Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Gordons Functional Health Pattern Elimination Pattern Do Case Studies from Critical Thinking Book Before Class! 1st CS on pg:327 Acute Renal Failure 2nd CS on pg:307 ESRD 3rd CS on pg:331 UTI Renal Conditions Unit 8 Part 2

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives 1. Discuss the anatomy and physiology of the renal system 2. Describe the effects of the aging on the G. U. system 3. Discuss the purpose, client preparation and nursing responsibilities of diagnostic procedures related to the renal system 4. Compare and contrast pyelonephritis, acute and chronic renal failure, their pathophysiology, clinical manifestations and management 5. Compare and contrast the clinical course of renal failure including pre-renal, inter-renal and post-renal 6. Describe the pathophysiological process of acute renal failure 7. Define acute tubular necrosis 8. Discuss the medical and nursing management of acute renal failure 9. Describe the effects of renal failure on other body systems 10.Compare and contrast chronic renal failure with acute renal failure 11. Describe the management chronic renal failure and how it affects the various body systems due to alteration of tissue perfusion 12. Define dialysis, describe the rational for dialysis and the methods of dialysis 13. Discuss the management of access ports used in dialysis 14. Describe expected outcomes of renal failure clients 15. Discuss medical and nursing management of the pre and post transplant client

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Required Reading Smeltzer & Bare: Chap 43, 44, 45 Preusser: Case Studies indicated above

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urinary Tract Infections (UTIs) The second most common reason for seeking health care A common site of nosocomial infection Lower UTIs –Cystitis –Prostatitis –Urethritis Upper UTIs –Pyelonephritis: acute and chronic –Interstitial nephritis –Renal abscess and perirenal abscess

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Contributing to UTI Function of glycosaminoglycan (GAG) Urethrovesical reflux Ureterovesical reflux Uropathogenic bacteria Shorter urethra in women Risk factors: see Charts 45-2 and 45-3

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urethrovesical Reflux and Ureterovesical Reflux

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. The most common way in which bacteria enter the urethra is through the bloodstream.

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Bladder Infection With Long-Term Catherization

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process—Assessment of the Patient With a UTI Symptoms include pain and burning upon urination; frequency; nocturia; incontinence; suprapubic, pelvic, or back pain; hematuria; or change in urine or urinary pattern About half of patients are asymptomatic Assess voiding patterns, association of symptoms with sexual intercourse, contraceptive practices, and personal hygiene Gerontologic considerations Assess urine, urinalysis, and urine cultures Other diagnostic tests

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process—Diagnosis of the Patient With a UTI Acute pain Deficient knowledge

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Collaborative Problems/Potential Complications Sepsis Renal failure

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process—Planning the Care of the Patient With a UTI Major goals include relief of pain and discomfort, increased knowledge of preventive measures and treatment modalities, and absence of complications

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions Prevention: avoid indwelling catheters; exercise proper care of catheters Exercise correct personal hygiene Take medications as prescribed: antibiotics, analgesics, and antispasmodics Apply heat to the perineum to relieve pan and spasm Increase fluid intake Avoid urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol Frequent voiding Patient education: see Chart 45-4

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which medication classification is the ideal treatment for urinary tract infection? a.Antifungal b.Antibacterial c.Antihistamine d.Antiviral

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urinary Incontinence An underdiagnosed and underreported problem that can significantly impact the quality of life and decrease independence and may lead to compromise of the upper urinary system Urinary incontinence is not a normal consequence of aging Risk factors: see Chart 45-5

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Urinary Incontinence Stress Urge Reflex Overflow Functional Iatrogenic Mixed incontinence

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which type of incontinence includes the involuntary loss of urine associated with overdistention of the bladder? a.Urge b.Overflow c.Stress d.Functional

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Teaching Urinary incontinence is not inevitable and is treatable Management takes time (provide encouragement and support) Develop and use a voiding log or diary Behavioral interventions: see Chart 45-7 Medication teaching related to pharmacologic therapy Strategies for promoting continence: see Chart 45-8

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urinary Retention Inability of the bladder to empty completely Residual urine: amount of urine left in the bladder after voiding Causes include age (50 to 100 mL in adults older than age 60 due to decreased detrusor muscle activity), diabetes, prostate enlargement, pregnancy, neurologic disorders, and medications Assessment Nursing measures to promote voiding

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urolithiasis and Nephrolithiasis Calculi (stones) in the urinary tract or kidney Pathophysiology Causes: may be unknown Manifestations –Depend upon location and presence of obstruction or infection –Pain and hematuria Diagnosis: x-ray, blood chemistries, and stone analysis; strain all urine and save stones

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Sites of Urinary Calculi

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Methods of Treating Renal Stones

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Methods of Treating Renal Stones (cont.)

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Methods of Treating Renal Stones (cont.)

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Teaching Signs and symptoms to report Follow-up care Urine pH monitoring Measures to prevent recurrent stones Importance of fluid intake Dietary teaching Medication teaching as needed See Chart 45-11

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Urinary Diversion Reasons: bladder cancer or other pelvic malignancies, birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis; used as a last resort for incontinence Types: –Cutaneous urinary diversion: ileal conduit, cutaneous ureterostomy, vesicostomy, and nephrostomy –Continent urinary diversion: Indiana pouch, Kock pouch, and ureterosigmoidostomy

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Cutaneous Urinary Diversions

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Continent Urinary Diversions

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses—Preoperative Anxiety Imbalanced nutrition Deficient knowledge

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses—Postoperative Risk for impaired skin integrity Acute pain Disturbed body image Potential for sexual dysfunction Deficient knowledge