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MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
MANAGEMENT OF PATIENT WITH RENAL DISORDER
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MANAGEMENT OF PATIENT WITH RENAL DISORDER

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  1. Chapter 44Management of Patients With Renal Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  2. Renal Disorders• Fluid and electrolyte imbalances• Most accurate indicator of fluid loss or gain in an acutely ill patient is weight Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  3. QuestionIs the following statement True or False?The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  4. AnswerTrueThe most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1 kg weight gain is equal to 1000 mL of retained fluid. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  5. Causes of Acute Renal Failure• Hypovolemia• Hypotension• Reduced cardiac output and heart failure• Obstruction of the kidney or lower urinary tract• Obstruction of renal arteries or veins Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  6. Causes of Chronic Renal Failure• Diabetes mellitus• Hypertension• Chronic glomerulonephritis,• Pyelonephritis or other infections• Obstruction of urinary tract• Hereditary lesions• Vascular disorders• Medications or toxic agents Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  7. Glomerular Diseases• An inflammation of the glomerular capillaries• Acute nephritic syndrome• Chronic glomerulonephritis• Nephrotic syndrome Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  8. Acute Nephritic Syndrome• Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis• Manifestations include hematuria, edema, azotemia, proteinuria, and hypertension• May be mild, or may progress to acute renal failure• Medical management includes supportive care and dietary modifications; treat cause if appropriate— antibiotics, corticosteroids, and immunosuppressants Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  9. Nursing Management: Acute NephriticSyndrome• Patient assessment• Maintain fluid balance• Fluid and dietary restrictions• Patient education• Follow-up care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  10. Chronic Glomerulonephritis• Causes include repeated episodes of acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage.• Symptoms vary; may be asymptomatic for years, as glomerular damage increases, before signs and symptoms develop of renal insufficiency/failure.• Abnormal laboratory tests include urine with fixed specific gravity, casts, and proteinuria; and electrolyte imbalances and hypoalbuminemia.• Medical management is determined by symptoms. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  11. Nursing Management ChronicGlomerulonephritis• Assessment• Potential fluid and electrolyte imbalances• Cardiac status• Neurologic status• Emotional support• Teaching self-care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  12. Nephrotic Syndrome• Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins• Results in hypoalbuminemia and edema• Causes include chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythmatosus, multiple myeloma, and renal vein thrombosis.• Medical management includes drug and dietary therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  13. Sequence of Events in NephroticSyndrome Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  14. Renal Failure• Results when the kidneys cannot remove wastes or perform regulatory functions• A systemic disorder that results from many different causes• Acute renal failure is a reversible syndrome that results in decreased GFR and oliguria• Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  15. Nursing Process: The Care of the Patientwith Renal Failure—Assessment• Fluid status• Nutritional status• Patient knowledge• Activity tolerance• Self-esteem• Potential complications Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  16. Nursing Process: The Care of the Patientwith Renal Failure—Diagnoses• Excess fluid volume• Imbalanced nutrition• Deficient knowledge• Risk for situational low self-esteem Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  17. Collaborative Problems/PotentialComplications• Hyperkalemia• Pericarditis• Pericardial effusion• Pericardial tamponade• Hypertension• Anemia• Bone disease and metastatic calcifications Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  18. Nursing Process: The Care of the Patientwith Renal Failure—Planning• Goals may include maintaining of IBW without excess fluid, maintenance of adequate nutritional intake, increased knowledge, participation of activity within tolerance improved self-esteem, and absence of complications. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  19. Excess Fluid Volume• Assess for signs and symptoms of fluid volume excess, and keep accurate I&O and daily weights• Limit fluid to prescribe amounts• Identify sources of fluid• Explain to patient and family the rationale for the restriction• Assist patient to cope with the fluid restriction• Provide or encourage frequent oral hygiene Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  20. Imbalanced Nutrition• Assess nutritional status; weight changes and lab data• Assess patient nutritional patterns and history; note food preferences• Provide food preferences within restrictions• Encourage high-quality nutritional foods while maintaining nutritional restrictions• Assess and modify intake related to factors that contribute to altered nutritional intake, eg, stomatitis or anorexia• Adjust medication times related to meals Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  21. Risk for Situational Low Self Esteem• Assess patient and family responses to illness and treatment• Assess relationships and coping patterns• Encourage open discussion about changes and concerns• Explore alternate ways of sexual expression• Discuss role of giving and receiving love, warmth, and affection Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  22. Hemodialysis System Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  23. Hemodialysis Catheter Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  24. Internal Arteriovenous Fistula and Graft Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  25. Peritoneal Dialysis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  26. Peritoneal Dialysis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  27. QuestionIs the following statement True or False?Failure of the temporary dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  28. AnswerFalseFailure of the permanent, not the temporary, dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  29. Nursing Management of the HospitalizedPatient on Dialysis (1 of 2)• Protection of vascular access; assess site for patency and signs of potential infection, and do not use for blood pressure or blood draws.• Monitor fluid balance indicators and monitor IV therapy carefully; accurate I&O, IV administration pump.• Assess for signs and symptoms of uremia and electrolyte imbalance; regularly check lab data.• Monitor cardiac and respiratory status carefully.• Hypertension: monitor blood pressure, antihypertensive agents must be held on dialysis days to avoid hypotension. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  30. Nursing Management of the HospitalizedPatient on Dialysis (2 of 2)• Monitor all medications and medication dosages carefully. Avoid medications containing potassium and magnesium.• Address pain and discomfort.• Stringent infection control measures.• Dietary considerations: sodium, potassium, protein, and fluid; address individual nutritional needs.• Skin care: pruritis is a common problem; keep skin clean and well moisturized, and trim nails and avoid scratching.• CAPD catheter care. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  31. Kidney Surgery• Preoperative considerations• Perioperative concerns• Postoperative management – Potential hemorrhage and shock – Potential abdominal distention and paralytic ileus – Potential infection – Potential thromboembolism Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  32. Patient Positioning and IncisionalApproaches Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  33. Renal Transplantation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  34. Postoperative Nursing Management• Assessment: include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system• Diagnoses: ineffective airway clearance, ineffective breathing pattern, acute pain, fear and anxiety, impaired urinary elimination, and risk for fluid imbalance• Complications: bleeding , pneumonia, infection, and DVT Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  35. Interventions• Pain relief measures and analgesic medications• Promote airway clearance and effective breathing pattern by appropriate pain relief, deep breathing coughing exercises, and incentive spirometry and positioning• Monitor UO and maintain potency of urinary drainage systems• Use strict asepsis with catheter and appropriate technique in providing all care• Monitor for signs and symptoms of bleeding• Encourage leg exercises, early ambulation, and monitor for signs of DVT Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  36. Patient Teaching• Instruct both patient and family• Drainage system care• Strategies to prevent complications• Signs and symptoms• Follow-up care• Fluid intake• Health promotion and health screening Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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