Microsoft Power Point Renal System Disorders


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Microsoft Power Point Renal System Disorders

  1. 1. Renal System Disorders Nio C. Noveno, RN, MAN Noveno, RN,
  2. 2. The Human Kidney Renal Disorders 2
  3. 3. The Nephron Renal Disorders 3
  4. 4. Functions of the Renal System Excretion of waste Regulation of acid-base balance Formation of erythropoietin Regulation of fluid and electrolyte balance (RAAS) Regulation of phosphate and calcium Renal Disorders 4
  5. 5. Classification of Renal Disorders Obstructive disorders Acute renal failure Chronic renal failure Renal Disorders 5
  6. 6. Obstructive disorders Can occur anywhere in the urinary tract Signs and symptoms depend on the site of location and size of obstruction Renal Disorders 6
  7. 7. Causes of urinary tract obstruction Ureteral obstruction Lower urinary tract Bladder neoplasms Calculi Trauma Urethral strictures Enlarged lymph nodes Calculi Congenital anomalies Tumors Benign prostatic Kidney hypertrophy Calculi Polycystic kidney disease Renal Disorders 7
  8. 8. Renal stones Crystallization of minerals around an organic matrix (blood, pus, devitalization tissue) Usually idiopathic: – Infection Renal Disorders 8
  9. 9. SITES OF STONE FORMATION Renal Disorders 9
  10. 10. Composition of renal stones Calcium (oxalate and phosphate) Uric acid Hypercalcemia High purine diet Hyperthyroidism Gout Chemotherapy Vitamin D intoxication Immobilization Cystine Tumors Genetic disorder Renal tubular acidosis Intake of steroids Struvite Infection related Renal Disorders 10
  11. 11. Renal Stones Diagnostics Urinalysis KUB-UTZ KUB-IVP CT scan Cystoscopy BUN, Creatinine Clinical manifestations Pain Hematuria Renal Disorders 11
  12. 12. Diagnostic Procedures Renal Disorders 12
  13. 13. Medical management Medications Pain medications Medications to Ca & PO4 content – Ascorbic acid Medications to uric acid formation – Sodium bicarbonate – Allopurinol Surgery Extracorporeal shockwave lithotripsy Percutaneous lithotripsy Renal Disorders 13
  15. 15. Nursing management Administer medications as ordered Strain urine to detect passage of stones Monitor I & O Encourage to increase OFI >3 L/day Instruct client on infection prevention Renal Disorders 15
  16. 16. Bladder carcinoma Most common among 60-70 years old Males>females Predisposing factors: – Cigarette smoking – Exposure to rubber dyes – Abuse of phenacetin-containing analgesics – Recurrent UTI – Recurrent nephrolithiasis Renal Disorders 16
  17. 17. Bladder carcinoma Clinical manifestations – Gross painless hematuria – Dysuria – Frequent urination Diagnostics – Urinalysis – IVP – Cystoscopy with biopsy – CT scan Renal Disorders 17
  18. 18. Bladder carcinoma Medical Management Nursing management Surgical treatment Encourage to: Radiation – Increase OFI Chemotherapy – Quit smoking Assess for presence of UTI Renal Disorders 18
  19. 19. Bladder carcinoma Teach patient on stoma Care of the STOMA care Immediate post-OP: Opening should be Color of drainage is bright no more than 2-3 red/pink mm larger than the Report: gray or black stoma discoloration Change every 3-5 Position pouch at the side of days bed for drainage Report signs of UTI Monitor urine output daily – Cloudy urine Monitor for signs of peritonitis – Hematuria Abdominal pain, – Strong odor distention, fever – Fever – Flank pain Renal Disorders 19
