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Presents… THE GROUP 3
THE    RENAL  SYSTEM
KIDNEY   <ul><li>Overview  </li></ul><ul><li>The kidney is essential in maintaining water, salt, and electrolyte balance a...
ACUTE RENAL FAILURE  (ARF) <ul><li>also known as acute kidney failure or acute kidney injury, is a rapid loss of renal fun...
ETIOLOGY <ul><li>The majority of cases of ARF are seen in surgical patients, trauma victims and patients with various acut...
<ul><li>Depending on the severity and duration of the renal dysfunction, this accumulation is accompanied by metabolic dis...
 
CAUSES
SYMPTOMS <ul><li>Swelling, especially of the legs and feet.  </li></ul><ul><li>Little or no urine output.  </li></ul><ul><...
Sudden loss of ability of the kidney to excrete  wastes, concentrate urine, and conserve electrolytes.  Evaluate for possi...
ASSESSMENT <ul><li>Oliguric Phase  </li></ul><ul><ul><ul><ul><li>Urine output = 400 ml/< per day  </li></ul></ul></ul></ul...
<ul><li>Diuretic Phase   </li></ul><ul><ul><ul><ul><li>Urine output = 3-5 L per day  </li></ul></ul></ul></ul><ul><ul><ul>...
DIAGNOSTICS <ul><li>Laboratory Test </li></ul><ul><li>Blood and urine tests may include:   </li></ul><ul><li>Serum creatin...
<ul><li>Imaging tests may include: </li></ul><ul><li>Abdominal ultrasound </li></ul><ul><li>Computed tomography (CT) scan ...
NURSING DIAGNOSIS <ul><li>Excess Fluid Volume related to inability of the kidneys to produce urine secondary to ARF </li><...
NURSING CARE: <ul><li>Monitor/maintain fluid and electrolyte balance  </li></ul><ul><li>Monitor alteration in fluid volume...
CHRONIC RENAL FAILURE  (CRF) <ul><li>Is the progressive loss of kidney function. The kidneys attempt to compensate for ren...
 
ETIOLOGY <ul><li>Diabetic glomerulosclerosis  </li></ul><ul><li>Hypertensive nephrosclerosis   </li></ul><ul><li>Glomerulo...
SIGNS AND SYMPTOMS <ul><li>Fatigue </li></ul><ul><li>Frequent hiccups </li></ul><ul><li>General ill feeling  </li></ul><ul...
<ul><li>Decreased sensation in the hands, feet, or other areas  </li></ul><ul><li>Easy bruising or bleeding </li></ul><ul>...
CAUSES <ul><li>Diabetes.  </li></ul><ul><li>High blood pressure (hypertension). </li></ul><ul><li>Obstruction of urine flo...
Progressive  kidney function destruction (Surviving nephrons takes over the  Function of loss) Glumerular Filtration  Neph...
ASSESSMENT <ul><li>Nausea, vomiting, diarrhea or constipation; decreased urinary output;dyspnea </li></ul><ul><li>Stomatit...
<ul><li>Urinalysis  </li></ul><ul><li>Creatinine </li></ul><ul><li>BUN </li></ul><ul><li>Creatinine clearance </li></ul><u...
<ul><li>Abdominal ultrasound </li></ul><ul><li>X-rays of the kidneys and abdomen </li></ul><ul><li>Erythropoietin </li></u...
COMPLICATIONS <ul><li>Hyperkalemia  </li></ul><ul><li>Pericarditis </li></ul><ul><li>Hypertension </li></ul><ul><li>Anemia...
NURSING CARE <ul><li>Prevent neurologic complications </li></ul><ul><li>Promote optimal GI function </li></ul><ul><li>Moni...
<ul><li>Medical Management </li></ul><ul><li>Diet restrictions </li></ul><ul><li>Multivitamins </li></ul><ul><li>Hematinic...
NURSING DIAGNOSIS <ul><li>Excess Fluid Volume related to decreased urine output, dietary excesses, and retention of sodium...
UREMIA <ul><li>Literally means “urine in the blood” also known as “uremic syndrome” are used to describe a set of symptoms...
CAUSES <ul><li>increased production of urea in the liver, due to:  </li></ul><ul><ul><li>high protein diet  </li></ul></ul...
Signs and  Symptoms <ul><li>Nausea  </li></ul><ul><li>Vomiting  </li></ul><ul><li>Headache </li></ul><ul><li>Loss of energ...
Nursing care <ul><li>Meticulous oral hygiene should be given hourly to combat unpleasant symptoms. </li></ul><ul><li>Small...
