interventions for clients with renal disorders. pyelonephritis bacterial infection in the kidney...

Interventions for Interventions for Clients with Renal Clients with Renal Disorders Disorders

PyelonephritisPyelonephritis

Bacterial infection in the kidney (upper Bacterial infection in the kidney (upper urinary tract)urinary tract)

Key features include:Key features include: Fever, chills, tachycardia, and tachypneaFever, chills, tachycardia, and tachypnea Flank, back, or loin painFlank, back, or loin pain Abdominal discomfortAbdominal discomfort Turning, nausea and vomiting, urgency, Turning, nausea and vomiting, urgency,

frequency, nocturiafrequency, nocturia General malaise or fatigueGeneral malaise or fatigue

Key Features of Chronic Key Features of Chronic PyelonephritisPyelonephritis

HypertensionHypertension Inability to conserve sodiumInability to conserve sodium Decreased concentrating abilityDecreased concentrating ability Tendency to develop hyperkalemia Tendency to develop hyperkalemia

and acidosisand acidosis

Acute Pain InterventionsAcute Pain Interventions

Pain management interventionsPain management interventions LithotripsyLithotripsy Percutaneous ultrasonic Percutaneous ultrasonic

pyelolithotomypyelolithotomy Diet therapyDiet therapy Drug therapyDrug therapy

AntibioticsAntibiotics Urinary antisepticsUrinary antiseptics

Surgical ManagementSurgical Management

Preoperative carePreoperative care AntibioticsAntibiotics Client educationClient education

Operative procedure: pyelolithotomy, Operative procedure: pyelolithotomy, nephrectomy, ureteral diversion, nephrectomy, ureteral diversion, ureter reimplantatonureter reimplantaton

Postoperative care for urologic Postoperative care for urologic surgerysurgery

Potential for Renal FailurePotential for Renal Failure

Interventions include:Interventions include: Use of specific antibioticsUse of specific antibiotics Compliance with therapies and regular Compliance with therapies and regular

follow-upfollow-up Blood pressure controlBlood pressure control Fluid therapyFluid therapy Diet therapyDiet therapy Other interventions Other interventions

Renal AbscessRenal Abscess

A collection of fluid and cells caused A collection of fluid and cells caused by an inflammatory response to by an inflammatory response to bacteriabacteria

Manifestations: fever, flank pain, Manifestations: fever, flank pain, general malaisegeneral malaise

Drainage by surgical incision or Drainage by surgical incision or needle aspirationneedle aspiration

Broad-spectrum antibiotics Broad-spectrum antibiotics

Renal TuberculosisRenal Tuberculosis

Diagnosis Diagnosis Antitubercular therapy with rifampin, Antitubercular therapy with rifampin,

isoniazid, and pyrazinamideisoniazid, and pyrazinamide Complications renal failure, kidney Complications renal failure, kidney

stones, obstruction, and bacterial stones, obstruction, and bacterial superinfection of the urinary tractsuperinfection of the urinary tract

Surgical excision possibleSurgical excision possible

Acute GlomerulonephritisAcute Glomerulonephritis

AssessmentAssessment Management of infectionManagement of infection Prevention of complicationsPrevention of complications

DiureticsDiuretics Sodium, water, potassium, and protein Sodium, water, potassium, and protein

restrictionsrestrictions Dialysis, plasmapheresisDialysis, plasmapheresis Client educationClient education

Chronic GlomerulonephritisChronic Glomerulonephritis

Develops over a period of 20 to 30 Develops over a period of 20 to 30 years or longeryears or longer

AssessmentAssessment Interventions include:Interventions include:

Slowing the progression of the disease Slowing the progression of the disease and preventing complicationsand preventing complications

Diet changesDiet changes(Continued)(Continued)

Chronic GlomerulonephritisChronic Glomerulonephritis

(Continued)(Continued)

Fluid intakeFluid intake Drug therapyDrug therapy Dialysis, transplantationDialysis, transplantation

