infants)
      • X-ray and Intravenous Urography (X-rays of the urological system following intravenous injection of iodinated contrast material)
    • Complications
      • Damage and scarring of the urinary tract lining
      • Pyelonephritis
      • Chronic Renal Failure due to extensive kidney damage
      • Sepsis
    • Nursing Diagnosis
      • Acute Pain related to Inflammation and Infection of Urethra, Bladder and Other Urinary Tract Structures
      • Altered Urinary Elimination related to Irritation and Inflammation of the Bladder Mucosa
      • Altered Health Maintenance related to Prevention of Recurrent Infections
      • Deficient Knowledge related to Factors Predisposing the Patient to Infection and Recurrence, Detection and Prevention of Recurrence and Pharmacologic Therapy
      • Risk for Fluid Volume deficit related to Fever, Nausea, Vomiting and Possible Diarrhea
    • Nursing Interventions
      • Promotive
        • Eat well-balanced diet.
        • Good hygiene practice.
      • Preventive
        • Do not delay urination.
        • Empty bladder regularly.
        • Clean the urethral meatus after intercourse.
        • Increase fluid intake.
        • Careful sexual practice.
        • Intake of grape juice.
      • Curative
        • Medications given:
        • cholinergics to relieve urinary retention
        • anti-cholinergics to decrease bladder muscle spasm
        • antibiotics: Ciprofloxacin
        • phenazopyridine for pain
        • Revision of abnormalities in urinary tract.
      • Rehabilitative
        • Education about importance of completing medication cycle.
        • Evaluation and instruction about voiding patterns, sexual practices, and hygiene practices.
    • ACUTE GLOMERULONEPHRITIS
      • A specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium
    • Etiology
      • Beta-hemolytic Streptococcal infection
      • Viral or parasitic infection
    • A ntigen (group a beta-hemolytic streptococcus Antigen- antibody product Deposition of antigen-antibody complex in glomerulus Increased production of epithelial cells lining the glomerulus Leukocytes infiltrate the glomerulus Thickening of the glomerular filtration membrane Pathophysiology Scarring and loss of glomerular filtration membrane Decreased glomerular filtration rate
    • Assessment
      • Hematuria
      • Oliguria
      • Edema (peripheral or periorbital)
      • Headache
      • flank pain
      • Shortness of breath or
      • Dyspnea
      • Hypertension
      • Skin rashes
      • Arthritis
      • Pharyngitis
      • Impetigo
      • Respiratory infection
      • Pulmonary hemorrhage
      • Heart murmur may indicate endocarditis
      • Scarlet fever
      • Weight gain
      • Abdominal pain
      • Anorexia
      • Skin pallor
      • Palpable purpura in patients with Henoch-Schönlein purpura
      • Oral ulcers
    • Diagnostics:
      • Complete blood cell count
      • Electrolytes, including BUN and creatinine (to estimate the glomerular filtration rate [GFR]): The BUN and creatinine levels will exhibit a degree of renal compromise.
      • Urinalysis
      • Streptozyme test: This test includes many streptococcal antigens that are sensitive for screening but are not quantitative.
      • Antistreptolysin O (ASO)
      • Erythrocyte sedimentation ratio (ESR) usually is increased.
      • Urine or plasma creatinine level greater than 40; decreased renin level is noted.
      • Blood cultures
      • Ultrasonography
      • Abdominal radiographic imaging (ie, computed tomography)
      • Renal biopsy
    • Complications
      • Sclerosis progressing toward renal failure
      • Other complications can develop in patients who present with severe hypertension, encephalopathy, and pulmonary edema. It includes the following:
        • Hypertensive retinopathy
        • Hypertensive encephalopathy
        • Rapidly progressive glomerulonephritis
        • Chronic renal failure
      • Nephrotic syndrome
    • Nursing Diagnosis
      • Alteration in Nutrition due to Compromised Renal Function
      • Fluid Volume Excess due to Reduced Urine Output
      • Activity Intolerance due to Need to Rest the Kidney
      • Potential Impairment of Skin Integrity due to Edema
      • Potential for Infection due to Reduction in Natural Defense Mechanisms
    • Nursing Interventions
      • Promotive
        • eat balanced diet
        • teach client to live healthfully
      • Preventive
        • prompt treatment of URTI or sore throat
        • culture and sensitivity test; antibiotics as indicated
      • Curative
        • bed rest
        • dietary sodium restrictions
        • low protein diet
        • sufficient carbohydrate to prevent muscle wasting and nitrogen imbalance
        • antibiotic: Penicillin
        • anti-hypertensive drugs
        • diuretic therapy
      • Rehabilitative
        • maintain follow-up healthcare
        • report any exacerbation in signs and symptoms
    • CHRONIC GLOMERULONEPHRITIS
      • Is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of glomeruli.
    • Etiology
      • Acute glomerulonephritis
      • Immunologic reactions in the body
    • Assessment
      • Symptoms:
      • Headache
      • Dyspnea
      • Blurring of vision
      • Lassitude
      • Weakness or fatigue
      • Signs:
      • Hypertension
      • Edema
      • Nocturia
      • Weight loss
      • Hematuria
      • Proteinuria
      • Casts and blood in the urine
    • Diagnostics:
      • Serum chemistry
      • CBC
      • Urinalysis
      • Renal ultrasonogram
      • Biopsy
      • Kidney
    • Complications
        • Metabolic acidosis
        • Pulmonary edema
        • Pericarditis
        • Uremic encephalopathy
        • Uremic gastrointestinal bleeding
        • Uremic neuropathy
        • Severe anemia and hypocalcemia
        • Hyperkalemia
    • Nursing Diagnosis
      • Altered Nutrition: Less Than Body Requirements related to Increased Metabolic Demands
      • Fluid Volume Excess related to Reduced Urine Output
      • Fatigue related to Increased Metabolic Demands
      • Risk for Impaired Skin Integrity
      • Risk for Infection related to Altered Immune Response Secondary to Treatment
    • Nursing Interventions
      • Promotive
        • eat balanced diet
        • teach client to live healthfully
      • Preventive
        • avoid infections, especially respiratory and urinary tract infection
      • Curative
        • high calorie, low protein, sodium restricted diet
        • provide/assist in hygiene
        • monitor signs of pulmonary edema and congestive heart failure
        • rest is essential
        • take prescribed medications appropriately
      • Rehabilitative
        • maintain follow-up healthcare
        • report any exacerbation in signs and symptoms
    • REFERENCES:
      • Textbooks:
      • Joyce M Black
      • Medical Surgical Nursing
      • 6 th Edition
      • p.805-806, 856-867
      • Langford & Thompson
      • Handbook of Diseases
      • 3 rd Edition
      • p.674-676
      • Brunner and Smeltzer
      • Medical Surgical Nursing
      • 3 rd Edition
      • p. 310-315
      • Josie Quiambao-Udan
      • Mastering Fundamemntals of Nursing
      • 1 st Edition
      • p. 303-304, 312-314
      • Links:
      • http://emedicine.medscape.com/article/777272-followup
      • http://emedicine.medscape.com/article/777272-treatment
      • http://emedicine.medscape.com/article/777272-diagnosis
      • http://emedicine.medscape.com/article/777272-overview