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Urinary System Disorders: Urethra, Bladder, Ureters, Kidney

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Urinary system disorders.pptx1

  1. 1. URINARY SYSTEM DISORDERS<br />
  2. 2. Objectives:<br />After 12 hrs. varied teaching learning activities, the students should:<br />Review the anatomy and physiology of the urinary system.<br />Explain the role of the urinary system in maintaining homeotasis.<br />Identify abnormal findings that may indicate impairment of the urinary system.<br />Implement appropriate nursing management techniques for patients with urinary and kidney problem<br />Use the nursing process as framework, for the care of patients undergoing surgery.<br />Demonstrate compassion when caring for patients with Urinary system problem<br />
  3. 3. Overview<br />4 components<br />
  4. 4.
  5. 5. Anatomy of the Kidney<br />Cup-like that collects its urine<br />
  6. 6. The Nephron<br />Basic structural and functional unit of kidney<br />
  7. 7. AMOUNT AND COMPOSITION OF BODY FLUIDS<br />60% of adult’s weight – fluids and electrolytes.<br />FACTORS THAT INFLUENCE THE AMOUNT OF BODY FLUID<br />Age Medications<br />Surgery Stress<br />Illness Diet<br />Gender<br />Body Fat<br />Climate<br />
  8. 8. 2 FLUID COMPARTMENTS<br />Intracellular – 2/3 of body fluids in the skeletal muscle mass<br />Extracellular<br />Intravascular – contains plasma - 3L of the 6L of blood volume<br />Interstitial – fluids that surrounds the cell = 11–12 L<br />Transcellular– contains approximately 1L of fluid. Ex. CSF, pericardial, synovial, intraocular, pleural, sweat<br />
  9. 9. FLUID INTAKE<br />Fluid requirement/day- 2,500 mL<br />Ave. adult drinks 1,500 mL/day<br />Remaining 1,000 mL is preformed water.<br />Thirst is triggered by:<br />Intracellular dehydration<br />Excess angiotensin II (potent vasoconstrictor)<br />Hemorrhage<br />
  10. 10. ROUTES OF GAINS AND LOSES<br /><ul><li>Kidneys – 1-2 L daily urine volume</li></ul> - 1 mL urine/kg/hr<br /><ul><li>Skin – 0-1,000 mL or more/hr (varies)</li></ul> - sensible<br /> -insensible – 600 mL/day<br /><ul><li>Lungs – 400 mL/hr
  11. 11. GI tract – 100-200 mL/day</li></li></ul><li>FLUID IMBALANCES<br />2 BASIC TYPES<br />Isotonic – occurs when water and electrolytes are lost and gained in equal proportions<br />Osmolar – loss or gain of only water<br />4 CATEGORIES OF FLUID IMBALANCE<br />Isotonic loss of water and electrolytes (Fluid volume deficit)<br />Osmolar loss of only water (Dehydration)<br />Isotonic gain of water and electrolytes (fluid volume excess)<br />Osmolar gain of only water (Overhydration)<br />
  12. 12. Formation of Urine<br />THREE PROCESSES IN URINE FORMATION<br />Glomerular Filtration<br />Tubular reabsorption<br />Tubular secretion<br />Glomerular Filtration Rate- amount of fluid filtered from the blood into the capsule per minute.<br />120-125 ml/min held constant by instrinsic control<br />Myogenic<br />Reninangiotensin mechanism<br />
  13. 13.
