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Group 1 Robb

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Group 1 Robb Group 1 Robb Presentation Transcript

  • GROUP ACTIVITY POWERPOINT PRESENTATION Abella, Fernie Acielo, Kharen Grace Celoso, Rickel Dasas, Gerald Cris Otayde, Ruffa Tolentino, Santa Rina
    • URINARY SYSTEM
    • is a group of organs in the body concerned with filtering out excess fluid and other substances from the bloodstream.
    • Function:
    • Excretion
    • Maintain blood volume and concentration
    • pH regulation
    • Blood pressure
    • Erythrocyte concentration
    • Vitamin D production
  •  
    • KIDNEYS
    • are two bean-shaped organs, one on each side of the backbone.
    • each contains from one to two million nephrons.
    • Functions:
    • balance solute and water transport
    • excrete metabolic waste products
    • conserve nutrients
    • regulate acid – base balance
    • secrete hormones
    • form urine
  • The Nephron
    • The nephron is a tube; closed at one end, open at the other. It consists of a:
    • Bowman's capsule
    • Glomerulus
    • Proximal convoluted tubule
    • Loop of Henle
    • Distal convoluted tubule
    • Collecting duct
    • URETERS
    • are bilateral tube approximately 10 – 12 inches ( 25 – 30) long. It has 3 layers:
          • Epithelial mucosa
          • Middle layer of smooth muscles
          • Outer layer of fibrous connective tissue
    • Function:
    • transport urine from the kidney to the bladder trhough peristaltic waves.
    • URINARY BLADDER
    • is posterior to the symphysis pubis. The sizre of the bladder varies with the amount of urine it contain. It can hold 300 – 500 ml of urine before internal pressure rises and signals the need to empty the bladder through micturation.
    • Function:
    • serves as a storage site for urine.
    • MALES:
    • the bladder lies immediately in front of the rectum.
    • FEMALES:
    • the bladder lies next to the vagina and the uterus.
    • URETHRA
    • is a thin-walled muscular tube that channels urine to the outside of the body. It extends from the base of the bladder to the external urinary meatus.
    • MALES:
    • the urethra is approximately 8 inches long and serves as a channel for semen as well as urine. Prostate gland encircle the urethra at the base of the bladder.
    • FEMALES:
    • the urethra is approximately 1.5 inches long and the urinary meatus is anterior to the vaginal orifice.
    • ACID-BASE REGULATION
    • Overview:
    • most metabolic processes occurring in the body result in the production of acid.
    • pH – a reflection of acid to base in extracellular fluid.
    • It is the hydrogen ion concentration of a solution.
    • normal pH: 7.35 – 7.45
    • 7.35 acidic
    • 7.45 alkalitic
    • ACIDS – any substance capable of liberating a hydrogen ion.
    • BASES – any substance that can accept hydrogen ion, thereby taking out of solution.
    • 2 types of ACID-BASE REGULATION
    • chemical regulation - occurs through one or more buffering system by which Hydrogen ion are either added or eliminated.
    • Major chemical regulator of plasma pH is Bicarbonate-carbonic acid buffer system.
    • ratio = 20 parts bicarbonate-1 part carbonic acid maintains normal plasma pH.
    • oxygen regulation – lungs and kidneys facilitate the ratio of bicarbonate carbonic acid.
    • CO 2 + H 2 0 = H 2 CO 3 ( carbonic acid )
    • pH
    • 6.8 7.35 7.45 8.0
    Death Alkalosis Normal Acidosis Death
    • ACID – BASE IMBALANCES
    • 2 TYPES:
    • Acidosis- excessive accumulation of acids or excessive loss of bicarbonate in body fluids.
    • Alkalosis- excessive accumulation of bases or loss of acid in body fluids.
