1. Interventions for Clients with Renal Disorders

2. Pyelonephritis Bacterial infection in the kidney (upper urinary tract)
Key features include:
Fever, chills, tachycardia, and tachypnea
Flank, back, or loin pain
Abdominal discomfort
Turning, nausea and vomiting, urgency, frequency, nocturia
General malaise or fatigue

3. Key Features of Chronic Pyelonephritis
Hypertension
Inability to conserve sodium
Decreased concentrating ability
Tendency to develop hyperkalemia and acidosis

4. Acute Pain Interventions
Pain management interventions
Lithotripsy
Percutaneous ultrasonic pyelolithotomy
Diet therapy
Drug therapy
Antibiotics
Urinary antiseptics

5. Surgical Management Preoperative care
Antibiotics
Client education
Operative procedure: pyelolithotomy, nephrectomy, ureteral diversion, ureter reimplantaton
Postoperative care for urologic surgery

6. Potential for Renal Failure
Interventions include:
Use of specific antibiotics
Compliance with therapies and regular follow-up
Blood pressure control
Fluid therapy
Diet therapy
Other interventions

7. Potential for Renal Failure
Interventions include:
Use of specific antibiotics
Compliance with therapies and regular follow-up
Blood pressure control
Fluid therapy
Diet therapy
Other interventions

8. Renal Abscess
A collection of fluid and cells caused by an inflammatory response to bacteria
Manifestations: fever, flank pain, general malaise
Drainage by surgical incision or needle aspiration
Broad-spectrum antibiotics

9. Renal Tuberculosis Diagnosis
Antitubercular therapy with rifampin, isoniazid, and pyrazinamide
Complications renal failure, kidney stones, obstruction, and bacterial superinfection of the urinary tract
Surgical excision possible

10. Acute Glomerulonephritis
Assessment
Management of infection
Prevention of complications
Diuretics
Sodium, water, potassium, and protein restrictions
Dialysis, plasmapheresis
Client education

11. Chronic Glomerulonephritis
Develops over a period of 20 to 30 years or longer
Assessment
Interventions include:
Slowing the progression of the disease and preventing complications
Diet changes
(Continued)

12. Chronic Glomerulonephritis (Continued)
Fluid intake
Drug therapy
Dialysis, transplantation

13. Nephrotic Syndrome
Condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and be removed from the blood
Severe loss of protein into the urine
(Continued)

14. Nephrotic Syndrome (Continued
Treatment involves:
Immunosuppressive agents
Angiotensin-converting enzyme inhibitors
Heparin
Diet changes
Mild diuretics

15. Nephrosclerosis
Thickening in the nephron blood vessels, resulting in narrowing of the vessel lumen
Occurs with all types of hypertension, atherosclerois, and diabetes mellitus
Collaborative management: control high blood pressure and preserve renal function

16. Renovascular Disease
Profoundly reduces blood flow to the kidney tissue
Causes ischemia and atrophy of renal tissue
Diagnosis
Interventions: drugs to control high blood pressure and procedures to restore the renal blood supply

17. Diabetic Nephropathy
Diabetic nephrophathy is a microvascular complication of either type 1 or type 2 diabetes.
First manifestation is persistent albuminuria.
Avoid nephrotoxic agents and dehydration.
Assess need for insulin.

18. Cysts and Benign Tumors
Thorough evaluation for cancer is needed.
Cyst can fill with fluid and cause local tissue damage as it enlarges.
Many cysts cause no symptoms.
Cysts are a structural birth defect that occur in fetal life.
Simple renal cysts are drained by percutaneous aspiration.

19. Renal Cell Carcinoma
Paraneoplastic syndromes include anemia, erythrocytosis, hypercalcemia, liver dysfunction, hormonal effects, increased sedimentation rate, and hypertension.
(Continued)

20. Renal Cell Carcinoma (Continued)
Nonsurgical management includes:
Radiofrequency ablation, although effect is not known
Chemotherapy: limited effect
Biological response modifiers and tumor necrosis factor: lengthen survival time

21. Surgical Management Preoperative care Operative procedure
Postoperative care: monitoring, pain management, and prevention of complications

22. Renal Trauma Minor injuries such as contusions, small lacerations
Major injuries such as lacerations to the cortex, medulla, or branches of the renal artery
Collaborative management
Nonsurgical management: drug therapy and fluid therapy
Surgical management: nephrectomy or partial nephrectomy

23. Polycystic Kidney Disease
Inherited disorder in which fluid-filled cysts develop in the nephrons
Key features include:
Abdominal or flank pain
Hypertension
Nocturia
Increased abdominal girth

24. Polycystic Kidney Disease (Continued)
Constipation
Bloody or cloudy urine
Kidney stones

25. Interventions Pain management Bowel management Medication management
Energy management
Fluid monitoring
Urinary retention care
Infection protection

26. Interventions/Complications
Acute and chronic pain
Constipation
Hypertension and renal failure
Nursing interventions to promote self-management and understanding
Fluid therapy
Drug therapy
Measure and record blood pressure
Diet therapy

27. Hydronephrosis, Hydroureter, and Urethral Stricture
Provide privacy for elimination.
Conduct Credé maneuver as necessary.
Apply double-voiding technique.
Apply urinary catheter as appropriate.
Monitor degree of bladder distention.
(Continued

28. Hydronephrosis, Hydroureter, and Urethral Stricture (Continued)
Catheterize for residual.
Intermittently catheterize as appropriate.
Follow infection protection measures.

