Acid-base balance regulation
<ul><li>-a number of mechanisms work together to maintain </li></ul><ul><li>the pH of the body with in this normal range. ...
There are three primary systems that regulate the hydrogen ion concentration in the body fluids   1. The chemical acid bas...
<ul><li>ACID-BASE IMBALANCES </li></ul>
Metabolic Acidosis <ul><li>DEFINITION: </li></ul><ul><li>- Metabolic acidosis  is an increased production of metabolic aci...
<ul><li>CAUSES </li></ul><ul><li>Diabetic ketoacidosis (buildup of ketones) </li></ul><ul><li>Drugs and substances such as...
MANIFESTATIONS <ul><li>nausea </li></ul><ul><li>vomiting </li></ul><ul><li>fatigue  </li></ul><ul><li>Breathing becomes de...
MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms </li></ul><ul><li>health history, and lab results </li...
Metabolic Alkalosis <ul><li>DEFINITION </li></ul><ul><li>Metabolic alkalosis is a metabolic condition in which the pH of t...
LABORATORY VALUES - The pH is higher (above 7.45) and the bicarbonate levels are increased (>26 mmol/l).  CAUSES <ul><li>L...
MANIFESTATIONS <ul><li>general weakness </li></ul><ul><li>muscle cramps,  </li></ul><ul><li>hyperactive reflexes,  </li></...
MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results.  </li></ul><ul><li>I...
Respiratory Acidosis <ul><li>DEFINITION </li></ul><ul><li>-Respiratory acidosis  is an abnormal decrease in the pH of the ...
CAUSES <ul><li>COPD </li></ul><ul><li>Blockage of the airway due to swelling,  </li></ul><ul><li>a foreign object, or vomi...
MANIFESTATIONS <ul><li>restlessness  </li></ul><ul><li>apprehension  </li></ul><ul><li>lethargy are initial signs </li></u...
MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results.  </li></ul><ul><li>I...
Respiratory Alkalosis <ul><li>DEFINITION </li></ul><ul><li>- Respiratory alkalosis is a condition where the amount of carb...
CAUSES <ul><li>anxiety, hysteria and stress  </li></ul><ul><li>moving into high altitude areas, when the low atmospheric p...
MANIFESTATIONS <ul><li>confusion,  </li></ul><ul><li>dizziness,  </li></ul><ul><li>paresthesias (tingling of extremities),...
MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results.  </li></ul><ul><li>I...
  THE   URINARY  SYSTEM
- The urinary system (also called excretory system or the genitourinary system) is the organ system that produces, stores,...
KIDNEYS <ul><li>The human kidneys:  </li></ul><ul><ul><li>are two bean-shaped organs, one on each side of the backbone.  <...
The Nephron <ul><li>It consists of a:  </li></ul><ul><li>Bowman's capsule.  Located at the closed end, the wall of the nep...
 
URETERS <ul><li>- the  ureters  are muscular ducts that propel  urine  from the  kidneys  to the  urinary bladder . In the...
URINARY SYSTEM  DISORDERS <ul><li>HYDRONEPHROSIS </li></ul><ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Hydrone...
ETIOLOGY <ul><li>The obstruction may be either partial or complete and can occur anywhere from the  urethral meatus  to th...
SCHEMATIC DIAGRAM
ASSESSMENT <ul><li>the kidney swells, due to a backup of urine.  </li></ul><ul><li>nausea, </li></ul><ul><li>vomiting,  </...
<ul><li>DIAGNOSTICS </li></ul><ul><li>Abdominal ultrasound  </li></ul><ul><li>Pyelogram   </li></ul><ul><li>Surgery:   pye...
INTRA-OPERATIVE NURSING CARE <ul><li>Laparoscopic pyeloplasty is performed under a general anesthetic. The typical length ...
 
POST-OPERATIVE NURSING CARE <ul><li>Pain medication via an intravenous patient-controlled analgesia (PCA) pump or by injec...
NURSING DIAGNOSIS <ul><li>Urinary retention related to obstruction. </li></ul><ul><li>Impaired skin integrity related to p...
NEPHROTIC SYNDROME <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Nephrotic syndrome refers to a number of renal ...
PATHOPHYSIOLOGY <ul><li>- Damage to nephron causes it to not function, glomeruli allows excretion of protein in large amou...
ASSESSMENT <ul><li>proteinuria </li></ul><ul><li>progressive edema (eyes, ankles, face, anasarca)    hydrothorax, ascites...
DIAGNOSTICS   Urine protein tests   Blood protein tests  SURGERY :   kidney transplant, nephrectomy   <ul><li>PRE-OPERATIV...
INTRA-OPERATIVE NURSING CARE <ul><li>-Laparoscopic partial nephrectomy is performed under a general anesthetic. The typica...
POST-OPERATIVE NURSING CARE <ul><li>Pain medication can be controlled and delivered by the patient via an intravenous  pat...
COMPLICATIONS <ul><li>Atherosclerosis and related heart diseases </li></ul><ul><li>Renal vein thrombosis </li></ul><ul><li...
INTERVENTIONS <ul><li>MEDICAL MANAGEMENT   </li></ul><ul><li>1. DRUG THERAPY </li></ul><ul><li>a. Corticosteroids to resol...
URINARY TRACT INFECTIONS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>A urinary tract infection (UTI) is a bacter...
ETIOLOGY <ul><li>E.coli is main culprit </li></ul><ul><li>females>males </li></ul><ul><li>improper wiping </li></ul><ul><l...
