WHAT IS ARF? <ul><li>Rapid loss of renal function due to damage to the kidneys (Decreased GFR). </li></ul><ul><li>Occurs a...
<ul><li>Prerenal: </li></ul><ul><ul><li>hypovolemia </li></ul></ul><ul><ul><li>Low Cardiac Output </li></ul></ul><ul><ul><...
Pathophysiology:  ARF Predisposing factors: Age Gender Race Genetics Precipitating Factors: Environment Lifestyle Disease ...
<ul><li>Diuretic Phase </li></ul><ul><li>BUN, Creatinine </li></ul><ul><li>Urine output </li></ul><ul><li>Return of Renal ...
<ul><li>History:   </li></ul><ul><li>Ask client about: </li></ul><ul><li>Exposure to nephrotoxins </li></ul><ul><li>Recent...
<ul><li>Urinalysis   </li></ul><ul><li>*Specific Gravity  – </li></ul><ul><li>Creatinine Clearance Test –  </li></ul><ul><...
<ul><li>Complication </li></ul><ul><li>Infection </li></ul><ul><li>Kidney failure </li></ul><ul><li>Uremic syndrome (uremi...
<ul><li>Medical Management </li></ul><ul><li>1. Fluid and electrolyte replacements (IVF) </li></ul><ul><li>2. Drug therapi...
<ul><li>Promotive </li></ul><ul><li>Client education on ARF </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Good Nut...
CHRONIC RENAL FAILURE
Chronic Renal Failure <ul><li>is a slowly worsening loss of the ability of the kidneys function </li></ul><ul><li>ranges f...
Stages of CRF Stage 1: Diminished renal reserve Stage II: Renal Insuffiency Stage III: End Stage Renal Disease(ESRD) <ul><...
<ul><li>Predisposing factors: </li></ul><ul><li>Age( common in older adults) </li></ul><ul><li>Gender </li></ul><ul><li>Ra...
<ul><li>Initial symptoms may </li></ul><ul><li>include the following: </li></ul><ul><li>Fatigue </li></ul><ul><li>Frequent...
Complications <ul><li>Anemia </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Decreased immune response  </li>...
<ul><li>Progressive deterioration of GF, tubular secretion and reabsorption  </li></ul>Oliguria Increase BUN Increase crea...
Medical intervention <ul><li>Blood transfusions  </li></ul><ul><li>Diuretic therapy </li></ul><ul><li>anti hypertensive ag...
<ul><li>Promotive </li></ul><ul><li>Client education  </li></ul><ul><li>Discuss the relationship between diabetes, hyperte...
<ul><li>Curative </li></ul><ul><li>Prevent neurologic complications. </li></ul><ul><li>Promote optimal GI function </li></...
Uremia
Uremia <ul><li>The term uremia, which literally means urine in the blood. </li></ul><ul><li>Is a clinical syndrome associa...
Clinical Manifestations
Interventions: <ul><li>Medical: </li></ul><ul><ul><ul><li>Diuretics </li></ul></ul></ul><ul><ul><ul><li>Sodium Bicarbonate...
<ul><li>Promotive: </li></ul><ul><li>Client education on Uremia </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Prev...
<ul><li>Curative: </li></ul><ul><ul><li>Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine ...
<ul><li>Potential Fluid Volume Deficit </li></ul><ul><li>Skin Integrity Impairment </li></ul><ul><li>Potential for injury ...
Peritoneal   and Hemodialysis
<ul><li>Dialysis  </li></ul><ul><li>is a treatment that removes substances such as water, salts, and waste products which ...
<ul><li>Process of Dialysis </li></ul><ul><li>Ultrafiltration   </li></ul><ul><ul><li>refers to removal of fluid from the ...
 
<ul><li>COMPLICATIONS OF </li></ul><ul><li>PERITONEAL DIALYSIS </li></ul><ul><li>Infections.  </li></ul><ul><li>Weight gai...
<ul><li>Types of Dialysis :   </li></ul><ul><ul><li>A.  Peritoneal Dialysis  </li></ul></ul><ul><ul><li>Involves repeated ...
B . Hemodialysis <ul><li>Is used for clients with irreversible renal failure and fluid and electrolytes imbalances. Usuall...
Types of Access for Hemodialysis   <ul><li>Primary AV fistula </li></ul><ul><ul><li>It requires a surgical procedure in wh...
Peritoneal   and Hemodialysis VIDEO CLIP
Nursing Care of the Client Undergoing Peritoneal Dialysis <ul><ul><li>PREDIALYSIS CARE </li></ul></ul><ul><li>Document vit...
