INFLAMMATORY DISORDERS

1. Urinary Tract Infections (UTI)

- bacteria get in the urine from the skin around the genitals or rectum to the bloodstream, they can create infection and inflammation at any point along the ways - common in females 1. short urethra 2. no prostatic fluid Risk factors: - gender - age - instrumentation of the urinary tract (cystoscopy, urinary cathertrization) Causes: - Gram (+) and (-) microorganisms: 1. E. coli 2. Kleibshiella 3. Proteus 4. Pseudomonas Assessment: - Frequency - Urgency - Dysuria (burning) - Foul- smelling urine - Suprapubic pain - Malaise - Fever, chills - Nausea and vomiting - Low back pain - Urine 1. + RBC, WBC, pus, bacteria Management: 1. Increase fluid intake (34 L/ day) 2. Limit or avoid intake of caffeine, alcohol, spicy foods and tomatoes. 3. Culture and sensitivity of urine before antibiotic therapy 4. Acidify the urine 5. Hot Sitz Bath 6. 3 Ws: Wash, Wear, Wipe 7. Empty bladder every 2-3 hours 8. Empty bladder immediately after intercourse 9. Antibiotics: a. Bactrim, Macrodantin (antiseptic), Ciprofloxacin (Fluoroquinolone), Ampicillin, Amoxicillin and Cephalosporins)

UPPER UTI include: - Acute pyelonephritis - Chronic pyelonephritis - Renal abscess - Interstitial nephritis - Perirenal abscess Uncomplicated LOWER/ UPPER UTI often NOSOCOMIAL (acquired in the hospital) and related to catheterization, occurs in the patient with: - Urologic abnormalities - Pregnancy - Immunosuppression - DM Risk factors for secondary UTI: Women: 1. Sexual intercourse 2. Pregnancy 3. DM Men: 1. Lack of circumcision 2. Prostatic hypertrophy 3. Homosexual activity Both: 1. Obstruction of urinary flow 2. Residual urine in the bladder 3. Vesicourethral reflux

LOWER UTI
Several mechanisms maintain the sterility of the bladder- the physical barrier of the urethra, urine flow, ureterovesical function competence, various antibacterial enzymes and antibodies and antiadherent effects mediated by the mucosal cells of the bladder.

BACTERIURIA
Defined as more than 100, 000 colonies of bacteria/milliliter of urine Routes of infection: 1. Transurethral Diagnostic findings: - Urine culture Management: Goal: eliminate the

- Cellular studies infection to prevent future occurrences and potential - CT scan - Ultrasonograph complications y 1. Acute Pharmacologic Therapy - Urinalysis - Antibacterial - UTZ studies (kidneys and Single dose pelvis) administration short Prevention: course (3-4 days)/ (7-10 - Practice safer days regimen) sex Clinical - Wipe female - Antibiotic Manifestation: genitals from therapy - Dysuria front to back 1. Meds: - Burning on - Wash daily, ampicilin/ urination especially amoxicillin - Frequency in before and after , voiding sex phenazopy (voiding - Dont use too ridine, more than q much feminine fluoroquin 5 hrs) wash olones, - Urgency - Handwashing cephalospo - Nocturia - Avoid rins - Incontinence prolonged - Suprapubic periods of full 2.Long term and pelvic bladder pharmacologic therapy: pain Complications: - Hematuria 2.1 Full-dose 1. Sepsis and back antimicrobial 2. Renal failure pain therapy - Septic shock 2.2 Low-dose - Urosepsis preventive (sepsis therapy resulting (trimethoprin w/ from infected or w/o urine) sulfamethoxazol e bactrim (cotrimoxazole)

route (ascending infection) 2. Bloodstream (hematogenous spread) 3. By means of fistula flow of the intestine (direct extension)

Nursing Interventions: 1. Relieving pain 2. Monitoring and managing potential complications 3. Teaching patient self-care: - Prevent/ mange recurrent UTI - Practicing careful personal hygiene - Increase fluid intake (34L/day) - Urinating regularly (every 2-3 hrs during the day; completely empty the bladder) - Avoid coffee, tea, colas, alcohol and other drinks that may irritate urinary tract - Vitamin C (1,000 mg/day) - Cranberry juice and blueberries - Zinc (30-50 mg/dl) - Garlic, celery seed, parsley, asparagus - Test urine for presence of

bacteria

URETHRITIS
Inflammation of the urethra that causes symptoms similar to UTI Clinical Manifestations: Diagnostic test: Interventions: MEN - Antibiotic - Urinalysis - Burning in therapy (pyuria) urination - Estrogen - Urethral culture - Discharge from cream - Pelvic exam (low the urethral estrogen levels meatus in the vagina - Most common result to tissue cause is STDs changes) - Gonorrhea/ no- Urethroscopy specific (low estrogen urethritis changes with - Chlamydia (a ST urethral tissues) gram (-) bacteria) - Trichomonas vaginalis (protozoan found in male and female genitalia) WOMEN - Similar to those bacterial cystitis

