1. Medical and Nursing Care of Patients with Renal and Urinary Diversion
Medical Surgical Nursing
Mary A. Roche, MSN, RN, CS

2. Why is this Important? Late diagnosis Maintenance
Often occurs because 2/3 of functions are lost before symptoms appear
Maintenance
Patients can be maintained at the level of renal insufficiency
2/22/2019
Mary A. Roche, MSN, RN, CS

3. Renal Functions Excretory Function – Urine Formation
Regulatory Functions – Acid Base Balance
Renal Related Endocrine Functions
2/22/2019
Mary A. Roche, MSN, RN, CS

4. Renal System Diagram Renal System Kidneys Bladder Ureters 2/22/2019
Mary A. Roche, MSN, RN, CS

5. Regulatory Functions Partial Control of Acid-Base Balance
Renal Regulation of Water
Renal Regulation of Electrolytes
Sodium And Potassium
2/22/2019
Mary A. Roche, MSN, RN, CS

6. Renal Endocrine Functions
Renin – Controls Blood Pressure, Sodium and Water
Erythropoietin – Bone Marrow Stimulator
Prostaglandins
Vitamin D/Calcium
Insulin – the Biodegradation of Insulin
Regulation of pH is Controlled by Kidney
2/22/2019
Mary A. Roche, MSN, RN, CS

7. Renin-Angiotensin-Aldosterone System
Reduced
Blood Pressure
Distal tubular
sodium
Renin
Converting
Enzyme
Angiotensin I
Angiotensin II
Angiotensin III
Angiotensin
substrate
Figure Role of renin-angiotnsin-aldosterone system in regulation of blood pressure.
Solid lines represent positive interactions; Broken lines show negative interactions or feedback inhibition.
[From Kumar, V., Cotran, R.S., & Robbins, S.L. [1992] Basic Pathology [5th Ed.]. Philadelphia; W.B. Saunders]
Vasoconstriction
Increased
peripheral resistance
Aldosterone
Secretion
Sodium and fluid
retention
Increased
cardiac output
Elevation of Blood Pressure
2/22/2019
Mary A. Roche, MSN, RN, CS

8. Assessment Of Renal Problems
Medical History
Physical Signs and Symptoms
Renal System Lab Tests
2/22/2019
Mary A. Roche, MSN, RN, CS

9. Conditions Related To Renal Impairment
Hypertension
Diabetes Mellitus
Systemic Lupus Erythematosus
Infectious Diseases
Streptococcal
UTI
Congenital Abnormalities
ex., Polycystic Kidney Disease
SLE - Systemic Lupus
UTI - Urinary Tract Infection
2/22/2019
Mary A. Roche, MSN, RN, CS

10. Symptoms of Renal Disease
Fatigue
Change in Mentation
Headache
Hypertension
Change in Body Weight
Pain
2/22/2019
Mary A. Roche, MSN, RN, CS

11. Blood Chemistries Renal Insufficiency Creatinine Clearance
BUN - Greater Than 20 Mg Per 100 cc
BUN - Normal 5-20 Mg Per 100 cc
Slightly Higher In Elderly
Serum Creatinine – 0.1 Mg Per Dl
Creatinine Clearance
Average Ml Per Minute
Best Indicator Of Overall Renal Function.
Bun/Creatinine Ratio – 12: 1 To 20:1
BUN - Bili-urea-nitrogen
2/22/2019
Mary A. Roche, MSN, RN, CS

12. Acute Renal Failure Causes Phases Prevention Medical Management
Prerenal
Renal
Post Renal
Phases
Onset
Acute
Recovery
Prevention
Medications
Diet
Medical Management
Drug therapy
Dialysis
Nursing Management
Monitoring
Comfort Measures
2/22/2019
Mary A. Roche, MSN, RN, CS

13. Causes of Renal Failure
Prerenal
Systemic Conditions
Hepatitis
Renal
Internal
Nephridities
Nephrotic syndrome
Postrenal
Obstructions
2/22/2019
Mary A. Roche, MSN, RN, CS