    • 4 sub types:
        • Metabolic acidosis
        • Metabolic alkalosis
        • Respiratory acidosis
        • Respiratory alkalosis
  • METABOLIC ACIDOSIS ↓ ↓ Anorexia Nausea and vomiting Abdominal pain Weakness Fatigue General malaise Decreasing level of consciousness Dysrhythmias Bradycardia Warm, flushed face Hyperventilation acid production. acid excretion bicarbonate loss chloride pH HCO 3 PaCO 2 Rate and depth of respirations increase, eliminating additional CO 2 (bicarbonate deficit)- is characterized by low ph (<7.35) and low bicarbonate (<22 mEq/L). It may be caused by excess acid or loss of bicarbonate from the body.. Manifestation Causes ABG Compensatory Mechanism Definition
    • Diagnostic Tests:
    • ABG - < 7.35 pH; < 22 mEq/L; < PaCO2
    • Serum electrolytes - ↑serum potassium, ↓magnesium levels.
    • ECG – may show changes which reflect both the acidosis & hyperkalemia
    • Medications:
    • Sodium bicarbonate
    • lactate, citrate, and acetate solutions
    • ( alkalinizing solutions are given IV for sever acute metabolic acidosis; oral route is given for chronic metabolic acidosis)
  • Nursing Management: Nursing Outcomes Nursing Intervention Nursing Management
    • Cardiac Pump Effectiveness
    • Electrolye & acid-base balance
    • Vital signs status
    • Safe from physical injury
    • Acid-base management
    • Vital signs monitoring
    • Electrolyte management
    • Fluid management
    • Provide safety
    • Decreased Cardiac Output
    • Risk for Excess Fluid Volume
    • Risk for Injury
  • METABOLIC ALKALOSIS Confusion Decreasing level of consciousness Hyperreflexia Tetany Dsyrhythias Hypotension Seizures Respiratory failure bicarbonate excess pH HCO 3 PaCO 2 Rate and depth of respirations decrease, retaining CO 2 Metabolic alkalosis (bicarbonate excess) is characterized by high ph(>7.45) and high bicarbonate (>26mEq/L).It may be caused by loss of acid or excess bicarbonate in the body. Manifestation Causes ABG Compensatory Mechanism Definition
  • Diagnostic Tests: ABG – pH > 7.45 and bicarbonate > 26 mEq/L; PaCO2 is >45 mmHg Serum electrolytes - ↓ potassium-serum (< 3.5 mEq/L) and decreased chloride (< 95 mEq/L). Serum bicarbonate level is high. Urine pH - low (pH 1 to 3) if metabolic acidosis is caused by hypokalemia ECG pattern – show changes similar to hypokalemia. Medical management: Prescribing K ( potassium salt ) if hypokalemia is present or NaCl solutions to correct volume depletion when extracellular fluid volume has decrease rapidly.
  • Nursing Management
    • Respiratory status: Gas exchange
    • Electrolytes & Acid-base balance
    • Fluid Balance
    • Acid-base management
    • Fluid Management
    • Intravenous therapy
    • Risk for Impaired Gas Exchange
    • Deficient Fluid volume
    Nursing Outcomes Nursing Interventions Nursing Diagnosis
  • RESPIRATORY ACIDOSIS ACUTE Headache Warm, flushed skin Blurred vision Irritability , altered mental status Decreasing LOC Cardiac arrest. CHRONIC Weakness Dull headache Sleep disturbance with daytime sleepiness Impaired memory Personality changes Retained CO 2 and excess carbonic acid. ↓ pH HCO 3 PaCO 2 Kidneys conserved bicarbonate to restore carbonic acid: bicarbonate ratio of 1:20 characterized by a pH of < 7.35 and a PaCO2 greater that 45 mmHg. It may be acute or chronic . In chronic respiratory acidosis, the bicarbonate is higher than 26 mEq/L as the kidneys compensate by retaining bicarbonate. Manifestation Causes ABG Compensatory Mechanism Definition
  • DIAGNOSTIC EXAM ABG’s show pH less than7.35 and Paco2 of more than mmHg Serum electrolytes may show hypochloremia (chloride level < 98mEq/L) in chronic respiratory acidosis. Pulmonary Function Test may be done to determine if chronic lung diseases is the cause of the respiratory acidosis. MEDICATION: Bronchodilator drugs Antibiotics prescribed to treat respiratory infections IV sodium bicarbonate
  • Nursing Management:
    • Electrolytes & Acid-base balance