UPPER UTI
PYELONEPHRITIS
Is a bacterial infection of the renal pelvis tubules and interstitial tissue of one or both kidneys

Causes: Ascending infection (urinary catheterization, recurrent UTI) Microorganisms: - E. coli - Staphylococcus - Streptococcus - Pseudomonas - Candida albicans - Khlebsiella Risk factors: - Chronic renal calculi - DM - Gender (female) - Instrumentation

Clinical Manifestations: - Tachypnea - Fever - Chills - Pyuria - Nausea and vomiting - Abdominal colic malaise - Headache - Nocturia

Nursing Management: 1. Monitor and record accurately I/O. 2. Prevent dehydration. 3. Assess the patients temperature every 4 hours and Diagnostic findings: administer - UTZ studies anitpyretics - CT scan and - IV pyelogram antibiotic Lab: agents. - Urinalysis 4. Bed rest - Blood cultures 5. Adequate - x-ray (KUB) fluids (23L/day) 6. Emptying the bladder regularly and performing recommende d perineal hygiene

CHRONIC PYELONEPHRITIS
- Results from repeated/ continued UPPER UTI of the effects of such infections - permanently damages renal tissues - decreased tubular reabsorption and secretion= hypertension

Clinical Manifestations: Diagnostic findings: Medical Management: - Fatigue - IVP - Long-term of prophylactic - Headache - Urine tests antimicrobial - Poor appetite - Blood tests therapy - Nocturia - X-ray (KUB) - Meds: - Polyuria Complications: Antibiotics (10- Excessive - End- stage 14 days), antithirst Renal Disease inflammatory - Weight loss (ESRD) drugs (NSAIDS, - Hypertension - Hypertension opioids), - Inability to - Formation of Macrodantin conserve Na kidney stones - Tendency to Surgery: develop - Pyelolithotomy hyperkalemia Patient Education: - Drug - Nephrctomy or acidosis compliance - Uteroplasty - Report - Ureteral changes during implantation therapy - Encourage increase fluids - Report urine output - Monitor weight - Early reporting of signs of infection

UROSEPSIS
- Sepsis resulting from infected urine, may often UTI; sepsis from any source is a systemic infection that can lead to overwhelming organ failure, shock or death

Risk factors: Clinical Management: 1. Immunocomp Manifestations: 1. Patient and s.o. - Hypotension romised health teaching: - Oliguria individuals HYGIENE - Tachypnea 2. Older women 2. Handwashing/ - Tachycardia 3. DM and aseptic technique - Leucopenia kidney stones 3. Indwelling catheter - Hypo/hyper 4. Indwelling (if necessary) thermia catheters 4. IV therapy - Altered 5. Medications: mental a. Opioids (for status pain) (restless, b. Cephalospori agitated n irritable, c. Sympathomi disoriented, metics lethargic, (dopamine) coma)

GLOMERULONEPHRITIS
-inflammation of the glomerular capillaries

ACUTE GLOMERULONEPHRITIS
-more common in children older than 2 years of age (pre-school and school age) but can occur nearly any age -Recovery: 2 years Etiology: Prevention: - Antigen (Group - Prompt A betatreatment of hemolytic URTI/ Sore streptococcus) throat - Culture and Classic signs: sensitivitiy; 1. Proteinuria antibiotics as Medical Management: -Drug of CHOICE: Antibiotic: Penicillins - Corticosteroids -Antihypertensive -Immunosuppresants - Erythromycin/

2. Hematuria 3. Azotemia (high levels of nitrogenous content in the blood Early: hematuria

needed Fluid-related factors of Glomerular filtration Rate: 1. Permeability of the capillary walls 2. Vascular pressure 3. Filtration rate

Azithromycin - Diuretics - Kayexalate - Angiotensin II agonists - Plasmapheresis/ Dialysis Nursing Management: - Promote rest - CHO diet as prescribed; decrease CHON (if BUN and serum creatinine are increased) - BP changes monitoring. - Weighing daily. - Report signs needing physicians prompt intervention - Careful monitoring of patients I/O. - Patient/ Family Teaching