  20. 20. Benign Prostatic Hyperplasia (BPH) Most common problem of adult male reproductive organ Cause is not completely understood Not a predisposing factor for prostatic carcinoma Renal Disorders 20
  21. 21. Benign Prostatic Hyperplasia (BPH) Diagnostics Clinical manifestations Dribbling Digital rectal exam Hesitancy Urinalysis Diminution in caliber BUN/Creatinine and force of urinary Cystourethroscopy stream PSA Feeling of incomplete emptying Irritative symptoms Renal Disorders 21
  22. 22. Benign Prostatic Hyperplasia (BPH) Renal Disorders 22
  23. 23. Benign Prostatic Hyperplasia (BPH) Non-surgical Medical Management procedures Pharmacologic Thermotherapy treatment Prostatic balloon Anti-androgens device – Finasteride Stents/coils – Alpha-adrenergic TULIP (transurethral ultrasound-guided blockers laser prostatectomy) – Terazosin Surgical procedures Renal Disorders 23
  24. 24. Benign Prostatic Hyperplasia (BPH) Nursing management: 1. Provide medications as ordered 2. Maintain patency of 3-way Foley • Observe aseptic technique • Irrigate with NSS (as ordered) 3. Control & treat bladder spasms • Short, frequent walks • Decrease frequency of bladder irrigation • Administer anti-cholinergics and anti- spasmodics Renal Disorders 24
  25. 25. Benign Prostatic Hyperplasia (BPH) Prevent hemorrhage 4. • Prevent straining (heavy lifting, constipation), prolonged periods of travel, sexual activity until doctor approves so. • Avoid rectal procedures. 5. Provide for bladder training after Foley catheter removal • Perineal exercise • Limit fluid intake in the evening • Restrict intake of caffeine-containing compounds • Withhold anti-cholinergics and anti- spasmodics if permitted Renal Disorders 25
  26. 26. Benign Prostatic Hyperplasia (BPH) Provide health teaching on: 5. • Increasing OFI • Signs of UTI and report once noted • Avoidance of heavy lifting, straining and prolonged travel. • Possible impotence Renal Disorders 26
  27. 27. Prostate cancer Highest incidence in African-American over age 60 Adenocarcinoma; growth related to presence of androgens Clinical manifestations: – Same as BPH – Hard, nodular, fixed mass upon rectal exam Laboratory diagnostics: – Elevated PSA, acid & alkaline phosphatase – Bone scan Renal Disorders 27
  28. 28. Prostate cancer Renal Disorders 28
  29. 29. Prostate cancer Nursing interventions: Medical management: 1. Administer prescribed Drug therapy: medications Estrogens, 2. If with radiotherapy: chemotherapeutic • Double flush the toilet agents after use. • Advise to avoid placing Radiation therapy children on their lap. Surgery: Perineal • Avoid sexual intercourse prostatectomy for the whole duration of therapy. 3. Provide care post- prostatectomy Renal Disorders 29
  30. 30. Acute renal failure (ARF) Sudden cessation of kidney function; reversible Renal Disorders 30
  31. 31. Acute renal failure (ARF) Sudden cessation of kidney function; reversible Causes: Ischemic (pre-renal) 1. Obstruction (post-renal) 3. • Dehydration • Stones • Blood loss (surgery, trauma) • Tumors • Cardiac failure • Strictures/stenosis • Shock Toxic substance (renal) 2. • Solvents (carbon Other causes: 4. tetrachloride, methanol, • Acute ethylene glycol) glomerulonephritis • Heavy metals (lead, arsenic, • Malignant mercury) hypertension • Antibiotics • Hemolysis (aminoglycosides, amphotericin B) • Pesticides • Mushrooms Renal Disorders 31