 
ASSESSMENT <ul><li>fever,  </li></ul><ul><li>dysuria,  </li></ul><ul><li>frequency,  </li></ul><ul><li>urgency,  </li></ul...
DIAGNOSTICS <ul><li>Urine tests   </li></ul><ul><li>Urinalysis   </li></ul><ul><li>Ultrasound of urinary organs   </li></u...
NURSING DIAGNOSIS <ul><li>High risk for infection due to catherization, alkaline urine </li></ul><ul><li>Perineal pain due...
<ul><li>Identify and correct structural anomalies if present </li></ul><ul><li>Prevent recurrence </li></ul><ul><li>Preser...
ACUTE  GLOMERULONEPHRITIS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Acute glomerulonephritis (AGN) is active...
PATHOPHYSIOLOGY <ul><li>- antigen/antibody reaction, (to strep) affects glomerular tissue and alters permeability, causing...
ASSESMENT <ul><li>wide range; usually see ~ 1-3 week post strep infection;  </li></ul><ul><li>urine cloudy; smoky brown  ...
<ul><li>DIAGNOSTICS </li></ul><ul><ul><li>Bladder Tests   </li></ul></ul><ul><ul><li>Urinary Tract Infection (UTI) Tests  ...
COMPLICATIONS <ul><li>Nephrotic syndrome  </li></ul><ul><li>Acute nephritic syndrome  </li></ul><ul><li>Chronic renal fail...
INTERVENTIONS <ul><li>MEDICAL </li></ul><ul><li>1.  Antibiotic for streptococcal infection </li></ul><ul><li>2. Administer...
CHRONIC GLUMERULONEPHRITIS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>-Chronic glomerulonephritis is the advanc...
PATHOPHYSIOLOGY <ul><li>-Reduction in nephron mass from the initial injury reduces the GFR. This reduction leads to hypert...
ASSESSMENT <ul><li>Malaise </li></ul><ul><li>Weight loss </li></ul><ul><li>Edema </li></ul><ul><li>Increasing irritability...
DIAGNOSTICS <ul><li>Urinalysis </li></ul><ul><li>BUN and serum creatinine </li></ul><ul><li>Immunologic tests </li></ul><u...
COMPLICATIONS <ul><li>High blood pressure. Damage to your kidneys and the resultant buildup of wastes in the bloodstream c...
INTERVENTIONS <ul><li>MIO </li></ul><ul><li>Assess specific gravity of urine </li></ul><ul><li>Weight the client daily </l...
REFERENCES: <ul><li>Medical-surgical Nursing (A nursing Process Approach,3 rd  edition) by LONG, PHIPPS, CASSMEYER </li></...
<ul><li>“ Desire is the key to motivation, but it's the determination and commitment to an unrelenting pursuit of your goa...
<ul><li>THANK YOU FOR  LISTENING….!!!! </li></ul><ul><li>Prepared by: </li></ul><ul><li>GROUP 1 </li></ul><ul><li>ARRIOLA,...
Upcoming SlideShare
Loading in …5
×

Group 1

2,501 views

Published on

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,501
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Group 1

  1. 1. Acid-base balance regulation
  2. 2. <ul><li>-a number of mechanisms work together to maintain </li></ul><ul><li>the pH of the body with in this normal range. </li></ul><ul><li>Metabolic processes in the body continuously </li></ul><ul><li>produced acids, which fall into two categories: </li></ul><ul><li>volatile acids and nonvolatile acids. </li></ul><ul><li>Volatile acids can be eliminated from the body as a gas. </li></ul><ul><li>Nonvolatile acids that must be metabolized or excreted from the body in fluid. </li></ul>
  3. 3. There are three primary systems that regulate the hydrogen ion concentration in the body fluids 1. The chemical acid base buffer system of the body fluids, which immediately combine with acid or base to prevent excessive changes in hydrogen ion concentration. 2. The respiratory centre which regulates the removal of CO2 (and therefore H2CO3) from the extracellular fluid. 3. The kidneys which can excrete either acid or alkaline urine, there by readjusting the extracellular fluid hydrogen ion concentration toward normal during acidosis or alkalosis.