    • Respiratory status: ventilation
    • Acid-base management
    • Respiratory Monitoring
    • Ventilation assistance
    • Impaired Gas exchange
    • Ineffective airway clearance
    Nursing Outcomes Nursing Interventions Nursing Diagnosis
  • RESPIRATORY ALKALOSIS Dizziness Numbness and tingling around mouth , of hands and feet Palpitations Dyspnea Chest tightness Anxiety/panic Tremors, tetany seizures, loss of consciousness Loss of CO2 and deficient carbonic acid. pH ↓ HCO 3 ↓ PaCO 2 Kidneys excrete bicarbonate and conserve Hydrogen ions to restore carbonic acid: bicarbonate ratio Respiratory alkalosis is characterized by a pH greater than 7.45 and Paco2 of less than 35 mmHg. It is always caused by hyperventilation leading to a carbon dioxide deficit. Manifestation Causes ABG Compensatory Mechanism Definition
  • DIAGNOSTIC EXAMS ABG’s generally show a pH greater than 7.45 and Paco2 less than 35 mmHg. In chronic hyperventilation, there is a compensatory decrease in serum bicarbonate to less than 22 mEq/ L and the pH may be near normal. MEDICATIONS: sedative or anxiety
  • Nursing Management:
    • Anxiety control
    • Respiratory status: Gas exchange
    • Acid-base management
    • Anxiety reduction
    • Ineffective breathing pattern
    • Risk for injury
    Nursing Outcome Nursing Intervention Nursing Diagnosis
    • HYDRONEPHROSIS
    • distention of renal PELVIS and CALICES with urine.
    • Cause:
    • obstruction or atrophy of the urinary tract.
    • Mechanical obstruction result from:
    • ureteral tumors, calculi, benign or malignant hyperplasia of the prostate, or carcinoma of the bladder, urethra, or glans penis
    • Inflammatory obstruction:
    • produces edema and narrowing of the urethra or ureter
    • Dilatation of structure behind obstruction
    • Backflow of urine
    • Dilatation of kidney pelvis
    • Pressure Stasis of urine
    • on kidney structure
    • Dilation of Pressure on
    • Kidney tubules renal arteries
    • Ischemia
    Infection calculi Infection calculi Tubular damage HYDRONEPHROSIS
  • Assessment:
    • Decreased urine blood flow
    • Hematuria, pyuria, dysuria, alternating oliguria and polyuria, and complete anuria
    • Mild pain
    • Nausea, vomiting, abdominal fullness, pain on urination, dribbling, and hesitancy
    • Severe, colicky renal pain or dull flank pain that may radiate to the groin
    • Diagnostics:
    • X-ray
    • Cystoscopy
    • Excretory urography
    • Retrograde pyelography
    • Renal ultrasonography
    • Surgical Management
    • Urethral catheterization
    • A ureteral stent (tube that allows the ureter to drain into the bladder)
    • percutaneous nephrostomy tube (allows the blocked urine to drain through the back)
    • A narrow or abnormal section of the ureter may be surgically removed
      • NEPHROTIC SYNDROME
      • A nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.
      • Causes:
      • tiny blood vessels in the kidneys that filter waste and extra water from the blood is damaged.
      • ASSESSMENT:
      • Anorexia
      • Ascites
      • Depression
      • High blood pressure
      • Lethargy
      • Orthostatic hypotension
      • Pallor
      • Periorbital edema
      • Fluid retention
  • Increased aldosterone secretion Decreased Renal function Salt and water retention Decreased renal function Edema NEPHROTIC SYNDROME Reduced intravascular oncotic pressure Loss of fluid into the interstitial space Reduced plasma volume
    • Diagnostics:
    • Urinalysis
    • Renal biopsy
    • Complications:
    • Thromboemboli (mobilized blood clots)
    • Renal vein thrombosis
    • Deep vein thrombosis
    • pulmonary embolism
  • Nursing Diagnosis
    • Excess fluid volume related to edema and fluid retention.
    • Altered nutrition: Less than body requirements related to excessive protein loss and anorexia.
    • Risk for infection related to suppression of inflammatory response.
    • Risk for impaired integrity related to edema.
