chapter 074
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Chapter 74
Interventions for Clients with
Renal Disorders
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Polycystic Kidney Disease
Inherited disorder in which fluid-filled
cysts develop in the nephrons
Etiology and Genetic Risk Autosomal dominant form
50% chance of inheritance
Autosomal recessive form
25% chance of inheritance(Continued)
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Polycystic Kidney Disease(Continued)
Key features include: Abdominal or flank pain Hypertension
Nocturia Increased abdominal girth Bloody or cloudy urine Kidney stones Constipation
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Interventions/Complications
Acute and chronic pain NSAIDs and ASA CAUTIOUSLY
Lipid soluble antibiotics Bactrim, Septra, Cipro
Constipation Fluid, fiber, exercise
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Interventions/Complications
Hypertension and renal failure Nursing interventions to promote self-management and
understanding Fluid therapy
Drink at least 2 liter of fluid per day
Restrict sodium intake to control BP Fluid restriction is not necessary
Drug therapy Antihypertensive agents diuretics
Measure and record blood pressure Diet therapy
Low sodium diet? Protein
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Hydronephrosis,
Hydroureter, and UrethralStricture Provide privacy for elimination. Conduct Cred maneuver as necessary.
Apply double-voiding technique.
Apply urinary catheter as appropriate.
Monitor degree of bladder distention.(Continued)
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Hydronephrosis,Hydroureter, and UrethralStricture(Continued) Catheterize for residual. Intermittently catheterize as appropriate.
Follow infection protection measures.
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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.
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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
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Key Features of ChronicPyelonephritis Hypertension
Inability to conserve sodium
Decreased concentrating ability
Tendency to develop hyperkalemia and
acidosis
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Acute Pain Interventions
Pain management interventions
Lithotripsy
Percutaneous ultrasonic pyelolithotomy
Diet therapy
Drug therapy Antibiotics
Urinary antiseptics
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Surgical Management
Preoperative care Antibiotics
Client education
Operative procedure: pyelolithotomy,
nephrectomy, ureteral diversion, ureter
reimplantaton
Postoperative care for urologic surgery
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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
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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
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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
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Acute Glomerulonephritis
Assessment Onset approximately 10 days from time of
infection.
Streptococcal infection most common
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Acute Glomerulonephritis
Management of infection
Prevention of complications Diuretics
Sodium, water, potassium, and protein
restrictions
Dialysis, plasmapheresis
Client education
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ChronicGlomerulonephritis Develops over a period of 20 to 30 years
or longer AssessmentEdema:
presacral tissue
Pedal
Pretibial
Adventitious breath
sounds
Uremic symptoms
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Chronic Glomerulonephritis
Interventions include: Slowing the progression of the disease and
preventing complications
Diet changes(Continued)
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ChronicGlomerulonephritis(Continued) Fluid intake
Drug therapy
Dialysis, transplantation
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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)
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Nephrotic Syndrome(Continued)
Treatment involves: Immunosuppressive agents
Angiotensin-converting enzyme inhibitors
Heparin Diet changes
If GFR is normal, dietary intake of complete proteins
is needed
Mild diuretics and sodium restriction
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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
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Renovascular Disease
Profoundly reduces blood flow to the kidneytissue
Causes ischemia and atrophy of renal tissue Diagnosis
Magnetic resonance angiography Renal vein renin levels Radionuclide imaging
Interventions: drugs to control high bloodpressure and procedures to restore the renalblood supply
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Diabetic Nephropathy
Diabetic nephrophathy is a microvascular
complication of either type 1 or type 2
diabetes.
First manifestation is persistentalbuminuria.
Avoid nephrotoxic agents and
dehydration. Assess need for insulin.
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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.
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Renal Cell Carcinoma
Paraneoplastic syndromes include
anemia, erythrocytosis, hypercalcemia,
liver dysfunction, hormonal effects,
increased sedimentation rate, andhypertension.
PTH produced by tumor cells can cause
hypercalcemia (Continued)
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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
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Surgical Management
Preoperative care
Operative procedure
Postoperative care:
Monitoring Assess for hemorrhage and adrenal insufficiency
Altered LOC
Hypotension
Decreased urine output
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Surgical Management
Post-op Care Cont. pain management
Opioid analgesics
prevention of complications
Antibiotics Steroids
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Renal Trauma
Minor injuries such as contusions, small
lacerations
Major injuries such as lacerations to the
cortex, medulla, or branches of the renalartery
Pedicle injuries are lacerations or breaks
in the renal artery or renal vein.
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Renal Trauma
Collaborative management
Nonsurgical management: drug therapy
and fluid therapy Dopamine
Clotting
Surgical management: nephrectomy or
partial nephrectomy Bench surgery
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