  14. 14. CHARACTERISTICS OF NORMAL URINE<br />Pale to deep yellow, clear<br />Odor – Aromatic<br />Specific Gravity – 1.001 – 1.030<br />pH- 4.5-8.0<br />Protein – Negative to trace<br />Glucose – Negative<br />WBC – 0-5 hpf<br />RBC – 0-5/hpf<br />Casts – Negative to occasional<br />
  15. 15. Defects of Genitourinary Tract<br />Inguinal Hernia<br />Hydrocele- fluid in the scrotum<br />Phimosis – narrowing or preputial opening of foreskin<br />Hypospadias – urethral opening located behind the glans penis<br />Epispadias<br />Chordee – ventral curvature of penis<br />
  16. 16. UTI<br />a bacterial infection that affects any part of the urinary tract.<br />The most common type of UTI:<br />bladder infection (cystitis).<br />kidney infection (pyelonephritis)<br />Risk Factors<br />Female:<br />Short, straight urethra<br />Proximity of urinary meatus to vagina and anus<br />Sexual intercourse<br />Use of spermicidal compound for birth control<br />Male:<br />Uncircumcized<br />Prostatic hypertrophy<br />Rectal intercourse<br />Both:<br />Aging<br />Urinary tract obstruction<br />Neurogenic bladder dysfunction<br />Vesicoureteral reflux<br />Genetic factors<br />Catheterization<br />
  17. 17. Symptoms & Signs<br />For bladder infection<br />Frequent urination along with the feeling of having to urinate even though there may be very little urine to pass. <br />Nocturia<br />Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with urination (dysuria). <br />Pain in the midline suprapubic region. <br />Pyuria<br />Hematuria<br />Pyrexia<br />Cloudy and foul-smelling urine <br />Some urinary tract infections are asymptomatic<br />
  18. 18. For Kidney Infections<br />Aforementioned symptoms. <br />Emesis<br />Back, side (flank) or groin pain. <br />Abdominal pain or pressure. <br />Shaking chills and high spiking fever. <br />Night Sweats. <br />Extreme Fatigue. <br />
  19. 19. Epidemiology<br />Most common in sexually active women<br />Diabetes<br />anatomical malformations of the urinary tract.<br />Allergies<br />Use of urinary catheters as bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium<br />
  20. 20. CYSTITIS<br />PYELONEPHRITIS<br />Is inflammation of the urinary bladder<br />Types<br />bacterial cystitis most often caused by coliform bacteria being transferred from the bowel through the urethra into the bladder <br />interstitial cystitis (IC) is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection<br />radiation cystitis often occurs in patients undergoing radiation for the treatment of cancer. <br />inflammation of the renal pelvis, and kidney tissues.<br />Acute- bacterial “ascending infection”<br />Chronic-non bacterial and inflammatory processes <br />
  21. 21. Causes, incidence and risk factors<br />sexually active women ages 20 to 50 but may also occur in those who are not sexually active or in young girls.<br />escherichia coli ("E. coli“)<br />Sexual intercourse<br />insertion of instruments into the urinary tract<br />obstruction of the bladder or urethra with resultant stagnation of urine<br />
  22. 22. Diagnosis<br />urine culture and sensitivity<br />urinalysis.<br />IVP<br />Cystoscopy<br />Manual prostate and pelvic exam<br />Treatment<br />oral antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMZ), cephalosporins, nitrofurantoin, or a fluoroquinolone (e.g. ciprofloxacin, levofloxacin). <br />
  23. 23. Nursing Management<br />increased water-intake<br />frequent voiding<br />avoidance of sugars and sugary foods<br />Avoid caffeinated drinks<br />drinking unsweetened cranberry juice<br />as well as taking vitamin C with the last meal of the day<br />Prevention<br />Cleaning the urethral meatus after intercourse<br />urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra. <br />Having adequate fluid intake, especially water. <br />Not resisting the urge to urinate. <br />Bathing in warm water without soap, bath foams, etc. <br />Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens. <br />
  24. 24. URINARY RETENTION<br />also known as ischuria is a lack of ability to urinate<br />Signs and Symptoms<br />poor urinary stream with intermittence<br />straining, a sense of incomplete voiding and urgency<br />
  25. 25. Causes:<br />BPH<br />Prostatic Cancer<br />Damage to the bladder<br />Obstruction in the urethra<br />
