Ncm Ppt6


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Ncm Ppt6

  2. 2. Acid-Base Regulation Acids release H + ions in a solution Overview: Hydrogen ions determine the relative acidity of body fluids by: Bases accept H + ions in a solution
  3. 3. <ul><li>The H + ion concentration of a solution is measured as its pH. </li></ul><ul><li>Relationship between Hydrogen ion concentration & pH: </li></ul><ul><ul><li>H + ↑ -- pH ↓ = solution becomes ACIDIC </li></ul></ul><ul><ul><li>H + ↓ -- pH ↑ = solution becomes ALKALITIC </li></ul></ul>
  4. 4. Normal Arterial Blood Gas Value Normal Range Significance pH 7.35 – 7.45 <ul><li>Reflects hydrogen ion concentration </li></ul><ul><li><7.35 = acidosis </li></ul><ul><li>> 7.45 = alkalosis </li></ul>PaCO 2 35 to 45 mmHg <ul><li>Partial pressure of CO 2 in arterial blood </li></ul><ul><li>< 35 mmHg = hypocapnia </li></ul><ul><li>>45 mmHg = hypercapnia </li></ul>PaO 2 80 – 100 mmHg <ul><li>Partial pressure of O 2 in arterial blood </li></ul><ul><li>< 80 mmHg = hypoxemia </li></ul>HCO 3 - 22 to 26 mEq/L Bicarbonate concentration in plasma
  5. 5. Acid-Base Balance Regulation <ul><li>Metabolic Process – continuously produce acids </li></ul><ul><li>2 Categories: </li></ul><ul><ul><li>Volatile Acids </li></ul></ul><ul><ul><li>- can be eliminated from the body as gas </li></ul></ul><ul><ul><li>- carbonic acid (H 2 CO 3 ) is the only volatile acid produced in the body </li></ul></ul><ul><ul><li>H 2 CO 3 -> CO 2 and H 2 O </li></ul></ul>
  6. 6. <ul><ul><li>Non-volatile Acid </li></ul></ul><ul><ul><li>- all other acids produced in the body that must be metabolized or excreted from the body fluids. </li></ul></ul><ul><ul><li>- examples are lactic acid, hydrochloric acid, phosphoric acid, sulfuric acid </li></ul></ul>
  7. 7. 1. Buffers 3 Systems working together in the body to maintain the pH despite continuous acid production: <ul><li>Buffer base </li></ul><ul><li>Buffer base includes - bicarbonates (HCO3) in plasma and red cells. phosphates (PO4) in plasma and red cells haemoglobin (Hb) and plasma proteins </li></ul>
  8. 8. 2. Respiratory System <ul><li>-regulates carbonic acid in the body by eliminating or retaining carbon dioxide. </li></ul><ul><li>Acute increases in carbon dioxide or hydrogen ions in the blood stimulate the respiratory center in the brain resulting to increased rate and depth of respiration. </li></ul><ul><li>Alkalosis, by contrast, depresses the respiratory center. Both rate and depth of respiration decrease, and CO 2 is retained. The retained carbon dioxide then combines with water to restore carbonic acid levels and bring the pH back within the normal range. </li></ul>Video clip of Acid-Base balance
  9. 9. 3. Renal System <ul><ul><li>Responsible for the long-term regulation of the acid-base balance in the body. The kidneys regulate bicarbonate levels in extracellular fluid by regenerating bicarbonate ions as well as reabsorbing them in the renal tubules. </li></ul></ul><ul><li>In acidosis, when excess hydrogen ion is present and the pH falls, the kidneys excrete hydrogen ions and retain bicarbonate. </li></ul><ul><li>In alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate to restore acid base balance. </li></ul>Video Clip of Urine formation
  10. 10. ACID-BASE IMBALANCES <ul><li>2 Major Categories: </li></ul><ul><ul><li>Acidosis – occurs when the hydrogen ion concentration increases above normal (pH below 7.35) </li></ul></ul><ul><ul><li>Alkalosis – occurs when the hydrogen ion concentration falls below normal (pH above 7.45) </li></ul></ul><ul><li>Classified as: </li></ul><ul><ul><li>Metabolic – primary change is in the concentration of bicarbonate </li></ul></ul><ul><ul><li>Respiratory – primary change in the concentration of carbonic acid. </li></ul></ul>
