Medical and Nursing Care of Patients with Renal and Urinary Diversion Medical Surgical Nursing Mary A. Roche, MSN, RN, CS

Why is this Important? Late diagnosis Maintenance Often occurs because 2/3 of functions are lost before symptoms appear Maintenance Patients can be maintained at the level of renal insufficiency 2/22/2019 Mary A. Roche, MSN, RN, CS

Renal Functions Excretory Function – Urine Formation Regulatory Functions – Acid Base Balance Renal Related Endocrine Functions 2/22/2019 Mary A. Roche, MSN, RN, CS

Renal System Diagram Renal System Kidneys Bladder Ureters 2/22/2019 Mary A. Roche, MSN, RN, CS

Regulatory Functions Partial Control of Acid-Base Balance Renal Regulation of Water Renal Regulation of Electrolytes Sodium And Potassium 2/22/2019 Mary A. Roche, MSN, RN, CS

Renal Endocrine Functions Renin – Controls Blood Pressure, Sodium and Water Erythropoietin – Bone Marrow Stimulator Prostaglandins Vitamin D/Calcium Insulin – the Biodegradation of Insulin Regulation of pH is Controlled by Kidney 2/22/2019 Mary A. Roche, MSN, RN, CS

Renin-Angiotensin-Aldosterone System Reduced Blood Pressure Distal tubular sodium Renin Converting Enzyme Angiotensin I Angiotensin II Angiotensin III Angiotensin substrate Figure 50-1. Role of renin-angiotnsin-aldosterone system in regulation of blood pressure. Solid lines represent positive interactions; Broken lines show negative interactions or feedback inhibition. [From Kumar, V., Cotran, R.S., & Robbins, S.L. [1992] Basic Pathology [5th Ed.]. Philadelphia; W.B. Saunders] Vasoconstriction Increased peripheral resistance Aldosterone Secretion Sodium and fluid retention Increased cardiac output Elevation of Blood Pressure 2/22/2019 Mary A. Roche, MSN, RN, CS

Assessment Of Renal Problems Medical History Physical Signs and Symptoms Renal System Lab Tests 2/22/2019 Mary A. Roche, MSN, RN, CS

Conditions Related To Renal Impairment Hypertension Diabetes Mellitus Systemic Lupus Erythematosus Infectious Diseases Streptococcal UTI Congenital Abnormalities ex., Polycystic Kidney Disease SLE - Systemic Lupus UTI - Urinary Tract Infection 2/22/2019 Mary A. Roche, MSN, RN, CS

Symptoms of Renal Disease Fatigue Change in Mentation Headache Hypertension Change in Body Weight Pain 2/22/2019 Mary A. Roche, MSN, RN, CS

Blood Chemistries Renal Insufficiency Creatinine Clearance BUN - Greater Than 20 Mg Per 100 cc BUN - Normal 5-20 Mg Per 100 cc Slightly Higher In Elderly Serum Creatinine – 0.1 Mg Per Dl Creatinine Clearance Average 108-120 Ml Per Minute Best Indicator Of Overall Renal Function. Bun/Creatinine Ratio – 12: 1 To 20:1 BUN - Bili-urea-nitrogen 2/22/2019 Mary A. Roche, MSN, RN, CS

Acute Renal Failure Causes Phases Prevention Medical Management Prerenal Renal Post Renal Phases Onset Acute Recovery Prevention Medications Diet Medical Management Drug therapy Dialysis Nursing Management Monitoring Comfort Measures 2/22/2019 Mary A. Roche, MSN, RN, CS

Causes of Renal Failure Prerenal Systemic Conditions Hepatitis Renal Internal Nephridities Nephrotic syndrome Postrenal Obstructions 2/22/2019 Mary A. Roche, MSN, RN, CS

Prerenal Causes Perfusion Problems Septic Shock Circulatory Volume Depletion Volume Shifts Decreased Cardiac Output Decreased Peripheral Resistance Vascular Obstruction Septic Shock 2/22/2019 Mary A. Roche, MSN, RN, CS

Renal Causes Signs and Symptoms of Failure Diabetic Retention of Waste Retention of Fluid Inability of Kidneys to Regulate Electrolytes Diabetic 2/22/2019 Mary A. Roche, MSN, RN, CS

Postrenal Causes Obstruction in Urinary Tract Prostatic Hypertrophy Calculi Tumors Urethral Strictures or Stenosis 2/22/2019 Mary A. Roche, MSN, RN, CS

Phases of Acute Renal Failure Onset Oliguric-Anuric Oliguric – less than 400 ml in 24 hours Anuric – less than 100 ml in 24 hours Diuretic Recovery/Convalescent 2/22/2019 Mary A. Roche, MSN, RN, CS

Prevention of Acute Renal Failure Monitor for: Signs of Shock Fluid Balance Adequate Vascular Perfusion Potentially Nephrotoxic Drugs 2/22/2019 Mary A. Roche, MSN, RN, CS

Medical Management Oliguric/Anuric Phase Diuretic Phase Recovery Phase Convalescent Phase See Page 277 Of Handout 2/22/2019 Mary A. Roche, MSN, RN, CS

Key Features of Chronic Renal Failure

Key Features of Chronic Renal Failure Neurological Cardiovascular Respiratory Hematologic Gastrointestinal Urinary Musculoskeletal Integumentary Reproductive Metabolic See Pages 279 To 283 In Handout Refer To Iggy Page 1886, Chart 75-3 2/22/2019 Mary A. Roche, MSN, RN, CS

Neurological Decreased attention Slurred Speech Lethargy Tremors Seizures Ataxia Paresthesia Asterixis Coma 2/22/2019 Mary A. Roche, MSN, RN, CS

Cardiovascular Cardiomyopathy Hypertension Peripheral edema Congestive Heart Failure Uremic pericarditis Pericardial effusion Pericardial friction rub Cardiac tamponade 2/22/2019 Mary A. Roche, MSN, RN, CS

Respiratory Uremic halitosis Tachypnea Kussmaul’s respirations Sugar breath Uremic pneumonitis Pulmonary edema Pleural Effusion Depressed cough reflex Crackles 2/22/2019 Mary A. Roche, MSN, RN, CS

Hematologic Severe anemias Abnormal bleeding and bruising 2/22/2019 Mary A. Roche, MSN, RN, CS

Gastrointestinal Anorexia Nausea, Vomiting, Diarrhea Uremic colitis Uremic gastritis Metallic taste in mouth Ferritin in stools Stomatitis 2/22/2019 Mary A. Roche, MSN, RN, CS

Urinary Early Late Proteinuria Hematuria Dilute Nocturia Polyuria Oliguria Anuria Proteinuria Hematuria Dilute straw-like appearance 2/22/2019 Mary A. Roche, MSN, RN, CS

Integumentary Decreased skin turgor Yellow-gray pallor Pruritis Severe itching Ecchymosis Hemorrhagic purpura Soft tissue calcifications Uremic frost Very late and premorbid 2/22/2019 Mary A. Roche, MSN, RN, CS

Musculoskeletal Muscle weakness and cramping Pathological fractures Bone pain Renal osteodystrophy 2/22/2019 Mary A. Roche, MSN, RN, CS

Reproductive Decreased fertility Infrequent or absent menses Decreased libido Impotence 2/22/2019 Mary A. Roche, MSN, RN, CS

Renal Lecture End of Section One