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Nursing Care of Clients with Kidney Disorders

Pathophysiology of Congenital Disorders : 

Pathophysiology of Congenital Disorders Congenital Kidney Malformation _________—absence of kidney _________—underdevelopment of kidney Alterations in kidney position—affects ureters and urine flow ____________—increased risk for hydronephrosis

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders _____________ Kidney Disease Autosomal __________—common form affecting adults _________________ and massive kidney enlargement ___________ in other areas ___________ disease Congenital _______________________ Heart valve defects

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders Glomerular Disorder ________________ Acute glomerulonephritis Rapidly progressive glomerulonephritis Chronic glomerulonephritis Nephritic syndrome ________________ Diabetic nephropathy Lupus nephritis

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders _________ Kidney Disorder Renal function is dependent upon adequate __________________ _______________can result from or cause kidney disease Renal _______________ occlusion Renal _____________________-

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders Kidney _________ trauma most common _________ injuries Hematuria, flank or abdominal pain, oliguria, anuria

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders Renal ________ ________ are infrequent, malignant can be primary or secondary Often silent with few manifestations Often result in _____________ syndrome Hypercalcemia, hypertension, and hyperglycemia

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders Acute Renal Failure _____renal, intrinsic or _____renal, and _____renal Most common cause: 1. 2.

Prerenal : 

Prerenal Involves with blood flow to the kidneys through the _________________ Decreased blood ______ causes a decrease in the ________ Examples: ?

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Intrarenal : 

Intrarenal Involves the ________changes from disease or ______ substances, usually involving the tubules or glomeruli Kidneys suffer direct damage Examples: ?

Postrenal : 

Postrenal Anything that causes _________ of the outflow of urine from ________ through the __________ to the _______ and beyond. Examples: ????

Stages : 

Stages ______: Initial phase of insult or injury Immediate assessment and intervention may reverse the course at this point ______: Usually present 24-48 hours after onset. Lasts ave. 8-14 days Output: < 400cc/day The longer this stage lasts, the more likely it will develop into chronic renal failure

Stages : 

Stages __________ Symptoms: Increased__________ Symptoms: Decreased ___________ Symptoms: Fluid overload---___________ Dialysis may be necessary

Stages : 

Stages ______________________ Lasts about ___ days Increased _____ Recovery can take up to____ months Nursing: Watch for F & E balance Monitor meds excreted by kidneys Dietary restrictions Survival rate in uncomplicated cases:____

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders ___________Renal Failure or CKD Progressive renal tissue destruction with loss of function Eventually progresses to end stage renal disease (ESRD) CKD stages Stage 1&2: GFR___________ Stage 3 : GFR______________ Stage 4: GFR_______________ Stage 5: GFR______________

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Risk Factors for Kidney Disorders : 

Risk Factors for Kidney Disorders ___________ Disorder Primary ___________ disorders: infection with a group A beta-hemolytic streptococcus, staphylococcus and viruses Need early and effective treatment of these infections Secondary _________- disorders: related to presence of chronic systemic diseases Need measures to reduce the risk of associated nephritis _____________ Kidney Disorder Often a result of vessel damage from hypertension or presence of emboli Need management of such disorders as atrial fibrillation and hypertension

Risk Factors for Kidney Disorders : 

Risk Factors for Kidney Disorders Kidney ____________ Often result of blunt force and penetrating injuries Routine personal safety and good health practices Renal ______________ Major risk factors: smoking and obesity Contributing factor: chronic irritation from renal calculi Need education about smoking cessation and healthy diet Need specific dietary and medication education to reduce risk of calculi

Risk Factors for Kidney Disorders : 

Risk Factors for Kidney Disorders ______________________ Risk factors: prerenal, intrarenal, and post-renal Education include support of hydration, control of systemic diseases, and management of obstructive disorders ______________ Often results from acute renal failure - Co- morbid conditions

