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1
Q

Nursing Implementation

A 
Voiding diary
Kegels
Medications
Surgery
Teaching
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2
Q

UTI: Nursing Assessment

A

Health history
Assessment
Diagnostics
Recognize those at risk

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3
Q

UTI: Drug Therapy

A

Antibiotic selected on empiric therapy or results of sensitivity testing
Uncomplicated cystitis treated by short-term course of antibiotics
Complicated UTIs require long-term treatment

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4
Q

UTI: Drug Therapy

A

Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric uncomplicated or initial

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5
Q

UTI: Drug Therapy

A 
Pyridium is OTC that provides soothing effect on urinary tract mucosa
Combination agents (e.g., Urised) used to relieve pain
- Preparations with methylene blue tint urine blue or green
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6
Q

Nursing Planning

A

Client will have:

  • Relief of pain
  • Normal body temperature
  • No complications
  • Normal renal function
  • No recurrence of symptoms
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7
Q

UTI: Nursing Implementation

A

Acute Interventions

  • Adequate fluid intake
  • Avoid caffeine, alcohol, citrus juices, chocolate, and highly- spiced foods (potential bladder irritants)
  • Application of local heat to suprapubic or lower back may relieve discomfort
  • Instruct client about drug therapy and side effects
  • What to watch for and report
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8
Q

Acute Pyelonephritis: Collaborative Care

A

Hospitalization for clients with severe infections and complications such as N&V with dehydration
Given parenteral antibiotics to establish high serum levels
Relapses treated with 6-week course of antibiotics
Reinfections treated as individual episodes or managed with long-term therapy
- Prophylaxis may be used for recurrent

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9
Q

UTI: Nursing Implementation

A

Health Teaching

  • Emptying bladder regularly and completely
  • Evacuating bowel regularity
  • Wiping perineal area from front to back
  • Drinking adequate fluids (35 ml/kg)
  • Daily intake of cranberry juice or cranberry essence may help reduce risk
  • Avoid unnecessary catheterization and early removal or in-dwelling catheters (Prevents nosocomial infections)
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10
Q

UTI: Nursing Implementation

A

Health Promotion
- Early treatment for cystitis to prevent ascending infections (Client with structural abnormalities at high risk; stress for regular medical care)

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11
Q

UTI: Nursing Implementation

A

Ambulatory and Home Care

  • Encourage adequate fluids even after infection
  • Rest to increase comfort
  • Low-dose, long-term antibiotics to prevent relapses or reinfections
  • Explain rational to enhance compliance
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12
Q

Urinary Calculi

A 
Assess risk factors:
Family Hx
Dehydration
Excess calcium, oxalate, protein intake
Gout
Hyperparathyroidism
Urinary stasis
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13
Q

Urinary Calculi

A 
Medications
Dietary management
Surgery
- Lithotripsy
- ESWL
- Cystoscopy
- Nephrolithotomy
- Nephrectomy
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14
Q

Urinary Calculi: Nursing Diagnoses

A

Pain

Impaired Urinary Elimination

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15
Q

Renal Failure

A

Goals:

  • Preserve existing renal function
  • Treat clinical manifestations
  • Prevent complications
  • Provide for the client’s comfort
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16
Q

Renal Failure: Treatments

A

Correction of extracellular fluid volume overload or deficit
Nutritional therapy
Erythropoietin therapy
Calcium supplementation, phosphate binders, or both
Measures to lower potassium
Antihypertensive therapy
Adjustment of drug dosages according to degree of renal function
Renal replacement therapy (dialysis, kidney transplant)

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17
Q

Drug Therapy: Hyperkalemia

A

IV glucose and insulin
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate)

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18
Q

Drug Therapy: Hypertension

A

Sodium and fluid restriction

Antihypertensive drugs

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19
Q

Drug Therapy: Renal osteodystrophy

A

Phosphate intake restricted to

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20
Q

Drug Therapy: Anemia

A

Erythropoietin

  • Epogen
  • Procrit
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21
Q

Complications of Drug Therapy

A

Drug Toxicity

  • Digitalis
  • Antibiotics
  • Pain Medication
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22
Q