Complications: Late: circulatory - CHF congestion leading to - Pulmonary (1) HTN, (2) edema, edema and (3) kidney failure - Increased ICP Severe form of the disease: Headache. Malaise, flank pain Diagnostic findings: - Urinalysis - Serum BUN GFR: 120 ml/min - CBC - ESR

CHRONIC GLOMERULONEPHRITIS
- may be due to repeated episodes of acute glomerulonephritis, hypertensive nephritis, hypertensive nephrosclerosis, hyperlipidemia, chronic tubulointerstitial injury

- chronic nephritic syndrome -non-infectious disease; no history of infection - Slow, progressive destruction (sclerosis) of the glomeruli - Gradual loss of renal function - Size of kidneys decrease - Tubular atrophy - Chronic intestinal inflammation, arteriosclerosis Diet: Clinical Medical Management: 1. Dietary Na Manifestations: - Na and water restriction restriction - Headache (25- Blurred vision - Antihypertensive 35kcal/day) agents - Proteinuria 2. Dietary - Pruritus - Diuretics (during CHON daytime) - Hematuria restriction - Mild to severe Nursing Interventions: (1anemia - Give emotional 1.2g/KBW) - Fatigue support 3. P restriction (lassitude/ - Do reverse (if GFR is less body isolation than 10 weakness) - Drug compliance ml/min) - HTN teaching - HF Causes include: - Report signs and - SLE symptoms of Diagnostic findings: - Good infection - Urinalysis Pastures - Renal biopsy Syndrome - Hemolytic Uremic Syndrome

NEPHROTIC SYNDROME (NS)

- Is the condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine to be removed from the blood - Not a specific glomerular disease but a cluster of clinical findings

- Marked by increase in protein (albumin) and decrease albumin in the blood resulting to edema - High serum cholesterol and low density lipoproteins (hyperlipidemia) - Associated with: 1. Allergies 2. DM 3. Systemic infections 4. CHF 5. Chronic constrictive pericarditis 6. Renal transplantation 7. Pregnancy Assessment and Clinical Manifestations: Diagnostic Findings: - Edema, - Proteinemia generalized edema (predominate (anasarca) ly albumin) - Hypovolemia, exceeding 3.5 hypotension, weak g/day pulse - Renal biopsy - Malaise/ fatigue - Suppressive - Maasive therapy using proteinuria steroids and - Hyperlipidemia cytotoxic/ (blood test) immunosupp - Hypoalbuminemia ressive agents (blood test) - ACE inhibitors Complications: 1. Infection - Mild diuretics and Na 2. Thrmboembolism restriction especially in the - Urinalysis renal vein 3. Pulmonary emboli - Blood test 4. Accelerated atherosclerosis (due to hyperlipidemia) 5. Fluid overload Medical Management: Drug of CHOICE: Prednisone (corticosteroid) -ACE inhibitors (for HTN) immunosuppressant drugs: Azathioprine, chlorambucil, cyclosporine - Heparin - Antibiotics - Simvastatin (cholesterollowering drug)

hypovolemia

VASCULAR DISORDERS
(Anatomic Structures)
-no lab studies, no blood tests

1. RENAL ARTERY STENOSIS (RAS)

- can affect one or both kidneys - suspected when hypertension develops between age of 30 and after 50 with no history of increased BP - narrowing of one or both renal arteries and their branches - because of hypertension - cause: 1. atherosclerosis with gradual occlusion of the renal artery lumen by plaque (in men) 2. most common casue is fibromuscular dysplasia, structureal abnormalities involving the intimal, medial (adventitial layers of the arterial wall)- in younger women Risk factors: - hypertension (severe) - vascular disorders - history of smoking Diagnostic tests: - x-rays, CT scan reveals changes - renal arteriography - MRI - Doppler UTZ Clinical manifestations: Medications: 1. Cholesterol- abdominal lowering drugs bruits 2. Aspirins (anti- hypertension coagulant) - unexpected azotemia Surgical Management: - Nephrectomy - Surgical bypass - Percutaneous angioplasty with or without stenting ***cessation of smoking is advised