Nursing Care of the Client Undergoing Hemodialysis <ul><ul><li>POSTDIALYSIS </li></ul></ul><ul><li>Monitor BUN, serum elec...
<ul><li>Excess Fluid Volume  </li></ul><ul><li>Imbalanced Nutrition: Less Than Body Requirements  </li></ul><ul><li>Risk f...
Nephrectomy
<ul><li>A  Nephrectomy  is the surgical removal of a kidney or a section of a kidney. </li></ul><ul><li>Types: </li></ul><...
<ul><li>Why do nephrectomy need to be done? </li></ul><ul><li>Cancer,cyst or infection </li></ul><ul><li>To donate kidneys...
<ul><li>Test before surgery: </li></ul><ul><li>ECG </li></ul><ul><li>Chest radiography </li></ul><ul><li>CBC </li></ul><ul...
<ul><li>Pre-op care </li></ul><ul><li>Informed consent </li></ul><ul><li>Health hx </li></ul><ul><li>Physical exam </li></...
Large right renal tumor visible as an abdominal mass.
To remove a kidney in an open procedure, an incision is made below the ribcage (A). The kidney is exposed (B) and connecti...
Renal tumor after surgical removal
<ul><li>When to call professional? </li></ul><ul><li>develop a fever  </li></ul><ul><li>incision becomes red, tender or sw...
 
<ul><li>Kidney transplantation or renal transplantation is the Organ Transplant of a kidney in a patient  with end-stage r...
<ul><li>Recipient factor </li></ul><ul><li>Nutritional state </li></ul><ul><li>Immunological integrity </li></ul><ul><li>A...
<ul><li>Preparation: </li></ul><ul><li>Blood and urine tests </li></ul><ul><li>X-rays, ultrasounds, CT/MRI scan </li></ul>...
 
<ul><li>Maintain urinary catheter patency and closed system </li></ul><ul><li>MIO </li></ul><ul><li>Monitor v/s and hemody...
<ul><li>Informed consent </li></ul><ul><li>Continue dialysis as ordered </li></ul><ul><li>Administer immunosupressive drug...
<ul><li>it used to require a  </li></ul><ul><li>very  large scar to </li></ul><ul><li>remove a kidney for </li></ul><ul><l...
Once the kidney is removed, it is flushed with a preservative solution and prepared for implantation by the transplant sur...
 
 
Neurologic bladder is a dysfunction that results from a lesion of the nervous system . <ul><li>Causes:   </li></ul><ul><li...
<ul><li>Pathophysiology  </li></ul><ul><li>Spastic bladder </li></ul><ul><li>Simple reflex are between bladder and </li></...
<ul><li>Pathophysiology </li></ul><ul><li>Flaccid Bladder </li></ul><ul><li>Damage to the sacral spinal cord at the level ...
<ul><li>Infection </li></ul><ul><li>Urolithiasis </li></ul><ul><li>Renal failure </li></ul><ul><li>Hydronephrosis </li></u...
<ul><li>Pharmacologic </li></ul><ul><li>Therapy </li></ul><ul><li>Bethanechol (urecholine)-parasympathetic medication </li...
<ul><li>Bladder retraining </li></ul><ul><li>Dietary measures </li></ul><ul><li>(moderate to high fluid and diet that acid...
<ul><li>Impaired urinary elimination related to impaired bladder innervation </li></ul><ul><li>Self –care deficit: toileti...
