RenalRenal

NURS 2016NURS 2016

Chapters: 44, 45Chapters: 44, 45

UrolithiasisUrolithiasis

Nephrolithiasis vs urolithiasisNephrolithiasis vs urolithiasisFactors favouring stone formation:Factors favouring stone formation: Infections Infections Urinary stasisUrinary stasis Periods of immobilityPeriods of immobility Altered calcium metabolismAltered calcium metabolismCauses:Causes: Conditions that promote increased Conditions that promote increased

Calcium in blood & urineCalcium in blood & urine

Clinical ManifestationsClinical Manifestations

ObstructionObstruction

InfectionInfection

EdemaEdema

Nursing AssessmentNursing Assessment

Pain: severity & locationPain: severity & location

Signs of UTISigns of UTI

Signs of obstructionSigns of obstruction

Stones in urineStones in urine

InterventionsInterventions

PainPain Opiates & NSAIDOpiates & NSAID Hot baths, moist heatHot baths, moist heat Fluid intake encouragedFluid intake encouraged

NutritionNutrition Fluids to ensure > 2L urine/dayFluids to ensure > 2L urine/day Protein < 60 mg/dayProtein < 60 mg/day

Nursing DiagnosesNursing Diagnoses Acute pain, Acute pain, as evidencedas evidenced by complaints, facial by complaints, facial

grimicing and restlessness, grimicing and restlessness, related torelated to irritation of irritation of stone and inadequate pain control or comfort measuresstone and inadequate pain control or comfort measures

Anxiety, Anxiety, as evidenced byas evidenced by expressions of concern about expressions of concern about future treatments, future treatments, related torelated to uncertain outcome and uncertain outcome and lack of knowledge regarding possible surgery.lack of knowledge regarding possible surgery.

Ineffective therapeutic regime management, Ineffective therapeutic regime management, as as evidenced byevidenced by questions that indicate inadequate questions that indicate inadequate knowledge of disorder, knowledge of disorder, related torelated to lack of knowledge lack of knowledge about prevention of recurrence, diet, fluid about prevention of recurrence, diet, fluid requirements, and symptoms of recurrence.requirements, and symptoms of recurrence.

Impaired urinary elimination, Impaired urinary elimination, as evidenced byas evidenced by decrease decrease in urinary output and blood urine, in urinary output and blood urine, related torelated to … …

Risk of infection, related to …Risk of infection, related to …

EducationEducation

High fluid intake (drink in evening & High fluid intake (drink in evening & night)night)

Discourage excessive intake of vitamins Discourage excessive intake of vitamins & minerals& minerals

Urine culture every 1-2 monthsUrine culture every 1-2 months Avoid excessive sweating & dehydrationAvoid excessive sweating & dehydration Avoid sudden increase in environments Avoid sudden increase in environments

temperature signs & symptoms of stone temperature signs & symptoms of stone formation, obstruction, S&S infectionformation, obstruction, S&S infection

Infections of the Urinary Infections of the Urinary TractTract

Lower UTILower UTI Cystitis: inflammation of the urinary Cystitis: inflammation of the urinary

bladderbladder Prostatitis: inflammation of the prostateProstatitis: inflammation of the prostate Urethritis: inflammation of the urethraUrethritis: inflammation of the urethra

Upper UTIUpper UTI Acute & chronic pyelonephitis: Acute & chronic pyelonephitis:

inflammation of the renal pelvisinflammation of the renal pelvis Interstitial Nephritis: inflammation of the Interstitial Nephritis: inflammation of the

kidneyskidneys

Urinary Tract InfectionUrinary Tract Infection

LowerLower UpperUpperPain, burningPain, burning FeverFeverFrequencyFrequency ChillsChillsUrgencyUrgency Flank or lower back Flank or lower back

painpainNocturiaNocturia Nausea & vomitingNausea & vomitingIncontinenceIncontinence Headache & malaiseHeadache & malaiseDysuriaDysuria Supra pubic, back or Supra pubic, back or Hematuria Hematuria pelvic painpelvic pain

Treatment & PreventionTreatment & Prevention

PharmacologyPharmacology Septra, Bactrim, Azithromycin Septra, Bactrim, Azithromycin