2. NEPHROSCLEROSIS
- A problem of thickening in the nephron blood vessel, resulting in narrowing of the vessel lumen. This change decrease renal blood flow and kidney tissues are chronically hypoxic; may cause of ESRD secondary to many disorder - Caused by hypertension 2. BENIGN Risk factors: Two forms of NEPHROSCLER NEPHROSCLEROSIS: - Genetics OSIS 1. MALIGNANT - History of (Accelerated) - Found in older hypertensi NEPHROSCLEROSI adults and often on S associated with - Associated with atherosclerosis Factors that malignant and increase the risks: hypertension hypertension - Obesity (diastolic BP - DM higher than 130 Diagnostic test: - Smoking mmHg) - Urinalysis - Sedentary - Blood analysis lifestyle Clinical Manifestations: - Renal biopsy CARDIOVASCULAR - Edema Medical Management: - Hypertension - Antihypertensiv - Arrhythmias e therapy - Pericarditis - ACE inhibitors - Cardiac tamponade - Diuretics HEMATOLOGIC - Anemia - Alterations in coagulation - Increased susceptibility in infection SKIN - Yellow, pale, dry,

pruritus, ecchymosis SKELETAL - Hyperphosphatemi a - Osteodystrophy - Hypocalcemia - Shortening of limbs NEUROLOGIC - Alteration in neurologic functions - Peripheral neuropathy

OBSTRUCTIVE DISORDERS
(Structural/ Functional changes in the Urinary Tract)
1. HYDRONEPHROSIS
- are problems of urine outflow obstruction - prompt recognition and treatment are crucial to prevent permanent renal damage - dilation of renal calyces and renal pelvic (unilateral/ bilateral)

HYDRONEPHROSIS
- the kidney enlarges as urine collects in the pelvis and kidney tissue; the capacity of the rena pelvis is normally 5- 8 ml, obstruction in the pelvis/ at the ureteropelvic junction (UPJ) quickly distends the renal pelvis - more common in men due to BPH - women: between 20 to 60s due to pregnancy and uterine CA

Clinical manifestations: - Hematuria - HTN - Hesitancy - Urgency - Incontinence Chronic: - Increased BUN, creatinine

Diagnostic test: - Urinalysis - Blood test - IVP - UTZ - CT Scan

Management: - Urinary catheterization - Morphine (for pain)

HYDROURETER - an enlargement of the ureter - the effects are similar but the obstructions are in the lower urinary tract

URETHRAL STRICTURE
- The obstruction is very low in the UT, causing bladder distention; condition in which as section of the urethra is narrowed (congenital or acquired due to instrumentation, catheterization) - Common in MEN than WOMEN - Narrowing or constriction of the lumen of the urethra Causes: Scars in urethra Inflammation Tumors Gonorrhea Chlamydia Clinical Manifestations: SURGICAL - Urethroplast - Difficulty in y initiating - Stents voiding - Retention - Hydronephrosi Infection Protection: - Maintain s asepsis for - Fever patient at - Chills risk - Malaise - Inspect

Diagnostic findings: - Retrograde pyelogram - Cystourethrograp

hy - IV urography - Sonography (renal echography) - CT scan

Management: NURSING - Fluid monitoring - Monitor weight - Monitor I/O - Monitor serum Urinary Retention and electrolyte Care: 1. Provide Crede values Maneuver - Keep accurate I/O record 2. Use doublevouching - Dialysis technique 3. Insert urinary catheter as appropriate

condition of any surgical wound - Obtain culture - Take antibiotics

RENAL CALCULI
(nephrolithiasis) No known cause Presence/ formation of calculi Lithotripsy (treatment) Asymptomatic to few May be solitary or multiple May damage renal parenchyma Result from: o Dehydration o Infection o Changes in urine pH o Diet o Immobilization o Metabolic factors

- Composition of STONE: o Calcium (oxalate and phosphate) o Uric acid o Struvite (elements: Mg, K) o Cystine Metabolic disorder that causes RENAL CALCULI formation: 1. Hypercalcemia 2. Hyperurecemia 3. Hyperoxaluria Risk factors: - Genetic - Immobility - Dehydration - Accumulation of urine Clinical manifestations: - Pain - Fever - Nausea and vomiting - Chills - Nocturia 4. Oliguria 5. Pyuria 6. Anuria (in rare cases) Complication: Renal failure Diagnostic test: - CBC - Serum Ca and K Management: - IV: NSAIDs, opioids - IV fluids - Antiemetics - Antibiotics - Diuretics Surgical Management: 1. Extracorpor al shock wave lithotripsy (ESWL) 7. Fragments of stones passes for 6 weeks after the surgery 2. Percutaneo us Nephrolitho tomy 8. Treat larger stones by pulverizing or extracting it 3. Ureteroscop y 9. Less than 2 cm calculi Conservativ e therapy: 1. High fluid diet 2. Low oxalate diet

3. 4. 5.

6.