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Group 3 Fisher

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Group 3 Fisher

  1. 2. WHAT IS ARF? <ul><li>Rapid loss of renal function due to damage to the kidneys (Decreased GFR). </li></ul><ul><li>Occurs abruptly and can be reversible </li></ul><ul><li>Rapid elevation of BUN and serum creatinine </li></ul>Types: 1. Prerenal 2. Intrarenal 3. Postrenal Phases: 1. Oliguric Phase 2. Diuretic Phase 3. Recovery or Convalescent Phase
  2. 3. <ul><li>Prerenal: </li></ul><ul><ul><li>hypovolemia </li></ul></ul><ul><ul><li>Low Cardiac Output </li></ul></ul><ul><ul><li>Altered vascular resistance </li></ul></ul><ul><li>Intrarenal: </li></ul><ul><ul><li>Glomerular/microvascular injury </li></ul></ul><ul><ul><li>Acute tubular necrosis </li></ul></ul><ul><li>Postrenal: </li></ul><ul><ul><li>Interstitial nephritis </li></ul></ul><ul><ul><li>Ureteral Obstruction </li></ul></ul><ul><ul><li>Urethral Obstruction </li></ul></ul>Etiology
  3. 4. Pathophysiology: ARF Predisposing factors: Age Gender Race Genetics Precipitating Factors: Environment Lifestyle Disease Trauma, Infection Acute Injury to Kidneys Partial Destruction of the Functional Units of the Kidney Decreased GFR Oliguria Anuria Creatinine BUN Azotemia Sp. Gravity Edema Electrolyte Imbalance Inability to excrete fluid loads & metabolic wastes Hyperkalemia Hyponatemia Metabolic Acidosis
  4. 5. <ul><li>Diuretic Phase </li></ul><ul><li>BUN, Creatinine </li></ul><ul><li>Urine output </li></ul><ul><li>Return of Renal Functions to Normal Level or near normal </li></ul>Recovery Phase Normal Kidney Function Normal Serum Electrolytes
  5. 6. <ul><li>History: </li></ul><ul><li>Ask client about: </li></ul><ul><li>Exposure to nephrotoxins </li></ul><ul><li>Recent surgery or trauma </li></ul><ul><li>Transfusions </li></ul><ul><li>Factors that might lead to reduced renal blood flow </li></ul><ul><li>Acute illnesses such as influenza, cold, gastroenteritis and sore throat </li></ul><ul><li>* Obtain drug history </li></ul>Physical Assessment <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 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>Assessment
  6. 7. <ul><li>Urinalysis </li></ul><ul><li>*Specific Gravity – </li></ul><ul><li>Creatinine Clearance Test – </li></ul><ul><li>* a blood and timed urine specimen that evaluates kidney function </li></ul><ul><li>* Normal Values- 100-120 ml/min </li></ul><ul><li>Potassium Test – </li></ul><ul><li>Serum Sodium – </li></ul><ul><li>BUN - (Normal Values: 8 to 25 mg/dl) </li></ul><ul><li>Serum Creatinine - (Normal Values: 0-1 mg/dl) </li></ul><ul><li>Radiographic tests </li></ul><ul><li>Computed Tomography </li></ul><ul><li>Renal Ultrasonography </li></ul><ul><li>X-rays of the kidneys </li></ul><ul><li>Aortorenal angiography </li></ul><ul><li>KUB </li></ul><ul><li>Renal biopsy </li></ul><ul><li>IVP </li></ul>Diagnostic Tests
  7. 8. <ul><li>Complication </li></ul><ul><li>Infection </li></ul><ul><li>Kidney failure </li></ul><ul><li>Uremic syndrome (uremia) </li></ul><ul><li>Heart problems/diseases </li></ul><ul><li>Pericarditis </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Decreased functioning of white blood cells </li></ul><ul><li>Decreased immune response </li></ul><ul><li>Electrolyte imbalances </li></ul><ul><li>Nursing Diagnoses: </li></ul><ul><li>1.Fluid volume excess </li></ul><ul><li>2.Imbalanced nutrition less than body requirements </li></ul><ul><li>3.Deficient knowledge </li></ul><ul><li>4.Decreased cardiac output </li></ul><ul><li>5.Impaired urinary elimination </li></ul>
  8. 9. <ul><li>Medical Management </li></ul><ul><li>1. Fluid and electrolyte replacements (IVF) </li></ul><ul><li>2. Drug therapies (diuretics, dopamine, sodium bicarbonate, calcium channel blockers, ACE inhibitors) </li></ul><ul><li>3. Blood transfusions </li></ul><ul><li>4. Laboratory and radiographic examinations </li></ul><ul><li>5. Diet Restrictions </li></ul><ul><li>Surgical </li></ul><ul><li>Interventions : </li></ul><ul><li>Kidney Transplants </li></ul><ul><li>Dialysis </li></ul><ul><li>Continuous Renal Replacement Therapy </li></ul>