  26. 26. Diagnostic tests<br />Uroflowmetry may aid in establishing the type of micturition abnormality. A post-void residual scan may show the amount of urine retained. <br />Serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate cancer. <br />Urea and creatinine determinations may be necessary to rule out backflow kidney damage.<br />
  27. 27. obstruction of the urinary tract may cause:<br />Bladder stones<br />Hydronephrosis<br />Diverticula<br />
  28. 28. Treatment<br />ACUTE :<br />urinary catheterization <br />suprapubiccystostomy<br />CHRONIC:<br />transurethral resection of the prostate, TURP<br />
  29. 29. Benign prostatic hyperplasia<br />increase in size of the prostate in middle-aged and elderly men<br />Symptoms:<br />urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary retention.<br />results in: <br />stasis of bacteria in the bladder residue and an increased risk of urinary tract infections. Urinary bladder stones, Urinary retention<br />
  30. 30. Diagnosis<br />Rectal examination<br />blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels<br />transrectalultrasonography<br />Ultrasound examination of the testicles, prostate and kidneys<br />
  31. 31. Treatment<br />Lifestyle<br />Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules.<br />Medications<br />Alpha blockers (α1-adrenergic receptorantagonists) provide symptomatic relief of BPH symptoms. Available drugs include doxazosin, terazosin, alfuzosin and tamsulosin. <br />Alpha-blockers relax smooth muscle in the prostate and the bladder neck, and decrease the degree of blockage of urine flow. <br />The 5α-reductase inhibitors (finasteride and dutasteride) are another treatment option. When used together with alpha blockers a reduction of BPH progression to acute urinary retention and surgery has been noted in patients with larger prostates.<br />
  32. 32. Surgery<br />If medical treatment fails, transurethral resection of prostate (TURP)<br />Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), TransUrethral Microwave ThermoTherapy (TUMT), TransUrethral Needle Ablation (TUNA), ethanol injection<br />
  33. 33. KIDNEY STONE ALSO CALLED RENAL CALCULI<br />are solid concretions (crystal aggregations) of dissolved minerals in urine<br />nephrolithiasis and urolithiasis<br />at least 2-3 millimeters can cause obstruction of the ureter.<br />severe episodic pain, most commonly felt in the flank, lower abdomen and groin a condition called renal colic<br />Hematuria<br />Staghorn calculus (struvite stone)<br />Star shaped bladder urolith<br />
  34. 34. Kidney Stones<br />Calcium oxalate stones -consumption of low-calcium diets <br />Other types of kidney stones are composed of struvite(magnesium, ammonium and phosphate) are always associated with urinary tract infections<br />uric acid is associated with conditions that cause high blood uric acid levels, such as gout, leukemias; <br />calcium phosphate is associated with conditions such as hyperparathyroidism and renal tubular acidosis.<br />cystine.<br />
  35. 35. Medical Management<br />non-invasive Extracorporeal Shock Wave Lithotripsy or (ESWL) <br />Ureteral (double-J) stents<br />
  36. 36. HYDRONEPHROSIS<br />is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney.<br />Ultrasound picture of hydronephrosis caused by a left ureteral stone.<br />
  37. 37. Etiology<br />The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis.<br />The obstruction may arise from either inside or outside the urinary tract or may come from the wall of the urinary tract itself.<br /> Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder.<br /> Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurologicaldeficits. <br />Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urinary tract.<br />
  38. 38. Acute renal failure<br />is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. <br />Characteristics<br />1. Abrupt onset<br />2. Lead to<br />a.Azotemia = accumulation of nitrogenous wastes in the blood<br /><ul><li>b. Oliguria = < 400 ml per 24 hours; 40% of failure is nonoliguric or anuria</li></li></ul><li>Causes<br />Acute Renal Failure<br />Pre-renal Functional<br />Post-renal Obstructive<br /> Renal Structural<br />a. decrease in renal perfusion pressure; no kidney pathology<br />a. Any obstruction to excretion of normal urine<br />a. Acute parenchymal changes that damage nephrons<br />b. Intrarenal = uric acid crystals and methotrexate toxicity<br />b. Specifically: acute glomerulonephritis, vascular disease, interstitial nephritis, acute tubular necrosis<br />b. Hepatorenal syndrome from hemorrhage, dehydration, excessive diuresis or massive paracentesis]<br />c. Extrarenal = BPH, renal calculi, and obstruction to flow (more common)<br />