Peritoneal  Dialysis <ul><li>uses a membrane inside your body (peritoneal membrane) as a filter to clear wastes and extra ...
 
COMPLICATIONS  <ul><li>Abdominal infection  </li></ul><ul><li>Amyloidosis (stiffening of kidney due to protein deposit)  <...
Nursing Care <ul><li>Pre-dialysis care </li></ul><ul><ul><ul><li>Document V/S including temperature, orthostatic blood pre...
<ul><li>Intradialysis Care </li></ul><ul><ul><ul><ul><li>Use strict aseptic technique during the dialysis procedure and wh...
<ul><ul><ul><ul><li>Note the clarity and odor of return dialysate. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Accurately...
NURSING DIAGNOSIS <ul><li>Risk for Excess Fluid Volume related to fluid retention  </li></ul><ul><li>Risk for Deficient Fl...
HEMODIALYSIS <ul><li>-means “cleaning the blood” — and that is exactly what this treatment does.  </li></ul><ul><li>Is for...
 
DIALYZER <ul><li>The dialyzer is the piece of equipment that actually filters the blood.  </li></ul>
COMPLICATIONS <ul><li>Low blood pressure (hypotension) </li></ul><ul><li>Muscle cramps   </li></ul><ul><li>Itchin   </li><...
NURSING DIAGNOSIS <ul><li>Deficient Fluid Volume or Excess Fluid Volume related to impaired renal function, fluid shifts b...
NEPHRECTOMY  <ul><ul><li>surgical removal of an entire kidney </li></ul></ul><ul><ul><li>indications include renal tumor, ...
 
<ul><li>There are two general types:  </li></ul><ul><li>Partial nephrectomy:  a part of the kidney is removed.  </li></ul>...
The two main ways that a kidney may be removed:  <ul><li>Open Nephrectomy  </li></ul><ul><li>  - most often used </li></ul...
 
COMPLICATIONS  <ul><li>Possible complications of a nephrectomy procedure include infection, bleeding (hemorrhage), and pos...
NURSING INTERVENTION  <ul><li>Pre-operative care </li></ul><ul><li>Provide routine pre-op care. </li></ul><ul><li>Ensure a...
<ul><li>Post-operative:  </li></ul><ul><li>Provide routine post-op care.  </li></ul><ul><li>Assess urine output every hour...
<ul><li>Provide client teaching and discharge planning concerning </li></ul><ul><li>Prevention of urinary stasis  </li></u...
KIDNEY TRANSPLANT <ul><li>Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient...
There are two main problems with kidney transplants <ul><li>First, there is a shortage of organs from people who have died...
 
 
NURSING INTERVENTION <ul><li>Pre-operative  </li></ul><ul><ul><ul><li>Provide routine pre-op care </li></ul></ul></ul><ul>...
<ul><li>Post-operative  </li></ul><ul><ul><ul><ul><li>Provide routine post-op care </li></ul></ul></ul></ul><ul><ul><ul><u...
<ul><ul><li>Assess for organ rejection </li></ul></ul><ul><ul><li>Provide client teaching and discharge planning concernin...
NEUROGENIC  BLADDER <ul><li>refers to several bladder dysfunctions caused by lesions of the central or peripheral nervous ...
CAUSES <ul><li>Spinal cord injuries resulting in paralysis  </li></ul><ul><li>Other disorders such as syphilis, diabetes m...
SYMPTOMS  <ul><li>Urinary incontinence, characterized by either involuntary release of large volumes of urine or continuou...
NURSING CARE <ul><li>Bladder training </li></ul><ul><li>Prevent autonomic dysreflexia </li></ul><ul><li>Teach methods to s...
NURSING DIAGNOSIS  <ul><li>Risk for infection </li></ul><ul><li>Urinary retention related to lower motor neurons lesion. <...
Prepared by:
ACKNOWLEDGEMENT <ul><li>WE WOULD LIKE TO EXTEND OUR WARMTH THANKS TO  MR.JHOEY E. POTATO  FOR HIS SINCERE LOVE, SUPPORT AN...