  9. 10. <ul><li>Promotive </li></ul><ul><li>Client education on ARF </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Good Nutrition and </li></ul><ul><li>exercise </li></ul><ul><li>Preventive </li></ul><ul><li>Be alert to the general appearance of your urine. </li></ul><ul><li>Regular medical check up </li></ul><ul><li>Adequate fluid intake </li></ul><ul><li>Curative </li></ul><ul><li>Assessment:VS, fluid overload, LOC </li></ul><ul><li>Monitor laboratory values as ordered </li></ul><ul><li>Monitor/maintain fluid and electrolyte balance </li></ul><ul><li>Administer drugs as ordered </li></ul><ul><li>Rehabilitative </li></ul><ul><li>Provide client teaching and discharge planning </li></ul>Nursing Care:
  10. 11. CHRONIC RENAL FAILURE
  11. 12. Chronic Renal Failure <ul><li>is a slowly worsening loss of the ability of the kidneys function </li></ul><ul><li>ranges from mild dysfunction to severe kidney failure. </li></ul><ul><li>kidneys attempt to compensate for renal damage by hyperfiltration within the remaining functional nephrons. Over time, hyperfiltration causes further loss of function </li></ul>
  12. 13. Stages of CRF Stage 1: Diminished renal reserve Stage II: Renal Insuffiency Stage III: End Stage Renal Disease(ESRD) <ul><li>Etiology </li></ul><ul><li>Diabetes mellitus (28%) </li></ul><ul><li>Hypertension (25%) </li></ul><ul><li>Glomerulonephritis (21%) </li></ul><ul><li>Polycystic Kidney Disease (4%) </li></ul><ul><li>Other (23%): Obstruction, infection, etc. </li></ul>
  13. 14. <ul><li>Predisposing factors: </li></ul><ul><li>Age( common in older adults) </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Genetics( hx of DM and HPN) </li></ul>Precipitating Factors: Lifestyle Chronic conditions( HPN and DM) Glumerolunephritis Dehydration infection Decreased renal reserve (Renal tissue destruction and hypertrophy of functional nephrons) Glomerular sclerosis/ scarring Polyuria Azotemia HPN Renal insuffiency PATHOPHYSIOLOGY OF CRF
  14. 15. <ul><li>Initial symptoms may </li></ul><ul><li>include the following: </li></ul><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>Later symptoms may include </li></ul><ul><li>the following: </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><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>Symptoms
  15. 16. Complications <ul><li>Anemia </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Decreased immune response </li></ul><ul><li>Electrolyte abnormalities including hyperkalemia </li></ul><ul><li>End-stage renal disease </li></ul><ul><li>Hemorrhage </li></ul><ul><li>High blood pressure </li></ul><ul><li>Increased infections </li></ul><ul><li>Pericarditiss </li></ul><ul><li>Skin dryness, itching /scratching with resultant skin infection </li></ul><ul><li>Nursing Diagnoses </li></ul><ul><li>Impaired Tissue perfusion: Renal </li></ul><ul><li>Imbalanced Nutrition: less than body requirements </li></ul><ul><li>Excess Fluid volume </li></ul><ul><li>Disturbed body image </li></ul><ul><li>Fatigue </li></ul><ul><li>Risk for infection </li></ul>
  16. 17. <ul><li>Progressive deterioration of GF, tubular secretion and reabsorption </li></ul>Oliguria Increase BUN Increase creatinine Kidney atrophy and fibrosis ESRD
  17. 18. Medical intervention <ul><li>Blood transfusions </li></ul><ul><li>Diuretic therapy </li></ul><ul><li>anti hypertensive agents </li></ul><ul><li>Sodium bicarbonate may be used to correct mild acidosis </li></ul><ul><li>Surgical intervention </li></ul><ul><li>Dialysis or kidney transplant </li></ul><ul><li>May eventually be needed. </li></ul>
  18. 19. <ul><li>Promotive </li></ul><ul><li>Client education </li></ul><ul><li>Discuss the relationship between diabetes, hypertension, and kidney disease. </li></ul><ul><li>Encourage the client with ESRD to investigate options for early transplantation to avoid long term dialysis. </li></ul><ul><li>Preventive </li></ul><ul><li>Be alert to the general appearance of your urine. </li></ul><ul><li>Diabetics should control blood sugar and blood pressure closely and should refrain from smoking. </li></ul><ul><li>Reduce intake of soda pop soft drinks </li></ul><ul><li>1 to 2 quarts of fluid a day to flush out body wastes. </li></ul><ul><li>kidney function with a blood test (serum creatinine) and a urinalysis periodically. </li></ul>
  19. 20. <ul><li>Curative </li></ul><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>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><ul><li>Rehabilitative </li></ul><ul><li>follow up care </li></ul><ul><li>Frequent medical visits </li></ul><ul><li>A dietary consult is needed to modify the client’s diet </li></ul><ul><li>home care nursing or social work assistance </li></ul>
  20. 21. Uremia