  39. 39. Comparing Categories of Acute Renal Failure <br />
  40. 40. Pre-renal (causes in the blood supply): <br />Hypovolemia, usually from shock or dehydration<br />fluid loss or excessive diuretics use.<br />hepatorenal syndrome in which renal perfusion is compromised in liver failure vascular problems, such as atheroembolic disease and renal vein thrombosis (which can occur as a complication of the nephrotic syndrome) <br />
  41. 41. Renal (damage to the kidney itself):<br />infection usually sepsis (systemic inflammation due to infection),rarely of the kidney itself, termed pyelonephritis toxins <br />medication (e.g. some NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium) rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the blood affects the kidney; it can be caused by injury (especially crush injury and extensive blunt trauma), statins, stimulants and some other drugs <br />hemolysis - the hemoglobin damages the tubules; it may be caused by various conditions such as sickle-cell disease<br />
  42. 42. Post-renal (obstructive causes in the urinary tract)<br />due to: medication interfering with normal bladder emptying. <br />benign prostatic hypertrophy or prostate cancer. <br />kidney stones. due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer). obstructed urinary catheter. <br />
  43. 43. D. Pathogenesis<br />1. Loss of renal autoregulation (altered renal blood flow)<br />2. Initially renal blood flow decrease, but then GFR decreases out of proportion to renal flow<br />3. Tubular obstruction may cause tubular reabsorption and (tubular obstruction)<br />4. Decreased GFR because of hydrostatic pressure (back leak theory)<br />E. Clinical picture<br />1. Severe decrease GFR<br />2. Oliguria or anuria (30-50% no oliguria)<br />3. Increased BUN & creatinine<br />
  44. 44. Type of acute renal failure<br />Acute tubular necrosis = ARF caused by destruction of tubular epithelial cells<br />1. ATN = most common cause of ARF<br />2. Common causes <br />a.Ischemiaresulting from shock, hemolysis or skeletal muscle breakdown; patchy damage to tubules with blocking of tubule by cell casts & dilation of Bowman's capsule.<br />b. Nephrotoxicagents from hemolysis, intravascular coagulation, precipitation of oxalate and uric acid crystals, and tissue hypoxia; more damage to & casts in distal tubules and necrosis in all nephrons.<br />Aging with decrease in nephrons or dehydration can increase toxicity<br /><ul><li>Many antibiotics (tetracyclines, aminoglycosides cephalosporins, ampho-B) and contrast materials with iodine</li></li></ul><li>F. Stages of ARF<br />1. Initiation = inciting event causing tubular necrosis & altered blood flow<br />2. Maintenance stage (1-3 weeks)<br />a. Oliguria<br />b. Electrolyte imbalances<br />c. Urine specific gravity at 1.010 which = plasma specific gravity<br />d. Renal blood flow down which = decrease GFR<br />e. Water excess with dilutional hyponatremia<br />f. Hyperkalemia from decreased excretion and excessive muscle breakdown; also increased creatinine, phosphate, and urea<br />g. Metabolic acidosis<br />
  45. 45. h. Anemiabecausesuppressederythropoietin<br />i. Progressiveazotemia<br />3. Recovery (begins >24 hrs post onset)<br />a.Diuresis; gradual increase in output asmuchas 6L/day<br />b. Tubular function still altered because large amounts of Na+ and K+ still lost in urine<br />c. Dehydration, hypokalemia<br />d. Increased RBC production<br />e. Continues over 6-12 months; 30% never fully recover renal function<br />
  46. 46. G. Treatment principles<br /><ul><li> correcting fluid and electrolyte disturbances
  47. 47. treating infections
  48. 48. nutrition