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Group 3

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Group 3

  1. 1. Presents… THE GROUP 3
  2. 2. THE RENAL SYSTEM
  3. 3. KIDNEY <ul><li>Overview </li></ul><ul><li>The kidney is essential in maintaining water, salt, and electrolyte balance and is an endocrine gland that secretes at least 3 hormones. </li></ul><ul><li>The kidney helps control blood pressure and is especially susceptible to damage if blood pressure is too high or too low. </li></ul>
  4. 4. ACUTE RENAL FAILURE (ARF) <ul><li>also known as acute kidney failure or acute kidney injury, 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. </li></ul>
  5. 5. ETIOLOGY <ul><li>The majority of cases of ARF are seen in surgical patients, trauma victims and patients with various acute medical illnesses. These account for 90 to 95 percent of all cases. Acute renal failure in the obstetric patients accounts for an additional 5 to 10 percent. </li></ul><ul><li>There are many possible causes of ARF, the most common of which are hypotension and prerenal hypovolemia. </li></ul>
  6. 6. <ul><li>Depending on the severity and duration of the renal dysfunction, this accumulation is accompanied by metabolic disturbances, such as metabolic acidosis (acidification of the blood) and hyperkalaemia (elevated potassium levels), changes in body fluid balance, and effects on many other organ systems. It can be characterised by oliguria or anuria (decrease or cessation of urine production), although nonoliguric ARF may occur. It is a serious disease and treated as a medical emergency. </li></ul>
  7. 8. CAUSES
  8. 9. SYMPTOMS <ul><li>Swelling, especially of the legs and feet. </li></ul><ul><li>Little or no urine output. </li></ul><ul><li>Thirst and a dry mouth. </li></ul><ul><li>Rapid heart rate. </li></ul><ul><li>Feeling dizzy when you stand up. </li></ul><ul><li>Loss of appetite, nausea, and vomiting. </li></ul><ul><li>Feeling confused, anxious and SYMPTOMS restless, or sleepy. </li></ul><ul><li>Pain on one side of the back, just below the rib cage and above the waist (flank pain). </li></ul>
  9. 10. Sudden loss of ability of the kidney to excrete wastes, concentrate urine, and conserve electrolytes. Evaluate for possible causes especially if potentially reversible. Acute tubular necrosis (Intra-renal) Infection (Pre-renal) Decreased blood flow (Pre-renal) trauma, complicated surgery, septic shock, hemorrhage, burns, dehydration Or poor intake Over exposure to metals, Solvents, radiographic contrast Materials, certain antibiotics (Intra-renal) Disorders of the blood or auto- Immune disorders (Intra-renal) Urinary Tract obstruction (Post-renal) Stricture of ureters, GU tumor, kidney Or ureteral stones, nephrocalcinosis Or enlarged prostate
  10. 11. ASSESSMENT <ul><li>Oliguric Phase </li></ul><ul><ul><ul><ul><li>Urine output = 400 ml/< per day </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increased BUN, s. creatinine </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Edema, HPN </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperkalemia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyponatremia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hypermagnesemia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperphosphatemia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic Acidosis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lasts 1-3 weeks </li></ul></ul></ul></ul>
  11. 12. <ul><li>Diuretic Phase </li></ul><ul><ul><ul><ul><li>Urine output = 3-5 L per day </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Initially </li></ul></ul></ul></ul><ul><ul><ul><ul><li>BUN, s. creatinine elevated </li></ul></ul></ul></ul><ul><ul><ul><ul><li>BP elevated </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic acidosis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Later </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Normalize </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hypokalemia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lasts 1 week </li></ul></ul></ul></ul><ul><li>Recovery Phase </li></ul><ul><ul><ul><ul><li>Takes 3- 12 months </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Avoid nephrotoxic drugs </li></ul></ul></ul></ul>
  12. 13. DIAGNOSTICS <ul><li>Laboratory Test </li></ul><ul><li>Blood and urine tests may include: </li></ul><ul><li>Serum creatinine </li></ul><ul><li>Blood urea nitrogen (BUN) </li></ul><ul><li>Blood electrolyte tests, such as calcium, phosphate (phosphorus), potassium, and sodium </li></ul><ul><li>Complete blood count (CBC) </li></ul><ul><li>Erythrocyte sedimentation rate (ESR, or sed rate) or antinuclear antibodies (ANA) test </li></ul>