29. Nephrostomy Client preparation Procedure Follow-up care including:
Assess for
amount of drainage.
type of urinary damage expected.
manifestations of infection.
Monitor nephrostomy site for leaking urine.

30. Interventions for Clients with Acute and Chronic Renal Failure

31. Acute Renal Failure Pathophysiology
Types of acute renal failure include:
Prerenal
Intrarenal
Postrenal

32. Phases of Acute Renal Failure
Phases of rapid decrease in renal function lead to the collection of metabolic wastes in the body.
Phases include:
Onset
Diuretic
Oliguric
Recovery
Acute syndrome may be reversible with prompt intervention.

33. Assessment History Clinical manifestations Laboratory assessment
Radiographic assessment
Other diagnostic assessments such as renal biopsy

34. Drug Therapy Cardioglycides Vitamins and minerals
Biologic response modifiers
Phosphate binders
Stool softeners and laxatives
Monitor fluids
Diuretics
Calcium channel blockers

35. Treatment Diet therapy Dialysis therapies Hemodialysis
Peritoneal dialysis

36. Continuous Renal Replacement Therapy
Standard treatment
Dialysate solution
Vascular access
Continuous arteriovenous hemofiltration
Continuous venovenous hemofiltration

37. Posthospital Care
If renal failure is resolving, follow-up care may be required.
There may be permanent renal damage and the need for chronic dialysis or even transplantation.
Temporary dialysis is appropriate for some clients.

38. Chronic Renal Failure
Progressive, irreversible kidney injury; kidney function does not recover
Azotemia
Uremia
Uremic syndrome

39. Stages of Chronic Renal Failure
Diminished renal reserve
Renal insufficiency
End-stage renal disease

40. Stages of Chronic Renal Failure Changes
Kidney
Metabolic
Urea and creatinine
Electrolytes
Sodium
Potassium
Acid-base balance
Calcium and phosphorus

41. Stages of Chronic Renal Failure Changes (Continued)
Cardiac
Hypertension
Hyperlipidemia
Congestive heart failure
Uremic pericarditis
Hematologic
Gastrointestinal

42. Clinical Manifestations
Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin

43. Hemodialysis Client selection Dialysis settings
Works using passive transfer of toxins by diffusion
Anticoagulation needed, usually heparin treatment

44. Hemodialysis Nursing Care
Postdialysis care:
Monitor for complications such as hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps.
Monitor vital signs and weight.
Avoid invasive procedures 4 to 6 hours after dialysis.
Continually monitor for hemorrhage

45. Complications of Hemodialysis
Dialysis disequilibrium syndrome
Infectious diseases
Hepatitis B and C infections
HIV exposure—poses some risk for clients undergoing dialysis

46. Peritoneal Dialysis
Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate.
Types of peritoneal dialysis:
Continuous ambulatory peritoneal
Automated peritoneal
Intermittent peritoneal
Continuous-cycle peritoneal

47. Complications Peritonitis Pain Exit site and tunnel infections
Poor dialysate flow
Dialysate leakage
Other complications

48. Nursing Care During Peritoneal Dialysis
Before treating, evaluate baseline vital signs, weight, and laboratory tests.
Continually monitor the client for respiratory distress, pain, and discomfort.
Monitor prescribed dwell time and initiate outflow.
Observe the outflow amount and pattern of fluid.

49. Renal Transplantation
Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure

50. Postoperative Care Urologic management
Assessment of urine output hourly for 48 hours.
Complications include:
Rejection
Acute tubular necrosis

51. Postoperative Care Thrombosis Renal artery stenosis
Other complications
Immunosuppressive drug therapy
Psychosocial preparation

52. Interventions for Clients with Urinary Problems

53. Cystitis Inflammation of the bladder
Most commonly caused by bacteria that move up the urinary tract from the external urethra to the bladder, viruses, fungi, or parasites
Catheter-related infections common during hospital stay

54. Incidence and Prevalence of Cystitis
Frequenct urge to urinate
Dysuria
Urgency
Urinalysis needed when testing for leukocyte esterase
Type of organism confirmed by urine culture
Other diagnostic assessments

55. Drug Therapy Urinary antiseptics Antibiotics Analgesics Antispasmodics
Antifungal agents
Long-term antibiotic therapy for chronic, recurring infections

