Risk factors: Inability or failure to empty bladder completely Obstructed urinary flow Decreased natural host defenses or immunosuppression

Instrumentation of the urinary tract Inflammation or abrasion of the urethral mucosa Contributing conditions such as: DM, Pregnancy,neurologic disorders, gout.

Loss of integrity of the mucosal lining

Decreased resistance to invading organisms

Bacteria enters the urethra

Attachment & Proliferation of bacteria in the urethra

Irritation of the lining of the bladder

Bacteria Travels from urethra to bladder, attach to and colonize the bladder

Urethrovesical reflux

urethritis

Cystitis Urine stagnation

Urine cultures, Test for WBCs, Test for STDs, CT Scan

Pain Swelling, Discharges accumulation of leukocytes

Ureterovesical Reflux

Cystolithiasis, Pregnancy, Untreated UTI

Acute pain related to infection within the urinary tract Deficient knowledge about factors predisposing the pt. to infection & recurrence, detection, & prevention of recurrence &

Introduction of bacteria to the ureters

oliguria Passing a cloudy or strong smelling urine pressure on lower abdomen low grade fever

Ureteritis Urinalysis, cystoscopy, Imaging test (ultrasound & x-ray) Infection ascends to the kidneys

Risk for hypertermia

Pyelonephritis

Relieving pain >Antispasmodic agents, Application of heat, Inc. fluid intake, Analgesics, frequent voiding Monitoring & managing potential complications >Using strict aseptic technique in any procedures Frequent inspection of urine,Performing a meticulous perineal care, maintaining a closed system. Promoting Home and community-Based care >Good hygiene, increasing fluid intake, urinating regularly & more frequently.

Ultrasound study or ct scan, iv urogram, measurement of creatinine clearance, blood urea nitrogen, creatinine levels.

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Activation of the immune response

General feeling of being well

Flank Pain Back Pain

Decreased erythropoietin

Release of pyrogens from bacteria

Malaise

Acute Pain

Decreased Stimulation of bone marrows

Release of prostaglandin e2

Irritation of the urinary tract lining/

N&V Hematuria

Decreased Erythropoiesis

Elevation of the body thermostat by the hypothalamus

Dysuria

Decreased RBC production

Vasoconstriction

Reduced heat loss through the skin

Anemia

Shivering Chills ineffective tissue perfusion

Fever

Decrease temperature >loosen clothing

Relieving pain >Increase fluid intake to decrease burning sensation

Adequate tissue perfusion >Monitor v/s, capillary refill, color of skin & mucosa, provide oxygen as needed

Microorganisms circulate in the blood stream

Acute glomerulonephritis

Over production of antibodies

Deposition of antigen-antibody complex in glomerulus

Post infections

Acute inflammation & damage within the nephrons including the glomerulus

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Increased production of epithelial cells lining the glomerulus

leukocyte infiltration of the glomerulus

thickening of the glomerular infiltration membrane Marked Proteinuria Pitting edema hypoalbuminemia hyperlipidemia fatty cast in the urine

Scarring and loss of glomerular filtration membrane

Decreased GFR Hematuria

Excess fluid volume related to accumulation of fluids in the body

Chronic glomerulonephritis

Repeated episodes of acute Glomerulonephritis

Elevate edematous extremities, change position frequently Encourage bed rest

Cortex shrinks to a layer 1 to 2 mm thick or less

Bands of scar tissue distort the remaining cortex Electron microscopy and immunoflourescent analysis Surface of the kidney rough and irregular Urinalysis, chest x-ray, ECG, CT scan, MRI Numerous glomeruli and their tubules become scarred

Branches of the renal artery are thickened Hypertension elevated BUN & Serum Creatinine vascular changes severe nosebleed pedal edema loss of weight and strength

Branches of the renal artery are thickened

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Risk for decreased cardiac output

Monitor F&E Give emotional Support Instruction to the patient include explanations and scheduling for follow-up evaluations: BP, and blood studies and creatinine levels

Volume Depletio n:Renal losses

Chronic glomerulonephritis progresses Acute pyelonephritis Acute glomerulonephirtis Renal obstruction

Acute renal Failure Intrarenal Failure

Prerenal failure

Intrarenal Failure

Impaired blood flow

Acute parechymal damage to the glomeruli or kidney tubules

Pressure rises in the kidney

Hypo perfusion

Problem on osmosis

Monitor fluid & Electrolyte balance Reducing metabolic pain: Bed Rest Prevent infection: Asespsis Provide skin care Provide psychosocial support

tubular back leak

Fluid & electrolyte imbalance Impaired skin integrity Formation of cast/ vasoconstriction

Dry skin Drowsiness headache muscle twitching seizure may appear critically ill & lethargic

Decrease GFR

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Chronic renal failure

Urinalysis, Blood test, renal ultrasound, Ct/MRI scan, ECG, Renal endoscopy, Renal Biopsy,

Sodium & water

potassium Balance

Elimination of nitrogenous waste

Erythropoeitin production

Acid-Base balance

Hypertension

Hyperkalemia Uremia Edema

Anemia Acidosis

Increased vascular volume

Skeletal buffering Pericarditis Heart failure Coagulopathies

Skin disorder

G.I. Manifestation

Neurologic Manifestation

Sexual Dysfunction

Risk for decreased cardiac output

Disturbed thought process

Osteodystrophies

Assess degree of hypertension Assess level of activity Investigate report of chest pain Hyperparathyroidism Hypocalcemia

Activation of vit. D

Phosphate elimination

END STAGE RENAL DISEASE

Uremic syndrome develops

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PATHOPHYSIOLOGY OF RENAL DISEASES

SUbmitted by:Billy Gayados, BSN-III, BLOCK-M SUbmitted to: MR. Dennis ramos

LEGEND:
DIAGNOSTICS SIgns & Symptoms Disease Nursing Diagnosis Nursing Responsibilities

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