  11. 11. 7.40 7.35 7.45 COMPENSATED ACIDOSIS ALKALOSIS ABG Made Easy <ul><li>Anything below 7.35 is UNCOMPENSATED ACIDOSIS </li></ul><ul><li>Anything above 7.45 is UNCOMPENSATED ALKALOSIS </li></ul><ul><li>If less than 7.40 but NOT below 7.35 is COMPENSATED ACIDOSIS </li></ul><ul><li>If above 7.40 but NOT above 7.45 is COMPENSATED ALKALOSIS </li></ul><ul><li>pCO2 is ↓35 – RESPIRATORY ALKALOSIS </li></ul><ul><li>pCO2 ↑ 45 – RESPIRATORY ACIDOSIS </li></ul>
  12. 12. Metabolic Acidosis Definition: -characterized by low pH (<7.35) and low bicarbonate (<22mEq/L) Compensatory Mechanisms: - the respiratory system attempts to return the pH to normal by increasing the rate & depth of respiration. CO 2 elimination increases, and the PaCO 2 falls. Effects on ABG: ↓ pH ↓ HCO 3 - ↓ PaCO 2
  13. 13. Cause: Excess non-volatile acids; bicarbonate deficiency <ul><li>Manifestations: </li></ul><ul><li>Anorexia </li></ul><ul><li>Nausea & Vomiting </li></ul><ul><li>Abdominal Pain </li></ul><ul><li>Weakness </li></ul><ul><li>Fatigue </li></ul><ul><li>General Malaise </li></ul><ul><li>Decreasing level of consciousness </li></ul><ul><li>Dysrhythmias </li></ul><ul><li>Bradycardia </li></ul><ul><li>Warm, flushed skin </li></ul><ul><li>Hyperventilation (Kussmaul’s respirations) </li></ul>
  14. 14. <ul><li>Medications: </li></ul><ul><li>Sodium bicarbonate </li></ul><ul><li>lactate, citrate, and acetate solutions </li></ul><ul><li>( alkalinizing solutios are given IV for sever acute metabolic acidosis; oral route is given for chronic metabolic acidosis) </li></ul><ul><li>Diagnostic Tests: </li></ul><ul><li>ABG - < 7.35 pH; < 22 mEq/L; < PaCO2 </li></ul><ul><li>Serum electrolytes - ↑serum potassium, ↓magnesium levels. </li></ul><ul><li>ECG – may show changes which reflect both the acidosis & hyperkalemia </li></ul>
  15. 15. Nursing Management: <ul><li>Decreased Cardiac Output </li></ul><ul><li>Risk for Excess Fluid Volume </li></ul><ul><li>Risk for Injury </li></ul><ul><li>Acid-base management </li></ul><ul><li>Vital signs monitoring </li></ul><ul><li>Electrolyte management </li></ul><ul><li>Fluid management </li></ul><ul><li>Provide safety </li></ul><ul><li>Cardiac Pump Effectiveness </li></ul><ul><li>Electrolye & acid-base balance </li></ul><ul><li>Vital signs status </li></ul><ul><li>Safe from physical injury </li></ul>Nursing Management Nursing Intervention Nursing Outcomes
  16. 16. Metabolic Alkalosis Definition: - is characterized by a high pH (> 7.45) and a high bicarbonate ( > 26 mEq/L). Compensatory Mechanism: - Rate and depth of respirations decrease, retaining CO 2 Effects on ABG: - ↑pH - ↑ HCO 3 - - ↑PaCO 2
  17. 17. Nursing Management: Cause: Bicarbonate excess Nursing Diagnosis Nursing Interventions Nursing Outcomes <ul><li>Risk for Impaired Gas Exchange </li></ul><ul><li>Deficient Fluid volume </li></ul><ul><li>Acid-base management </li></ul><ul><li>Fluid Management </li></ul><ul><li>Intravenous therapy </li></ul><ul><li>Respiratory status: Gas exchange </li></ul><ul><li>Electrolytes & Acid-base balance </li></ul><ul><li>Fluid Balance </li></ul>
  18. 18. <ul><li>Manifestations: </li></ul><ul><li>Confusion </li></ul><ul><li>Decreasing levels of consciousness </li></ul><ul><li>hyperreflexia </li></ul><ul><li>Tetany </li></ul><ul><li>Dysrhythmias </li></ul><ul><li>Hypotension </li></ul><ul><li>Seizures </li></ul><ul><li>Respiratory failure </li></ul>
  19. 19. <ul><li>Diagnostic Tests: </li></ul><ul><li>ABG – pH > 7.45 and bicarbonate > 26 mEq/L; PaCO 2 is >45 mmHg </li></ul><ul><li>Serum electrolytes - ↓ potassium-serum (< 3.5 mEq/L) and decreased chloride (< 95 mEq/L). Serum bicarbonate level is high. </li></ul><ul><li>Urine pH - low (pH 1 to 3) if metabolic acidosis is caused by hypokalemia </li></ul><ul><li>ECG pattern – show changes similar to hypokalemia </li></ul>
