UNIVERSIDAD NACIONAL UNIVERSIDAD NACIONAL PEDRO RUIZ GALLOPEDRO RUIZ GALLO

FACULTAD DE ENFERMERIAFACULTAD DE ENFERMERIASEGUNDA ESPECIALIDAD SEGUNDA ESPECIALIDAD

““CUIDADOS DE ENFERMERIA A CUIDADOS DE ENFERMERIA A PERSONAS PERSONAS

CON AFECCIONES NEFROLOGICASCON AFECCIONES NEFROLOGICAS”” LAMBAYEQUELAMBAYEQUE

CURSO : INGLES TECNICOCURSO : INGLES TECNICOIV UNIDAD :The renal nurseIV UNIDAD :The renal nurse

Cardiovascular system and Vital Signs Cardiovascular system and Vital Signs DOCENTE: Magister Lupe Rivera GonzalesDOCENTE: Magister Lupe Rivera Gonzales

TRANSPLANT RENALTRANSPLANT RENAL• Surgical TechniqueSurgical Technique• Surgical implantation of the graft is performed through Surgical implantation of the graft is performed through

an extraperitoneal incision in the right or left iliac an extraperitoneal incision in the right or left iliac fossa. The external iliac artery and vein are fossa. The external iliac artery and vein are skeletonized and the surrounding lymphatics ligated. skeletonized and the surrounding lymphatics ligated. Care is taken to minimize the amount of dissection in Care is taken to minimize the amount of dissection in the renal hilum and periureteral fat so as to reduce the the renal hilum and periureteral fat so as to reduce the risk of compromising renal and ureteral arterial blood risk of compromising renal and ureteral arterial blood supply. Under normal circumstances, right renal grafts supply. Under normal circumstances, right renal grafts are placed in the left iliac fossa and left grafts in the are placed in the left iliac fossa and left grafts in the right fossa in order to facilitate the vascular right fossa in order to facilitate the vascular anastomosis and ensure correct orientation of the anastomosis and ensure correct orientation of the ureter. This involves reversing the anterior-posterior ureter. This involves reversing the anterior-posterior orientation of the kidney; hence, a left donor kidney is orientation of the kidney; hence, a left donor kidney is flipped anteroposteriorly before it is placed in the right flipped anteroposteriorly before it is placed in the right iliac fossa .iliac fossa .

• An end renal artery-to-side external iliac An end renal artery-to-side external iliac artery anastomosis is preferred over the artery anastomosis is preferred over the end-to-end renal-to-internal iliac artery end-to-end renal-to-internal iliac artery technique because it carries a lower technique because it carries a lower incidence of renal artery stenosis . An incidence of renal artery stenosis . An end-to-side anastomosis is made between end-to-side anastomosis is made between the renal and external iliac veins . the renal and external iliac veins .

• The ureteral length is kept as short as The ureteral length is kept as short as possible to reduce the risk of ischemia and possible to reduce the risk of ischemia and subsequent necrosis or fibrosis of the distal subsequent necrosis or fibrosis of the distal segment. An antirefluxing extravesical segment. An antirefluxing extravesical ureteroneocystostomy is created by ureteroneocystostomy is created by placing a small incision anterolaterally in placing a small incision anterolaterally in the bladder and anastomosing the ureter to the bladder and anastomosing the ureter to bladder, mucosa to mucosa. The muscular bladder, mucosa to mucosa. The muscular layers of the bladder wall are then closed layers of the bladder wall are then closed over the ureter, forming an intramural over the ureter, forming an intramural tunnel to prevent reflux . Stenting of the tunnel to prevent reflux . Stenting of the transplanted ureter is generally not transplanted ureter is generally not required except in cases where the required except in cases where the anastomosis is technically difficult and anastomosis is technically difficult and postoperative edema and hydronephrosis postoperative edema and hydronephrosis are likely.are likely.

Native kidneys are left in situ unless the patient has chronic vesicoureteral reflux or renal parenchymal infection, infected stones, or renovascular hypertension refractory to medical therapy. In patients with massively enlarged polycystic kidneys, one may be removed to make room for the transplant .

A RENAL NURSEA RENAL NURSE• The lives of people suffering from The lives of people suffering from renal failure are extremely limited, they renal failure are extremely limited, they

can never go far from a dialysis machine can never go far from a dialysis machine and so day may feel imprisoned by the and so day may feel imprisoned by the endlesscycle of treatment . Part of the endlesscycle of treatment . Part of the work of a renal nurse is to provide work of a renal nurse is to provide emotional support and to educated them emotional support and to educated them in the alterations they need to make to diet in the alterations they need to make to diet and lifestyle in order to stay alive. Patients and lifestyle in order to stay alive. Patients need to take the pressure off their failing need to take the pressure off their failing kidneys by reducing their intake of proteins kidneys by reducing their intake of proteins ,sodium, and potassium and they need to ,sodium, and potassium and they need to know what not to eat .know what not to eat .

ENFERMERIA NEFROLOGICAENFERMERIA NEFROLOGICA

Hospital 12 de Octubre Madrid España.Pag. Web del

Servicio de Nefrología

Cardiovascular System : Patient CareCardiovascular System : Patient Care • In develop countries more people die In develop countries more people die

from coronary heart disease than any from coronary heart disease than any othe kills.It kills one in foru men and one othe kills.It kills one in foru men and one in six women .It happens when the blood in six women .It happens when the blood supply to the heart blocked in the arteries supply to the heart blocked in the arteries bay fatty deposits called atheroma in a bay fatty deposits called atheroma in a process called atheroesclerosis.It leads to process called atheroesclerosis.It leads to Angina (chest pain) and can caused a Angina (chest pain) and can caused a heart attack.The medical term for it is heart attack.The medical term for it is Myocardial Infarction The term Cardiac Myocardial Infarction The term Cardiac arrest is also used though this only relly arrest is also used though this only relly applies to hearts that actually stop. applies to hearts that actually stop.