  4. 4. <ul><li>ACID-BASE IMBALANCES </li></ul>
  5. 5. Metabolic Acidosis <ul><li>DEFINITION: </li></ul><ul><li>- Metabolic acidosis is an increased production of metabolic acids, usually resulting from disturbances in the ability to excrete acid via the kidneys . </li></ul><ul><li>COMPENSATORY MECHANISM: </li></ul><ul><li>-The body attempts to compensate for this with the respiratory system in a classic pattern known as Kussmaul’s Breathing, which is a pattern of deep and rapid respirations. This pattern increases expiration of CO2 and therefore decreases acidosis (increasing pH). </li></ul><ul><li>LABORATORY VALUES(ABG): </li></ul><ul><li>The pH is low (under 7.35) and the bicarbonate levels are decreased (<22 mmol/l). </li></ul>
  6. 6. <ul><li>CAUSES </li></ul><ul><li>Diabetic ketoacidosis (buildup of ketones) </li></ul><ul><li>Drugs and substances such as acetazolamide DIAMOX, alcohol, aspirin ECOTRINASPERGUM, iron </li></ul><ul><li>Lactic acidosis (buildup of lactic acid as occurs in shock) </li></ul><ul><li>Loss of bases, such as bicarbonate, through the digestive tract from diarrhea, an ileostomy, or a colostomy </li></ul><ul><li>Kidney failure </li></ul><ul><li>Poisons such as carbon monoxide, cyanide, ethylene glycol, methanol, </li></ul><ul><li>Renal tubular acidosis (a form of kidney malfunction) </li></ul>
  7. 7. MANIFESTATIONS <ul><li>nausea </li></ul><ul><li>vomiting </li></ul><ul><li>fatigue </li></ul><ul><li>Breathing becomes deeper and slightly faster </li></ul><ul><li>extremely weak and drowsy </li></ul><ul><li>may feel confused and increasingly nauseated </li></ul><ul><li>blood pressure can fall, leading to shock, coma, and death. </li></ul>
  8. 8. MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms </li></ul><ul><li>health history, and lab results </li></ul><ul><li>Identify the underlying cause to intervene appropriately </li></ul><ul><li>When there is sever acidosis (pH < 7.1), sodium bicarbonate is necessary to bring the pH to a safe level </li></ul><ul><li>Correct the sodium and water deficits, as well. </li></ul>
  9. 9. Metabolic Alkalosis <ul><li>DEFINITION </li></ul><ul><li>Metabolic alkalosis is a metabolic condition in which the pH of the blood is elevated beyond the normal range. This is usually the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. </li></ul><ul><li>COMPENSATORY MECHANISM </li></ul><ul><li>Compensation for metabolic alkalosis occurs mainly in the lungs, which retain carbon dioxide (CO2) through slower breathing, or hypoventilation (respiratory compensation). CO2 is then consumed toward the formation of the carbonic acid intermediate, thus decreasing pH. Respiratory compensation, though, is incomplete. The decrease in [H+] suppresses the peripheral chemoreceptors, which are sensitive to pH. But, because respiration slows, there's an increase in Pco2 which would cause an offset of the depression because of the action of the central chemoreceptors which are sensitive to the partial pressure of CO2 in the blood. So, because of the central chemoreceptors, respiration rate would be increased. </li></ul><ul><li>Renal compensation for metabolic alkalosis, less effective than respiratory compensation, consists of increased excretion of HCO3- (bicarbonate), as the filtered load of HCO3- exceeds the ability of the renal tubule to reabsorb it. </li></ul>
  10. 10. LABORATORY VALUES - The pH is higher (above 7.45) and the bicarbonate levels are increased (>26 mmol/l). CAUSES <ul><li>Loss of hydrogen ions </li></ul><ul><li>Retention of bicarbonate </li></ul><ul><li>Shift of hydrogen ions into intracellular space </li></ul><ul><li>Alkalotic agents </li></ul><ul><li>Contraction alkalosis </li></ul>
  11. 11. MANIFESTATIONS <ul><li>general weakness </li></ul><ul><li>muscle cramps, </li></ul><ul><li>hyperactive reflexes, </li></ul><ul><li>tetany (due to a decrease in calcium); </li></ul><ul><li>shallow and slow respirations; </li></ul><ul><li>confusion and seizures may occur in severe situations. </li></ul><ul><li>Increased blood pH; </li></ul><ul><li>increased HCO3; normal PaCO2 or elevated if compensation is occurring. </li></ul>
  12. 12. MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results. </li></ul><ul><li>Identify the underlying cause to intervene appropriately. </li></ul><ul><li>If potassium levels are decreased administer potassium as ordered per physician. </li></ul><ul><li>If acid-base disturbance is due to hypochloremic alkalosis with volume depletion, administer a sodium chloride IV solution. </li></ul><ul><li>If the condition is caused by hyperaldosteronism, administer potassium. </li></ul>
  13. 13. Respiratory Acidosis <ul><li>DEFINITION </li></ul><ul><li>-Respiratory acidosis is an abnormal decrease in the pH of the blood due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide concentration ( Pa CO2). </li></ul><ul><li>COMPENSATORY MECHANISM </li></ul><ul><li>Increase RR/depth to eliminate CO2 </li></ul><ul><li>Sequestration (hiding) H+ ions & CO2 in chemical & protein buffers </li></ul><ul><li>Kidneys conserve bicarbonate ions </li></ul><ul><li>LABORATORY VALUES </li></ul><ul><li>-The pH is low (under 7.35) and the pulmonary levels are increased ( > 26 mmol/l). </li></ul>
  14. 14. CAUSES <ul><li>COPD </li></ul><ul><li>Blockage of the airway due to swelling, </li></ul><ul><li>a foreign object, or vomit can induce respiratory acidosis. </li></ul><ul><li>Drugs like anesthetics, sedatives, and narcotics can interfere with breathing by depressing the respiratory center in the brain. </li></ul><ul><li>Head injuries or brain tumors can also interfere with signals sent by the brain to the lungs. </li></ul><ul><li>Such neuromuscular diseases as Guillain-Barré syndrome or myasthenia gravis can impair the muscles around the lungs making it more difficult to breathe. </li></ul><ul><li>Conditions that cause chronic metabolic alkalosis can also trigger respiratory acidosis. </li></ul>