  49. 49. drugs and metabolites aren't excreted</li></ul>II. Chronic renal failure= slowly progressive loss of nephrons and damage to glomeruli characterized by irreversible reduction in the GFR. Affects all functions normally carried out by the kidneys.<br />A. Causes:<br />1. Glomerulopathies<br />2. Tubulo-interstitial renal diseases<br />3. Hereditary diseases<br />4. Vascular diseases:<br />5. Obstructive nephropathy<br />
  50. 50. B. Problems created by CRF<br />1. Fluid imbalance<br />Unable to concentrate urine early so excess H20 loss<br />Until 25% loss of function maintains solute, then once past threshold osmotic diuresis with dehydration<br />As progresses, inability to dilute urine so isosthenuria (urine and plasma have same, fixed specific gravity 1.010)<br />2. Na+ imbalance<br />a. Intact nephrons receive more Na+ so...<br />b. Osmotic diuresis, so...<br />c. Reduction in blood volume and GFR<br />
  51. 51. 3. K+ imbalance<br />a. If water balance is maintained and acidosis controlled, not a problem<br />b. Hyperkalemia if increased acidosis or hyponatremia or catabolism<br />c. Hypokalemia if diuretic therapy, vomiting, renal tubular disease that prevents reabsorption.<br />4. Acid-base imbalance<br />a. Metabolic acidosis because kidneys can't excrete enough H+<br />b. Renal tubule dysfunction leads to progressive inability toe excrete H+<br />c. H+ excretion is proportional to GFR<br />d. Acids are continuously formed, but glomerulus cannot filer as effectively, production of ammonia decreases, and tubular damage<br />
  52. 52. 5. Anemia - Hct. proportionate to azotemia<br />a. Short life span of RBCs because of altered plasma<br />b. Increased loss of RBCs because of GI ulceration, dialysis, and lab draws<br />c. Reduced erythropoietin because of decreased renal formation and inhibition from uremia<br />d. Folate deficiency if dialysis<br />e. Iron deficiency<br />f. Elevated parathyroid which stimulates fibrous replacement of bone marrow<br />6. Bleeding disorders<br />a.Thrombocytopenia or platelet dysfunction<br />b.Nitrogenous wastes increase risk of hemorrhage<br />
  53. 53. 7. Urea and creatinine alterations (renal function studies)<br />a.BUN increases (also increases with shock, protein intake, infection, gout) <br />b.Creatinine - excretion=production<br />c.BUN up with nonrenal; hepatorenal then BUN low<br />F. Uremic syndrome= symptomatic renal failure associated with metabolic events and multi-organ complications <br />1. Cardiovascular<br />a. Fluid and Na+ retention<br />b. Accelerated atherosclerosis<br />c. Pericarditis increased without dialysis<br />d. Heart Failure<br />
  54. 54. 2. Hematologic<br /><ul><li>severe anemia
  55. 55. From decreased erythropoietin
  56. 56. Uremia = decrease RBC life span
  57. 57. Uremia = inability of cells to pump out Na+ so swelling and hemolysis
  58. 58. Immunosuppression from reduction of lymphocytes
  59. 59. Platelet defects = bleeding</li></ul>3. Dermatologic<br /><ul><li>Pallor from anemia and retention of pigmented urochromes
  60. 60. Dehydration and atrophy of the sweat glands
  61. 61. Uremic itching = (?) skin deposits, peripheral neuropathy
  62. 62. Uremic frost = urea deposits from sweat
  63. 63. Soft tissue calcification from hyperparathyroidism </li></li></ul><li>4. GI - retention of metabolic acids and waste products<br />a. N&V (nausea and vomiting)<br />b. Hiccups<br />c. Anorexia<br />d. Irritation, inflammation, ulceration of GI tract - mouth to colon<br />e. Uremic fetor when urea broken down to ammonia<br />5. Reproductive - Amenorrhea, infertility, decreased libido, decreased testosterone<br />6. Endocrine<br />b. Hypothyroidism<br />a. Hyperparathyroidism<br />
  64. 64. 7. Neurologic<br />Encephalopathy - fatigue, decreased concentration, irritability, depression, drowsiness, insomnia, personality changes, seizures, and death<br />Peripheral neuropathy - burning, numbness, delayed sensory and motor responses<br />Diagnosis<br />Creatinine or blood urea nitrogen tests<br />Urinalysis<br />Blood test<br />Medical ultrasonography of the tract ( is essential to rule out obstruction of the urinary tract)<br />
  65. 65. Treatment<br />There are several modalities of renal replacement therapy (RRT) for patients with acute renal failure: <br />Intermittent hemodialysis <br />Continuous hemodialysis (used in critically ill patients) <br />
  66. 66. DIALYSIS<br /><ul><li>Is used to substitute some kidney functions during renal failure.