  21. 22. Uremia <ul><li>The term uremia, which literally means urine in the blood. </li></ul><ul><li>Is a clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities, which develop in parallel with deterioration of renal function. </li></ul><ul><li>Pathophysiology of Uremia </li></ul><ul><li>Normally, the kidney is the site of hormone production and secretion, acid-base homeostasis, fluid and electrolyte regulation, and waste-product elimination. Uremia usually develops only after the creatinine clearance falls to less than </li></ul><ul><li>10 mL/min. </li></ul>
  22. 23. Clinical Manifestations
  23. 24. Interventions: <ul><li>Medical: </li></ul><ul><ul><ul><li>Diuretics </li></ul></ul></ul><ul><ul><ul><li>Sodium Bicarbonate or calcium carbonate – to correct mild acidosis, to decrease serum potassium levels and normalize serum calcium levels. </li></ul></ul></ul><ul><ul><ul><li>Antipruritic, such as trimeprazine or diphenhydramine for itching </li></ul></ul></ul><ul><ul><ul><li>Aluminum hydroxide gel to lower serum phosphate levels </li></ul></ul></ul><ul><ul><ul><li>The patient may also benefit from supplementary vitamins </li></ul></ul></ul><ul><ul><ul><li> (vitamin D and iron) and essential amino acids. </li></ul></ul></ul><ul><ul><ul><li>Ampicillin for infection </li></ul></ul></ul><ul><li>B. Surgical : </li></ul><ul><ul><ul><ul><li>Kidney transplantation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hemodialysis or peritoneal dialysis </li></ul></ul></ul></ul>
  24. 25. <ul><li>Promotive: </li></ul><ul><li>Client education on Uremia </li></ul><ul><li>Healthy lifestyle </li></ul><ul><li>Preventive: </li></ul><ul><li>Good Nutrition and exercise </li></ul><ul><li>Frequent medical Check-up </li></ul>Nursing Care
  25. 26. <ul><li>Curative: </li></ul><ul><ul><li>Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet itchy skin, restlessness, seizures). </li></ul></ul><ul><ul><li>Monitor serum electrolytes, BUN, and creatinine as ordered. </li></ul></ul><ul><ul><li>Monitor/prevent alteration in fluid and electrolyte balance. </li></ul></ul><ul><li>Rehabilitative: </li></ul><ul><ul><li>Frequent medical visits are necessary </li></ul></ul><ul><ul><li>A dietary consult is needed to modify the client’s diet </li></ul></ul><ul><ul><li>Teach about the need for fluid intake restriction </li></ul></ul><ul><ul><li>Discharge planning </li></ul></ul>
  26. 27. <ul><li>Potential Fluid Volume Deficit </li></ul><ul><li>Skin Integrity Impairment </li></ul><ul><li>Potential for injury related to weakness and confusion </li></ul><ul><li>Potential self-esteem disturbance </li></ul><ul><li>Potential alterations in nutritional requirements for specific nutrients - potassium, sodium, and protein </li></ul>Nursing Diagnosis
  27. 28. Peritoneal and Hemodialysis
  28. 29. <ul><li>Dialysis </li></ul><ul><li>is a treatment that removes substances such as water, salts, and waste products which build up in patients with failing kidneys. </li></ul><ul><li>USES: </li></ul><ul><ul><li>Used to remove excess water and nitrogenous wastes, reducing the manifestations of renal failure. </li></ul></ul><ul><ul><li>Used temporarily if the client has ARF or as permanent, life sustaining treatment if the client has CRF. </li></ul></ul><ul><ul><li>Used to control uremia and to physically prepare the client to receive a transplanted kidney . </li></ul></ul>
  29. 30. <ul><li>Process of Dialysis </li></ul><ul><li>Ultrafiltration </li></ul><ul><ul><li>refers to removal of fluid from the blood using either osmotic or hydrostatic pressure to produce the necessary gradient. </li></ul></ul><ul><ul><li>Diffusion </li></ul></ul><ul><ul><li>refers to the passage of particles (ions) from an area of </li></ul></ul><ul><ul><li>high concentration to an area of low concentration. </li></ul></ul><ul><li>Both processes occur across a semipermeable membrane with pores large enough to allow certain particles (such as urea, creatinine,and </li></ul><ul><li>electrolytes) to pass through but too small to allow the passage of larger particles (such as protein and red blood cells). </li></ul>
  30. 32. <ul><li>COMPLICATIONS OF </li></ul><ul><li>PERITONEAL DIALYSIS </li></ul><ul><li>Infections. </li></ul><ul><li>Weight gain. </li></ul><ul><li>Weakening of the abdominal muscles (hernia). </li></ul><ul><li>Fluid overload. </li></ul><ul><li>High blood pressure. </li></ul><ul><li>Air embolus. </li></ul><ul><li>COMPLICATIONS OF HEMODIALYSIS </li></ul><ul><li>Infection. </li></ul><ul><li>Low blood pressure (hypotension).. </li></ul><ul><li>Itching. </li></ul><ul><li>Anemia. </li></ul><ul><li>Sleep problems. </li></ul><ul><li>Bone diseases. </li></ul>