  20. 20. Respiratory Acidosis Definition: - characterized by a pH of < 7.35 and a PaCO 2 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. Compensatory Mechanism: - Kidneys conserve bicarbonate to restore carbonic acid; bicarbonate ratio of 1:20
  21. 21. Effects on ABG: - ↓ pH - ↑ PaCO 2 - ↑HCO 3 - Causes: Retained CO 2 and excess carbonic acid <ul><li>Manifestations: </li></ul><ul><li>Acute Respiratory Acidosis: </li></ul><ul><ul><ul><ul><li>Headache </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Blurred Vision </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Warm, flushed skin </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Irritability, altered mental status </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Decreasing level of consciousness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cardiac arrest </li></ul></ul></ul></ul>
  22. 22. <ul><li>Continuation… </li></ul><ul><li>Chronic Respiratory Acidosis: </li></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Dull Headache </li></ul></ul><ul><ul><li>Sleep Disturbances </li></ul></ul><ul><ul><li>Impaired Memory </li></ul></ul>Diagnostic Test: ABG – pH < 7.35 and PaCO2 >45 mmHg. Serum electrolytes – may show hypochloremia (chloride level < 98 mEq/L) in chronic respiratory acidosis Pulmonary function – determine if chronic lung disease is caused by respiratory acidosis.
  23. 23. Nursing Management: Nursing Diagnosis Nursing Interventions Nursing Outcomes <ul><li>Impaired Gas exchange </li></ul><ul><li>Ineffective airway clearance </li></ul><ul><li>Acid-base management </li></ul><ul><li>Respiratory Monitoring </li></ul><ul><li>Ventilation assistance </li></ul><ul><li>Electrolytes & Acid-base balance </li></ul><ul><li>Respiratory status: ventilation </li></ul>
  24. 24. Respiratory Alkalosis Definition: - characterized by a pH > 7.45 and a PaCO 2 of < 35 mmHg. Compensatory Mechanism: Kidneys excrete bicarbonate and conserve H + to restore carbonic acid: bicarbonate ratio. Effects on ABG: - ↑pH - ↓PaCO 2 - ↓HCO 3
  25. 25. <ul><li>Manifestations: </li></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Numbness and tingling around mouth, hands and feet </li></ul></ul><ul><ul><li>Palpitations </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Chest tightness </li></ul></ul><ul><ul><li>Anxiety/panic </li></ul></ul><ul><ul><li>Tremors </li></ul></ul><ul><ul><li>Tetany </li></ul></ul><ul><ul><li>Seizures, loss of consciousness </li></ul></ul>Causes: Loss of CO 2 and deficient carbonic acid
  26. 26. Nursing Management: Diagnostic Tests: ABG - generally show pH > 7.45 and PaCO 2 less that 35 mmHg. Nursing Diagnosis Nursing Intervention Nursing Outcome <ul><li>Ineffective breathing pattern </li></ul><ul><li>Risk for injury </li></ul><ul><li>Acid-base management </li></ul><ul><li>Anxiety reduction </li></ul><ul><li>Anxiety control </li></ul><ul><li>Respiratory status: Gas exchange </li></ul>
  27. 28. <ul><li>are two bean-shaped organs, one on each side of the backbone. </li></ul><ul><li>Each kidney has a ureter which drains urine from the kidney central collecting area(renal pelvis) into the bladder. From the bladder, urine drains from the urethra, out of the body through the penis in male and the vulva in females. </li></ul><ul><li>receive 20–25% of the total arterial blood pumped by the heart. </li></ul><ul><li>Each contains from one to two million nephrons . </li></ul><ul><li>Functions of the kidney </li></ul><ul><li>Filter metabolic waste product and excess sodium and water from the blood and help eliminate them from the body </li></ul><ul><li>Regulate blood pressure and red blood cell production </li></ul><ul><li>Regulate acid-base balance </li></ul>Kidney
  28. 29. The Nephron <ul><li>The nephron is a tube; closed at one end, open at the other. It consists of a: </li></ul><ul><li>Bowman's capsule </li></ul><ul><li>Glomerulus </li></ul><ul><li>Proximal convoluted tubule </li></ul><ul><li>Loop of Henle </li></ul><ul><li>Distal convoluted tubule </li></ul><ul><li>Collecting duct </li></ul>