  15. 15. MANIFESTATIONS <ul><li>restlessness </li></ul><ul><li>apprehension </li></ul><ul><li>lethargy are initial signs </li></ul><ul><li>muscle twitching, tremors, seizures, and coma can ensue; </li></ul><ul><li>rapid respirations initially and then decreased due to adaptation </li></ul><ul><li>vasodilation due to acidosis (CO2 is a vasodilator), </li></ul><ul><li>skin might be pink, unless there is hypoxemia </li></ul><ul><li>tachycardia. </li></ul><ul><li>Decreased blood pH; Increased PaCO2; Normal HCO3 or elevated if compensation is occurring </li></ul>
  16. 16. MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results. </li></ul><ul><li>Identify the underlying cause to intervene appropriately. </li></ul><ul><li>Restore alveolar ventilation (this will remove excess CO2), and if spontaneous ventilation is compromised (e.g. due to drug overdose or neuromuscular disorders) provide mechanical ventilation. </li></ul><ul><li>Monitor the pH, PaCO2, PaO2, and HCO3 very closely. A rapid decline of the PaCO2 can lead to respiratory alkalosis with seizures and death. </li></ul><ul><li>Check for hypoxemia and hypercapnia when administering oxygen. Oxygen can work as a respiratory depressant when the person's respiratory center is no longer stimulated by a low pH and elevated PaCO2. </li></ul><ul><li>Renal buffering generally corrects an uncomplicated chronic respiratory acidosis. </li></ul>
  17. 17. Respiratory Alkalosis <ul><li>DEFINITION </li></ul><ul><li>- Respiratory alkalosis is a condition where the amount of carbon dioxide found in the blood drops to a level below normal range. This condition produces a shift in the body's pH balance and causes the body's system to become more alkaline (basic). This condition is brought on by rapid, deep breathing called hyperventilation. </li></ul><ul><li>COMPENSATORY MECHANISM </li></ul><ul><li>Decrease RR/depth to retain CO2 </li></ul><ul><li>Release H+ ions from chemical & protein buffers </li></ul><ul><li>Kidneys eliminate bicarbonate buffers </li></ul><ul><li>LABORATORY VALUES </li></ul><ul><li>- The pH is higher (above 7.45) and the pulmonary levels are decreased(<22 mmol/l). </li></ul>
  18. 18. CAUSES <ul><li>anxiety, hysteria and stress </li></ul><ul><li>moving into high altitude areas, when the low atmospheric pressure of oxygen stimulates increased ventilation </li></ul><ul><li>pyrexia in fever, which stimulates the respiratory centre in the brainstem </li></ul><ul><li>drugs, including doxapram and large doses of aspirin, which also stimulate the respiratory centre </li></ul><ul><li>CNS causes, including stroke, subarachnoid haemorrhage, meningitis </li></ul><ul><li>pregnancy </li></ul><ul><li>a hypoxic drive in lung disease, such as pneumonia </li></ul><ul><li>caffeine overdose and coffee abuse </li></ul><ul><li>sexual activity due to excitation </li></ul>
  19. 19. MANIFESTATIONS <ul><li>confusion, </li></ul><ul><li>dizziness, </li></ul><ul><li>paresthesias (tingling of extremities), </li></ul><ul><li>seizures and coma; </li></ul><ul><li>tachypnea (deep and rapid respirations) causes respiratory alkalosis. </li></ul><ul><li>Nausea and vomiting might be present. </li></ul><ul><li>Increased blood pH; </li></ul><ul><li>Decreased PaCO2; </li></ul><ul><li>Normal HCO3 or decreased if compensation is occurring. </li></ul>
  20. 20. MEDICAL AND NURSING MANAGEMENT <ul><li>Assess the clinical symptoms, health history, and lab results. </li></ul><ul><li>Identify the underlying cause to intervene appropriately. </li></ul><ul><li>Correct the hypoxemia and reverse the hypermetabolic states if present. </li></ul><ul><li>Correct symptoms from hysterical hyperventilation by rebreathing from a paper bag (increases PaCO2). </li></ul>
  21. 21. THE URINARY SYSTEM
  22. 22. - The urinary system (also called excretory system or the genitourinary system) is the organ system that produces, stores, and eliminates urine. OVERVIEW OF ANATOMY AND PHYSIOLOGY In humans it includes <ul><li>two kidneys </li></ul><ul><li>two ureters </li></ul><ul><li>the bladder </li></ul><ul><li>and the urethra </li></ul><ul><li>The analogous organ in invertebrates is the nephridium </li></ul>
  23. 23. KIDNEYS <ul><li>The human kidneys: </li></ul><ul><ul><li>are two bean-shaped organs, one on each side of the backbone. </li></ul></ul><ul><ul><li>Represent about 0.5% of the total weight of the body, </li></ul></ul><ul><ul><li>but receive 20–25% of the total arterial blood pumped by the heart. </li></ul></ul><ul><ul><li>Each contains from one to two million nephrons. </li></ul></ul><ul><li>FUNCTIONS </li></ul><ul><ul><li>Blood Filtering </li></ul></ul><ul><ul><li>Excretion of waste products </li></ul></ul><ul><ul><li>Homeostasis </li></ul></ul><ul><ul><li>Acid-base balance </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Plasma volume </li></ul></ul><ul><ul><li>Hormone secretion </li></ul></ul>
  24. 24. The Nephron <ul><li>It consists of a: </li></ul><ul><li>Bowman's capsule.  Located at the closed end, the wall of the nephron is pushed in forming a double-walled chamber. </li></ul><ul><li>Glomerulus.  A capillary network within the Bowman's capsule. Blood leaving the glomerulus passes into a second capillary network (not shown in the figure) surrounding the </li></ul><ul><li>Proximal convoluted tubule. Coiled and lined with cells carpeted with microvilli and stuffed with mitochondria. </li></ul><ul><li>Loop of Henle.  It makes a hairpin turn and returns to the </li></ul><ul><li>Distal convoluted tubule, which is also highly coiled and surrounded by capillaries. </li></ul><ul><li>Collecting duct. It leads to the pelvis of the kidney from where urine flows to the bladder and, periodically, on to the outside world. </li></ul>- A nephron (from Greek νεφρός (nephros) meaning &quot;kidney&quot;) is the basic structural and functional unit of the kidney. -The nephron is a tube; closed at one end, open at the other.