  31. 33. <ul><li>Types of Dialysis : </li></ul><ul><ul><li>A. Peritoneal Dialysis </li></ul></ul><ul><ul><li>Involves repeated cycles instilling dialysate into the peritoneal cavity, allowing time for substance exchange, and then removing the dialysate by gravity. </li></ul></ul><ul><ul><li>2L of dialysate is instilled and left for 30-45 mins. dwell time. It is replaced 4-6 hrs everyday. </li></ul></ul>
  32. 34. B . Hemodialysis <ul><li>Is used for clients with irreversible renal failure and fluid and electrolytes imbalances. Usually the treatment of choice for removal of toxic agents such as barbiturates in the blood. </li></ul><ul><li>It usually is done 3 days per week and takes 3 to 5 hours per day. </li></ul>
  33. 35. Types of Access for Hemodialysis <ul><li>Primary AV fistula </li></ul><ul><ul><li>It requires a surgical procedure in which an artery is anastomosed to a vein. </li></ul></ul><ul><ul><li>During dialysis, two needles are inserted into the fistula vein. </li></ul></ul><ul><li>Internal Arteriovenous Graft </li></ul><ul><ul><li>One end of the artificial graft is anastomosed to an artery, tunneled under the skin, and anastomosed to a vein </li></ul></ul><ul><li>Central Venous Catheter </li></ul><ul><ul><li>A central venous catheter uses a thin flexible tube that is placed into a large vein (may be subclavian, jugular femoral veins). </li></ul></ul>
  34. 36. Peritoneal and Hemodialysis VIDEO CLIP
  35. 37. Nursing Care of the Client Undergoing Peritoneal Dialysis <ul><ul><li>PREDIALYSIS CARE </li></ul></ul><ul><li>Document vital signs. </li></ul><ul><li>Measure and record abdominal girth. </li></ul><ul><li>Warm the dialysate solution to body temperature (98.6 oF or 37oC). </li></ul><ul><ul><li>INTRADIALYSIS </li></ul></ul><ul><li>Use strict aseptic technique </li></ul><ul><li>Instill dialysate into the abdominal cavity over a period of approx. 10 mins. Clamp tubing and allow the dialysate to remain in the abdomen for the prescribed dwell time. </li></ul><ul><li>During instillation and dwell time, observe closely for signs of respiratory distress. </li></ul><ul><ul><li>Note the color, clarity and odor of returned dialysate. </li></ul></ul><ul><li>POSTDIALYSIS </li></ul><ul><li>Assess vital signs, including temperature. </li></ul><ul><li>Time meals to correspond with dialysis outflow. </li></ul><ul><li>Maintain fluid and dietary restrictions </li></ul>
  36. 38. Nursing Care of the Client Undergoing Hemodialysis <ul><ul><li>POSTDIALYSIS </li></ul></ul><ul><li>Monitor BUN, serum electrolyte and creatinine levels. </li></ul><ul><li>Assess for other responses to dialysis, such as dehydration, nausea and vomiting, muscle cramps or seizure activity. </li></ul><ul><li>Assess for bleeding at the site or elsewhere . </li></ul><ul><ul><li>PREDIALYSIS CARE </li></ul></ul><ul><li>Weigh daily or between dialysis runs as indicated. Weight is an accurate indicator of fluid volume status. </li></ul><ul><ul><li>INTRADIALYSIS </li></ul></ul><ul><li>Use strict aseptic technique during the dialysis procedure and when caring for the peritoneal catheter. </li></ul>
  37. 39. <ul><li>Excess Fluid Volume </li></ul><ul><li>Imbalanced Nutrition: Less Than Body Requirements </li></ul><ul><li>Risk for Systemic Infection related to Dialysis Infection </li></ul><ul><li>Impaired Tissue Integrity related to chemical irritants of inflammatory response </li></ul><ul><li>Acute pain related to insertion site . </li></ul>NURSING DIAGNOSIS
  38. 40. Nephrectomy
  39. 41. <ul><li>A Nephrectomy is the surgical removal of a kidney or a section of a kidney. </li></ul><ul><li>Types: </li></ul><ul><li>Partial- part of one kidney </li></ul><ul><li>Simple- all of one kidney </li></ul><ul><li>Radical-all of one kidney together with the adrenal gland and neighboring lymph node </li></ul><ul><li>Bilateral- both kidneys </li></ul>
  40. 42. <ul><li>Why do nephrectomy need to be done? </li></ul><ul><li>Cancer,cyst or infection </li></ul><ul><li>To donate kidneys for organ transplant </li></ul><ul><li>Possible complications: </li></ul><ul><li>Infection </li></ul><ul><li>Bleeding </li></ul><ul><li>Post-op pneumonia </li></ul><ul><li>Kidney failure </li></ul><ul><li>Thrombophelibitis </li></ul><ul><li>Hypotension </li></ul><ul><li>atelectasis </li></ul>