  29. 30. Hydronephrosis <ul><li>Is distention (dilatation) of the kidney with urine cause by backward pressure on the kidney when the flow of urine is obstructed </li></ul><ul><li>Assessment: </li></ul><ul><ul><li>Flank Pain </li></ul></ul><ul><ul><li>Abdominal mass </li></ul></ul><ul><ul><li>Nausea and vomiting </li></ul></ul><ul><ul><li>Urinary tract infection </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Painful urination (dysuria) </li></ul></ul><ul><ul><li>Increased urinary frequency </li></ul></ul><ul><ul><li>Increased urinary urgency </li></ul></ul>Specimen of a kidney that had undergone extensive dilation due to hydronephrosis . Note the extensive atrophy and thinning of the renal cortex.
  30. 31. <ul><li>Causes: </li></ul><ul><li>structural abnormalities </li></ul><ul><li>stones in the renal pelvis </li></ul><ul><li>compression of the ureter by fibrous bands, and abnormally located artery or vein or a tumor </li></ul><ul><ul><ul><ul><li>stones in the ureter </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tumor in or near the ureter </li></ul></ul></ul></ul><ul><ul><ul><ul><li>birth defect </li></ul></ul></ul></ul><ul><ul><ul><ul><li>an injury and an infection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>disorders from the muscle or nerve in the ureter or bladder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Formation of fibrous tissue resulting from surgery or drugs (methysergide) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>obstruction of urine flow, due to prostrate enlargement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>severe UTI </li></ul></ul></ul></ul>
  31. 32. Diagnostic exams: Ultrasound scanning Intravenoous urography X-ray Cystoscopy (with Video clip) <ul><li>Surgical Management </li></ul><ul><li>Urethral catheterization </li></ul><ul><li>A ureteral stent (tube that allows the ureter to drain into the bladder) </li></ul><ul><li>percutaneous nephrostomy tube (allows the blocked urine to drain through the back) </li></ul><ul><li>A narrow or abnormal section of the ureter may be surgically removed </li></ul>
  32. 33. Normal Abnormal                                                          
  33. 35. NEPHROTIC SYNDROME <ul><li>Is a disorder caused by damage to the small blood vessels in your kidneys that filter waste and excess water from your blood. When healthy, these small blood vessels keep blood protein from seeping into your urine and out of your body </li></ul><ul><li>ASSESSMENT: </li></ul><ul><li>Proteinuria </li></ul><ul><li>Increased WBC in the urine </li></ul><ul><li>Thromboembolism </li></ul><ul><li>Pulmonary emboli </li></ul><ul><li>Edema </li></ul><ul><li>Accelerated atherosclerosis </li></ul><ul><li>High serum cholesterol and low-density lipoprotein </li></ul>
  34. 36. CAUSES: <ul><li>Infection due to a deficient </li></ul><ul><li>immune response </li></ul><ul><li>Chronic glomerulonephritis </li></ul><ul><li>Diabetes mellitus with </li></ul><ul><li>intercapillary glomerulosclerosis </li></ul><ul><li>Amyloidosis of the kidney </li></ul><ul><li>Systematic lupus erythematosus </li></ul><ul><li>Multiple myeloma </li></ul><ul><li>Renal vein thrombosis </li></ul>
  35. 37. <ul><li>Protein electrophoresis </li></ul><ul><li>Immunoelectrophoresis </li></ul><ul><li>Needle biopsy </li></ul>DIAGNOSTIC EXAMS <ul><li>INTERVENTIONS: </li></ul><ul><li>MEDICAL </li></ul><ul><li>Diuretics </li></ul><ul><li>ACE inhibitors with loop diuretics </li></ul><ul><li>Antineoplastic agents </li></ul><ul><li>Immunosuppressants medications </li></ul><ul><li>Antibiotics </li></ul><ul><li>Statins </li></ul><ul><li>SURGICAL </li></ul><ul><li>Nephrectomy </li></ul>Histopathological image of diabetic glomerulosclerosis with nephrotic syndrome. H&E stain.