  13. 14. <ul><li>Imaging tests may include: </li></ul><ul><li>Abdominal ultrasound </li></ul><ul><li>Computed tomography (CT) scan </li></ul><ul><li>Abdominal X-ray or a spiral CT scan </li></ul><ul><li>Retrograde pyelography </li></ul><ul><li>Magnetic resonance imaging (MRI) </li></ul><ul><li>Kidney scan (renal scintigraphy) </li></ul>
  14. 15. NURSING DIAGNOSIS <ul><li>Excess Fluid Volume related to inability of the kidneys to produce urine secondary to ARF </li></ul><ul><li>Deficient Fluid Volume related to fluid loss from a variety of causes </li></ul><ul><li>Risk for Impaired Skin Integrity related to poor cellular nutrition and edema </li></ul><ul><li>Risk for Infection related to lowered resistance </li></ul><ul><li>Anxiety related to unknown outcome of disease process </li></ul>
  15. 16. NURSING CARE: <ul><li>Monitor/maintain fluid and electrolyte balance </li></ul><ul><li>Monitor alteration in fluid volume </li></ul><ul><li>Promote optimal nutritional status </li></ul><ul><li>Prevent complications from impaired mobility </li></ul><ul><li>Prevent fever or infection </li></ul><ul><li>Support client/significant others and reduce/relieve anxiety </li></ul><ul><li>Provide care for the client receiving dialysis if used </li></ul><ul><li>Provide client teaching and discharge planning concerning </li></ul>
  16. 17. CHRONIC RENAL FAILURE (CRF) <ul><li>Is the progressive loss of kidney function. The kidneys attempt to compensate for renal damage by hyperfiltration (excessive straining of the blood) within the remaining functional nephrons (filtering units that consist of a glomerulus and corresponding tubule). Over time, hyperfiltration causes further loss of function. </li></ul>
  17. 19. ETIOLOGY <ul><li>Diabetic glomerulosclerosis </li></ul><ul><li>Hypertensive nephrosclerosis  </li></ul><ul><li>Glomerulonephritis </li></ul><ul><li>SLE, Wegener's granulomatosis  </li></ul><ul><li>Tubulointerstitial disease </li></ul><ul><li>Reflux nephropathy (chronic pyelonephritis) </li></ul><ul><li>Analgesic nephropathy </li></ul><ul><li>Obstructive nephropathy (stones, BPH) </li></ul><ul><li>Polycystic kidney disease </li></ul>
  18. 20. SIGNS AND SYMPTOMS <ul><li>Fatigue </li></ul><ul><li>Frequent hiccups </li></ul><ul><li>General ill feeling </li></ul><ul><li>Generalized itching ( pruritus) </li></ul><ul><li>Headache </li></ul><ul><li>Nausea, vomiting </li></ul><ul><li>Unintentional weight loss </li></ul><ul><li>Blood in the vomit or in stools </li></ul><ul><li>Decreased alertness, including drowsiness, confusion, delirium, or coma </li></ul>
  19. 21. <ul><li>Decreased sensation in the hands, feet, or other areas </li></ul><ul><li>Easy bruising or bleeding </li></ul><ul><li>Increased or decreased urine output </li></ul><ul><li>Muscle twitching or cramps </li></ul><ul><li>Seizures </li></ul><ul><li>White crystals in and on the skin (uremic frost) </li></ul><ul><li>Abnormally dark or light skin </li></ul><ul><li>Agitation </li></ul><ul><li>Breath odor </li></ul><ul><li>Excessive nighttime urination </li></ul><ul><li>Excessive thirst </li></ul><ul><li>High blood pressure </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Nail abnormalities </li></ul><ul><li>Paleness </li></ul>
  20. 22. CAUSES <ul><li>Diabetes. </li></ul><ul><li>High blood pressure (hypertension). </li></ul><ul><li>Obstruction of urine flow </li></ul><ul><li>Kidney diseases </li></ul><ul><li>Kidney artery stenosis </li></ul><ul><li>Toxins </li></ul>
  21. 23. Progressive kidney function destruction (Surviving nephrons takes over the Function of loss) Glumerular Filtration Nephrons Hypertrophy Nephrons die (remaining one have increasingly difficult job) Decreased demand of Protein absorption for Remaining nephron Progressive loss Of nephrons, Scar tissue accumulates And renal blood flow reduced Loss of Excretory And non- Excretory Function CRF
  22. 24. ASSESSMENT <ul><li>Nausea, vomiting, diarrhea or constipation; decreased urinary output;dyspnea </li></ul><ul><li>Stomatitis, hypotension (early), hypertension(later), lethargy, convulsions, memory impairment, pericardial friction rub, HF </li></ul><ul><li>Diagnostic test: urinalysis </li></ul><ul><ul><li>Protein, sodium, and WBC elevated </li></ul></ul><ul><ul><li>Specific gravity, platelets, and calcium decreased </li></ul></ul>