  41. 43. <ul><li>Test before surgery: </li></ul><ul><li>ECG </li></ul><ul><li>Chest radiography </li></ul><ul><li>CBC </li></ul><ul><li>Electrolyte profile with BUN and creatinine levels </li></ul><ul><li>Pulmonary function test </li></ul><ul><li>Blood gas analysis(ABG) </li></ul><ul><li>CT scan- most cost effective </li></ul>
  42. 44. <ul><li>Pre-op care </li></ul><ul><li>Informed consent </li></ul><ul><li>Health hx </li></ul><ul><li>Physical exam </li></ul><ul><li>Pre-op breathing exercises </li></ul><ul><li>Instruct client to avoid smoking </li></ul><ul><li>Ask for use of alcohol or ingestion of drugs or aspirin </li></ul><ul><li>Intra-op Care </li></ul><ul><li>Avoid intraoperative hypotension </li></ul><ul><li>Post op care </li></ul><ul><li>v/s q15 for 1 hr, q30 next and hourly if stable </li></ul><ul><li>Appropriate Blood and fluid replacement </li></ul><ul><li>Early mobilization </li></ul><ul><li>Elastic support of legs </li></ul>
  43. 45. Large right renal tumor visible as an abdominal mass.
  44. 46. To remove a kidney in an open procedure, an incision is made below the ribcage (A). The kidney is exposed (B) and connections to blood vessels and the ureter are severed (C). The kidney is removed in one piece (D).
  45. 47. Renal tumor after surgical removal
  46. 48. <ul><li>When to call professional? </li></ul><ul><li>develop a fever </li></ul><ul><li>incision becomes red, tender or swollen </li></ul><ul><li>nausea, vomiting or severe abdominal pain occurs </li></ul><ul><li>develop a cough or have difficulty breathing </li></ul><ul><li>NURSING DIAGNOSIS </li></ul><ul><li>High Risk for Ineffective </li></ul><ul><li>therapeutic Regimen related to </li></ul><ul><li>insufficient knowledge of </li></ul><ul><li>hydration requirements. </li></ul><ul><li>Acute pain related to distention </li></ul><ul><li>of renal capsule and incision. </li></ul><ul><li>High risk for ineffective </li></ul><ul><li>respiratory function related to pain on </li></ul><ul><li>breathing and coughing secondary </li></ul><ul><li>to location of incision . </li></ul>
  47. 50. <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>Classification: </li></ul><ul><li>deceased-donor (cadaveric) </li></ul><ul><li>living-donor </li></ul><ul><li>a. living related </li></ul><ul><li>b. living unrelated </li></ul>
  48. 51. <ul><li>Recipient factor </li></ul><ul><li>Nutritional state </li></ul><ul><li>Immunological integrity </li></ul><ul><li>Absence of other disease affecting immune response </li></ul><ul><li>Metabolic disease or systemic disease </li></ul><ul><ul><ul><li>Donor Factors </li></ul></ul></ul><ul><li>Type of Organ </li></ul><ul><li>Relationship with the recipient </li></ul><ul><li>Degree of cross match </li></ul><ul><li>Cause of death </li></ul>
  49. 52. <ul><li>Preparation: </li></ul><ul><li>Blood and urine tests </li></ul><ul><li>X-rays, ultrasounds, CT/MRI scan </li></ul><ul><li>Candidates for KT: </li></ul><ul><li>Px with ESRD </li></ul><ul><li>Contraindication: </li></ul><ul><li>Active cancer </li></ul><ul><li>HIV infectiserious heart or lung disease </li></ul><ul><li>Hepatitis C </li></ul><ul><li>Severe infection </li></ul>
  50. 54. <ul><li>Maintain urinary catheter patency and closed system </li></ul><ul><li>MIO </li></ul><ul><li>Monitor v/s and hemodynamic pressure closely </li></ul><ul><li>Fluid replacements </li></ul><ul><li>Diuretics as ordered </li></ul><ul><li>Monitor serum electrolytes and renal function tests </li></ul><ul><li>Monitor for possible complications </li></ul><ul><li>a. hemorrhage </li></ul><ul><li>b. infection </li></ul><ul><li>c. renal artery thrombosis </li></ul><ul><li>Impaired tissue perfusion </li></ul><ul><li>Imbalance Nutrition: Less than body requirements </li></ul><ul><li>Risk for infection </li></ul><ul><li>Disturbed body image </li></ul><ul><li>Fluid imbalance </li></ul>nursing diagnosis
  51. 55. <ul><li>Informed consent </li></ul><ul><li>Continue dialysis as ordered </li></ul><ul><li>Administer immunosupressive drugs as ordered before surgery </li></ul><ul><li>Screen Pt for infection </li></ul><ul><li>Provide routine pre-op care </li></ul><ul><li>Donor kidney- placed in iliac fossa, anterior to iliac crest </li></ul><ul><li>Native kidney- left in for hormones unless prone to chronic infection </li></ul>
  52. 56. <ul><li>it used to require a </li></ul><ul><li>very large scar to </li></ul><ul><li>remove a kidney for </li></ul><ul><li>donation. </li></ul>in the past.... With laparoscopic surgery techniques, the donor kidney can be removed with very small incisions and little scarring Now...