  36. 39. PATHOPHYSIOLOGY Damaged glomerular capillary membrane Loss of plasma proteins(Albumin) Hyperlipidemia Hypoalbuminemia Generalized edema Activation of Renin-Angiotensin system Sodium and water retention EDEMA Stimulates synthesis of lipoproteins Decreased oncotic pressure
  37. 40. <ul><li>COMPLICATIONS: </li></ul><ul><li>Thromboemboli (mobilized blood clots) </li></ul><ul><li>Renal vein thrombosis </li></ul><ul><li>Deep vein thrombosis </li></ul><ul><li>pulmonary embolism </li></ul>Nursing Diagnosis Excess fluid volume - it is due to excessive leakage of plasma proteins into the urine because of impairment of the glomerular capillary membrane
  38. 41. <ul><li>Nursing management </li></ul><ul><li>In the early stages, nursing management is similar to that of acute glomerulonephritis. </li></ul><ul><li>As the disease worsens, management is similar to that of chronic renal failure. </li></ul><ul><li>Monitor intake and output; note signs of low plasma volume and impaired circulation with prerenal acute renal failure. </li></ul><ul><li>Instruct patient in selecting a high-protein diet while restricting cholesterol and fat intake. </li></ul>
  39. 42. URINARY TRACT INFECTION <ul><li>Etiology </li></ul><ul><li>- most community acquired UTIs are caused by E.coli – a common gram(-) enteral bacteria. </li></ul><ul><li>- about 10%-15% of syumptomatic UTIs are caused staphylococcus saprophyticus , a gram(+) organism. </li></ul><ul><li>- catheter associated UTIs often involve other gram(-) bacteria such as proteus, Klebseilla, Seratia, Pseudomonas. </li></ul>
  40. 43. Lower UTI a.) Urethritis - inflammation of urethra b.) Prostatitis – infection of prostate gland c.) Cystitis – inflammation of urinary bladder Upper UTI a.) Pyelonephritis – inflammation of kidneys
  41. 44. Infection gain access to bladder SCHEMATIC DIAGRAM Colonized epithelium Evade host defense mechanism Inflammation Organisms ascends to urethra and bladder ADHERE MUCOSAL SURFACES
  42. 45. <ul><li>ASSESSMENT: </li></ul><ul><li>Frequency </li></ul><ul><li>Urgency </li></ul><ul><li>Burning sensation </li></ul><ul><li>Lower abdominal, flank and back pain </li></ul><ul><li>Nausea and Vomiting </li></ul><ul><li>Fever </li></ul><ul><li>DIAGNOSTICS </li></ul><ul><li>Urinalysis </li></ul><ul><li>Gram stain of the urine </li></ul><ul><li>Urine culture and sensitivity </li></ul><ul><li>WBC with differential </li></ul><ul><li>COMPLICATIONS </li></ul><ul><li>Sepsis ( urosepsis ) </li></ul><ul><li>Renal failure </li></ul>
  43. 46. NURSING DIAGNOSES: <ul><li>Acute pain related to infection within the urinary tract </li></ul><ul><ul><li>Is caused primarily by distention and increased pressure within the tract </li></ul></ul><ul><li>Impaired urinary elimination </li></ul><ul><ul><li>Inflammation of the bladder and urethral mucosa affects the normal process and patterns of voiding causing frequency, urgency and burning or urination as well as nocturia. </li></ul></ul>
  44. 47. <ul><li>Ineffective health maintenance </li></ul><ul><ul><li>the client with UTI is at an increased for future UTI and needs to understand the disease process, risk factors, measures to prevent recurrent infestion, diagnostic procedures and home care </li></ul></ul><ul><li>Deficient knowledge </li></ul><ul><ul><li>about factors predisposing the patient to infection and recurrence, detection and prevention of recurrence and pharmacologic therapy. </li></ul></ul>