Nephrotic SyndromeNephrotic Syndrome

Condition of increased glomerular Condition of increased glomerular permeability that allows larger permeability that allows larger molecules to pass through the molecules to pass through the membrane into the urine and be membrane into the urine and be removed from the bloodremoved from the blood

Severe loss of protein into the urineSevere loss of protein into the urine(Continued)(Continued)

Nephrotic SyndromeNephrotic Syndrome (Continued(Continued

Treatment involves:Treatment involves: Immunosuppressive agentsImmunosuppressive agents Angiotensin-converting enzyme Angiotensin-converting enzyme

inhibitorsinhibitors HeparinHeparin Diet changesDiet changes Mild diureticsMild diuretics

NephrosclerosisNephrosclerosis

Thickening in the nephron blood Thickening in the nephron blood vessels, resulting in narrowing of the vessels, resulting in narrowing of the vessel lumenvessel lumen

Occurs with all types of hypertension, Occurs with all types of hypertension, atherosclerois, and diabetes mellitusatherosclerois, and diabetes mellitus

Collaborative management: control Collaborative management: control high blood pressure and preserve high blood pressure and preserve renal functionrenal function

Renovascular DiseaseRenovascular Disease

Profoundly reduces blood flow to the Profoundly reduces blood flow to the kidney tissuekidney tissue

Causes ischemia and atrophy of renal Causes ischemia and atrophy of renal tissuetissue

DiagnosisDiagnosis Interventions: drugs to control high Interventions: drugs to control high

blood pressure and procedures to blood pressure and procedures to restore the renal blood supplyrestore the renal blood supply

Diabetic NephropathyDiabetic Nephropathy

Diabetic nephrophathy is a Diabetic nephrophathy is a microvascular complication of either microvascular complication of either type 1 or type 2 diabetes.type 1 or type 2 diabetes.

First manifestation is persistent First manifestation is persistent albuminuria.albuminuria.

Avoid nephrotoxic agents and Avoid nephrotoxic agents and dehydration.dehydration.

Assess need for insulin.Assess need for insulin.

Cysts and Benign TumorsCysts and Benign Tumors

Thorough evaluation for cancer is needed.Thorough evaluation for cancer is needed. Cyst can fill with fluid and cause local Cyst can fill with fluid and cause local

tissue damage as it enlarges.tissue damage as it enlarges. Many cysts cause no symptoms.Many cysts cause no symptoms. Cysts are a structural birth defect that Cysts are a structural birth defect that

occur in fetal life.occur in fetal life. Simple renal cysts are drained by Simple renal cysts are drained by

percutaneous aspiration.percutaneous aspiration.

Renal Cell CarcinomaRenal Cell Carcinoma

Paraneoplastic syndromes include Paraneoplastic syndromes include anemia, erythrocytosis, anemia, erythrocytosis, hypercalcemia, liver dysfunction, hypercalcemia, liver dysfunction, hormonal effects, increased hormonal effects, increased sedimentation rate, and hypertension.sedimentation rate, and hypertension.


Renal Cell CarcinomaRenal Cell Carcinoma


Nonsurgical management includes:Nonsurgical management includes: Radiofrequency ablation, although effect Radiofrequency ablation, although effect

is not knownis not known Chemotherapy: limited effectChemotherapy: limited effect Biological response modifiers and tumor Biological response modifiers and tumor

necrosis factor: lengthen survival timenecrosis factor: lengthen survival time


Preoperative carePreoperative care Operative procedureOperative procedure Postoperative care: monitoring, pain Postoperative care: monitoring, pain

management, and prevention of management, and prevention of complicationscomplications

Renal TraumaRenal Trauma

Minor injuries such as contusions, small Minor injuries such as contusions, small lacerationslacerations

Major injuries such as lacerations to the Major injuries such as lacerations to the cortex, medulla, or branches of the renal cortex, medulla, or branches of the renal arteryartery