  25. 26. URETERS <ul><li>- the ureters are muscular ducts that propel urine from the kidneys to the urinary bladder . In the adult, the ureters are usually 25–30 cm (10–12 in) long. </li></ul><ul><li>-It is responsible for transporting urine from the kidneys to the bladder. </li></ul><ul><li>URINARY BLADDER </li></ul><ul><li>- urinary bladder is a soild, muscular , and distensible (or elastic) organ that sits on the pelvic floor in mammals . </li></ul><ul><li>-It is the organ that collects urine excreted by the kidneys prior to disposal by urination . Urine enters the bladder via the ureters and exits via the urethra . </li></ul><ul><li>URETHRA </li></ul><ul><li>- urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the outside, and also a reproductive function in the male, as a passage for semen . </li></ul>
  26. 27. URINARY SYSTEM DISORDERS <ul><li>HYDRONEPHROSIS </li></ul><ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Hydronephrosis is distention and dilation of the renal pelvis and calyces , usually caused by obstruction of the free flow of urine from the kidney , leading to progressive atrophy of the kidney. </li></ul>
  27. 28. ETIOLOGY <ul><li>The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis . </li></ul><ul><li>The obstruction may arise from either inside or outside the urinary tract or may come from the wall of the urinary tract itself. </li></ul><ul><li>Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder. </li></ul><ul><li>Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurological deficits. </li></ul><ul><li>Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urinary tract </li></ul>
  28. 29. SCHEMATIC DIAGRAM
  29. 30. ASSESSMENT <ul><li>the kidney swells, due to a backup of urine. </li></ul><ul><li>nausea, </li></ul><ul><li>vomiting, </li></ul><ul><li>urinary tract infection, </li></ul><ul><li>fever, </li></ul><ul><li>painful urination, </li></ul><ul><li>increased urinary frequency and urgency, </li></ul><ul><li>flank pain, and swelling of the abdomen. </li></ul><ul><li>Unilateral hydronephrosis may occur without any symptoms, while acute obstruction can cause intense pain. </li></ul><ul><li>Blood tests can show raised creatinine and electrolyte imbalance. </li></ul><ul><li>Urinalysis may show an elevated pH due to the secondary destruction of nephrons within the affected kidney. </li></ul><ul><li>Loin or flank pain. </li></ul><ul><li>An enlarged kidney may be palpable on examination. </li></ul><ul><li>acute urinary retentio </li></ul>
  30. 31. <ul><li>DIAGNOSTICS </li></ul><ul><li>Abdominal ultrasound </li></ul><ul><li>Pyelogram </li></ul><ul><li>Surgery: pyeloplasty </li></ul><ul><li>PRE-OPERATIVE NURSING CARE </li></ul><ul><li>Informed consent </li></ul><ul><li>Physical exam </li></ul><ul><li>EKG (electrocardiogram) </li></ul><ul><li>CBC (complete blood count) </li></ul><ul><li>PT / PTT (blood coagulation profile) </li></ul><ul><li>Comprehensive Metabolic Panel (blood chemistry profile) </li></ul><ul><li>Urinalysis </li></ul><ul><li>Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery </li></ul><ul><li>NPO </li></ul>
  31. 32. INTRA-OPERATIVE NURSING CARE <ul><li>Laparoscopic pyeloplasty is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 3 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage/narrowing without having to place his hands into the abdomen. </li></ul><ul><li>A small plastic tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge the pyeloplasty repair and help drain the kidney. This stent will remain in place for 4 weeks and is usually removed in the doctor's office. A small drain will also be left exiting your flank to drain away any fluid around the kidney and pyeloplasty repair. </li></ul>
  32. 34. POST-OPERATIVE NURSING CARE <ul><li>Pain medication via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) </li></ul><ul><li>Medication is available to treat persistent nausea. </li></ul><ul><li>Incentive Spirometry </li></ul><ul><li>Early ambulation </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>MIO </li></ul><ul><li>COMPLICATIONS </li></ul><ul><li>Bleeding </li></ul><ul><li>Infection </li></ul><ul><li>Hernia </li></ul><ul><li>Tissue / organ injury </li></ul><ul><li>Conversion to open surgery </li></ul><ul><li>Failure to correct UPJ obstruction </li></ul>
  33. 35. NURSING DIAGNOSIS <ul><li>Urinary retention related to obstruction. </li></ul><ul><li>Impaired skin integrity related to presence of lesions. </li></ul><ul><li>Impaired physical mobility related to pain and inflammation. </li></ul><ul><li>High risk for infection related to altered immune response. </li></ul><ul><li>Pain related to obstruction, inflammation and pressure. </li></ul><ul><li>NURSING CARE </li></ul><ul><li>Treat the underlying cause </li></ul><ul><li>Promote urinary drainage with catheter </li></ul><ul><li>Urinary antiseptics </li></ul><ul><li>Antispasmodics for colicky spasms </li></ul>