  45. 48. NURSING INTERVENTION MEDICAL <ul><li> Antibacterial agents </li></ul><ul><ul><li>Eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora (3-4 days of treatment </li></ul></ul><ul><ul><li>Cephalosporins (Ampicillin) </li></ul></ul><ul><ul><li>-- aminoglycoside combination for complicated UTI, may require 7-10 days of therapy. </li></ul></ul><ul><ul><li>Levofloxacin ( Levaquis ) </li></ul></ul><ul><ul><li>-- good choice for short care therapy of uncomplicated, mild to moderate UTI </li></ul></ul><ul><ul><li>Nitrofurantoin </li></ul></ul><ul><ul><li>-- should not be used inpatients with renal insufficiency because it is ineffective at glomerular filtration rate decreased than 50 mg per minute and may cause peripheral neuropathy </li></ul></ul><ul><ul><li>Phenazopyridine ( Pyridium ) </li></ul></ul><ul><ul><li>-- a urinay analgesic to relieve the discomfort associated with infection. </li></ul></ul>
  46. 49. SURGICAL <ul><li>Surgery may be indicated for recurrent UTI if diagnostic testing indicates calculi, structural anomalies, or strictures that contribute to the risk of infection. </li></ul><ul><li>Uteroplasty – surgical repair of a ureter. </li></ul><ul><li>Ureteral Stent – a thin catheter inserted into the ureter to provide for urine flow and ureteral support. </li></ul>
  47. 50. NURSING CARE <ul><li>Promotive </li></ul><ul><li>Teach measures to prevent UTI to all clients, particularly to young, sexually active women. </li></ul><ul><li>Encourage clients to maintain a generous fluid intake of 2-2.5 quarts/day, increasing intake during hot weather or strenous activities </li></ul><ul><li>Discuss the need to avoid voluntary urinary retention, emptying the bladder every 3-4 hrs. </li></ul><ul><li>instruct women to cleanse the perineal area from front to back after voiding and defecating. </li></ul><ul><li>Teach to void before and after intercourse. </li></ul><ul><li>Avoid bubble bath, feminine hygiene sprays and vaginal douche. </li></ul><ul><li>Wear cotton briefs, avoid synthetic material. </li></ul><ul><li>If post menopausal, use hormone replacement therapy or estrogen cream </li></ul>
  48. 51. <ul><li>PREVENTION </li></ul><ul><li>Fluid intake (3-4L/day) </li></ul><ul><li>3 W’s: wash, wear, wipe </li></ul><ul><li>Empty bladder every 2-3 hours </li></ul><ul><li>Empty bladder immediately after intercourse </li></ul>
  49. 52. <ul><li>CURATIVE </li></ul><ul><li>Antibiotic therapy: Ciprofloxacin (Cipro), Cephalexin (Keflex ) </li></ul><ul><li>C and S of urine before antibiotic therapy </li></ul><ul><li>Acidify urine </li></ul><ul><li>Analgesic: PYRIDIUM (Phenazopyridine) </li></ul><ul><li>Urinary antiseptics : Cinoxacin (Cinobac), Norfloxacin (Noroxin) </li></ul><ul><li>Sulfonamides : Cotrimoxazole ( Bactrim) </li></ul><ul><li>Cholinergics : (to relieve urinary retention) Bethanechol Chloride (Urecholine) </li></ul><ul><li>Anticholinergics: Propantheline Bromide (Pro-Banthine) </li></ul>
  50. 53. ACUTE GLOMEROLUNEPHRITIS <ul><li>The inflammation of the gromerular capillary membrane. </li></ul><ul><li>Acute poststreptococcal gromerulonephritits is the most common form. </li></ul><ul><li>Infection of the pharynx or skin with group A ß-hemolytic streptococcus is the usual initiating event for this disorder. </li></ul>