Collaborative managementCollaborative management Nonsurgical management: drug therapy and Nonsurgical management: drug therapy and

fluid therapyfluid therapy Surgical management: nephrectomy or Surgical management: nephrectomy or

partial nephrectomypartial nephrectomy

Polycystic Kidney DiseasePolycystic Kidney Disease

Inherited disorder in which fluid-filled Inherited disorder in which fluid-filled cysts develop in the nephronscysts develop in the nephrons

Key features include:Key features include: Abdominal or flank painAbdominal or flank pain HypertensionHypertension NocturiaNocturia Increased abdominal girthIncreased abdominal girth

Polycystic Kidney DiseasePolycystic Kidney Disease


ConstipationConstipation Bloody or cloudy urineBloody or cloudy urine Kidney stonesKidney stones

InterventionsInterventions

Pain managementPain management Bowel managementBowel management Medication managementMedication management Energy managementEnergy management Fluid monitoringFluid monitoring Urinary retention careUrinary retention care Infection protectionInfection protection

Interventions/ComplicationsInterventions/Complications

Acute and chronic painAcute and chronic pain ConstipationConstipation Hypertension and renal failureHypertension and renal failure

Nursing interventions to promote self-Nursing interventions to promote self-management and understandingmanagement and understanding

Fluid therapyFluid therapy Drug therapyDrug therapy Measure and record blood pressureMeasure and record blood pressure Diet therapyDiet therapy

Hydronephrosis, Hydroureter, Hydronephrosis, Hydroureter, and Urethral Strictureand Urethral Stricture

Provide privacy for elimination.Provide privacy for elimination. Conduct Credé maneuver as Conduct Credé maneuver as

necessary.necessary. Apply double-voiding technique.Apply double-voiding technique. Apply urinary catheter as appropriate.Apply urinary catheter as appropriate. Monitor degree of bladder distention.Monitor degree of bladder distention.

(Continued(Continued

Hydronephrosis, Hydroureter, Hydronephrosis, Hydroureter, and Urethral Strictureand Urethral Stricture (Continued)(Continued)

Catheterize for residual.Catheterize for residual. Intermittently catheterize as Intermittently catheterize as

appropriate.appropriate. Follow infection protection measures.Follow infection protection measures.

NephrostomyNephrostomy

Client preparationClient preparation ProcedureProcedure Follow-up care including:Follow-up care including:

Assess for Assess for amount of drainage.amount of drainage. type of urinary damage expected.type of urinary damage expected. manifestations of infection.manifestations of infection.

Monitor nephrostomy site for leaking Monitor nephrostomy site for leaking urine.urine.

Interventions for Clients Interventions for Clients with Acute and Chronic with Acute and Chronic Renal FailureRenal Failure

Acute Renal FailureAcute Renal Failure

PathophysiologyPathophysiology Types of acute renal failure include:Types of acute renal failure include:

Prerenal Prerenal Intrarenal Intrarenal Postrenal Postrenal

Phases of Acute Renal Phases of Acute Renal FailureFailure

Phases of rapid decrease in renal function Phases of rapid decrease in renal function lead to the collection of metabolic wastes in lead to the collection of metabolic wastes in the body.the body.

Phases include:Phases include: Onset Onset Diuretic Diuretic Oliguric Oliguric Recovery Recovery

Acute syndrome may be reversible with Acute syndrome may be reversible with prompt intervention.prompt intervention.