  23. 25. <ul><li>Urinalysis </li></ul><ul><li>Creatinine </li></ul><ul><li>BUN </li></ul><ul><li>Creatinine clearance </li></ul><ul><li>Potassium test </li></ul><ul><li>Arterial blood gas and blood chemistry analysis </li></ul><ul><li>Abdominal CT scan </li></ul><ul><li>Abdominal MRI </li></ul>DIAGNOSTICS
  24. 26. <ul><li>Abdominal ultrasound </li></ul><ul><li>X-rays of the kidneys and abdomen </li></ul><ul><li>Erythropoietin </li></ul><ul><li>PTH </li></ul><ul><li>Renal scan </li></ul><ul><li>Serum magnesium - test </li></ul><ul><li>Urinary casts </li></ul>
  25. 27. COMPLICATIONS <ul><li>Hyperkalemia </li></ul><ul><li>Pericarditis </li></ul><ul><li>Hypertension </li></ul><ul><li>Anemia </li></ul><ul><li>Bone disease and metastatic and vascular calcifications </li></ul>
  26. 28. NURSING CARE <ul><li>Prevent neurologic complications </li></ul><ul><li>Promote optimal GI function </li></ul><ul><li>Monitor/prevent alteration in fluid and electrolyte balance </li></ul><ul><li>Assess for hyperphosphatemia as (parenthesis, muscles cramps, seizures, abnormal reflexes) ordered </li></ul><ul><li>Promote maintenance of skin integrity </li></ul><ul><li>Monitor for bleeding complications, prevent injury to client </li></ul><ul><li>Promote/ maintain maximal cardiovascular function </li></ul><ul><li>Provide care for client receiving dialysis </li></ul>
  27. 29. <ul><li>Medical Management </li></ul><ul><li>Diet restrictions </li></ul><ul><li>Multivitamins </li></ul><ul><li>Hematinics </li></ul><ul><li>Aluminum hydroxide gels </li></ul><ul><li>Antihypertensive </li></ul>
  28. 30. NURSING DIAGNOSIS <ul><li>Excess Fluid Volume related to decreased urine output, dietary excesses, and retention of sodium and water </li></ul><ul><li>Imbalance Nutrition: Less than body requirements related to anorexia, nausea, vomiting, dietary restrictions and altered oral mucous membrane </li></ul><ul><li>Activity Intolerance related to fatigue, anemia, retention of wastes products and dialysis procedure </li></ul><ul><li>Disturbed self-esteem related to dependency, role changes, change in body image, and change in sexual dysfunction </li></ul><ul><li>Deficient Knowledge regarding nutrition and treatment </li></ul>
  29. 31. UREMIA <ul><li>Literally means “urine in the blood” also known as “uremic syndrome” are used to describe a set of symptoms that result from loss of renal function. This loss may be sudden or may develop over a long period; it may be self-limited or irreversible. </li></ul>
  30. 32. CAUSES <ul><li>increased production of urea in the liver, due to: </li></ul><ul><ul><li>high protein diet </li></ul></ul><ul><ul><li>increased protein breakdown (surgery, infection, trauma, cancer) </li></ul></ul><ul><ul><li>gastrointestinal bleeding </li></ul></ul><ul><ul><li>drugs (e.g. tetracyclines and corticosteroids) </li></ul></ul><ul><li>decreased elimination of urea, due to: </li></ul><ul><ul><li>decreased blood flow through kidney (e.g. hypotension, cardiac failure) </li></ul></ul><ul><ul><li>urinary outflow obstruction </li></ul></ul><ul><li>dehydration </li></ul><ul><li>chronic infection of the kidney, such as chronic pyelonephritis </li></ul>
  31. 33. Signs and Symptoms <ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Headache </li></ul><ul><li>Loss of energy </li></ul><ul><li>Sore mouth </li></ul><ul><li>Drowsiness </li></ul><ul><li>Muscle twitches </li></ul><ul><li>Muscle cramps </li></ul><ul><li>Abnormal skin sensations </li></ul><ul><li>Skin discoloration </li></ul><ul><li>Skin itch </li></ul>
  32. 34. Nursing care <ul><li>Meticulous oral hygiene should be given hourly to combat unpleasant symptoms. </li></ul><ul><li>Small frequent feeding </li></ul><ul><li>Keep the skin clean and dry </li></ul><ul><li>Provide a foot board to press against (help to relieve acute leg muscle cramps) </li></ul><ul><li>Provide emotional support </li></ul>
  33. 35. Peritoneal Dialysis <ul><li>uses a membrane inside your body (peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal. </li></ul><ul><li>It removes the toxic substances and metabolic wastes and to re-establish normal fluid and electrolyte imbalances. </li></ul><ul><li>The treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or renal transplantation. </li></ul>
  34. 37. COMPLICATIONS <ul><li>Abdominal infection </li></ul><ul><li>Amyloidosis (stiffening of kidney due to protein deposit) </li></ul><ul><li>Diabetes (requires blood sugar monitoring) </li></ul><ul><li>Infected catheter </li></ul><ul><li>Peritonitis (caused by bacterial infection of peritonium or scarring) </li></ul><ul><li>Vitamin and mineral deficiencies </li></ul>