Pathophysiology of Common Kidney Disorders : 

Pathophysiology of Common Kidney Disorders

Diagnostic Studies to Identify Kidney Disorders : 

Diagnostic Studies to Identify Kidney Disorders Congenital Kidney Malformation Diagnostic tests: renal ultrasound and IVP Polycystic Kidney Disease Diagnostic tests: renal ultrasound, IVP, CT Glomerular Disease Laboratory: throat or skin cultures, antistreptolysin O (ASO) titers, and erythrocyte sedimentation rate (ESR), BUN, serum creatinine, urine creatinine, creatinine clearance, serum electrolytes, and urinalysis Diagnostic: KUB abdominal x-ray, kidney scans, biopsy

Diagnostic Studies to Identify Kidney Disorders : 

Diagnostic Studies to Identify Kidney Disorders Vascular Kidney Disorder Laboratory: blood chemistry and renal enzyme levels Diagnostic: renal ultrasound and renal angiography Renal artery stenosis diagnosis: captopril test for renin activity Kidney Trauma Laboratory: H&H, urinalysis, AST levels Diagnostic: renal ultrasonography, CT scan, IVP, renal arteriography Renal Tumor Diagnostic: ultrasound, CT, MRI, IVP, angiography, aortography, inferior venacavography, chest x-ray, bone scan, liver function testing

Diagnostic Studies to Identify Kidney Disorders : 

Diagnostic Studies to Identify Kidney Disorders Acute Renal Failure Laboratory: urinalysis, serum creatinine, BUN, serum electrolytes, ABGs, CBC Diagnostic: renal ultrasonography, CT scan, IVP, renal biopsy CKD Laboratory: urinalysis, urine culture, BUN and serum creatinine, creatinine clearance, serum electrolytes, and CBC. Diagnostic: renal ultrasonography and kidney biopsy.

Implications for Kidney Disorder Medications and Treatments : 

Implications for Kidney Disorder Medications and Treatments Congenital Kidney Malformation Nursing care is primarily ______________- Focus on _______________ Clients with __________ kidneys may require surgery Polycystic Kidney Disease ACE inhibitors or other anti-hypertensives Clients will ultimately require __________________ __________- testing important

Implications for Kidney Disorder Medications and Treatments : 

Implications for Kidney Disorder Medications and Treatments Glomerular Disease No medications available for cure Focus on treating underlying disorders, reducing __________, managing symptoms Treatments: bedrest, sodium/protein restriction, plasmapheresis, dialysis Vascular Kidney Disorder Surgery, anticoagulant therapy, hypertension control

Implications for Kidney Disorder Medications and Treatments : 

Implications for Kidney Disorder Medications and Treatments Kidney Trauma Treatment for minor kidney trauma is _________ More major trauma treatment focuses on controlling ___________ and treating or preventing _______ Nursing care focus: assessment and timely intervention to prevent complications Renal Tumor Treatment: radical ____________; chemotherapy generally not effective

Implications for Kidney Disorder Medications and Treatments : 

Implications for Kidney Disorder Medications and Treatments Acute Renal Failure Treatment focus: ___________/maintenance of renal perfusion, elimination of ____________ substances Common treatments: IV fluids, Dopamine infusion, diuretics, aggressive hypertension management, antacids, histamine H2-receptor antagonists or proton-pump inhibitors, and methods to control hyperkalemia and hyperphosphatemia ____________ may be required

Implications for Kidney Disorder Medications and Treatments : 

Implications for Kidney Disorder Medications and Treatments CKD Affects pharmacokinetics and _______________ of drug therapy Medications include drugs to manage 1 2 3 Nutrition and fluid management as renal function declines Dialysis or kidney transplant becomes necessary when medication/dietary treatments are no longer effective

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure Renal Replacement Therapies __________________ __________________ Kidney transplant Hemodialysis Dialysis center Three times/week, 9-12 total hours

Dialysis : 

Dialysis Definition: Process of removing _____from the blood by using semipermeable membrane that allows particles of varying sizes to pass through. Solute particles move toward the solution with lesser concentration. Water moves toward the solution with in which solute concentration is greater.