    • INTERVENTIONS:
    • A. MEDICAL
    • Diuretics
    • ACE inhibitors with loop diuretics
    • Anticoagulants
    • Zinc
    • Corticosteroids
    • Salt-free albumin
    • K supplement
    • Mineral & electrolyte replacement
    • Prophylaxis
    • B. SURGICAL
    • Nephrectomy
    • Nursing Care:
    • Monitor intake and output.
    • Weigh daily
    • Check urine protein levels frequently
    • Give diuretics in the morning
    • High protein, low sodium diet
    • Give prophylaxis medication
    • Give potassium supplements
    • Give mineral and electrolytes supplements
    • Monitor BP
    • Provide good skin and oral care.
  • Urinary Tract Infection
    • Occurs when host resistance is impaired
    • Bacterial caused
    • Common in women
    • Can be acquired through blood or lymph or may enter urethra
    • May occur in upper portion of the urinary tract (pyelonephritis) or in lower (cystitis, urethritis)
    • Risk factors:
    • Female
    • Vaginal infections
    • tight-fitting synthetic undergarment
    • impaired bladder innervation
    • infrequent voiding
    • instrumentation
    • Lower UTI:
    • a.) Urethritis - inflammation of urethra
    • b.) Prostatitis – infection of prostate gland
    • c.) Cystitis – inflammation of urinary bladder
    • Assessment:
    • Abdominal pain or tenderness over the bladder area Hematuria
    • Chills
    • Cramps or bladder spasms
    • Dysuria Malaise
    • Feeling of warmth during urination Nausea and vomiting
    • Fever
    • Urinary urgency and frequency
    • Upper UTI:
    • a.) Pyelonephritis – inflammation of kidneys( 3 renal pelvis)
        • Acute – usually results from an infection that ascends to the kidney from lower UTI
        • Chronic – involve chronic inflammation and scarring of the tubules and interstitial tissues of kidneys
        • Assessment:
        • high fever
        • chills
        • dysuria
        • bladder irritation
        • chronic fatigue
        • severe pain
  • Infection gain access to bladder SCHEMATIC DIAGRAM Colonized epithelium Evade host defense mechanism Inflammation Organisms ascends to urethra and bladder ADHERE MUCOSAL SURFACES
    • Diagnostics:
    • Urinalysis- RBC & WBC increased, Pyuria
    • Gram stain of the urine
    • Urine culture and sensitivity
    • Voiding cystoureterography or excretory urography
    • CXR of kidney, ureter and bladder
    • Cystoscopy
    • BUN tests
    • Complications:
    • Renal or perirenal abscess formation
    • Renal failure
    • Nursing Diagnosis:
    • Acute pain related to infection within the urinary tract.
    • Risk for infection related to reflux of urine into the urinary tract.
    • Impaired urinary elimination.
    • Ineffective health maintenance.
    • Deficient knowledge
    • Nursing Management:
    • Medical:
    • 1.Antibacterial drugs
    • Trimethopin- sulfamethoxasole
    • 2.Anticholinergics and antispasmodic- Ditropan and propantheline
    • ACUTE GLOMERULONEPHRITIS
    • Nephritis – describes a group of inflammatory but non infectious diseases characterized by wide spread kidney damage.
    • Glomerulonephritis – is a type of nephritis that occurs most frequently in children and young adults.
    • - twice in men than women.
    • Causes:
    • appears about 2-3 weeks after an URTI with group A beta-hemolytic streptococci, impetigo and viral infections such as mumps, hepatitis B or HIV may precede to A.G.
  • Antigen( group A beta hemolytic streptococcus Antigen-antibody product Deposition of the antigens-antibody complex in glomerulus Increased production of epithelial cells lining the glomerulus Leukocyte infiltration of the glomerulus Thickening of the glomerular filtration membrane Scarring and loss of glomerular filtration membrane Decreased glomerular filtrations PATHOPHYSIOLOGY
    • Clinical manifestation
    • hematuria
    • Edema and hypertension
    • Azotemia
    • Proteinuria
    • In some severe cases/form of this disease may complain of:
    • Headache
    • Malaise
    • Flank pain
    • Dyspnea
    • Engorged neck veins
    • Cardiomegaly
    • Pulmonary edema
    • DIAGNOSTIC FINDINGS
    • URINALYSIS - gross or microscopic hematuria gives the urine a dark, smoky of frankly bloody.
