Renal & Urologic Problems Nephrectomy NUR 302

Post Op Care Nephrectomy Flank incision, side lying position- >muscle aches post op Monitor urine output cc/hr Monitor resp status Medicate for pain Monitor for paralytic ileus

Urinary Diversion Incontinent urinary diversion Continent urinary diversion Orthotopic bladder substitution Pre-op info, assess readiness to learn, involve family, enterostomal nurse Post-op complications- shock & atelectesis

Urinary Diversion Prevent injury to stoma & good skin care important Maintain urine output- mucous in urine normal, hi fld intake Skin problems- alkaline encrustations with dermatitis, yeast infections, product allergies, sheering excoriations Properly fitting appliance

Urinary Diversion Address pt’s concerns- body image, offensive odors, sexual, professional & activity concerns Discharge- teach s/s infection & obstruction, care of ostomy Fitted with appliance 7-10 days post-op & may need to later be refitted Info where to buy supplies, emer phone #, ostomy clubs, MD follow up

Chronic Renal Failure Nur 302 Unit III

Chronic Renal Failure Progressive, irreversible destruction Diminished renal reserve Renal insufficiency End-stage renal disease (ESRD)/uremia Common causes: diabetes, & hypertension

Clinical Manifestations Renal insuff->polyuria Renal failure->oliguria then anuria Increased BUN & creatinine->n/v, lethargy,fatigue, headache Altered CHO metabolism & elevated triglycerides due to insulin resistance Metabolic acidosis, hyperkalemia, Ca, phosphate Na & Mg alterations

Clinical Manifestations Anemia, bleeding tendencies, infection Increased incidence of cancer Hypertension, CHF, arrhythmias Uremic lung, dyspnea, pleural effusion Stomatitis, uremic fetor Neuro changes Renal osteodystrophy, osteomalacia, osteitis fibrosa, soft tissue calcification

Clinical Manifestations Skin yellowish or pale, dry, scaly Pruritus esp when BUN very high Petechiae, ecchymosis, hair falls out Infertility & decreased libido Hypothyroidism Personality & behavior changes

Drug Therapy Hyperkalemia-> IV dextrose & insulin, Kayexelate Hypertension-> Ca channel blockers & ACE inhibitors, Na & fluid restriction Renal osteodystrophy->calcium carbonate (Tums), vit D (calcitrol) Anemia-> erythropoietin

Nursing Care See Nursing Care Plan 47-1 Health promotion – report changes in urine appearance or volume, follow up care to monitor renal function When conservative therapy ineffective, explain choices clearly -peritoneal or hemodialysis, transplant

Dialysis: general principles Diffusion Osmosis Ultra filtration

Peritoneal Dialysis Catheter placement in peritoneal cavity Dialysis soln with 1.5, 2.5, 4.25% glucose & electrolytes Cycles – inflow, dwell, drain Complications– site infection, peritonitis, Abd pain, outflow problems, hernias, low back pain, bleeding pul. problems

Hemodialysis Access sites- internal arteriovenous fistulas & grafts, temporary venous access eg Quinton cath Complications- hypotension, muscle cramps, blood loss, hepatitis, sepsis, disequilibrium syndrome Adaptation to dialysis