renal megan mcclintock, rn, ms 10/27/11
DESCRIPTION
Renal Megan McClintock, RN, MS 10/27/11. “TO PEE IS TO LIVE”. "Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival. But should the kidneys fail … neither bone, muscle, gland, nor brain could carry on.” - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/1.jpg)
RenalMegan McClintock, RN, MS
10/27/11
“TO PEE IS TO LIVE”
![Page 2: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/2.jpg)
"Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival. But should the kidneys fail … neither bone, muscle, gland, nor brain could carry on.”
Smith HW: Fish to philosopher, Boston, 1953, Little, Brown.
![Page 3: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/3.jpg)
KIDNEY DISEASE
Acute kidney injury (AKI) Chronic kidney disease (CKD)
• Sudden onset• Acute decrease in
urine output and/or increase in creatinine
• Potentially reversible• Mortality 60%
• Usually die from infection
• Gradual onset• GFR < 60 mL/min for >
3 months
• Progressive and irreversible
• Mortality 19-24% (need dialysis to survive)
• Usually die from CV disease
![Page 4: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/4.jpg)
ACUTE KIDNEY INJURY
• Prerenal causes – external to the kidney, sudden reduction in blood flow to the kidneys• Usually resolve quickly with correction of cause
• Intrarenal causes – infections, toxins, drugs, or direct trauma, ATN
• Postrenal causes –urinary tract obstructions• Usually resolve quickly with correction of cause
![Page 5: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/5.jpg)
ACUTE KIDNEY INJURYCLINICAL COURSE
• Oliguric Phase (10-14 days)– Urine output less than 400 mL/day– UA w/ casts, RBCs, WBCs, SG fixed at 1.010,
urine osmo of 300 mOsm/kg (may have proteinuria)
– Volume depletion but oftentimes fluid retention– Metabolic acidosis– Sodium imbalance– Potassium increase– Hematologic disorders– Waste product accumulation– Neuro disorders
![Page 6: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/6.jpg)
ACUTE KIDNEY INJURY CLINICAL COURSE
• Diuretic Phase (1-3 weeks)– Begins with a gradual increase in daily
urine output to 1-3 L– Nephrons still not fully functional– Kidneys can excrete waste, but still
can’t concentrate the urine– Hypovolemia– Hypotension– Hyponatremia, hypokalemia
![Page 7: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/7.jpg)
ACUTE KIDNEY INJURY CLINICAL COURSE
• Recovery Phase (12 months)– Begins when the GFR increases– BUN and creatinine plateau, then
decrease
![Page 8: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/8.jpg)
ACUTE KIDNEY INJURYTREATMENT
• Eliminate the cause, manage signs & symptoms, prevent complications– #1 goal is to ensure adequate cardiac
output and intravascular volume– Careful monitoring of I/Os– Prevent hyperkalemia– Use RRT (renal replacement therapy)
only if needed– Nutritional management
![Page 9: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/9.jpg)
ACUTE KIDNEY INJURYTREATMENT
• Avoid exposure to contrast media• Watch for nephrotoxic drugs• ACE inhibitors• Meticulous aseptic technique• Meticulous skin care• Meticulous mouth care
![Page 10: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/10.jpg)
ACUTE KIDNEY INJURYNURSING DIAGNOSES
• Decreased cardiac output• Excess fluid volume• Risk for infection• Imbalanced nutrition: less than body
requirements• Fatigue• Anxiety• Dysrhythmias • Sensory/perceptual alterations
![Page 11: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/11.jpg)
CHRONIC KIDNEY DISEASE
![Page 12: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/12.jpg)
CHRONIC KIDNEY DISEASE
• Frequently asymptomatic• Early on have no change in urine
output, may even have polyuria • Uremia develops when GFR is <10
mL/min• Persistent proteinuria• Tend to die of CV disease before
needing dialysis
![Page 13: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/13.jpg)
Fig 45-3 clinical manisfestations of chronic uremia
![Page 14: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/14.jpg)
CHRONIC KIDNEY DISEASE
TREATMENT• Treat high potassium• Control HTN• Treat anemia (EPO)• Treat hyperlipidemia• Restrict proteins• Restrict fluids• Restrict sodium, potassium, phosphates• Lots of teaching and reteaching
![Page 15: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/15.jpg)
