copyright © 2008 wolters kluwer health | lippincott williams & wilkins do case studies from...

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Do Case Studies from Critical Thinking Book Before ClassDo Case Studies from Critical Thinking Book Before Class!!1st CS on pg:327 Acute Renal Failure1st CS on pg:327 Acute Renal Failure

2nd CS on pg:307 ESRD2nd CS on pg:307 ESRD

3rd CS on pg:331 UTI3rd CS on pg:331 UTI

Unit 8Renal Conditions

Part 1Gordons Functional Health

Pattern Elimination Pattern


Common Fluid and Electrolyte Disturbances in Renal Disorders

Common Fluid and Electrolyte Disturbances in Renal Disorders

• Fluid volume loss or excess

• Protein deficit

• Electrolyte abnormalities including Na+, K+, Ca++, Mg++, bicarbonate, and phosphorus

• See Table 44-1


QuestionQuestion

The most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following?

a. Abdominal girth

b. Weight

c. Skin turgor

d. Level of consciousness


Glomerular DiseasesGlomerular Diseases

• An inflammation of the glomerular capillaries

• Acute glomerulonephritis

• Chronic glomerulonephritis

• Nephrotic syndrome


Acute GlomerulonephritisAcute Glomerulonephritis

• Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis

• Manifestations include hematuria, edema, azotemia, proteinuria, and hypertension

• May be mild or may progress to acute renal failure

• Medical management includes supportive care and dietary modifications; treat cause, if appropriate, using antibiotics, corticosteroids, and immunosuppressants


Sequence of Events in Acute Glomerulonephritis

Sequence of Events in Acute Glomerulonephritis


Nursing Management—AcuteGlomerulonephritis

Nursing Management—AcuteGlomerulonephritis

• Patient assessment

• Maintain fluid balance

• Fluid and dietary restrictions

• Patient education

• Follow-up care


Chronic GlomerulonephritisChronic Glomerulonephritis

• Causes include repeated episodes of acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage

• Some patients are asymptomatic for years; as glomerular damage increases, signs and symptoms of renal insufficiency and renal failure develop

• Abnormal laboratory test results include urine with fixed specific gravity, casts, and proteinuria; electrolyte imbalances; and hypoalbuminemia

• Medical management is determined by symptoms


Nursing Management of Chronic Glomerulonephritis

Nursing Management of Chronic Glomerulonephritis

• Assessment

• Potential fluid and electrolyte imbalances

• Cardiac status

• Neurologic status

• Emotional support

• Teaching self-care


Nephrotic Syndrome Nephrotic Syndrome

• Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins

• Results in hypoalbuminemia and edema

• Causes include chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythematosus, multiple myeloma, and renal vein thrombosis

• Medical management includes drug and dietary therapy


Sequence of Events in Nephrotic Syndrome

Sequence of Events in Nephrotic Syndrome


Renal FailureRenal Failure

• Results when the kidneys cannot remove wastes or perform regulatory functions

• A systemic disorder that results from many different causes

• Acute renal failure is a reversible syndrome that results in decreased glomerular filtration rate (GFR) and oliguria

• Chronic renal failure (ESRD) is progressive; irreversible deterioration of renal function results in azotemia


Causes of Acute Renal FailureCauses of Acute Renal Failure

• Hypovolemia

• Hypotension

• Reduced cardiac output and heart failure

• Obstruction of the kidney or lower urinary tract

• Obstruction of renal arteries or veins


Causes of Chronic Renal FailureCauses of Chronic Renal Failure

• Diabetes mellitus

• Hypertension

• Chronic glomerulonephritis

• Pyelonephritis or other infections

• Obstruction of urinary tract

• Hereditary lesions

• Vascular disorders

• Medications or toxic agents


QuestionQuestion

Tell whether the following statement is true or false.

Hypercalcemia is the most life-threatening of the fluid and electrolyte changes that occur in patients with renal disturbances.


Treatment Options for Renal FailureTreatment Options for Renal Failure

• Hemodialysis

• Peritoneal dialysis

• Continuous renal replacement therapies (CCRT)


Hemodialysis SystemHemodialysis System


Hemodialysis CatheterHemodialysis Catheter


Internal Arteriovenous Fistula and Graft Internal Arteriovenous Fistula and Graft


Continuous Venovenous Hemofiltration With Dialysis

Continuous Venovenous Hemofiltration With Dialysis


Peritoneal DialysisPeritoneal Dialysis


Peritoneal Dialysis (cont.)Peritoneal Dialysis (cont.)


QuestionQuestion

The movement of solute (waste products) from an area of higher concentration to an area of lower concentration is which of the following?

a. Anuria

b. Diffusion

c. Osmosis

d. Ultrafiltration


Nursing Management of the Hospitalized Patient on Dialysis

Nursing Management of the Hospitalized Patient on Dialysis

• Protect vascular access; assess site for patency and signs of potential infection, and do not use it for blood pressure or blood draws

• Monitor fluid balance indicators and monitor IV therapy carefully; keep accurate I&O and IV administration pump records

• Assess for signs and symptoms of uremia and electrolyte imbalance; regularly check lab data

• Monitor cardiac and respiratory status carefully

• Monitor blood pressure; antihypertensive agents must be held on dialysis days to avoid hypotension


Nursing Management of the Hospitalized Patient on Dialysis (cont.)