  51. 54. Increased gromerular permeability Decreased GFR hematuria proteinuria azotemia Activation of renin- angiotensin-aldosterone system hypoalbuminemia Sodium and water retention edema hypertension Initiating event (infection, antigen/antibody formation, systemic disease) Gromerular-capillary membrane inflammation PATHOGENESIS OF GROMERULONEPHRITIS
  52. 55. <ul><li>ASSESSMENT: </li></ul><ul><li>Health history: complains of facial or peripheral edema or weight gain, fatique, nausea and vomiting, headache, general malaise, abdominal or flank pain; cough or shortness of breath; changes in amount, color or character of urine; history of skin or pharyngeal infection, diabetes, SLE, or kidney disease </li></ul><ul><li>Physical Examination: </li></ul><ul><li>General appearance; vital signs, weight, presence of periorbital, facial, or peripheral edema; </li></ul><ul><li>Skin for lesions, infection; inspect throat, obtain culture as indicated; urine specimen </li></ul>
  53. 56. DIAGNOSTICS: <ul><li>CREATININE CLEARANCE </li></ul><ul><li>Preparation of the client: </li></ul><ul><li>Obtain a 24-hour urine specimen container without preservative </li></ul><ul><li>Instruct to begin the specimen collection at the designated time by voiding and discarding this initial specimen. Collect all urine voided for the next 24 hours, emptying the bladder at the end of the collection time and saving the specimen. </li></ul><ul><li>Instruct to void and save the specimen prior to defecating to prevent contamination or loss of urine. </li></ul><ul><li>Refrigerate or keep the urine specimen on ice during the collection period. </li></ul><ul><li>Post signs in the client’s room and bathroom indicating the hours of urine collection to prevent inadvertent discarding of the urine. </li></ul><ul><li>Collect a venous blood sample during the 24 hour urine collection. </li></ul>
  54. 57. <ul><li>COMPLICATIONS: </li></ul><ul><li>Hematuria </li></ul><ul><li>Proteinuria </li></ul><ul><li>Salt and water retention </li></ul><ul><li>Edema, periorbital and facial, dependent </li></ul><ul><li>Patient Teaching: </li></ul><ul><li>Generally no special diet required during the test </li></ul><ul><li>Follow instructions for 24 hour specimen collection if the test is being done on an outpatient basis. </li></ul><ul><li>Hypertension </li></ul><ul><li>azotemia </li></ul><ul><li>Fatigue </li></ul><ul><li>Anorexia, nausea and vomiting </li></ul><ul><li>headache </li></ul>
  55. 58. <ul><li>NURSING DIAGNOSIS: </li></ul><ul><li>Excess Fluid Volume </li></ul><ul><li>Excess fluid volume and resulting edema are common manifestations of glomerural disoeders. When proteins are lost in the urine, the oncotic pressure of plasma falls, and fluid shifts into the interstitial spaces. </li></ul><ul><li>2. Fatigue </li></ul><ul><li>Anemia, loss of plasma proteins, headache, anorexia, and nausea compound this fatigue. The ability to maintain usual physical and mental activities may be impaired. </li></ul><ul><li>3. Imbalance nutrition: less than body requirements </li></ul>
  56. 59. Ineffective Protection The effects of both the gromerular disorder and treatment with anti-inflammatory and cytotoxic drugs can depress the immune system, increasing the risk for infection. 5. Ineffective role performance The manifestation and treatment of gromerular disorders can affect to maintain usual roles and activities. Fatigue and muscle weakness may limit physical and social activities. Bed rest or activity limitations may be ordered to minimize the degree of proteinuria.