AssessmentAssessment

History History Clinical manifestationsClinical manifestations Laboratory assessmentLaboratory assessment Radiographic assessmentRadiographic assessment Other diagnostic assessments such Other diagnostic assessments such

as renal biopsyas renal biopsy

Drug TherapyDrug Therapy

CardioglycidesCardioglycides Vitamins and mineralsVitamins and minerals Biologic response modifiersBiologic response modifiers Phosphate bindersPhosphate binders Stool softeners and laxativesStool softeners and laxatives Monitor fluidsMonitor fluids DiureticsDiuretics Calcium channel blockersCalcium channel blockers

TreatmentTreatment

Diet therapyDiet therapy Dialysis therapiesDialysis therapies

HemodialysisHemodialysis Peritoneal dialysisPeritoneal dialysis

Continuous Renal Continuous Renal Replacement TherapyReplacement Therapy

Standard treatment Standard treatment Dialysate solutionDialysate solution Vascular accessVascular access Continuous arteriovenous Continuous arteriovenous

hemofiltration hemofiltration Continuous venovenous Continuous venovenous

hemofiltration hemofiltration

Posthospital CarePosthospital Care

If renal failure is resolving, follow-up If renal failure is resolving, follow-up care may be required.care may be required.

There may be permanent renal There may be permanent renal damage and the need for chronic damage and the need for chronic dialysis or even transplantation.dialysis or even transplantation.

Temporary dialysis is appropriate for Temporary dialysis is appropriate for some clients.some clients.

Chronic Renal FailureChronic Renal Failure

Progressive, irreversible kidney Progressive, irreversible kidney injury; kidney function does not injury; kidney function does not recoverrecover

AzotemiaAzotemia UremiaUremia Uremic syndromeUremic syndrome

Stages of Chronic Renal Stages of Chronic Renal FailureFailure

Diminished renal reserveDiminished renal reserve Renal insufficiencyRenal insufficiency End-stage renal diseaseEnd-stage renal disease

Stages of Chronic Renal FailureStages of Chronic Renal Failure ChangesChanges

• Kidney Kidney • Metabolic Metabolic – Urea and creatinineUrea and creatinine

• ElectrolytesElectrolytes– Sodium Sodium – PotassiumPotassium

• Acid-base balanceAcid-base balance• Calcium and phosphorusCalcium and phosphorus

Stages of Chronic Renal FailureStages of Chronic Renal FailureChanges Changes (Continued)(Continued)

• CardiacCardiac– HypertensionHypertension– HyperlipidemiaHyperlipidemia– Congestive heart failureCongestive heart failure– Uremic pericarditisUremic pericarditis

• HematologicHematologic• GastrointestinalGastrointestinal

Clinical ManifestationsClinical Manifestations

NeurologicNeurologic CardiovascularCardiovascular RespiratoryRespiratory Hematologic Hematologic GastrointestinalGastrointestinal UrinaryUrinary SkinSkin

HemodialysisHemodialysis

Client selectionClient selection Dialysis settingsDialysis settings Works using passive transfer of toxins Works using passive transfer of toxins

by diffusionby diffusion Anticoagulation needed, usually Anticoagulation needed, usually

heparin treatmentheparin treatment

Hemodialysis Nursing CareHemodialysis Nursing Care

Postdialysis care:Postdialysis care: Monitor for complications such as Monitor for complications such as

hypotension, headache, nausea, malaise, hypotension, headache, nausea, malaise, vomiting, dizziness, and muscle cramps.vomiting, dizziness, and muscle cramps.

Monitor vital signs and weight.Monitor vital signs and weight. Avoid invasive procedures 4 to 6 hours Avoid invasive procedures 4 to 6 hours

after dialysis.after dialysis. Continually monitor for hemorrhageContinually monitor for hemorrhage

Complications of Complications of HemodialysisHemodialysis

Dialysis disequilibrium syndromeDialysis disequilibrium syndrome Infectious diseasesInfectious diseases Hepatitis B and C infectionsHepatitis B and C infections HIV exposure—poses some risk for HIV exposure—poses some risk for

clients undergoing dialysisclients undergoing dialysis

Peritoneal DialysisPeritoneal Dialysis

Procedure involves siliconized rubber Procedure involves siliconized rubber catheter placed into the abdominal catheter placed into the abdominal cavity for infusion of dialysate.cavity for infusion of dialysate.

