GU Flashcards
Nursing Implementation
Voiding diary Kegels Medications Surgery Teaching
UTI: Nursing Assessment
Health history
Assessment
Diagnostics
Recognize those at risk
UTI: Drug Therapy
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
UTI: Drug Therapy
Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric uncomplicated or initial
UTI: Drug Therapy
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
Nursing Planning
Client will have:
- Relief of pain
- Normal body temperature
- No complications
- Normal renal function
- No recurrence of symptoms
UTI: Nursing Implementation
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
Acute Pyelonephritis: Collaborative Care
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
UTI: Nursing Implementation
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)
UTI: Nursing Implementation
Health Promotion
- Early treatment for cystitis to prevent ascending infections (Client with structural abnormalities at high risk; stress for regular medical care)
UTI: Nursing Implementation
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
Urinary Calculi
Assess risk factors: Family Hx Dehydration Excess calcium, oxalate, protein intake Gout Hyperparathyroidism Urinary stasis
Urinary Calculi
Medications Dietary management Surgery - Lithotripsy - ESWL - Cystoscopy - Nephrolithotomy - Nephrectomy
Urinary Calculi: Nursing Diagnoses
Pain
Impaired Urinary Elimination
Renal Failure
Goals:
- Preserve existing renal function
- Treat clinical manifestations
- Prevent complications
- Provide for the client’s comfort
Renal Failure: Treatments
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)
Drug Therapy: Hyperkalemia
IV glucose and insulin
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate)
Drug Therapy: Hypertension
Sodium and fluid restriction
Antihypertensive drugs
Drug Therapy: Renal osteodystrophy
Phosphate intake restricted to
Drug Therapy: Anemia
Erythropoietin
- Epogen
- Procrit
Complications of Drug Therapy
Drug Toxicity
- Digitalis
- Antibiotics
- Pain Medication
Nutritional Therapy
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)
Nursing Assessment
Complete history of any existing renal disease
Long-term health problems
Dietary habits
Nursing Diagnoses
Excess fluid volume Impaired skin integrity Risk for injury Activity intolerance Imbalanced nutrition: less than body requirements Anticipatory grieving Risk for infection
Planning
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
Nursing Implementations
Health Promotion Identify individuals at risk for CKD - History of renal disease - Hypertension - DM - Repeated urinary tract infection
Nursing Implementations
Acute Intervention
- Daily weight
- Daily Bps
- Identify S&S of fluid overload
- Strict dietary adherence
Nursing Implementation
Ambulatory and Home Care
- When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options
Evaluation
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
Dialysis
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)
Peritoneal Dialysis
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
Hemodialysis
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
Dialysis
Begun when the client’s uraemia can no longer be adequately managed conservatively
Initiated when the GFR
General Principles of Dialysis
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
Peritoneal Dialysis: Catheter placement
Peritoneal access is obtained by inserting a catheter through the anterior wall
Technique for catheter placement varies
Usually done via surgery
Peritoneal Dialysis: Dialysis Solutions and Cycles
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
Peritoneal Dialysis Systems
Automated peritoneal dialysis (APD)
Continuous ambulatory peritoneal dialysis (CAPD)
Peritoneal Dialysis Complications
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
Peritoneal Dialysis: Effectiveness and Adaptions
Short training program Independence Ease of traveling Fewer dietary restrictions Greater mobility than with HD
Hemodialysis: Vascular Access Sites
Shunts
Internal arteriovenous fistulas and grafts
Temporary vascular access
Hemodialysis: Dialyzers
Long plastic cartridge that contains thousands of parallel hollow tubes or fibres
Hemodialysis: Complications
Hypotension Muscle cramps Loss of blood Hepatitis Sepsis Disequilibrium syndrome
Continual Renal Replacement Therapy (CRRT)
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
Kidney Transplantation
Extremely successful
1-year graft survival rate
- 90% for cadaver transplants
- 95% for liver donor transplants
Kidney Transplantation: Recipient Selection
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
Kidney Transplantation: Donor Sources
Compatible blood type cadaver donors
Blood relatives
Emotionally related living donors
Altruistic living donors
Kidney Transplantation: Surgical Procedure
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
Kidney Transplantation: Kidney Transplant Recipient
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)
Kidney Transplantation: Preoperative Care
Emotional and physical preparation Immunosuppressive drugs ECG Chest x-ray Laboratory studies
Kidney Transplantation: Post-operative care
Liver donor
- Care is similar to laparoscopic nephrectomy
- Close monitoring of renal function
Recipient
- Maintenance of fluid and electrolyte balance is first priority
Kidney Transplantation: Immunosuppressive Therapy
Goals:
Adequately suppress the immune response
- Maintain sufficient immunity to prevent overwhelming infection
Kidney Transplantation: Complications
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)
Kidney Transplantation: Complications
Infection
- most common infections observed in the first month (Pneumonia, wound infections, IV line and drain infections)
Kidney Transplantation: Complications
Cardiovascular disease
- Transplant recipients have ^ incidence of atherosclerotic vascular disease
Malignancies
- Primary cause is immunosuppressive therapy
Kidney Transplantation: Complications
Recurrence of original renal disease
- Glomerulonephritis
- IgA nephtropathy
- DM
- Focal segmental sclerosis
Kidney Transplantation: Complications
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