FACTORS OF CORONARY FACTORS OF CORONARY HEART DISEASEHEART DISEASE

• The risk factors of coronary heart disease The risk factors of coronary heart disease are related to lifestyle sometimes ,though are related to lifestyle sometimes ,though not always ,linked to a genetic predisposition not always ,linked to a genetic predisposition to the disease . They are :to the disease . They are :

• High blood cholesterol (called High blood cholesterol (called hypercholesterolemia ) This is Adquired hypercholesterolemia ) This is Adquired through diabetes and kidney disease , poor through diabetes and kidney disease , poor diet , obesity ,and lack of physical activity. diet , obesity ,and lack of physical activity.

• Smoking: this raises blood pressure and Smoking: this raises blood pressure and increases the tendency for blood to clot.increases the tendency for blood to clot.

• High blood pressure . This tickens the walls High blood pressure . This tickens the walls of the arteries and makes them narrower of the arteries and makes them narrower

• Type a personality . This type of personality is Type a personality . This type of personality is charaterized by impatience competitivenness charaterized by impatience competitivenness and aggressiveness.and aggressiveness.

• When someone has a heart attack ,medical When someone has a heart attack ,medical treatments is urgent. They are given oxygen treatments is urgent. They are given oxygen through a face mask, nytroglycerine to improve through a face mask, nytroglycerine to improve blood flow,morphine to kill the pain , and blood flow,morphine to kill the pain , and aspirin to inhibit blood clotting . They may aspirin to inhibit blood clotting . They may then receive an emergency angioplasty then receive an emergency angioplasty which is a long tin tube passedinto the which is a long tin tube passedinto the artery ,allowing the blood to flow more freely. artery ,allowing the blood to flow more freely. A small spring –like device called a stent is A small spring –like device called a stent is then insertedthen inserted which holds the artery open.which holds the artery open.

• For people with severe coronary heart For people with severe coronary heart disease ,there is surgery in the form of disease ,there is surgery in the form of coronary artery bypass graftingcoronary artery bypass grafting , also , also called called revascularizationrevascularization . .

The coronay patientThe coronay patient

VocabularyVocabulary• Angina:Severe pain in the chest caused by alowsupply of Angina:Severe pain in the chest caused by alowsupply of

blood to the heart.blood to the heart.• Atria:the two upper spaces in the heart,used in the first Atria:the two upper spaces in the heart,used in the first

stage of sending the blood around the body.stage of sending the blood around the body.• Beta blockers :drugs used to control heart rhythm and Beta blockers :drugs used to control heart rhythm and

blood pressure.blood pressure.• Bilaterally :on both side.Bilaterally :on both side.• Congestive heart failure :a serious condition in which the Congestive heart failure :a serious condition in which the

heart is unable to pump enough blood to the body. heart is unable to pump enough blood to the body. • Diastole:the stage of the heart beat when the heart Diastole:the stage of the heart beat when the heart

muscle relaxes and the heart fills(llenar) with blood.muscle relaxes and the heart fills(llenar) with blood.• Electrode :one of several electrical device that are Electrode :one of several electrical device that are

placed on a patient’s body to measure electrical activity. placed on a patient’s body to measure electrical activity. For example when examining to heart.For example when examining to heart.

• Embolism :a condition in which a blood clot or an air Embolism :a condition in which a blood clot or an air bubble blocks an artery.bubble blocks an artery.

• Exertion :physical o mental effortExertion :physical o mental effort..

VocabularyVocabulary• Heart murmurs: sounds made by the heart that are not Heart murmurs: sounds made by the heart that are not

normal.normal.

• Myocardial infarction: the death of an area of heart Myocardial infarction: the death of an area of heart muscle caused by a block in its block supply.muscle caused by a block in its block supply.

• Oedema:a condition in which liquid collects in the Oedema:a condition in which liquid collects in the spaces inside the body an makes it swell(hinchar)spaces inside the body an makes it swell(hinchar)

• Pacemaker: an electronic device that is put inside a Pacemaker: an electronic device that is put inside a person’s body to help their heart beat regulary.person’s body to help their heart beat regulary.

• Pulmonary veins:veins that carry blood containing Pulmonary veins:veins that carry blood containing oxygenfrom the lungs to the heart.oxygenfrom the lungs to the heart.

• Ventricles:the two lower spaces in the heart that pump Ventricles:the two lower spaces in the heart that pump blood to the lungs or around the bodyblood to the lungs or around the body..

ECG : ELECTROCARDIOGRAMECG : ELECTROCARDIOGRAM

• A MEDICAL TEST USED TO MEASURE A MEDICAL TEST USED TO MEASURE ELECTRICAL ACTIVITY IN THE HEART ELECTRICAL ACTIVITY IN THE HEART TO DIAGNOSE HEART DISORDERS OR TO DIAGNOSE HEART DISORDERS OR BLOCKAGES IN THE ARTERIESBLOCKAGES IN THE ARTERIES

Monitoring patientMonitoring patient

THE VITAL SIGNSTHE VITAL SIGNS

• A patien’s pulse A patien’s pulse rate,temperature ,respiratory(=breathing) rate,temperature ,respiratory(=breathing) rate, and blood pressure .rate, and blood pressure .

THANKS

FOR YOU

ATTENTION