  53. 57. Once the kidney is removed, it is flushed with a preservative solution and prepared for implantation by the transplant surgeon
  54. 60. Neurologic bladder is a dysfunction that results from a lesion of the nervous system . <ul><li>Causes: </li></ul><ul><li>Spinal cord injury </li></ul><ul><li>Spinal tumor </li></ul><ul><li>Herniated vertebral disk </li></ul><ul><li>Multiple sclerosis </li></ul><ul><li>Congenital anomalities </li></ul><ul><li>Infection </li></ul><ul><li>DM </li></ul><ul><li>Types: </li></ul><ul><li>Spastic </li></ul><ul><li>Flaccid </li></ul>
  55. 61. <ul><li>Pathophysiology </li></ul><ul><li>Spastic bladder </li></ul><ul><li>Simple reflex are between bladder and </li></ul><ul><li>spinal cord at s2 through s4 </li></ul><ul><li>Causes reflex contraction of detrusor muscle </li></ul><ul><li>Disruption of CNS transmission above the sacral spinal cord segment </li></ul><ul><li>Spastic neurogenic bladder </li></ul>
  56. 62. <ul><li>Pathophysiology </li></ul><ul><li>Flaccid Bladder </li></ul><ul><li>Damage to the sacral spinal cord at the level of the reflex arc </li></ul><ul><li>Loss of detrusor muscle tone </li></ul><ul><li>Flaccid neurogenic bladder </li></ul>
  57. 63. <ul><li>Infection </li></ul><ul><li>Urolithiasis </li></ul><ul><li>Renal failure </li></ul><ul><li>Hydronephrosis </li></ul><ul><li>atrophy </li></ul><ul><li>Medical Management: </li></ul><ul><li>Continuous, intermittent or self catherization </li></ul><ul><li>Diet low in calcium </li></ul><ul><li>Encourage mobility and ambulation </li></ul><ul><li>Liberal fluid intake </li></ul>
  58. 64. <ul><li>Pharmacologic </li></ul><ul><li>Therapy </li></ul><ul><li>Bethanechol (urecholine)-parasympathetic medication </li></ul><ul><li>Anticholinesterase drugs- Neostagmine(prostagmin) </li></ul><ul><li>Diagnostic: </li></ul><ul><li>Urine culture </li></ul><ul><li>Urinalysis and serum BUN and creatinine </li></ul><ul><li>Cystometrography </li></ul>
  59. 65. <ul><li>Bladder retraining </li></ul><ul><li>Dietary measures </li></ul><ul><li>(moderate to high fluid and diet that acidifies urine) </li></ul><ul><li>Rhizotomy-destruction of the nerve supply to detrusor muscle on the external sphincter </li></ul>Surgery
  60. 66. <ul><li>Impaired urinary elimination related to impaired bladder innervation </li></ul><ul><li>Self –care deficit: toileting related to neurogenic injury </li></ul><ul><li>Risk for impaired skin integrity related to urinary incontinence </li></ul><ul><li>Risk for infection related to impaired urinary reflex </li></ul><ul><li>Obtain complete </li></ul><ul><li>nursing Hx </li></ul><ul><li>tenderness or bladder distension in lower abdomen and suprapubic region </li></ul><ul><li>dull percussion tone </li></ul><ul><li>Asses urine for color, clarity and odor </li></ul>Assessment Nursing diagnosis

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