  34. 36. NEPHROTIC SYNDROME <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Nephrotic syndrome refers to a number of renal conditions characterized by loss of protein in the urine. </li></ul><ul><li>ETIOLOGY </li></ul><ul><li>The most common primary causes are minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. </li></ul><ul><li>Secondary causes account for < 10% of childhood cases but > 50% of adult cases, most commonly diabetic nephropathy and pre-eclampsia. </li></ul><ul><li>Amyloidosis is an under recognized cause of 4% of cases. </li></ul>
  35. 37. PATHOPHYSIOLOGY <ul><li>- Damage to nephron causes it to not function, glomeruli allows excretion of protein in large amounts which causes upset in osmotic influence of vascular system, so fluid is pulled to interstitial spaces; decreased serum protein results. </li></ul>
  36. 38. ASSESSMENT <ul><li>proteinuria </li></ul><ul><li>progressive edema (eyes, ankles, face, anasarca)  hydrothorax, ascites, scrotum </li></ul><ul><li>weight  </li></ul><ul><li>Increased cholesterol and triglycerides (liver increases production of lipoproteins to compensate for protein loss) </li></ul><ul><li>vomiting; diarrhea, anorexia </li></ul><ul><li>RBC in urine (occult) </li></ul><ul><li>pale, irritable, listless </li></ul><ul><li>poor appetite </li></ul>
  37. 39. DIAGNOSTICS Urine protein tests Blood protein tests SURGERY : kidney transplant, nephrectomy <ul><li>PRE-OPERATIVE NURSING CARE </li></ul><ul><li>Informed consent </li></ul><ul><li>Physical exam </li></ul><ul><li>EKG (electrocardiogram) </li></ul><ul><li>CBC (complete blood count) </li></ul><ul><li>PT / PTT (blood coagulation profile) </li></ul><ul><li>Comprehensive Metabolic Panel (blood chemistry profile) </li></ul><ul><li>Urinalysis </li></ul><ul><li>Avoid medications 1 week prior to the date of surgery that can cause bleeding </li></ul><ul><li>Bowel Preparation </li></ul>
  38. 40. INTRA-OPERATIVE NURSING CARE <ul><li>-Laparoscopic partial nephrectomy is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 4 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the tumor without having to place his hands into the abdomen. The defect in the kidney is then sewn closed with sutures and a special sealant glue. The tumor is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites. </li></ul>
  39. 41. POST-OPERATIVE NURSING CARE <ul><li>Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) </li></ul><ul><li>You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea </li></ul><ul><li>You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while the patient is asleep) for approximately two days after the surgery. It is not uncommon to have blood-tinged urine for a few days after your surgery. </li></ul>
  40. 42. COMPLICATIONS <ul><li>Atherosclerosis and related heart diseases </li></ul><ul><li>Renal vein thrombosis </li></ul><ul><li>Acute renal failure </li></ul><ul><li>Chronic renal failure </li></ul><ul><li>Infections, including pneumococcal pneumonia </li></ul><ul><li>Malnutrition </li></ul><ul><li>Fluid overload, congestive heart failure, pulmonary edema </li></ul><ul><li>Severe infection. </li></ul><ul><li>Bleeding. </li></ul><ul><li>Reaction to the anesthesia used for surgery. </li></ul><ul><li>Failure of the donor kidney. </li></ul><ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Potential impairment of skin integrity due to edema </li></ul><ul><li>Ineffective individual coping due to long term illness </li></ul><ul><li>Altered nutrition less than body requirements due to anorexia and edema </li></ul><ul><li>High risk for infection due to decreased nutrition, immobility and edema </li></ul><ul><li>Knowledge deficit regarding health maintenance,lack of exposure/recall </li></ul>
  41. 43. INTERVENTIONS <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>1. DRUG THERAPY </li></ul><ul><li>a. Corticosteroids to resolve edema </li></ul><ul><li>b. Antibiotics for bacterial infections </li></ul><ul><li>c. Thiazide diuretics in edematous stage </li></ul><ul><li>d. Immunosupressants Therapy </li></ul><ul><li>2. Bed rest </li></ul><ul><li>3. Diet modification: high protein, low sodium </li></ul><ul><li>4. Monitor vital signs </li></ul><ul><li>5. Check daily weight/abdominal girth </li></ul><ul><li>6. MIO </li></ul>
  42. 44. URINARY TRACT INFECTIONS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it.When bacteria gets into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. </li></ul>
  43. 45. ETIOLOGY <ul><li>E.coli is main culprit </li></ul><ul><li>females>males </li></ul><ul><li>improper wiping </li></ul><ul><li>intercourse </li></ul><ul><li>bubble baths </li></ul><ul><li>trauma </li></ul><ul><li>Defects </li></ul><ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>- Growth of pathogens causes inflammation and irritation, edema of the ureters can occur resulting in obstruction of urine flow; eventual infection of the kidneys and renal pelvis occur </li></ul>
