Microsoft Power Point Renal System Disorders

Renal System Disorders
Nio C. Noveno, RN, MAN
Noveno, RN,

The Human Kidney

Renal Disorders nionoveno@hotmail.com 2

The Nephron


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


Classification of Renal Disorders

Obstructive disorders

Acute renal failure

Chronic renal failure


Obstructive disorders
Can occur anywhere in the urinary
tract

Signs and symptoms depend on the
site of location and size of
obstruction


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 stones
Crystallization of minerals around an
organic matrix (blood, pus,
devitalization tissue)

Usually idiopathic:
– Infection


SITES OF STONE FORMATION


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 Stones
Diagnostics
Urinalysis
KUB-UTZ
KUB-IVP
CT scan
Cystoscopy
BUN, Creatinine

Clinical manifestations
Pain
Hematuria

Diagnostic Procedures


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


EXTRACORPOREAL
SHOCKWAVE LITHOTRIPSY


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

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

Bladder carcinoma
– Gross painless hematuria
– Dysuria
– Frequent urination

Diagnostics
– Urinalysis
– IVP
– Cystoscopy with biopsy
– CT scan

Bladder carcinoma
Medical Management Nursing management

Surgical treatment Encourage to:
Radiation – Increase OFI
Chemotherapy – Quit smoking

Assess for presence
of UTI


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

Benign Prostatic Hyperplasia (BPH)

Most common
problem of adult male
reproductive organ

Cause is not
completely
understood

Not a predisposing
factor for prostatic
carcinoma


Diagnostics
Dribbling Digital rectal exam
Hesitancy Urinalysis
Diminution in caliber BUN/Creatinine
and force of urinary Cystourethroscopy
stream PSA
Feeling of incomplete
emptying
Irritative symptoms



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


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

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


Provide health teaching on:
5.
• Increasing OFI
• Signs of UTI and report once noted
• Avoidance of heavy lifting, straining and
prolonged travel.
• Possible impotence


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

Prostate cancer


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


Acute renal failure (ARF)
Sudden cessation of kidney function; reversible


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


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

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


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


Chronic renal failure (CRF)
Causes:

Chronic systemic disease
DM, HTN
Polycystic kidney disease
Long standing obstruction
Chronic glomerulonephritis
Recurrent infections


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


Stages of CRF

Decreased renal
reserve
Renal insufficiency

Renal failure

End-stage renal
disease

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

Peritoneal Dialysis


Peritoneal Dialysis
Intermittent:
8-12 H x 3-5x/week

Ambulatory:
3-5 passes/day

Continuous cycling:
3-7x during sleep


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

Hemodialysis
AV Fistulas
– Internal AVF
– Internal Graft AVF
– Internal AV Graft
with external
access device
Complications
– Thrombosis
– Local infections
– Aneurysms
– Steal syndrome

Hemodialysis


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.

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 Transplant


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


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-

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

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

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

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


Interpretation

UC PC FC

↓ or ↑ ↓ or ↑ normal
pH

↓ or ↑
HCO3- ↓ or ↑ ↓ or ↑
normal
↓ or ↑
↓ or ↑ ↓ or ↑
Paco2
normal

Renal System Disorders
Nio C. Noveno, USRN, MAN

Microsoft Power Point Renal System Disorders

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