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Learn about acute and chronic renal disorders, their key features, and interventions available. Explore surgical and nonsurgical management techniques and complications to look out for. Discover ways to manage renal failure effectively.
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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
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
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
Chronic Glomerulonephritis(Continued) • Fluid intake • Drug therapy • Dialysis, transplantation
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
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
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
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.
Continuous Renal Replacement Therapy • Standard treatment • Dialysate solution • Vascular access • Continuous arteriovenous hemofiltration • Continuous venovenous hemofiltration
Stages of Chronic Renal Failure • Diminished renal reserve • Renal insufficiency • End-stage renal disease
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
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