56. Nonsurgical Management
Urinary elimination
Diet therapy includes all food groups, calorie increase due to increase in metabolism caused by the infection, fluids, possible intake of cranberry juice preventively
Other pain relief measures, such as warm sitz baths

57. Catheter

58. Urethritis
Inflammation of the urethra that causes symptoms similar to urinary tract infection
Caused by sexually transmitted infections; treat with antibiotic therapy
Estrogen vaginal cream for postmenopausal women

59. Urethrala Strictures Narrowing of the urethra
Most common symptom—obstruction of urine flow
Surgical treatment by urethroplasty—best chance of long-term cure
Dilation of the urethra—a temporary measure
Urethroplasty

60. Urinary Incontinence Five types of incontinence include: Stress Urge
Mixed
Overflow
Functional

61. Collaborative Management
Assessment includes a thorough client history.
Clinical manifestations for urethral or uterine prolapse
Laboratory assessment by urinalysis
Radiographic assessment, especially before surgery
Other diagnostic assessments

62. Stress Urinary Incontinence
Interventions include:
Keeping a diary, behavioral interventions, diet modification, and pelvic floor exercises
Drug therapy: estrogen
Surgery
Collection devices and vaginal cone weights

63. Surgical Management Preoperative care Operative procedure
Postoperative care
Assess for and intervene to prevent or detect complications.
Secure urethral catheter.

64. Urge Urinary Incontinence
Interventions include:
Drugs: anticholinergics, possibly antihistamines, others
Diet therapy: avoid caffeine and alcohol
Behavioral interventions: exercises, bladder training, habit training, electrical stimulation

65. Reflux Urinary Incontinence
Interventions include:
Surgery to relieve the obstruction
Intermittent catheterization
Bladder compression and intermittent self-catheterization
Drug therapy
Behavioral interventions

66. Functional Urinary Incontinence
Interventions include:
Treatment of reversible causes
If incontinence is not reversible, urinary habit training
Final strategy—containment of urine and protection of the client’s skin
Applied devices
Urinary catheterization

67. Urolithiasis Presence of calculi (stones) in the urinary tract
Collaborative management
History of urologic stones
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic tests

68. IVP (Intravenous Pyelography)

69. Interventions Drug therapy
Opioid analgesics—often used to control pain
Nonsteroidal anti-inflammatory drugs
Pain medications at regular intervals
Constant delivery system
Spasmolytic drugs—important for relief of pain
Complementary and alternative therapy

70. Lithotripsy
Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to break the stone into small fragments.
Client undergoes conscious sedation
Topical anesthetic cream is applied to skin site of stone.
Continuous monitoring is by electrocardiography

71. Surgical Management Minimally invasive surgical procedures Stenting
Retrograde ureteroscopy
Percutaneous ureterolithotomy and nephrolithotomy
Open surgical procedures
Preoperative care
Operative procedure

72. Postoperative Care
Routine postoperative care procedures for assessment of bleeding, urine, and adequate fluid intake
Strained urine
Infection prevention
Drug therapy
Diet therapy
Prevention of obstruction

73. Drug Therapy
Drug selection to prevent obstruction depends on what is forming the stone:
Calcium
Oxalate
Uric acid
Cystine

74. Urothelial Cancer Collaborative management Assessment
Diagnostic assessment
Nonsurgical management
Prophylactic immunotherapy
Chemotherapy
Radiation therapy

75. Surgical Management Preoperative care Operative procedures
Postoperative care includes:
Collaboration with enterostomal therapist
Kock’s pouch
Neobladder

76. Bladder Trauma
Causes may be due to injury to the lower abdomen or stabbing or gunshot wounds.
Surgical intervention is required.
Fractures should be stabilized before bladder repair.

77. Hemodialysis Hospital, dialysis center
Pt’s blood moves from implanted shunt in arm artery  tube  machine  exchange of wastes, fluids, electrolytes
Semipermeable membrane separates pts blood from dialysis fluid

78. Hemodialysis Constituents move between the 2 compartments
Ex: wastes in blood  dialysate
bicarbonate in dialysate  blood
Blood cells, proteins remain in blood
Movement by ultrafiltration, diffusion, osmosis
 Blood to pt vein

80. Peritoneal Dialysis Administered in unit or at home
At night or continuously
CAPD (continuous ambulatory peritoneal dialysis)
Peritoneal membrane serves as semipermeable membrane
Catheter w/ entry and exit points implanted
Dialyzing fluid instilled in catheter into cavity

81. Peritoneal Dialysis Remains there
Allows exchange of wastes and electrolytes to occur
Dialysate drained from by gravity from cavity into container
Requires more time than hemo
Complications
Infection in peritoneal cavity

82. Peritoneal Dialysis

83. ESWL.Extracorporeal shock-wave lithotripsy (ESWL)