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

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

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

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

7. 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

8. 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

9. 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

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

14. Nephrotic Syndrome

15. Nephrosclerosis

16. Renovascular Disease

17. Diabetic Nephropathy

18. Cysts and Benign Tumors

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. 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. 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

27. 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.

31. Interventions for Clients with Acute and Chronic Renal Failure

32. Acute Renal Failure

33. 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.

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

35. Chronic Renal Failure

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

37. Clinical Manifestations
Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin

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

39. 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

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

41. 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.

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