Types of peritoneal dialysis:Types of peritoneal dialysis: Continuous ambulatory peritonealContinuous ambulatory peritoneal Automated peritonealAutomated peritoneal Intermittent peritonealIntermittent peritoneal Continuous-cycle peritonealContinuous-cycle peritoneal

ComplicationsComplications

PeritonitisPeritonitis PainPain Exit site and tunnel infectionsExit site and tunnel infections Poor dialysate flowPoor dialysate flow Dialysate leakageDialysate leakage Other complicationsOther complications

Nursing Care During Nursing Care During Peritoneal DialysisPeritoneal Dialysis

Before treating, evaluate baseline vital Before treating, evaluate baseline vital signs, weight, and laboratory tests.signs, weight, and laboratory tests.

Continually monitor the client for Continually monitor the client for respiratory distress, pain, and discomfort.respiratory distress, pain, and discomfort.

Monitor prescribed dwell time and initiate Monitor prescribed dwell time and initiate outflow.outflow.

Observe the outflow amount and pattern of Observe the outflow amount and pattern of fluid.fluid.

Renal TransplantationRenal Transplantation

Candidate selection criteriaCandidate selection criteria DonorsDonors Preoperative carePreoperative care Immunologic studiesImmunologic studies Surgical teamSurgical team Operative procedureOperative procedure

Postoperative CarePostoperative Care

Urologic managementUrologic management Assessment of urine output hourly for Assessment of urine output hourly for

48 hours.48 hours. Complications include:Complications include:

RejectionRejection Acute tubular necrosisAcute tubular necrosis


ThrombosisThrombosis Renal artery stenosis Renal artery stenosis Other complicationsOther complications Immunosuppressive drug therapyImmunosuppressive drug therapy Psychosocial preparationPsychosocial preparation

Interventions for Interventions for Clients with Urinary Clients with Urinary ProblemsProblems

CystitisCystitis

Inflammation of the bladderInflammation of the bladder Most commonly caused by bacteria Most commonly caused by bacteria

that move up the urinary tract from the that move up the urinary tract from the external urethra to the bladder, external urethra to the bladder, viruses, fungi, or parasitesviruses, fungi, or parasites

Catheter-related infections common Catheter-related infections common during hospital stayduring hospital stay

Incidence and Prevalence of Incidence and Prevalence of CystitisCystitis

Frequenct urge to urinateFrequenct urge to urinate Dysuria Dysuria Urgency Urgency Urinalysis needed when testing for Urinalysis needed when testing for

leukocyte esteraseleukocyte esterase Type of organism confirmed by urine Type of organism confirmed by urine

cultureculture Other diagnostic assessmentsOther diagnostic assessments


Urinary antisepticsUrinary antiseptics AntibioticsAntibiotics AnalgesicsAnalgesics AntispasmodicsAntispasmodics Antifungal agentsAntifungal agents Long-term antibiotic therapy for Long-term antibiotic therapy for

chronic, recurring infectionschronic, recurring infections

Nonsurgical ManagementNonsurgical Management

Urinary eliminationUrinary elimination Diet therapy includes all food groups, Diet therapy includes all food groups,

calorie increase due to increase in calorie increase due to increase in metabolism caused by the infection, metabolism caused by the infection, fluids, possible intake of cranberry fluids, possible intake of cranberry juice preventivelyjuice preventively

Other pain relief measures, such as Other pain relief measures, such as warm sitz bathswarm sitz baths

CatheterCatheter

UrethritisUrethritis

Inflammation of the urethra that Inflammation of the urethra that causes symptoms similar to urinary causes symptoms similar to urinary tract infectiontract infection

Caused by sexually transmitted Caused by sexually transmitted infections; treat with antibiotic therapyinfections; treat with antibiotic therapy

Estrogen vaginal cream for Estrogen vaginal cream for postmenopausal womenpostmenopausal women

Urethrala StricturesUrethrala Strictures

Narrowing of the urethraNarrowing of the urethra Most common symptom—obstruction Most common symptom—obstruction

of urine flowof urine flow Surgical treatment by urethroplasty—Surgical treatment by urethroplasty—

best chance of long-term curebest chance of long-term cure Dilation of the urethra—a temporary Dilation of the urethra—a temporary

measuremeasure UrethroplastyUrethroplasty

Urinary IncontinenceUrinary Incontinence

Five types of incontinence include:Five types of incontinence include: StressStress UrgeUrge Mixed Mixed Overflow Overflow FunctionalFunctional

Collaborative ManagementCollaborative Management

Assessment includes a thorough Assessment includes a thorough client history.client history.