  35. 38. Nursing Care <ul><li>Pre-dialysis care </li></ul><ul><ul><ul><li>Document V/S including temperature, orthostatic blood pressure (lying, sitting and standing), apical pulse, respirations, and lung sounds. </li></ul></ul></ul><ul><ul><ul><li>Weigh daily or between dialysis runs as indicated. </li></ul></ul></ul><ul><ul><ul><li>Note BUN, serum electrolytes, creatinine, ph and hematrocrit levels prior to peritoneal dialysis and periodically during the procedures. </li></ul></ul></ul><ul><ul><ul><li>Measure and record abdominal girth. </li></ul></ul></ul><ul><ul><ul><li>Maintain fluid and dietary restrictions as ordered. </li></ul></ul></ul><ul><ul><ul><li>Have the client empty the bladder prior to catheter insertion. </li></ul></ul></ul><ul><ul><ul><li>Warm the prescribed dialysate solution to body temperature using a warm water bath or heating pad on low setting. </li></ul></ul></ul><ul><ul><ul><li>Explain all procedures and expected sensations. </li></ul></ul></ul>
  36. 39. <ul><li>Intradialysis Care </li></ul><ul><ul><ul><ul><li>Use strict aseptic technique during the dialysis procedure and when caring for the peritoneal catheter. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Add prescribed medications to the dialysate; prime the tubing with solution and connect it to the peritoneal catheter, taping connections securely and avoiding kinks. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Instill dialysate into the abdominal cavity over a period of approx. 10min. Clamped tubing and allow the dialysate to remain in the abdomen for the prescribed dwell time. Keep drainage tubing clamped at all times during instillation and dwell time. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>During instillation and dwell time, observe closely for signs of respiratory distress. Place in Fowler’s or semi-fowler’s position and slow the rate of instillation slightly to relieve respiratory distress. </li></ul></ul></ul></ul>
  37. 40. <ul><ul><ul><ul><li>Note the clarity and odor of return dialysate. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Accurately record the amount and type of dialysate instilled, dwell time and amount and character of the drainage. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor BUN, serum electrolyte and creatinine level </li></ul></ul></ul></ul><ul><li>Post dialysis care </li></ul><ul><ul><ul><li>Assess V/S including temperature. </li></ul></ul></ul><ul><ul><ul><li>Time meals to correspond with dialysis outflow. </li></ul></ul></ul><ul><ul><ul><li>Teach the client and family about the procedure. </li></ul></ul></ul>
  38. 41. NURSING DIAGNOSIS <ul><li>Risk for Excess Fluid Volume related to fluid retention </li></ul><ul><li>Risk for Deficient Fluid Volume related to use of hypertonic dialysate with excessive removal of fluid from circulatory volume </li></ul><ul><li>Risk for trauma related to catheter inserted into peritoneal cavity with potential for perforation during insertion or by manipulation of the catheter </li></ul><ul><li>Pain related to insertion of catheter through abdominal wall / irritation of infection within peritoneal cavity </li></ul><ul><li>Risk for infection related to skin contaminants at catheter insertion site </li></ul>
  39. 42. HEMODIALYSIS <ul><li>-means “cleaning the blood” — and that is exactly what this treatment does. </li></ul><ul><li>Is for clients with acute or irreversible renal failure and fluids and electrolyte imbalances. </li></ul><ul><li>It is the most common method of dialysis. </li></ul>
  40. 44. DIALYZER <ul><li>The dialyzer is the piece of equipment that actually filters the blood. </li></ul>
  41. 45. COMPLICATIONS <ul><li>Low blood pressure (hypotension) </li></ul><ul><li>Muscle cramps </li></ul><ul><li>Itchin </li></ul><ul><li>Sleep problems </li></ul><ul><li>Anemia </li></ul><ul><li>Bone diseases </li></ul><ul><li>High blood pressure (hypertension </li></ul><ul><li>Fluid overload </li></ul><ul><li>Inflammation of the membrane surrounding the heart (pericarditis) </li></ul><ul><li>High potassium levels (hyperkalemia) </li></ul><ul><li>Infection </li></ul><ul><li>Depression </li></ul>
  42. 46. NURSING DIAGNOSIS <ul><li>Deficient Fluid Volume or Excess Fluid Volume related to impaired renal function, fluid shifts between dialysate and blood, and blood loss during hemodialysis </li></ul><ul><li>Imbalance Nutrition: Less than body requirements related to anorexia and nausea </li></ul><ul><li>Risk for Impaired Skin Integrity related to edema, dry skin and prirutis </li></ul><ul><li>Risk for infection related to the presence of an indwelling peritoneal catheter or related to venipuncture and connection of tubing during hemodialysis </li></ul>