Nutritional Therapy

A 
Protein restriction
- 0.6-0.8 g/kg body weight/ day
Water restriction
- Intake depends on daily output
Sodium and potassium restriction
- Diets vary from 2-4 g depending on degree of edema and HTN
- Sodium and salt should not be equated
Phosphate restriction
- 1000 mg/day
- Foods high in phosphate (dairy products)
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23
Q

Nursing Assessment

A

Complete history of any existing renal disease
Long-term health problems
Dietary habits

24
Q

Nursing Diagnoses

A 
Excess fluid volume
Impaired skin integrity
Risk for injury
Activity intolerance
Imbalanced nutrition: less than body requirements
Anticipatory grieving
Risk for infection
25
Q

Planning

A

Overall goals:
- Demonstrate knowledge and ability to comply with therapeutic regimen
Participate in decision making
Demonstrate effective coping strategies
Continue with activities of daily living within psychological limitations

26
Q

Nursing Implementations

A 
Health Promotion
Identify individuals at risk for CKD
- History of renal disease
- Hypertension
- DM
- Repeated urinary tract infection
27
Q

Nursing Implementations

A

Acute Intervention

  • Daily weight
  • Daily Bps
  • Identify S&S of fluid overload
  • Strict dietary adherence
28
Q

Nursing Implementation

A

Ambulatory and Home Care

- When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options

29
Q

Evaluation

A 
Maintenance of ideal body weight
Acceptance of chronic disease
No infections
No edema
No itching or skin dryness
Slowing of bone disease
Hematocrit and hemoglobin levels in acceptable range
30
Q

Dialysis

A

The movement of fluid and molecules across a semipermeable membrane from one compartment to another
Dialysis is a way to clean blood of wastes, fluids and salts that build up in the body when the kidneys fail
Two methods of dialysis available:
- Peritoneal dialysis (PD)
- Hemodialysis (HD)

31
Q

Peritoneal Dialysis

A

Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. This takes place inside the body and requires placement of a catheter in the peritoneal cavity to allow fluid to be instilled and drained out

32
Q

Hemodialysis

A

Uses a dialyzer or artificial kidney to filter the blood. This takes place outside the body and requires some form of access to the circulatory system. Accomplished with the use of a dialysis machine

33
Q

Dialysis

A

Begun when the client’s uraemia can no longer be adequately managed conservatively
Initiated when the GFR

34
Q

General Principles of Dialysis

A

Diffusion: movement of solutes across the peritoneal membrane from an area of higher concentration to an area of lower concentration
Osmosis: movement of water across the peritoneal membrane from an area of lower solute concentration to an area of higher solute concentration
Ultrafiltration: water removal related to an osmotic pressure gradient with the use of various concentrations of dialysate fluid

35
Q

Peritoneal Dialysis: Catheter placement

A

Peritoneal access is obtained by inserting a catheter through the anterior wall
Technique for catheter placement varies
Usually done via surgery

36
Q

Peritoneal Dialysis: Dialysis Solutions and Cycles

A

Available commercially in 1-or-2L plastic bags with glucose concentrations of 1.5%, 2.5% and 4.25%
Electrolyte composition similar to plasma
Three phases of the PD cycle
- Inflow (fill)
- Dwell (equilibration)
- Drain

37
Q

Peritoneal Dialysis Systems

A

Automated peritoneal dialysis (APD)

Continuous ambulatory peritoneal dialysis (CAPD)

38
Q

Peritoneal Dialysis Complications

A 
Exit site infection
Peritonitis
Abdominal pain
Outflow problems
Hernias
Lower back problems
Bleeding
Pulmonary complications
Protein loss
Carb and liquid abnormalities
Encapsulating sclerosing peritonitis
Loss of ultrafiltration
39
Q