Clinical manifestations for urethral or Clinical manifestations for urethral or uterine prolapseuterine prolapse

Laboratory assessment by urinalysisLaboratory assessment by urinalysis Radiographic assessment, especially Radiographic assessment, especially

before surgerybefore surgery Other diagnostic assessmentsOther diagnostic assessments

Stress Urinary IncontinenceStress Urinary Incontinence

Interventions include:Interventions include: Keeping a diary, behavioral interventions, Keeping a diary, behavioral interventions,

diet modification, and pelvic floor diet modification, and pelvic floor exercisesexercises

Drug therapy: estrogen Drug therapy: estrogen SurgerySurgery Collection devices and vaginal cone Collection devices and vaginal cone

weightsweights


Preoperative carePreoperative care Operative procedureOperative procedure Postoperative carePostoperative care

Assess for and intervene to prevent or Assess for and intervene to prevent or detect complications.detect complications.

Secure urethral catheter.Secure urethral catheter.

Urge Urinary IncontinenceUrge Urinary Incontinence

Interventions include:Interventions include: Drugs: anticholinergics, possibly Drugs: anticholinergics, possibly

antihistamines, othersantihistamines, others Diet therapy: avoid caffeine and alcoholDiet therapy: avoid caffeine and alcohol Behavioral interventions: exercises, Behavioral interventions: exercises,

bladder training, habit training, electrical bladder training, habit training, electrical stimulationstimulation

Reflux Urinary IncontinenceReflux Urinary Incontinence

Interventions include:Interventions include: Surgery to relieve the obstructionSurgery to relieve the obstruction Intermittent catheterizationIntermittent catheterization Bladder compression and intermittent Bladder compression and intermittent

self-catheterizationself-catheterization Drug therapyDrug therapy Behavioral interventionsBehavioral interventions

Functional Urinary Functional Urinary IncontinenceIncontinence

Interventions include:Interventions include: Treatment of reversible causesTreatment of reversible causes If incontinence is not reversible, urinary If incontinence is not reversible, urinary

habit traininghabit training Final strategy—containment of urine and Final strategy—containment of urine and

protection of the client’s skinprotection of the client’s skin Applied devicesApplied devices Urinary catheterization Urinary catheterization

UrolithiasisUrolithiasis

Presence of calculi (stones) in the Presence of calculi (stones) in the urinary tracturinary tract

Collaborative managementCollaborative management History of urologic stonesHistory of urologic stones Clinical manifestationsClinical manifestations Laboratory assessmentLaboratory assessment Radiographic assessmentRadiographic assessment Other diagnostic testsOther diagnostic tests

IVP (Intravenous IVP (Intravenous Pyelography)Pyelography)

InterventionsInterventions

Drug therapyDrug therapy Opioid analgesics—often used to control Opioid analgesics—often used to control

painpain Nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs Pain medications at regular intervalsPain medications at regular intervals Constant delivery systemConstant delivery system Spasmolytic drugs—important for relief of Spasmolytic drugs—important for relief of

painpain Complementary and alternative therapyComplementary and alternative therapy

LithotripsyLithotripsy

Extracorporeal shock wave lithotripsy uses Extracorporeal shock wave lithotripsy uses sound, laser, or dry shock wave energy to sound, laser, or dry shock wave energy to break the stone into small fragments.break the stone into small fragments.

