Interventions for Clients with Renal Disorders Pyelonephritis Bacterial

Interventions for Clients with Renal Disorders

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

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

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

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

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

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

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

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

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

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)

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

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)

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

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

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

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.

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.

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

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

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

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

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

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

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

Interventions/Complicatio ns § Acute and chronic pain § Constipation § Hypertension and renal failure § Nursing interventions to promote selfmanagement and understanding § Fluid therapy § Drug therapy § Measure and record blood pressure § Diet therapy

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

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

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.

Interventions for Clients with Acute and Chronic Renal Failure

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

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.

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

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

Treatment § Diet therapy § Dialysis therapies § Hemodialysis § Peritoneal dialysis

Continuous Renal Replacement Therapy § § Standard treatment Dialysate solution Vascular access Continuous arteriovenous hemofiltration § Continuous venous hemofiltration

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.

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

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

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

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

Clinical Manifestations § § § § Neurologic Cardiovascular Respiratory Hematologic Gastrointestinal Urinary Skin

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

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

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

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

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

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.

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

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

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