Transcript Chapter 46 Nursing Management Renal and Urologic Problems S. Buckley, RN, MS Mosby pp Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier.

Chapter 46
Nursing Management
Renal and Urologic Problems
S. Buckley, RN, MS
Mosby pp
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Infectious and Inflammatory Disorders of
the Urinary System
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Causes of urinary tract obstruction
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Immunologic Disorders
of the Kidney
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Glomerulonephritis
• Immunologic process resulting in inflammation
of the glomerulus.
• 3rd leading cause of renal failure in the US.
• Autoantibodies production stimulated by exogenous
agents (hydrocarbon, viruses (hep. B, C, rubella, bacteria
(streptococcal), chemicals, drugs), diseases or endogenous
(SLE)
• Clinical manifestations: hematuria, excretion
of RBCs, WBC, casts, decrease GFR, azotemia,
oliguria, hypertension, periorbital edema
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Acute Poststreptococcal
Glomerulonephritis
• Clinical manifestations and complicationsdevelops 5-21 days post infection of throat
by strep.
• Diagnostics: hx, physical assessment, CBC,
throat swab
• Tx; rest, sodium and fluid restriction,
diuretics, antihypertensive therapy,
emotional support, education, decrease
dietary protein.Antibiotics(if strep still
present), corticosteroids.
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Chronic glomerulonephritis
• End stage of acute disease
• Symptoms: proteinuria, hematuia slow
development of uremia, progresses toward
renal failure
• Dignostic: u/a, vs, ultrasound, CT, renal biopsy
• Tx-supportive an symptomatic: control
hypertension and uti’s, protein and phosphate
restriction may slow the rate of progression.
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Nephrotic Syndrome
• results when: glomerulus is permeable to plasma
protein, causing proteinuria, low plasma albumin
and tissue edema
• Symptoms: peripheral edema, massive
proteinuria, hypertension, , hyperlipidemia,
hypoalbuminemia, ascites, anasarca, calcium
abnormalitiesaltered immune response, altered
coagulation (hyper)
• Collaborative care-symptom management; relieve
edema, cure primary disease, low Na diet, low
protein, diuretics, NSAIDs, anticoagulant therapy,
corticosteroids.
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Nephrotic syndrome
nursing interventions
• Control edema: daily weights, I & o, girth or
extremity size, bp, trending of data, care of
skin (hygiene and avoid trauma)
• May become malnurished, may become
anorexic; serve small, frequent meals: low na,
low protein
• Susceptible to infections; avoid exposure,
emotional support re: poor body image
• Educate
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Obstructive Uropathies
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Obstructive Uropathies
• Any anatomic or functional condition that
blocks or impedes the flow of urine, may be
congenital or acquired.
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Fig. 46-3
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hydronephrosis
• Results from obstruction in urinary system,
causing reflux of urine and increased pressure,
ureteral dilation, kinking, and dilation and or
enlargement of the renal pelves and calyses.
• Causes pyelonephritis and renal atropy.
• If one kidney involved, other will compensate.
• Symptoms: alterations in kidney function (per
assessment, labs; increased BUN, creatinine,
oliguria or anuria.
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Fig. 46-4
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Urinary Tract Calculi
500,000 people/yr develop lithiasis, more common in warm
climates (dehydration)
Various types of calculi (p.1170), recurrence of stones -50%.
• Clinical manifestations-Pain in flank area (depends on location
of stone), severe, hematurin, reanl colic, N&V,
• Diagnostic studies-u/a, culture,VP, ultrasound, cystoscopy.
• Collaborative care-keep urine dilute and free flowing,reduces
risk of formation., analyze stone to determine cause and
prevent recurrance; screening of urine, CBC, urine ph.
– Endourologic procedure-bladder-cystoscopy, ureteroscopes,
– Lithotripsy-pulverizes stons with ultasonic vibrations.
– Surgical therapy-nephrolithotomy-incision into kidney to remove stone
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Fig. 46-6
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Nursing Management
Renal Calculi
• Nursing assessment-screen for
litiasis, mange acute attack;
pain control (opiods), infection
and/or obstruction elimination ,
hx, increase fluids (3000ml/day)
after acute attack, discourage
foods that increase stones.
• Diet; low na, modify depending
on type of stone (p.1171)
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Strictures
• Ureteral and urethral strictures-narrowing of
lumen, associated with unintended reslut of
sugical intervention, adhesions, scars or genetic
• Symptoms: diminshed force of urinary stream,
staining to void, split urine stream, frequency,
nocturia. Can lead to urinary retention and uti.
• Diagnostic; retrograde urethrography (RUG).
• Management; dilation of stricture by stent
placemtn, self-catherterization, or urethroplasty.
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Renal artery stenosis
RAS
• Partial occlusion of one or both renal arteries.
• Results in hypertension and low perfusion to
kidneys (hypertension, hematuria)
• Can result in sclerosis to one or both kidneys,
impacting filtering capacity ( elevated creatinine)
• Goals of therapy; control hypertension , increase
profusion.
• Collaborative care; percutaneous transluminal
renal angioplasty, surgical revascularization of
kidney.
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RAS
Clinical symptoms:
• Sudden onset of hypertension, asymmetry in kidney size on
imaging studies
• Diagnosis based on hx, clinical findings, lab, imaging, 24 hr
urine.
• Goals of therapy; control hypertension , increase profusion
(ACE inhibitors, diuretics, betablockers, and calcium channel
blockers)
• Collaborative care; percutaneous transluminal renal
angioplasty, surgical revascularization of kidney
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Hereditary Renal Diseases
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Polycystic Kidney Disease
• Most common life-threatening genetic disease in
the world, affecting 600,000 in US, 12.5/world!!
• Accounts for 10-15% of chronic kidney disease.
• 2 forms (childhood (rare), adult). Adult:
autosomal disorder, involves both kidneys, cysts
destroy surrounding tissue, filled with blood, pus.
Clinical manifestations-hypertension, hematuria,
feeling of heaviness in back, may have frequent
uti or kidney infection, chronic pain (abdominal
or flank), decreawed abiltiy to concentrate urine,
palpable kidneys, effects other organs
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PKD
• Diagnosis based on hx, IVP, ultrasound, CT.
Usually progresses to end-stage renal failure.
• Collaborative care; no specific tx. Major aim is
to prevent infections and symptoms. Kidney
transplant is only cure.
• Nursing interventions: management of endstage renal disease.
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Fig. 46-7
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Instrumentation
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•
•
•
•
Urethral catheterization
Ureteral catheters
Suprapubic catheters
Nephrostomy tubes
Intermittent catheterization
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Surgery of
the Urinary Tract
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Renal and Ureteral Surgery
• Preoperative management
• Postoperative management
– Urine output
– Respiratory status
– Abdominal distention
• Laparoscopic nephrectomy
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Urinary Diversion
• Incontinent urinary diversion
• Continent urinary diversions
• Orthotopic bladder substitution
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Fig. 46-12
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Fig. 46-13
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Fig. 46-14
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Nursing Management
Urinary Diversion
• Preoperative management
• Postoperative management
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