  57. 60. <ul><li>KIDNEY SCAN (RENAL SCAN) </li></ul><ul><li>Preparation of the Client: </li></ul><ul><li>Informed consent is required. Provide teaching. </li></ul><ul><li>Make sure that the client is well hydrated prior to the procedure. Provide 2-3 glasses before the procedure as indicated. </li></ul><ul><li>Obtain weight </li></ul><ul><li>Have void prior to procedure </li></ul><ul><li>After the procedure, increase fluid intake to promote excretion of the radioisotope. </li></ul><ul><li>No special radioactivity precautions are indicated; instruct to flush the toilet after voiding and wash hands. </li></ul>INTERVENTIONS:
  58. 61. <ul><li>Patient Teaching: </li></ul><ul><li>Increase fluid intake before and after the renal scan </li></ul><ul><li>No special diet required </li></ul><ul><li>The test takes 1-4 hours </li></ul><ul><li>No anesthesia is required </li></ul>
  59. 62. RENAL BIOPSY <ul><li>Preparation of the client: </li></ul><ul><li>Provide informed consent. Provide additional information as needed. </li></ul><ul><li>Maintain NPO status from midnight before the procedure </li></ul><ul><li>Note Hgb & Hct prior to the procedure </li></ul><ul><li>If the procedure is to be performed at the bedside, obtain biopsy tray and other necessary supplies </li></ul><ul><li>Following the procedure, apply a pressure dressing and position supine to help maintain pressure on the biopsy site. </li></ul>
  60. 63. 6. Monitor closely for bleeding during the first 24 hours after the procedure. a. Check the V/S frequently. Notify the physician of tachycardia, hypotension, and other signs of shock. b. Monitor biopsy site for bleeding c. Check hemoglobin and hematocrit d. Observe for and report complains of back or flank pain, shoulder pain, pallor, lightheadedness e. monitor urine output for quantity and hematuria. 7. Encourage fluids during the initial postprocedure period
  61. 64. <ul><li>Patient Teaching: </li></ul><ul><li>Local anesthesia used at the injection site. Procedure may be uncomfortable but should not be painful. </li></ul><ul><li>When the needle is inserted, you will be instructed not to breath to prevent kidney motion. </li></ul><ul><li>The procedure takes approx. 10 minutes. </li></ul><ul><li>Avoid coughing during the first 24 hours after the procedure. Avoid strenous activity for approx. 2 weeks after the procedure. </li></ul><ul><li>Repot any signs and symptoms of complications, such as hemorrhage or UTI, to the physician. </li></ul>
  62. 66. <ul><li>NURSING CARE: </li></ul><ul><li>Promotion: </li></ul><ul><li>Discuss the importance of effectively treating streptococcal infections in all age groups to help reduce risks for acute glomerulonephritis. </li></ul><ul><li>Stress the importance of completing the course of antibiotic therapy to eradicate the infecting bacteria. </li></ul><ul><li>Teach clients with DM and SLE about potential renal effects of their disease. </li></ul><ul><li>Discuss measures to reduce th risk of associated nephritis, such as effectively managing the disease, treating hypertension and avoiding drugs and substances that are potentially toxic to the kidneys. </li></ul>
  63. 67. <ul><li>Preventive: </li></ul><ul><li>Avoid drugs or substances that can be toxic to the kidneys </li></ul><ul><li>Curative: </li></ul><ul><li>Prescribe treatment, including activity and diet restrictions. </li></ul><ul><li>Rehabilitative: </li></ul><ul><li>Take medicines and complete the course of antibiotic therapy as prescribed. </li></ul>
  64. 68. CHRONIC GLOMEROLUNEPHRITIS <ul><li>Typically the end stage of other glomerular disorders such as RPGN, lupus nephritis, or diabetic nephropathy. </li></ul><ul><li>Slow, progressive destruction of the glomeruli and a gradual decline in renal function are characteristic of chronic glomerulonephritis. The kidneys decrease in size symmetrically, and their surface become granular or roughened. Eventually, the nephrons are lost. </li></ul>
  65. 69. 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
  66. 70. <ul><li>CAUSES: </li></ul><ul><li>Repeated episodes of AGN </li></ul><ul><li>Hypertensive nephrosclerosis </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Chronic tubulointerstitial injury </li></ul>DIAGNOSTIC: Chest x-ray : may show cardiac enlargement and pulmonary edema. ECG: may indicate left ventricular hypertrophy and signs of electrolyte disturbances CTscan and magnetic resonance MRI – show a decrease in the size of the renal cortex.
  67. 71. Note: Nusing Care for Chronic Glomerulonephritis is the same as Acute Glomerulonephritis.
  68. 72. Thank You...! by: Group 2, BSN 3-Fisher