    • LAB FINDINGS
      • proteinuria
      • elevated anti – streptolysin o titer
      • decreased Hgb
      • slightly increased BUN and serum creatinine levels
      • increased ESR
    • COMPLICATIONS:
    • Hematuria
    • Proteinuria
    • Salt and water retention
    • Edema, periorbital and facial, dependent
    • Hypertension
    • azotemia
    • Fatigue
    • Anorexia, nausea and vomiting
    • headache
    • Nursing Diagnosis
    • fluid volume excess related to increase Na ion retention.
    • infection related to group A β – hemolytic streptococcus
    • high risk for decrease cardiac output related to hypervolemia
    • risk for injury: Seizures related to hypertensive encephalopathy.
    • pain related to inflammatory response.
    • knowledge deficit related to new diagnosis.
    • INTERVENTIONS
    • MEDICAL
      • Antibiotics for streptococcal infection
      • Antihypertensive if blood pressure severely elevated
      • Digitalis if circulatory overload
      • Fluid restriction if renal insufficiency
      • Peritoneal dialysis if severe renal or cardiopulmonary problems develop
    • Nsg. Management:
    • bed rest when bp is elevated & edema is present.
    • Bp every 4 Hours as ordered.
    • encouraging adequate fluid intake.
    • monitor I&O.
    • Na & Protein are restricted.
    • increase in CHO to prevent catabolism of body protein stones.
    • CHRONIC GLOMERULONEPHRITIS
    • A slow progressive disease characterized by inflammation of the glomeruli.
    • causing irreversible damage to the nephrons.
    • Causes:
    • repeated A.G
    • DM
    • lupus erythematous
    • post streptoccal Glomerulonephritis
    • rapidly progressive Glomerulonephritis
    • Assessment:
    • generalized edema known as Anasarca (fluid shift from intravascular to interstitial & intacellular location.
  • Slow, progressive destruction of the glomerolus Cortex layer shrinks to 1-2 mm in thickness Bands of scar tissue distort the remaining cortex Surface of the kidney becomes rough & irregular shape Scarring at the glomeruli & tubules Thickenned branches of the renal artery Severe glomerular change End stage renal disease PATHOPHYSIOLOGY GLOMERULONEPHRITIS CHRONIC
    • DIAGNOSTIC EXAMS:
    • CBC- low RBC volume is detected.
    • BUN- Elevated serum creatinine, & uric acid levels.
    • Chest radiography
    • ECG (elevate cardia size because cardiac enlargement is common.
    • Percutaneous kidney biopsy
    • COMPLICATIONS:
    • Renal failure may develop
    • NSG. DIAGNOSIS
    • Excess fluid volume related to decreased glomerular filtration
    • Activity intolerance related to fatigue, anemia, retention of waste products & generalized edema.
    • Self-care deficit related to prescribed bed rest, lack of knowledge of treatment measures
    • Anxiety related to possibility of chronic illness
    • INTERVENTIONS:
    • A. Medical
    • Controlling HPN with medications & Na restrictions
    • Correcting fluid & electrolyte imbalance
    • Reducing edema with diuretic therapy
    • Eliminating UTI with antimicrobials
    • antibiotics
    • B. Surgical
      • Kidney transplant
    • Nursing Care
    • Accurately monitor V/S, I&O, & daily weight to evaluate fluid retention
    • Observe for signs of fluid, electrolyte, and acid base imbalances.
    • Low Na, high calorie meals with adequate proteins
    • Take diuretics in the morning so he won’t disrupt his sleeping patterns at night.
    • Monitor the patient closely and provide
    • supportive care.
    • REFERENCES:
      • Lippincott, Williams & Wilkins/ Understanding diseases/ © 2008/ pp 231-233
      • Individual Nsg. Care Plans © 2007 pp 449-480
      • Encycolpedia and Dictionary of Medicine Nursing Allied Health by Miller-keane 7 th edition ©2003 pp 854-855
      • Medical- Surgical Nursing 3rd edition/
      • Long, Phipps, Cassmeyer ©1994