Nursing Management of the Hospitalized Patient on Dialysis (cont.)

• Monitor all medications and medication dosages carefully; avoid medications containing potassium and magnesium

• Address pain and discomfort

• Implement stringent infection control measures

• Monitor dietary sodium, potassium, protein, and fluid; address individual nutritional needs

• Provide skin care: prevent pruritus; keep skin clean and well moisturized; trim nails and avoid scratching

• Provide CAPD catheter care


Nursing Process—Assessment of the Patient With Renal Failure

Nursing Process—Assessment of the Patient With Renal Failure

• Fluid status

• Nutritional status

• Patient knowledge

• Activity tolerance

• Self-esteem

• Potential complications


Nursing Process—Diagnosis of the Patient With Renal Failure

Nursing Process—Diagnosis of the Patient With Renal Failure

• Excess fluid volume

• Imbalanced nutrition

• Deficient knowledge

• Risk for situational low self-esteem


Collaborative Problems/Potential Complications

Collaborative Problems/Potential Complications

• Hyperkalemia

• Pericarditis

• Pericardial effusion

• Pericardial tamponade

• Hypertension

• Anemia

• Bone disease and metastatic calcifications


Nursing Process—Planning the Care of the Patient With Renal Failure

Nursing Process—Planning the Care of the Patient With Renal Failure

• Goals include maintaining IBW without excess fluid, maintenance of adequate nutritional intake, increased knowledge, participation in activities within tolerance, improved self-esteem, and absence of complications


QuestionQuestion

As renal failure progresses and the GFR falls below 50 mL/min, which change occurs?

a. Metabolic acidosis

b. Hypokalemia

c. Hypercalcemia

d. Hypophosphatemia


Excess Fluid Volume Excess Fluid Volume

• Assess for signs and symptoms of fluid volume excess; keep accurate I&O and daily weight records

• Limit fluid to prescribed amounts

• Identify sources of fluid

• Explain to patient and family the rationale for the restriction

• Assist patient in coping with the fluid restriction

• Provide or encourage frequent oral hygiene


Imbalanced NutritionImbalanced Nutrition

• Assess nutritional status, weight changes, and lab data

• Assess patient nutritional patterns and history; note food preferences

• Provide food preferences within restrictions

• Encourage high-quality nutritional foods while maintaining nutritional restrictions

• Assess and modify intake related to factors that contribute to altered nutritional intake, ie, stomatitis or anorexia

• Adjust medication times related to meals


Risk for Situational Low Self-EsteemRisk for Situational Low Self-Esteem

• Assess patient and family responses to illness and treatment

• Assess relationships and coping patterns

• Encourage open discussion about changes and concerns

• Explore alternate ways of sexual expression

• Discuss role of giving and receiving love, warmth, and affection


QuestionQuestion

A patient receiving peritoneal dialysis is complaining of pain with rebound tenderness. The dialysate drainage is cloudy. This symptom is indicative of which acute complication?

a. Hernia

b. Bleeding

c. Leakage

d. Peritonitis


Kidney SurgeryKidney Surgery

• Preoperative considerations

• Perioperative concerns

• Postoperative management

– Potential hemorrhage and shock

– Potential abdominal distention and paralytic ileus

– Potential infection

– Potential thromboembolism


Patient Positioning and Incisional Approaches

Patient Positioning and Incisional Approaches


Renal TransplantationRenal Transplantation


Postoperative Nursing ManagementPostoperative Nursing Management

• Assessment: include all body systems, pain, fluid, and electrolyte status; patency and adequacy of urinary drainage system

• Diagnoses: ineffective airway clearance, ineffective breathing pattern, acute pain, fear and anxiety, impaired urinary elimination, and risk for fluid imbalance

• Complications: bleeding, pneumonia, infection, and DVT

• See Chart 44-9


InterventionsInterventions

• Pain relief measures and analgesic medications

• Promote airway clearance and effective breathing pattern by appropriate pain relief, deep-breathing coughing exercises, and incentive spirometry and positioning

• Monitor UO and maintain potency of urinary drainage systems

• Use strict asepsis with catheter and appropriate techniques in providing all care

• Monitor for signs and symptoms of bleeding

• Encourage leg exercises, early ambulation, and monitor for signs of DVT


Patient TeachingPatient Teaching

• Instruct both patient and family

• Care of drainage system

• Strategies to prevent complications

• Signs and symptoms

• Follow-up care

• Fluid intake

• Health promotion and health screening


Renal CancerRenal Cancer

• Accounts for 3% of U.S. cancer deaths

• Risk factors include male sex, increased BMI, tobacco use

• Manifestations include hematuria, pain, and mass in flank

• Treatments

– Surgery: radical nephrectomy, laparoscopic nephrectomy, and partial nephrectomy

– Renal artery embolization

– Palliative radiation therapy

– Use of chemotherapy is limited

– Developing therapies

copyright © 2008 wolters kluwer health | lippincott williams & wilkins do case studies from...

Documents

acute glomerulonephritis

progressive glomerulonephritis

immunosuppressants slide

fluid balance fluid

level of consciousness

renal conditions

causes of glomerular

glomerular membrane