  32. 32. Physiologic effect Findings Symptoms Drowsiness, Confusion, Coma Oliguric GI bleeding ↑ BUN, Crea Asterixis Inability to excrete wastes Pericarditis Cardiac dysrhythmias ↑ K+, ↓ Na+, acidosis Kusmaull’s breathing Inability to regulate electrolytes Coma CHF Fluid overload Pulmonary edema Inability to excrete fluid loads Hypertension Urine output of 4-5 L/day Hypotension Tachycardia Hypovolemia Improving mental alertness Diuretic ↓ Na+ Weight loss ↓ K+ Dry mucous membranes Muscle weakness Constipation Recovery Return to normal Renal Disorders 32
  33. 33. Nursing management: Medical management: Supportive Dialysis Nursing management: 1. Maintain F & E balance • Accurate I & O • Weigh daily • Maintain fluid restrictions • Assess for signs of fluid overload 2. Maintain nutrition • Moderate CHON, low K+, high CHO, high fat • Measures to relieve nausea Renal Disorders 33
  34. 34. Nursing management: Maintain rest-activity balance 3. • Provide assistance in ADL • Maintain strict bed rest in acute phase Prevent injury 4. • Keep side rails elevated (pad if necessary) • Protect from bleeding Prevent infection 5. • Maintain asepsis • Reverse isolate • Turn frequently • Meticulous skin care • Relieve pruritus Renal Disorders 34
  35. 35. Chronic renal failure (CRF) Causes: Chronic systemic disease DM, HTN Polycystic kidney disease Long standing obstruction Chronic glomerulonephritis Recurrent infections Renal Disorders 35
  36. 36. Stages of CRF Decreased renal reserve (renal 1. 4. End-stage renal disease impairment) • GFR: <10% • GFR: 40-50% • BUN & crea severely • BUN & crea are normal increased • Asymptomaitc • Signs of CHF Renal insufficiency 2. • Hypocalcemia, • GFR: 20-40% hyperphosphatemia, • BUN & crea begins to rise hyperkalemia, hyponatremia • Mild anemia, mild azotemia • Fractures, joint pains • Polyuria, nocturia • Infertility, amenorrhea Renal failure 3. • Uremia • GFR: 10-20% • BUN & crea increase • Anemia, azotemia, metabolic acidosis Renal Disorders 36
  37. 37. Stages of CRF Decreased renal reserve Renal insufficiency Renal failure End-stage renal disease Renal Disorders 37
  38. 38. Renal Disorders 38
  39. 39. Chronic renal failure (CRF) Diagnostics: Anemia Blood chemistry – Epoieitin alfa Urinalysis – Iron KUB-TUZ – Folate and Vitamin B12 – Blood transfusion Medical management: Conservative TX Fluid and electrolyte control Hypertension – Hyperkalemia Diet Dialysis Dialysis Exchange resins – Hypocalcemia/ Renal transplant hyperphosphatemia Phosphate binders Diet Vitamin D Renal Disorders 39
  40. 40. Renal Disorders 40
  41. 41. Peritoneal Dialysis Renal Disorders 41
  42. 42. Peritoneal Dialysis Intermittent: 8-12 H x 3-5x/week Ambulatory: 3-5 passes/day Continuous cycling: 3-7x during sleep Renal Disorders 42
  43. 43. Peritoneal dialysis Must consider: (+) pink-tinged effluent – Explaining or presence of small procedure strings is normal Blood is normal for – Monitor VS (+ several days weight) With ascites from other – Note for signs of source, substitute a infection lower concentration of dialysate – Assess skin integrity Renal Disorders 43
  44. 44. Hemodialysis AV Fistulas – Internal AVF – Internal Graft AVF – Internal AV Graft with external access device Complications – Thrombosis – Local infections – Aneurysms – Steal syndrome Renal Disorders 44
  45. 45. Hemodialysis Renal Disorders 45