14. Prerenal Causes Perfusion Problems Septic Shock
Circulatory Volume Depletion
Volume Shifts
Decreased Cardiac Output
Decreased Peripheral Resistance
Vascular Obstruction
Septic Shock
2/22/2019
Mary A. Roche, MSN, RN, CS

15. Renal Causes Signs and Symptoms of Failure Diabetic Retention of Waste
Retention of Fluid
Inability of Kidneys to Regulate Electrolytes
Diabetic
2/22/2019
Mary A. Roche, MSN, RN, CS

16. Postrenal Causes Obstruction in Urinary Tract Prostatic Hypertrophy
Calculi
Tumors
Urethral Strictures or Stenosis
2/22/2019
Mary A. Roche, MSN, RN, CS

17. Phases of Acute Renal Failure
Onset
Oliguric-Anuric
Oliguric – less than 400 ml in 24 hours
Anuric – less than 100 ml in 24 hours
Diuretic
Recovery/Convalescent
2/22/2019
Mary A. Roche, MSN, RN, CS

18. Prevention of Acute Renal Failure
Monitor for:
Signs of Shock
Fluid Balance
Adequate Vascular Perfusion
Potentially Nephrotoxic Drugs
2/22/2019
Mary A. Roche, MSN, RN, CS

19. Medical Management Oliguric/Anuric Phase Diuretic Phase Recovery Phase
Convalescent Phase
See Page 277 Of Handout
2/22/2019
Mary A. Roche, MSN, RN, CS

20. Key Features of Chronic Renal Failure

21. Key Features of Chronic Renal Failure
Neurological
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Musculoskeletal
Integumentary
Reproductive
Metabolic
See Pages 279 To 283 In Handout
Refer To Iggy Page 1886, Chart 75-3
2/22/2019
Mary A. Roche, MSN, RN, CS

22. Neurological Decreased attention Slurred Speech Lethargy Tremors
Seizures
Ataxia
Paresthesia
Asterixis
Coma
2/22/2019
Mary A. Roche, MSN, RN, CS

23. Cardiovascular Cardiomyopathy Hypertension Peripheral edema
Congestive Heart Failure
Uremic pericarditis
Pericardial effusion
Pericardial friction rub
Cardiac tamponade
2/22/2019
Mary A. Roche, MSN, RN, CS

24. Respiratory Uremic halitosis Tachypnea Kussmaul’s respirations
Sugar breath
Uremic pneumonitis
Pulmonary edema
Pleural Effusion
Depressed cough reflex
Crackles
2/22/2019
Mary A. Roche, MSN, RN, CS

25. Hematologic Severe anemias Abnormal bleeding and bruising 2/22/2019
Mary A. Roche, MSN, RN, CS

26. Gastrointestinal Anorexia Nausea, Vomiting, Diarrhea Uremic colitis
Uremic gastritis
Metallic taste in mouth
Ferritin in stools
Stomatitis
2/22/2019
Mary A. Roche, MSN, RN, CS

27. Urinary Early Late Proteinuria Hematuria Dilute Nocturia Polyuria
Oliguria
Anuria
Proteinuria
Hematuria
Dilute
straw-like appearance
2/22/2019
Mary A. Roche, MSN, RN, CS

28. Integumentary Decreased skin turgor Yellow-gray pallor Pruritis
Severe itching
Ecchymosis
Hemorrhagic purpura
Soft tissue calcifications
Uremic frost
Very late and premorbid
2/22/2019
Mary A. Roche, MSN, RN, CS

29. Musculoskeletal Muscle weakness and cramping Pathological fractures
Bone pain
Renal osteodystrophy
2/22/2019
Mary A. Roche, MSN, RN, CS

30. Reproductive Decreased fertility Infrequent or absent menses
Decreased libido
Impotence
2/22/2019
Mary A. Roche, MSN, RN, CS

31. Renal Lecture
End of Section One