  43. 47. NEPHRECTOMY <ul><ul><li>surgical removal of an entire kidney </li></ul></ul><ul><ul><li>indications include renal tumor, massive trauma, removal for donor, polycystic kidneys. </li></ul></ul><ul><ul><li>is performed on patients with severe kidney damage from disease, injury, or congenital conditions. These include cancer of the kidney (renal cell carcinoma); polycystic kidney disease (a disease in which cysts, or sac-like structures, displace healthy kidney tissue); and serious kidney infections. </li></ul></ul><ul><ul><li>It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation. </li></ul></ul>
  44. 49. <ul><li>There are two general types: </li></ul><ul><li>Partial nephrectomy: a part of the kidney is removed. </li></ul><ul><li>Radical nephrectomy: the entire kidney is taken out. </li></ul>
  45. 50. The two main ways that a kidney may be removed: <ul><li>Open Nephrectomy </li></ul><ul><li> - most often used </li></ul><ul><li> - a cut is made in your backside or your abdomen and your kidney is taken out </li></ul><ul><li>Laporoscopic Nephrectomy </li></ul><ul><li> - After making several small cuts, the surgeon uses fiber-optic scopes and special surgical tools to operate inside the body without cutting you open </li></ul><ul><li> - The kidney is taken out of a larger hole and everything is sewn back up. </li></ul>
  46. 52. COMPLICATIONS <ul><li>Possible complications of a nephrectomy procedure include infection, bleeding (hemorrhage), and post-operative pneumonia. There is also the risk of kidney failure in a patient with impaired function or disease in the remaining kidney </li></ul>
  47. 53. NURSING INTERVENTION <ul><li>Pre-operative care </li></ul><ul><li>Provide routine pre-op care. </li></ul><ul><li>Ensure adequate fluid intake. </li></ul><ul><li>Assess electrolyte values and correct any imbalances before surgery. </li></ul><ul><li>Avoid nephrotoxic agents in any diagnostics tests. </li></ul><ul><li>Advise client to expect flank pain after surgery if retroperitoneal approach (flank incision) is used. </li></ul><ul><li>Explain that client will have chest tube if thoracic approach used. </li></ul>
  48. 54. <ul><li>Post-operative: </li></ul><ul><li>Provide routine post-op care. </li></ul><ul><li>Assess urine output every hour. It should be 30-50 ml/hr. </li></ul><ul><li>Observe urinary drainage on dressing and estimate amount. </li></ul><ul><li>Weigh daily. </li></ul><ul><li>Maintain adequate functioning of chest drainage system. Ensure adequate oxygenation and prevent pulmonary complications. </li></ul><ul><li>Administer analgesics as ordered. </li></ul><ul><li>Encourage early ambulation. </li></ul><ul><li>Teach client to splint incision while turning, coughing, deep breathing. </li></ul>
  49. 55. <ul><li>Provide client teaching and discharge planning concerning </li></ul><ul><li>Prevention of urinary stasis </li></ul><ul><li>Maintain of acidic urine </li></ul><ul><li>Avoidance of activities that might cause trauma to the remaining kidney (contacts sports, horse back riding)| </li></ul><ul><li>No lifting heavy objects for at least 6 months </li></ul><ul><li>Need to report an explained weight gain, decreased urine output, flank pain on unoperative side, hematuria </li></ul><ul><li>Need to notify physician if cold or other infections presents for more than 3 days </li></ul><ul><li>Medications regimen and avoidance of OTC drugs that may be nephrotoxic (except with physician approval) </li></ul>
  50. 56. KIDNEY TRANSPLANT <ul><li>Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. </li></ul><ul><li>A kidney transplant is the transfer of a healthy kidney from one person (the donor) into the body of a person who has little or no kidney activity (the recipient). </li></ul><ul><li>A person only needs one kidney to survive, therefore the donor can be living or recently deceased. Some people are born with only one working kidney. </li></ul>
  51. 57. There are two main problems with kidney transplants <ul><li>First, there is a shortage of organs from people who have died. Therefore, not everyone with renal failure receives a transplant, even if they're medically suitable. This shortage can be partially made up by using living donors, usually blood relatives or the partner of the person with kidney failure. </li></ul><ul><li>The second problem is that the recipient's body recognises the transplant as if it were an invader, and tries to destroy it. This is called rejection. </li></ul><ul><li>The recipient of a kidney transplant has to take a powerful combination of medicines to prevent rejection and to treat the complications of these medicines. </li></ul>