(Zithromax)(Zithromax) NitrofurantoinNitrofurantoin

HygieneHygiene Voiding habitsVoiding habits

Fluid intakeFluid intake

Neurogenic BladderNeurogenic Bladder

Spastic (reflex)Spastic (reflex) Upper motor neuron lesionUpper motor neuron lesion Loss of conscious sensation & Loss of conscious sensation &

cerebral motor controlcerebral motor control

FlaccidFlaccid Lower motor neuron lesionLower motor neuron lesion Bladder fills, distends, overflowsBladder fills, distends, overflows

Management GoalsManagement Goals

Prevent over distention of bladderPrevent over distention of bladder Empty bladder regularly & Empty bladder regularly &

completelycompletely Maintain sterility of urinary systemMaintain sterility of urinary system Maintain adequate bladder capacity Maintain adequate bladder capacity

without refluxwithout reflux UrecholineUrecholine

CatheterizationCatheterization

ContinuousContinuous

IntermittentIntermittent

SuprapubicSuprapubic

Nephrostomy TubeNephrostomy Tube

Temporary or permanent urinary Temporary or permanent urinary diversiondiversion

Inserted through skin & into renal Inserted through skin & into renal pelvispelvis

Prophylactic antibioticProphylactic antibiotic

Care of Nephrostomy Care of Nephrostomy TubeTube

Assess possible complicationsAssess possible complications Ensure unobstructed drainageEnsure unobstructed drainage Notify surgeon immediately if tube Notify surgeon immediately if tube

dislodgesdislodges Never clampNever clamp Never irrigateNever irrigate Encourage fluid intakeEncourage fluid intake Measure & record I & O accuratelyMeasure & record I & O accurately

Renal FailureRenal Failure

Systemic diseaseSystemic disease

Kidneys unable to remove body’s Kidneys unable to remove body’s metabolic wastesmetabolic wastes

Progressive & irreversibleProgressive & irreversible

Clinical ManifestationsClinical Manifestations

CardiovascularCardiovascular IntegumentaryIntegumentary PulmonaryPulmonary GastrointestinalGastrointestinal Neurological MusculosketalNeurological Musculosketal ReproductiveReproductive HematologicHematologic

StagesStages

Reduced renal reserveReduced renal reserve 40-70% loss of nephron function40-70% loss of nephron function asymptomaticasymptomatic

Renal insufficiencyRenal insufficiency 75-90% loss of nephron function75-90% loss of nephron function Increased creatinine & BUN – polyuri, Increased creatinine & BUN – polyuri,

nocturianocturia End stage renal diseaseEnd stage renal disease

Less than 10% nephron functionLess than 10% nephron function UremiaUremia

ManagementManagement

PharmacologicalPharmacological

DialysisDialysis

DietDiet

DialysisDialysis Dialysis cleans the blood, either by passing Dialysis cleans the blood, either by passing

it through an artificial kidney machine or by it through an artificial kidney machine or by filtering it within the abdomen. Wastes & filtering it within the abdomen. Wastes & excess water are removed during treatmentexcess water are removed during treatment

HemodialysisHemodialysismost commonmost commonblood is pumped through a dialyzer blood is pumped through a dialyzer

Peritoneal dialysisPeritoneal dialysisthe peritoneal cavity is filled with dialysatethe peritoneal cavity is filled with dialysate

Clinical CaseClinical Case 48 year old husband, 48 year old husband,

fatherfather Acute kidney failure – Acute kidney failure –

progressed to chronicprogressed to chronic Hemodialysis started 1 Hemodialysis started 1

wk ago (3x/wk)wk ago (3x/wk) c/o weakness, dry skin, c/o weakness, dry skin,

nauseanausea Dependent edema, Dependent edema,

tenacious sputum, tenacious sputum, serum K+highserum K+high

Quiet, moodyQuiet, moody

Planning Care: Mind Planning Care: Mind MappingMapping

Octogon: Octogon: assessment dataassessment data

Oval: nursing Oval: nursing diagnosisdiagnosis

Triangle: expected Triangle: expected outcomeoutcome

Rectangle: nursing Rectangle: nursing interventionintervention