Peritoneal Dialysis : 

Peritoneal Dialysis ____________ is the semipermeable membrane Process: Dialyzing solution (2L of hypertonic glucose) is instilled into the abd. cavity over 10 minutes. The exchange of fluids and electrolytes takes place over the dwell time(individually determined). Outflow uses gravity to remove fluid from cavity.

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure Peritoneal Dialysis Continuous ___________ peritoneal dialysis Continuous ___________ peritoneal dialysis

Peritoneal Dialysis : 

Peritoneal Dialysis ______________________________________________ 4-5 Exchanges/day Requires 30-90 minute Requires sterile conditions Breaks in the system No machinery Fewer diet restrictions __________________________________ Automated cycler exchanges fluid during sleep—3-5 exchanges Inflows 1-2 L. when wakes up and keeps it in the abd. until bed Break in system 2x/day

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure

Peritoneal Dialysis : 

Peritoneal Dialysis Nursing Implications Weigh patient daily Check dialysis for blood & cloudiness Teach and monitor sterile technique Emotional Support 20% drop after 2 years due to peritonitis, catheter complications, noncompliance, not adequate dialysis

Complications : 

Complications ________: No B/P’s or Venipunctures on arm with graft or shunt Hypovolemia: Monitor V/S especially immediately after dialysis __________: Mental confusion, HA, N/V Infection: Sterile technique Blood loss: Monitor clotting times _______: Leading cause of death due to elevated lipids

Hemodialysis : 

Hemodialysis Uses an artificial semipermeable membrane Machine shunts blood from the body through the dialyzer for diffusion and filtration and back into the patient’s body Can be temporary or permanent

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure

Dialysis Procedures to Manage Renal Failure : 

Dialysis Procedures to Manage Renal Failure

Types of Access : 

Types of Access ____________ External device Can be used immediately Clotting/infection* ____________ Internal Anastomosing artery to vein _____________

Access : 

Access Fistula & Graft

Kidney Transplant : 

Kidney Transplant

Kidney Transplant : 

Kidney Transplant Donor Selection _______________________ (65-75%) ________________ Histocompatability ______—4 inherited human leukocyte antigens ABO Free from _________

Kidney Transplant : 

Kidney Transplant Recipient Selection Free from _________ ___________ health May receive _______-specific blood transfusion preop

Resources : 

Resources End Stage Renal Disease (ESRD)United States Renal Data System website that is a national data base which collects, analyzes, and distributes information about ESRD in the USA. American Society of Nephrology Website with links to professional on-line journal.

Resources : 

Resources American Nephrology Nurses’Association Website including access to abstracts of their professional journal, CEU activities and more. TransplantationNational Kidney Foundation website with information for lay and professional about kidney disease including transplantation. Transplant Recipients International International organization website with information and resources for transplant candidates, recipients, donors and their families.

Resources : 

Resources Organ Donation/Transplantation United Network of Organ Sharing website with up to the minute information regarding transplantion. Extensive links to all forms of transplantation, procurement organizations and transplant centers. Polycystic Kidney Disease Website for PKD foundation focusing on research and a cure for PKD.

Resources : 

Resources Diabetes and ESRDAmerican Diabetes Association website with information of diabetes management and complications such as ESRD. Kidney Disease National Institute of Diabetes and Digestive and Kidney Disease website from the National Institute of Health.

Resources : 

Resources Peritoneal DialysisInternational Association for Peritoneal Dialysis website which has a mission of scientific and educational outreach. International Transplant Nurses’ SocietyInternational Transplant Nurses’ Society website which promotes the education and clinical practice excellence of nurses who are interested in and participate in the care of solid organ transplant patients.