  52. 60. NURSING INTERVENTION <ul><li>Pre-operative </li></ul><ul><ul><ul><li>Provide routine pre-op care </li></ul></ul></ul><ul><ul><ul><li>Discuss the possibility of post-op dialysis </li></ul></ul></ul><ul><ul><ul><li>Administer immunosuppressive medication as prescribe 2 days before the transplantation </li></ul></ul></ul><ul><ul><ul><li>Maintain protective isolation </li></ul></ul></ul><ul><ul><ul><li>Ensure that the client is free of any infections </li></ul></ul></ul>
  53. 61. <ul><li>Post-operative </li></ul><ul><ul><ul><ul><li>Provide routine post-op care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor fluid and electrolyte imbalance carefully </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Encourage frequent and early ambulation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor V/S, especially temperature </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Provide mouth care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor urine output every hour </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Maintain the client in semi-Fowlers position </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor the tree-way bladder irrigation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor for bowel sounds and initiate diet as prescribed when bowel sounds return </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Encourage coughing and deep breathing exercises </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Administer immunosuppressive agents, anti-fungal medications, antibiotics and corticosteriods as prescribed </li></ul></ul></ul></ul>
  54. 62. <ul><ul><li>Assess for organ rejection </li></ul></ul><ul><ul><li>Provide client teaching and discharge planning concerning. </li></ul></ul><ul><ul><li>Administer immunosuppressive agents, anti-fungal medications, antibiotics and corticosteriods as prescribed </li></ul></ul><ul><ul><ul><li>Immunosuppressive agents </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Cyclosporine (Sandimmune) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Azathioprine (Imuran) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Cyclophosphamide (Cytoxan) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Antilymphocytic Globulin (ALG), Antithymocytic Globulin (ATG) </li></ul></ul></ul></ul></ul>
  55. 63. NEUROGENIC BLADDER <ul><li>refers to several bladder dysfunctions caused by lesions of the central or peripheral nervous system. The manifestation depend on the site of the lesion. A neurologic bladder may involve a combination of one or more nervous system dysfunctions. </li></ul>
  56. 64. CAUSES <ul><li>Spinal cord injuries resulting in paralysis </li></ul><ul><li>Other disorders such as syphilis, diabetes mellitus, stroke, ruptured or herniated intervertebral disk </li></ul><ul><li>Degenerative neurological diseases such as multiple sclerosis and amyotrophic lateral sclerosis </li></ul><ul><li>Congenital spine abnormalities such as spina bifida </li></ul><ul><li>Long-term effects of alcoholism </li></ul>
  57. 65. SYMPTOMS <ul><li>Urinary incontinence, characterized by either involuntary release of large volumes of urine or continuous dribbling of small amounts. Bed-wetting may occur </li></ul><ul><li>Frequent urination </li></ul><ul><li>Persistent urge to urinate despite recent voiding; a constant feeling that the bladder is not completely empty </li></ul><ul><li>Pain or burning on urination </li></ul>
  58. 66. NURSING CARE <ul><li>Bladder training </li></ul><ul><li>Prevent autonomic dysreflexia </li></ul><ul><li>Teach methods to stimulate micturation </li></ul><ul><li>Perform intermittent catheterization </li></ul><ul><li>Teach intermittent self catheterization </li></ul>
  59. 67. NURSING DIAGNOSIS <ul><li>Risk for infection </li></ul><ul><li>Urinary retention related to lower motor neurons lesion. </li></ul><ul><li>Urinary incontinence related to upper motor neurons lesion. </li></ul><ul><li>Body image disturbances related to disease process. </li></ul>
  60. 68. Prepared by:
  61. 69. ACKNOWLEDGEMENT <ul><li>WE WOULD LIKE TO EXTEND OUR WARMTH THANKS TO MR.JHOEY E. POTATO FOR HIS SINCERE LOVE, SUPPORT AND KINDNESS FOR SHARING HIS VALUABLE “ LAPTOP ”… </li></ul><ul><li>“ AGING is a CHOICE…” </li></ul>

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