TREATING HYPERKALEMIA
• Insulin• Sodium Bicarbonate• Calcium Gluconate IV• Dialysis• Sodium Polystyrene Sulfonate
(kayexalate)• Dietary Restriction
![Page 16: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/16.jpg)
Dialysis
Peritoneal Dialysis (PD) Hemodialysis (HD)
![Page 17: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/17.jpg)
![Page 18: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/18.jpg)
![Page 19: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/19.jpg)
![Page 20: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/20.jpg)
![Page 21: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/21.jpg)
![Page 22: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/22.jpg)
PERITONEAL DIALYSIS
• Three phases of PD
• Manual vs Continuous
• Complications
![Page 23: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/23.jpg)
![Page 24: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/24.jpg)
![Page 25: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/25.jpg)
Fig 45-12
Temporary catheters
Fig 45-13 placement of jugular vein temporary dialysis catheter
![Page 26: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/26.jpg)
Fig 45-14 components of hemodialysis system
![Page 27: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/27.jpg)
![Page 28: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/28.jpg)
HEMODIALYSIS
• Pre & Post Dialysis Interventions• Complications
– Hypotension– Muscle cramps– Blood loss– Hepatitis
![Page 29: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/29.jpg)
PYELONEPHRITIS
• Cause – Bacteria (most common)• S/S – abrupt onset of chills, fever,
vomiting, malaise, CVA pain, dysuria, urinary urgency and frequency
• Labs – UA w/ pyuria, bacteriuria, hematuria, WBC casts; CBC w/ left shift (increase in bands)
• Cx – Urosepsis leading to septic shock and death, chronic pyelonephritis
![Page 30: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/30.jpg)
Pyelonephritis: glomerular hemorrhage
![Page 31: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/31.jpg)
Pyelonephritis - papillary necrosis
![Page 32: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/32.jpg)
PYELONEPHRITIS INTERVENTIONS
• Early tx for cystitis• Take antibiotics as prescribed• Follow-up urine culture• Drink at least 8 glasses of fluid daily• Rest
![Page 33: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/33.jpg)
GLOMERULONEPHRITIS
• Cause – Antibody-induced injury (exposure to drugs, immunizations, microbial/viral infxn)
• S/S – generalized edema, HTN, oliguria, hematuria, proteinuria, abd/flank pain
• Labs – UA w/ proteinuria, hematuria, WBC casts; increased BUN and creatinine, ASO titer
• Cx – Renal insufficiency, destruction of renal tissue
![Page 34: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/34.jpg)
GLOMERULONEPHRITIS INTERVENTIONS
• REST• Diuretics, restricted sodium and fluids• Restrict dietary protein if in BUN.• Treat severe HTN with anti-
hypertensives• No abx unless infection still present• Prevention - Take the FULL course of
antibiotics (treat strep)
![Page 35: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/35.jpg)
NEPHROTIC SYNDROME
• Cause – systemic disease, allergens, drugs, infxn, glomerulonephritis
• S/S – edema, massive proteinuria, HTN, hypoalbuminemia, hyperlipidemia
• Labs – low albumin, low protein, high cholesterol
• Cx – Infection, thromboembolism, skin breakdown, malnourishment, body image problems
![Page 36: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/36.jpg)
![Page 37: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/37.jpg)
![Page 38: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/38.jpg)
NEPHROTIC SYNDROME INTERVENTIONS
• ACE inhibitors, corticosteroids, diuretics, lipid-lowering agents
• Low sodium, low-moderate protein diet (focus on preventing malnutrition)
• Strict I/Os, daily weights• Protect skin• Prevention of infection
![Page 39: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/39.jpg)
Minute paper
• On the provided 3x5 card answer the following:
1)What was the most important thing you learned today.
2)What important point remains unclear to you?
![Page 40: Renal Megan McClintock, RN, MS 10/27/11](https://reader035.vdocuments.us/reader035/viewer/2022070411/56814703550346895db43f27/html5/thumbnails/40.jpg)