  67. 67. It is used to remove fluid and uremic waste products from the body when the kidneys are unable to do so.
  68. 68. It may be indicated to treat patients with edema that do not respond to treatment.
  69. 69. Acute dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, increasing acidosis, pericarditis and severe confusion. It may also be used to certain medications or other toxins in the blood.</li></li></ul><li>DIALYSIS<br /><ul><li>Chronic or maintenance dialysis is indicated in ESRD in the following instances:</li></ul>Presence of uremic signs and symptoms affecting all body systems (nausea and vomiting, severe anorexia, increasing lethargy, mental confusion)<br />Hyperkalemia and fluid overload not responsive to diuretics and fluid restriction.<br />General lack of well-being.<br /> An urgent indication for dialysis in patients with CRF is pericardial friction rub.<br />
  70. 70. PERITONEAL DIALYSIS<br />TYPES:<br />Intermittent peritoneal dialysis = acute or chronic renal failure<br />Continuous ambulatory peritoneal dialysis = chronic renal failure<br />Continuous cycling peritoneal dialysis = prolonged dwelling time<br />
  71. 71. PERITONEAL DIALYSIS<br />Indwelling catheter is implanted into the peritoneum.<br />A connecting tube is attached to the external end of peritoneal catheter T –tube.<br /> Plastic bag of dialysate solution is inserted to the end of T-tube; the other end is recap.<br />Dialysate bag is raised to shoulder level and infused by gravity in the peritoneal cavity<br />Infusion time = 10 minutes/2 liters; dwelling time is 4-6 hours depending on doctor’s order.<br />At the end of dwelling time, dialysis fluid is drained from the peritoneal cavity by gravity<br />Draining time is 10-20 minutes/2 liters <br />Then repeat the procedure when necessary<br />
  72. 72. Peritoneal Dialysis<br />Usually for patients with absolutely no other options of dialysis<br />Or as a temporary measure until options of dialysis sorted out<br />
  73. 73. Pre and post operative care for Tenckhoff catheter insertion<br />Pre operative care<br />Fast for 8 hours<br />Allow essential medications<br />Bowel preparation not necessary<br />Removal of body hair limited to that necessary to facilitate performance of procedure<br />Empty bladder<br />Single dose of prophylactic antibiotic<br />Operating room or well equipped procedure room<br />
  74. 74. Pre and post operative care for Tenckhoff catheter insertion<br />Post operative care<br />Catheter irrigation with 1 L of heparinized saline performed as an in-and-out flush within 72 hours following surgery and weekly thereafter until PD initiated<br />Delay PD for a min of 2 weeks to allow wound healing<br />Change dressings weekly for 2 weeks<br />Then patient should begin a routine of daily exit-site cleansing with antibacterial soap<br />Showering only permitted after 1 month if wound healing uncomplicated<br />Avoid catheter movement at the exit site<br />Use sterile gauze dressing over exit site<br />No tub bathing and swimming<br />
  75. 75. PERITONEAL DIALYSIS<br />
  76. 76. PERITONEAL DIALYSIS<br />
  77. 77. PERITONEAL DIALYSIS<br />NURSING CONSIDERATIONS:<br />Dialysate must be room-warmed before use ( for better absorption)<br />Drugs (heparin, potassium and antibiotics) must be added in advance.<br />Allow the solution to remain in the peritoneal cavity for the prescribed time.<br />Check outflow for cloudiness, blood and fibrin (early peritonitis).<br />NEVER PUSH THE CATHETER IN.<br />Monitor the VS regularly.<br />Keep a record of patient’s fluid balance (daily weighing)<br />Monitor blood chemistry<br />Turn the patient side to side if drainage stop<br />Observe for abdominal pain (cold solution), dialysate leakage (prevent infection)<br />Intake must be equal to output.<br />