Peritoneal Dialysis: Effectiveness and Adaptions

A 
Short training program
Independence
Ease of traveling
Fewer dietary restrictions
Greater mobility than with HD
40
Q

Hemodialysis: Vascular Access Sites

A

Shunts
Internal arteriovenous fistulas and grafts
Temporary vascular access

41
Q

Hemodialysis: Dialyzers

A

Long plastic cartridge that contains thousands of parallel hollow tubes or fibres

42
Q

Hemodialysis: Complications

A 
Hypotension
Muscle cramps
Loss of blood
Hepatitis
Sepsis
Disequilibrium syndrome
43
Q

Continual Renal Replacement Therapy (CRRT)

A

Alternative or adjunctive method for treating ARF
Solutes and a large volume of fluid can be removed slowly and continuously
Can be used in conjunction with HD for continuous fluid removal
Contraindications
- Presence of life-threatening manifestations of uremia

44
Q

Kidney Transplantation

A

Extremely successful
1-year graft survival rate
- 90% for cadaver transplants
- 95% for liver donor transplants

45
Q

Kidney Transplantation: Recipient Selection

A 
Candidacy determined by a variety of medical and psychosocial factors that vary among transplant centres
Contraindications to transplantation:
- Disseminated malignancies
- Cardiac disease
- Chronic respiratory failure
- Extensive vascular disease
- Chronic infection
- Unresolved psychological disorders
46
Q

Kidney Transplantation: Donor Sources

A

Compatible blood type cadaver donors
Blood relatives
Emotionally related living donors
Altruistic living donors

47
Q

Kidney Transplantation: Surgical Procedure

A

Donor nephrectomy performed by a urologist or transplant surgeon
Begins an hour or two before the recipients surgery is started
Laproscopic donor nephrectomy:
- Alternative to conventional nephrectomy

48
Q

Kidney Transplantation: Kidney Transplant Recipient

A

Transplanted kidney:
- Usually placed extraperitoneally in the iliac fossa
- Right ilias fossa is preferred
Before Incision:
- Urinary catheter placed into bladder
- Antibiotic solution instilled (Distends the bladder; decreases risk of infection)

49
Q

Kidney Transplantation: Preoperative Care

A 
Emotional and physical preparation
Immunosuppressive drugs
ECG
Chest x-ray
Laboratory studies
50
Q

Kidney Transplantation: Post-operative care

A

Liver donor
- Care is similar to laparoscopic nephrectomy
- Close monitoring of renal function
Recipient
- Maintenance of fluid and electrolyte balance is first priority

51
Q

Kidney Transplantation: Immunosuppressive Therapy

A

Goals:
Adequately suppress the immune response
- Maintain sufficient immunity to prevent overwhelming infection

52
Q

Kidney Transplantation: Complications

A

Rejection

  • Hyperacute (antibody-mediated, humoral) rejection (Occurs minutes to hours after transplantation)
  • Acute rejection (Occurs days to months after transplantation)
  • Chronic rejection (Process that occurs over months or years and is irreversible)
53
Q

Kidney Transplantation: Complications

A

Infection

- most common infections observed in the first month (Pneumonia, wound infections, IV line and drain infections)

54
Q

Kidney Transplantation: Complications

A

Cardiovascular disease
- Transplant recipients have ^ incidence of atherosclerotic vascular disease
Malignancies
- Primary cause is immunosuppressive therapy

55
Q

Kidney Transplantation: Complications

A

Recurrence of original renal disease

  • Glomerulonephritis
  • IgA nephtropathy
  • DM
  • Focal segmental sclerosis
56
Q

Kidney Transplantation: Complications

A

Corticosteroid-related complications

  • Aseptic necrosis of the hips, knees, and other joints
  • Peptic ulcer disease
  • Glucose intolerance and DM
  • Hyperlipidemia
  • Cataracts
  • Increased incidence of infections and malignancies

Nursing Theory IV (12 decks)

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