Download - MANAGEMENT OF PATIENT WITH RENAL DISORDER
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Chapter 44
Management of Patients With Renal Disorders
Chapter 44
Management of Patients With Renal Disorders
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Renal DisordersRenal Disorders
• Fluid and electrolyte imbalances
• Most accurate indicator of fluid loss or gain in an acutely ill patient is weight
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QuestionQuestion
Is the following statement True or False?
The most accurate indicator of fluid loss or gain in an acutely ill patient is weight.
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AnswerAnswer
True
The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1 kg weight gain is equal to 1000 mL of retained fluid.
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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
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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
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Glomerular DiseasesGlomerular Diseases
• An inflammation of the glomerular capillaries
• Acute nephritic syndrome
• Chronic glomerulonephritis
• Nephrotic syndrome
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Acute Nephritic Syndrome Acute Nephritic Syndrome
• 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—antibiotics, corticosteroids, and immunosuppressants
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Nursing Management: Acute Nephritic Syndrome Nursing Management: Acute Nephritic Syndrome
• Patient assessment
• Maintain fluid balance
• Fluid and dietary restrictions
• Patient education
• Follow-up care
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Chronic GlomerulonephritisChronic Glomerulonephritis
• Causes include repeated episodes of acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage.
• Symptoms vary; may be asymptomatic for years, as glomerular damage increases, before signs and symptoms develop of renal insufficiency/failure.
• Abnormal laboratory tests include urine with fixed specific gravity, casts, and proteinuria; and electrolyte imbalances and hypoalbuminemia.
• Medical management is determined by symptoms.
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Nursing Management Chronic GlomerulonephritisNursing Management Chronic Glomerulonephritis
• Assessment
• Potential fluid and electrolyte imbalances
• Cardiac status
• Neurologic status
• Emotional support
• Teaching self-care
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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 erythmatosus, multiple myeloma, and renal vein thrombosis.
• Medical management includes drug and dietary therapy
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Sequence of Events in Nephrotic SyndromeSequence of Events in Nephrotic Syndrome
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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 GFR and oliguria
• Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia
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Nursing Process: The Care of the Patient with Renal Failure—AssessmentNursing Process: The Care of the Patient with Renal Failure—Assessment
• Fluid status
• Nutritional status
• Patient knowledge
• Activity tolerance
• Self-esteem
• Potential complications
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Nursing Process: The Care of the Patient with Renal Failure—DiagnosesNursing Process: The Care of the Patient with Renal Failure—Diagnoses
• Excess fluid volume
• Imbalanced nutrition
• Deficient knowledge
• Risk for situational low self-esteem
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Collaborative Problems/Potential ComplicationsCollaborative Problems/Potential Complications
• Hyperkalemia
• Pericarditis
• Pericardial effusion
• Pericardial tamponade
• Hypertension
• Anemia
• Bone disease and metastatic calcifications
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Nursing Process: The Care of the Patient with Renal Failure—PlanningNursing Process: The Care of the Patient with Renal Failure—Planning
• Goals may include maintaining of IBW without excess fluid, maintenance of adequate nutritional intake, increased knowledge, participation of activity within tolerance improved self-esteem, and absence of complications.
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Excess Fluid Volume Excess Fluid Volume
• Assess for signs and symptoms of fluid volume excess, and keep accurate I&O and daily weights
• Limit fluid to prescribe amounts
• Identify sources of fluid
• Explain to patient and family the rationale for the restriction
• Assist patient to cope with the fluid restriction
• Provide or encourage frequent oral hygiene
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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, eg, stomatitis or anorexia
• Adjust medication times related to meals
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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
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Hemodialysis SystemHemodialysis System
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Hemodialysis CatheterHemodialysis Catheter
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Internal Arteriovenous Fistula and Graft Internal Arteriovenous Fistula and Graft
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Peritoneal DialysisPeritoneal Dialysis
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Peritoneal DialysisPeritoneal Dialysis
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QuestionQuestion
Is the following statement True or False?
Failure of the temporary dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis.
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AnswerAnswer
False
Failure of the permanent, not the temporary, dialysis access accounts for most hospital admissions of patients undergoing chronic hemodialysis.
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Nursing Management of the Hospitalized Patient on Dialysis (1 of 2)Nursing Management of the Hospitalized Patient on Dialysis (1 of 2)
• Protection of vascular access; assess site for patency and signs of potential infection, and do not use for blood pressure or blood draws.
• Monitor fluid balance indicators and monitor IV therapy carefully; accurate I&O, IV administration pump.
• Assess for signs and symptoms of uremia and electrolyte imbalance; regularly check lab data.
• Monitor cardiac and respiratory status carefully.
• Hypertension: monitor blood pressure, antihypertensive agents must be held on dialysis days to avoid hypotension.
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Nursing Management of the Hospitalized Patient on Dialysis (2 of 2)Nursing Management of the Hospitalized Patient on Dialysis (2 of 2)
• Monitor all medications and medication dosages carefully. Avoid medications containing potassium and magnesium.
• Address pain and discomfort.
• Stringent infection control measures.
• Dietary considerations: sodium, potassium, protein, and fluid; address individual nutritional needs.
• Skin care: pruritis is a common problem; keep skin clean and well moisturized, and trim nails and avoid scratching.
• CAPD catheter care.
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Kidney SurgeryKidney Surgery
• Preoperative considerations
• Perioperative concerns
• Postoperative management
– Potential hemorrhage and shock
– Potential abdominal distention and paralytic ileus
– Potential infection
– Potential thromboembolism
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Patient Positioning and Incisional ApproachesPatient Positioning and Incisional Approaches
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Renal TransplantationRenal Transplantation
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Postoperative Nursing ManagementPostoperative Nursing Management
• Assessment: include all body systems, pain, fluid and electrolyte status, and 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
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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 technique in providing all care
• Monitor for signs and symptoms of bleeding
• Encourage leg exercises, early ambulation, and monitor for signs of DVT
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Patient TeachingPatient Teaching
• Instruct both patient and family
• Drainage system care
• Strategies to prevent complications
• Signs and symptoms
• Follow-up care
• Fluid intake
• Health promotion and health screening