Client undergoes conscious sedationClient undergoes conscious sedation Topical anesthetic cream is applied to skin Topical anesthetic cream is applied to skin

site of stone.site of stone. Continuous monitoring is by Continuous monitoring is by

electrocardiographyelectrocardiography


Minimally invasive surgical proceduresMinimally invasive surgical procedures StentingStenting Retrograde ureteroscopyRetrograde ureteroscopy Percutaneous ureterolithotomy and Percutaneous ureterolithotomy and

nephrolithotomynephrolithotomy Open surgical proceduresOpen surgical procedures

Preoperative carePreoperative care Operative procedureOperative procedure


Routine postoperative care procedures for Routine postoperative care procedures for assessment of bleeding, urine, and assessment of bleeding, urine, and adequate fluid intakeadequate fluid intake

Strained urineStrained urine Infection preventionInfection prevention Drug therapyDrug therapy Diet therapyDiet therapy Prevention of obstructionPrevention of obstruction


Drug selection to prevent obstruction Drug selection to prevent obstruction depends on what is forming the stone:depends on what is forming the stone: CalciumCalcium OxalateOxalate Uric acidUric acid CystineCystine

Urothelial CancerUrothelial Cancer

Collaborative managementCollaborative management AssessmentAssessment Diagnostic assessmentDiagnostic assessment Nonsurgical managementNonsurgical management

Prophylactic immunotherapyProphylactic immunotherapy ChemotherapyChemotherapy Radiation therapyRadiation therapy


Preoperative carePreoperative care Operative proceduresOperative procedures Postoperative care includes:Postoperative care includes:

Collaboration with enterostomal therapistCollaboration with enterostomal therapist Kock’s pouchKock’s pouch NeobladderNeobladder

Bladder TraumaBladder Trauma

Causes may be due to injury to the Causes may be due to injury to the lower abdomen or stabbing or lower abdomen or stabbing or gunshot wounds.gunshot wounds.

Surgical intervention is required.Surgical intervention is required. Fractures should be stabilized before Fractures should be stabilized before

bladder repair.bladder repair.

HemodialysisHemodialysis

Hospital, dialysis centerHospital, dialysis center Pt’s blood moves from implanted Pt’s blood moves from implanted

shunt in arm artery shunt in arm artery tube tube machine machine exchange of wastes, fluids, exchange of wastes, fluids, electrolyteselectrolytes Semipermeable membrane Semipermeable membrane

separates pts blood from dialysis separates pts blood from dialysis fluidfluid

HemodialysisHemodialysisConstituents move between the 2 Constituents move between the 2

compartmentscompartmentsEx: wastes in blood Ex: wastes in blood dialysate dialysatebicarbonate in dialysate bicarbonate in dialysate blood bloodBlood cells, proteins remain in Blood cells, proteins remain in

bloodbloodMovement by ultrafiltration, Movement by ultrafiltration,

diffusion, osmosisdiffusion, osmosis Blood to pt veinBlood to pt vein


Administered in unit or at homeAdministered in unit or at home At night or continuouslyAt night or continuously

CAPD (continuous ambulatory CAPD (continuous ambulatory peritoneal dialysis)peritoneal dialysis)

Peritoneal membrane serves as Peritoneal membrane serves as semipermeable membranesemipermeable membrane

Catheter w/ entry and exit points Catheter w/ entry and exit points implantedimplanted

Dialyzing fluid instilled in catheter into Dialyzing fluid instilled in catheter into cavitycavity

Peritoneal DialysisPeritoneal Dialysis Remains there Remains there Allows exchange of wastes and Allows exchange of wastes and

electrolytes to occurelectrolytes to occur Dialysate drained from by gravity Dialysate drained from by gravity

from cavity into containerfrom cavity into container Requires more time than hemoRequires more time than hemo ComplicationsComplications

Infection in peritoneal cavityInfection in peritoneal cavity

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

interventions for clients with renal disorders. pyelonephritis bacterial infection in the kidney...

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