  44. 47. ASSESSMENT <ul><li>fever, </li></ul><ul><li>dysuria, </li></ul><ul><li>frequency, </li></ul><ul><li>urgency, </li></ul><ul><li>N & V, </li></ul><ul><li>wt. Loss, </li></ul><ul><li>abd. Or flank pain, </li></ul><ul><li>odor in urine; </li></ul><ul><li>may be asymptomatic with pyelo, </li></ul><ul><li>higher fever, </li></ul><ul><li>more back pain, </li></ul><ul><li>malaise, </li></ul><ul><li>vomiting – sicker! </li></ul><ul><li>Strong urge to urinate frequently, even immediately after the bladder is emptied </li></ul><ul><li>Painful burning sensation </li></ul><ul><li>Discomfort, pressure, or bloating in the lower abdomen </li></ul><ul><li>Cramping in the pelvic area or back </li></ul><ul><li>Cloudy or bloody urine, which may have a strong smell </li></ul>
  45. 48. DIAGNOSTICS <ul><li>Urine tests </li></ul><ul><li>Urinalysis </li></ul><ul><li>Ultrasound of urinary organs </li></ul><ul><li>Voiding cystourethrogram (VCUG) </li></ul><ul><li>Intravenous pyelogram (IVP) </li></ul><ul><li>Nuclear scans </li></ul><ul><li>COMPLICATIONS </li></ul><ul><li>Bacteremia </li></ul><ul><li>Chronic pyelonephritis </li></ul><ul><li>Renal abscess </li></ul><ul><li>Death </li></ul>
  46. 49. NURSING DIAGNOSIS <ul><li>High risk for infection due to catherization, alkaline urine </li></ul><ul><li>Perineal pain due to urinary tract infection </li></ul><ul><li>Knowledge deficit due to lack of information </li></ul><ul><li>INTERVENTIONS </li></ul><ul><li>A.MEDICAL </li></ul><ul><li>Administer antibiotics as ordered; prevention of kidney infection/glomerulonephritis important </li></ul><ul><li>sulfonamides or broad spectrum antibiotics </li></ul><ul><li>Eliminate infection </li></ul>
  47. 50. <ul><li>Identify and correct structural anomalies if present </li></ul><ul><li>Prevent recurrence </li></ul><ul><li>Preserve renal function </li></ul><ul><li>PREVENTION </li></ul><ul><li>Increase fluid, particularly those that acidify urine </li></ul><ul><li>Identify asymptomatic in fection </li></ul><ul><li>Cleanse genitalia from front to back </li></ul><ul><li>Void when necessary as opposed to holding urine in bladder. </li></ul>
  48. 51. ACUTE GLOMERULONEPHRITIS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>- Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering &quot;screens&quot; known as glomeruli that selectively remove uremic waste products. The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. </li></ul><ul><li>ETIOLOGY </li></ul><ul><li>Cryoglobulinemia </li></ul><ul><li>Goodpasteur’s syndrome (membranous antiglomerular basement membrane disease) </li></ul><ul><li>Lupus nephritis </li></ul><ul><li>Schönlein-Henoch purpura </li></ul><ul><li>Vasculitis </li></ul><ul><li>history of strep infection, scarlet fever or skin infection; peaks winter and spring; </li></ul><ul><li>males > female; 3-7 years </li></ul>
  49. 52. PATHOPHYSIOLOGY <ul><li>- antigen/antibody reaction, (to strep) affects glomerular tissue and alters permeability, causing spilling of blood and protein and eventually nephritic syndrome and renal failure. </li></ul>
  50. 53. ASSESMENT <ul><li>wide range; usually see ~ 1-3 week post strep infection; </li></ul><ul><li>urine cloudy; smoky brown  bloody; </li></ul><ul><li>periorbital edema; </li></ul><ul><li>fever (high 104  +, then  100  F); </li></ul><ul><li>HA; </li></ul><ul><li>diarrhea; </li></ul><ul><li>N/V; </li></ul><ul><li>CVA tenderness; </li></ul><ul><li> U/O -  S. G. with RBC, </li></ul><ul><li>WBC and protein; </li></ul><ul><li> bun and creatinine  RF; </li></ul><ul><li> K  renal failure; </li></ul><ul><li> BP and CV; </li></ul><ul><li>s/s CHF. </li></ul><ul><li>Sudden onset. </li></ul><ul><li>DIAGNOSTICS </li></ul>
  51. 54. <ul><li>DIAGNOSTICS </li></ul><ul><ul><li>Bladder Tests </li></ul></ul><ul><ul><li>Urinary Tract Infection (UTI) Tests </li></ul></ul><ul><ul><li>Cystitis Tests </li></ul></ul><ul><ul><li>Kidney Tests </li></ul></ul><ul><ul><li>Urine Protein Tests (Kidney Function) </li></ul></ul><ul><ul><li>Prostate Cancer Tests </li></ul></ul><ul><ul><li>Microalbumin Tests (Kidney) </li></ul></ul>
  52. 55. COMPLICATIONS <ul><li>Nephrotic syndrome </li></ul><ul><li>Acute nephritic syndrome </li></ul><ul><li>Chronic renal failure </li></ul><ul><li>End-stage renal disease </li></ul><ul><li>Hypertension </li></ul><ul><li>Malignant hypertension </li></ul><ul><li>Fluid overload -- congestive heart failure, pulmonary edema </li></ul><ul><li>Chronic or recurrent urinary tract infection </li></ul><ul><li>Increased susceptibility to other infections </li></ul><ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Fluid volume excess due to compromised regulatory mechanism, excess fluid intake, excess sodium intake </li></ul><ul><li>Alteration in nutrition due to compromised renal function </li></ul><ul><li>Activity intolerance due to need to rest the kidney </li></ul><ul><li>Potential impairment of the skin integrity due to edema </li></ul><ul><li>Potential for infection due to reduction in natural defense mechanisms </li></ul>