  46. 46. HEMODIALYSIS PERITONEAL DIALYSIS AVF ACCESS Subclavian vein Peritoneum Arteriovenous graft DURATION 2-4 H 36 H Disequilibrium syndrome Exit site infection Hypotension Peritonitis Bleeding Hernias COMPLICATIONS Sepsis Pulmonary complications Hepatitis Protein loss Monitor for VS and changes in Weigh before and after HD behavior VS q 15 mins Check patency of catheter Monitor I & O, signs of DE May procaine HCl in the dialysate to minimize NURSING INTERVENTIONS WOF signs of bleeding discomfort Do NOT use the AVF other than for Observe for signs of peritonitis dialysis Maintain aseptic technique Provide diversional activities during insertion of trochanter. Renal Disorders 46
  47. 47. Chronic renal failure (CRF) Nursing management: Maintain F & E balance – I & O q 80 – Weigh daily – Assess edema Auscultate breath sounds V/S q 80 Assess LOC q 80 High CHO diet, within prescribed Na+, K+, and CHON limits Administer medications as ordered Renal Disorders 47
  48. 48. Renal Transplant Renal Disorders 48
  49. 49. Renal Transplant Renal Disorders 49
  50. 50. Chronic renal failure (CRF) Nursing management cont…: Prevent infection and injury – Promote meticulous skin care – Protect from infectious agent – Protect confused person – Maintain asepsis – Avoid aspirin products – Encourage use of soft bristle toothbrush Promote comfort – Give anti-pruritics – Use emolient baths, keep skin moist – Provide good oral hygiene Renal Disorders 50
  51. 51. ACID-BASE DISORDERS Disorder Clinical manifestation Compensation Kidneys eliminate H+ ↑Paco2, ↑ or normal Respiratory acidosis HCO3-, ↓ pH and retain HCO3- Kidneys conserve H+ ↓ Paco2, ↓ or normal Respiratory alkalosis HCO3-, ↑ pH and eliminate HCO3- ↓ or normal Paco2, Lungs eliminate CO2 Metabolic acidosis ↓HCO3-, ↓ pH and conserve HCO3- Lungs hypoventilate to ↑ or normal Paco2, ↑ Paco2, kidneys Metabolic alkalosis ↑HCO3-, ↑ pH conserve H+ excrete HCO3- Renal Disorders 51
  52. 52. Causes of Acid-Base Disorders Nursing management: Metabolic acidosis Administer sodium Causes: bicarbonate DKA, uremia, Monitor for signs of starvation, diarrhea, hyperkalemia severe infections Provide alkaline mouthwash Manifestations: Lubricate lips to prevent Headache, nausea and vomiting dryness Signs of hyperkalemia I&O Seizures, coma, Institute seizure precaution hyperventilation Monitor ABG & electrolyte losses Renal Disorders 52
  53. 53. Causes of Acid-Base Disorders Metabolic alkalosis Causes: Nursing management: Severe vomiting, NGT Decreased suctioning, diuretic respirations therapy, excessive Replace fluids nad ingestion of NaHCO3, electrolytes losses biliary drainage I&O Assess for signs of Manifestations: hypokalemia Nausea and vomiting Monitor ABG & Signs and symptoms electrolytes of hypokalemia Renal Disorders 53
  54. 54. Causes of Acid-Base Disorders Respiratory acidosis Causes: Nursing management: Hypoventilation: COPD, barbiturate or sedative Semi-Fowler’s overdose, acute airway Patent airway obstruction, neuromuscular disorders Turn, cough, deep- breath Manifestations: Administer fluids Headache, weakness, O2 therapy visual disturbances, rapid Monitor ABG respirations, confusion, drowsiness, tachycardia, coma Renal Disorders 54
  55. 55. Causes of Acid-Base Disorders Respiratory alkalosis Causes: Nursing management: Hyperventilation, Offer reassurance mechanical Encourage breathing overventilation, encephalitis into a paper bag Manifestations: Provide sedation as Numbness and tingling of ordered mouth and extremities Monitor mechanical Inability to concentrate ventilation and ABG Rapid respirations, dry mouth, coma Renal Disorders 55
  56. 56. Interpretation UC PC FC ↓ or ↑ ↓ or ↑ normal pH ↓ or ↑ HCO3- ↓ or ↑ ↓ or ↑ normal ↓ or ↑ ↓ or ↑ ↓ or ↑ Paco2 normal Renal Disorders 56
  57. 57. Renal System Disorders Nio C. Noveno, USRN, MAN