  78. 78. HEMODIALYSIS<br />Is the process of cleansing the blood of accumulated waste products<br />Patient’s access is prepared and cannulated surgically<br /> One needle is inserted to the artery (brachial) then blood flow is directed to dialyzer (dialysis machine)<br /><ul><li>The machine is equipped with semi-permeable membrane surrounded with dialysis solution
  79. 79. Waste products in the blood move to the dialysis solution passing through the membrane by means of diffusion
  80. 80. Excess water is also removed from the blood by way of ultrafiltration
  81. 81. The blood is then returned to the vein after it has been cleansed.</li></li></ul><li>HEMODIALYSIS<br />
  82. 82. HEMODIALYSIS<br />Patient Access<br />Vascular catheter <br />A-V fistula <br />Synthetic vascular graft<br />
  83. 83. HEMODIALYSIS<br />
  84. 84. HEMODIALYSIS<br />NURSING CONSIDERATIONS:<br />Blood can be heparinized unless it is contraindicated to prevent blood clot.<br />Dialysis solution has some electrolytes and acetate and HCO3 added to achieve proper pH balance.<br />Methods of circulatory access: AV fistula; AV graft or U-tube<br />Assess the access site for bruit, signs of infections and ischemia of the hand.<br />Absence of thrill may indicate occlusion<br />No BP taking on the access site.<br />Cover the access site with adhesive bandage<br />Dietary adjustments of CHON, Na and fluid intake.<br />Monitor VS regularly<br />Check blood chemistry<br />Constant monitoring of hemodynamic status, electrolytes and acid-base balance.<br />
  85. 85. KIDNEY TRANSPLANT<br /><ul><li>Indicated for ESRD</li></ul>TYPES OF DONOR<br />Living<br />Cadaveric<br /><ul><li>Rejection and infection remain the major complication after surgery.
  86. 86. T and B lymphocytes are involved in the rejection response
  87. 87. To reduce the rejection process, immunosuppressive drugs are given
  88. 88. Watchout for infection after immunosuppressive medications</li></li></ul><li>KIDNEY TRANSPLANT<br />REJECTION RESPONSE<br />Hyper acute – occurs in the OR, kidney turns blue and flabby.<br /> Treatment: remove the kidney<br />2. Accelerated Acute – occurs 48-72 hours post-op; abrupt oliguria is seen.<br /> Treatment: dialysis, steroid and immunsuppressive drugs are initiated; with poor prognosis.<br />3. Acute – occurs 1 week to several weeks post-op, weight gain, oliguria, HPN, increased BUN, enlarged kidney are seen.<br /> Treatment: same with accelerated acute; with good prognosis.<br />4. Chronic – occurs months to years post-op, progressive decreased renal function is seen.<br /> Treatment: same as above; poor prognosis.<br />
  89. 89. end <br />
  90. 90. Nursing Diagnosis:<br /><ul><li>Fluid Volume Excess
  91. 91. Imbalanced Nutrition: less than body requirements
  92. 92. Risk for Infection</li></ul>Medical Management:<br /><ul><li>Maintaining fluid balance, avoiding fluid excesses, or possibly performing dialysis.</li></li></ul><li><ul><li>Maintenance of fluid balance is based on daily body weight, serial measurements of central venous pressure, serum and urine concentrations, fluid losses, blood pressure, and the clinical status of the patient.
  93. 93. Fluid excesses can be detected by the clinical findings of dyspnea, tachycardia, and distended neck veins. </li></ul>Nursing Management:<br />Monitoring fluid and electrolyte<br />Reducing metabolic rate<br />Promoting pulmonary function<br />
  94. 94. <ul><li>Providing support
  95. 95. Preventing infection
  96. 96. Providing skin care</li></li></ul><li>

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