  53. 56. INTERVENTIONS <ul><li>MEDICAL </li></ul><ul><li>1. Antibiotic for streptococcal infection </li></ul><ul><li>2. Administer diuretics (Lasix) </li></ul><ul><li>3. Digitalis if circulatory overload </li></ul><ul><li>4. fluid restriction if renal insufficiency </li></ul><ul><li>5. Antihypertensive if BP severely elevated </li></ul><ul><li>6. Bed rest until gross hematuria is gone </li></ul><ul><li>7.Low salt diet </li></ul><ul><li>NURSING CARE </li></ul><ul><li>Diversional activities </li></ul><ul><li>Avoid fatigue </li></ul><ul><li>Watch for infection </li></ul><ul><li>VS, esp. BP!! </li></ul><ul><li>I & O, wts. </li></ul><ul><li>Urine for protein and blood </li></ul><ul><li>Educate parents </li></ul>
  54. 57. CHRONIC GLUMERULONEPHRITIS <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>-Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and gradual, progressive destruction of the glomeruli (internal kidney structures). </li></ul><ul><li>ETIOLOGY </li></ul><ul><li>Diabetic nephropathy/sclerosis </li></ul><ul><li>Focal segmental glomerulosclerosis </li></ul><ul><li>IgA nephropathy (Berger's disease) </li></ul><ul><li>Lupus nephritis </li></ul><ul><li>Membranous glomerulonephritis </li></ul><ul><li>Mesangial proliferative disorder </li></ul><ul><li>Nephritis associated with disorders such as amyloidosis, multipl myeloma, or immune disorders, including AIDS </li></ul>
  55. 58. PATHOPHYSIOLOGY <ul><li>-Reduction in nephron mass from the initial injury reduces the GFR. This reduction leads to hypertrophy and hyperfiltration of the remaining nephrons and to the initiation of intraglomerular hypertension. These changes occur in order to increase the GFR of the remaining nephrons, thus minimizing the functional consequences of nephron loss. The changes, however, are ultimately detrimental because they lead to glomerulosclerosis and further nephron loss. Accumulation of toxic waste products (uremic toxins) affects virtually all organ systems. Azotemia occurring with the signs and symptoms listed above is known as uremia. Uremia occurs at a GFR of approximately 10 mL/min. Some of these toxins (eg, BUN, creatinine, phenols, guanidines) have been identified, but none has been found to be responsible for all the symptoms. </li></ul>
  56. 59. ASSESSMENT <ul><li>Malaise </li></ul><ul><li>Weight loss </li></ul><ul><li>Edema </li></ul><ul><li>Increasing irritability </li></ul><ul><li>Mental cloudiness </li></ul><ul><li>Metallic taste in the mouth </li></ul><ul><li>Polyuria </li></ul><ul><li>Nocturia </li></ul><ul><li>Headache </li></ul><ul><li>Dizziness </li></ul><ul><li>Digestive disturbances </li></ul><ul><li>Respiratory difficulty </li></ul><ul><li>Angina </li></ul><ul><li>Anorexia </li></ul>
  57. 60. DIAGNOSTICS <ul><li>Urinalysis </li></ul><ul><li>BUN and serum creatinine </li></ul><ul><li>Immunologic tests </li></ul><ul><li>Renal biopsy </li></ul><ul><li>Surgery: kidney transplant </li></ul>
  58. 61. COMPLICATIONS <ul><li>High blood pressure. Damage to your kidneys and the resultant buildup of wastes in the bloodstream can raise your blood pressure. </li></ul><ul><li>Acute kidney failure </li></ul><ul><li>Chronic kidney failure </li></ul><ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Activity intolerance due to generalized weakness, electrolyte imbalance </li></ul><ul><li>Altered nutrition less than body requirements due to anorexia and edema </li></ul><ul><li>High risk for infection due to decreased nutrition, immobility, edema </li></ul>
  59. 62. INTERVENTIONS <ul><li>MIO </li></ul><ul><li>Assess specific gravity of urine </li></ul><ul><li>Weight the client daily </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Observe for complications such as renal failure cardiac failure and hypertensive encephalopathy </li></ul><ul><li>Evaluate lab. Results such as BUN, creatinine, urinalysis </li></ul>
  60. 63. REFERENCES: <ul><li>Medical-surgical Nursing (A nursing Process Approach,3 rd edition) by LONG, PHIPPS, CASSMEYER </li></ul><ul><li>Medical-surgical Nursing (A physiologic approach,3 rd edition) by Luckmann and Sorensen vol.2 </li></ul><ul><li>www.yahoo.com.ph </li></ul><ul><li>www.google.com.ph </li></ul><ul><li>Wikipedia, free encyclopedia </li></ul>
  61. 64. <ul><li>“ Desire is the key to motivation, but it's the determination and commitment to an unrelenting pursuit of your goal - a commitment to excellence - that will enable you to attain the success you seek. “ </li></ul><ul><li>Mario Andretti </li></ul>
  62. 65. <ul><li>THANK YOU FOR LISTENING….!!!! </li></ul><ul><li>Prepared by: </li></ul><ul><li>GROUP 1 </li></ul><ul><li>ARRIOLA, JOELITA D. </li></ul><ul><li>BANATE,MENCHE J. </li></ul><ul><li>BERMUDO, JOY ANNE F. </li></ul><ul><li>CULLO, ELEGEN M. </li></ul><ul><li>LUTCHING, ROQUE JR. C. </li></ul><ul><li>PAEZ, ELPIDIO JR. L. </li></ul>THANK YOU FOR LISTENING…!!! PREPARED BY: GROUP1 Arriola, Joelita D. Banate, Menche Bermudo, Joy Anne Cullo, Elegen Lutching, Roque Jr. Paez, Elpidio Jr.

×