Limit: vitamin C, rhubarbs , tea, strawber ry, chocolate s, peanuts, spinach, wheat bran Low sodium diet Low purine diet Calcium restrictio ns Limit: dairy products (2 servings/ day), lemonad e (2L/day) , limit spinach Limit foods high in uric acid: red wine, sardines,

gravy, poultry, fish

VOIDING DISORDERS
1. URINARY RETENTION
- Inability to empty the bladder completely during attempts to void - Chronic urine retention often leads to overflow incontinence (from the pressure of the retained urine in the bladder) RESIDUAL URINE Urine that remains in the bladder after voiding Pathophysiology: Clinical manifestations: - May result - urinary from urgency DIABETES, - urinary prostatic hesitancy enlargement, - dribbling urethral - dullness on pathology bladder (infection, percussion tumor, - restlessness calculus), - diaphoresis trauma (pelvic - palpable injuries), bladder pregnancy/ distention neurologic - voiding at disorder such 25-50 ml as STROKE, urine at SPINAL CORD frequent INJURY, interval MULTIPLE SCLEROSIS/ Nursing Management: 1. Prevent overdistention of the bladder. 2. Treat infection. Correct obstruction. 3. Monitor urine output. 4. Encourage normal voiding patterns. 5. Applying warmth to relax the sphincter (sitz bath, warm compresses to the perineum, shower) 6. Encourage fluid intake. 7. Proper positioning

Diagnostic exams: during urination: - Suprapubic 1. Male: catheterizati standing on (residual Medications that cause upright retention: urine) 2. Female: - anticholinergi - Cystoscopy sitting c agents: upright atropine Complications: 8. Cognitive sulfate, - lead to stimulation: sound dicyclomine chronic of running water HCl infection upon urination - antispasmodic - renal calculi 9. Tactile stimulation agents: - polynephritis oxybutynin - sepsis Surgery: chloride and - Nephrostomy opioid suppositories - tricyclic antidepressan ts meds: imipramine (Tofranil), doxepine (Sinaguam)

PARKINSONS DISEASE.

2. URINARY INCONTINENCE
- Involuntary loss of urine from the bladder - Inability of the urinary sphincters to control release of urine Risk factors of Urinary Incontinence: - Pregnancy: vaginal delivery, episiotomy - Menopause - GI surgery - Pelvic muscle Treatment (Meds): - Antihistamine - Pseudoephedrine - Estrogen therapy - Antispasmodic - Anticholinergics - Tolterodine

a.

Stress Incontinence -The involuntary loss of urine through an

intact ureter as a result of sneezing, coughing, and changing position. -Affects women who have vaginal deliveries

Risk factors: Urethral irritation Obese Loss of urethrove sical junction Clinical Manifestations: Sphincter - Abdominal/ flank incontine pain nce - Hypertension Pelvic - Nocturia relaxation - Hematuria Multiple - Dysuria sclerosis - Constipation b. Urge Incontinence -urgency -The involuntary loss of urine associated with a strong urge to void that cannot be suppressed Diagnostic test: - Cyctoscopy

weakness Immobility High- impact exercise Stroke DM Morbid obesity Age-related changes in the urinary tract Cognitive disturbance: Dementia, Parkinsons disease Medications: 1. Diuretics 2. Sedatives 3. Hypnotics 4. Opioids

- Antipsychotic: Tofranil Behavioral Management: - Fluid management: ***Daily fluid intake: 5060 oz/ 1500-1600 ml - Standardized voiding frequency: 1. Timely voiding 2. Prompted voiding 3. Habit retraining 4. Bladder retraining bladder drill - Pelvic muscle exercises (Kegels exercise) - Indwelling catheterization - Credes method (lower motor neuron lesions) Surgical Management: - Periurethral bulking Patient Education: Promoting urinary continence: 1. Increase an awareness of the

Treatment: - Analgesics - Control HTN - Sodium restricted diet Pharmacologic therapy: - Anticholinergic

c. Reflex Incontinence -Involuntary loss of urine due to hyperreflexion in the absence of normal sensations usually associated with voiding d. Overflow Incontinence -Involuntary loss of urine in association with overdistention of the bladder Risk factors: fecal impaction, BPH e. Functional Incontinence -Refers to the involuntary loss of urine due to those instances which lower urinary tract function; other factors such as severe

agents - Tricyclic antidepressants medications - Pseudoephedrine sulfate - Hormone therapy (estrogen)

2. 3.

4. 5.

amount and timing of all fluid intake Avoid taking diuretics after 4 pm Avoid bladder irritants, such as caffeine and alcohol Perform pelvic floor muscle exercises Stop smoking

cognitive impairment (Alzheimers / dementia); physical abilities, physical barriers f. Iatrogenic Incontinence -Refers to the involuntary loss of urine due to extrinsic medical factors, predominantly medications. g. Mixed Incontinence -Combination of STRESS and URGE incontinence

CONGENITAL DISORDERS
1. POLYCYSTIC KIDNEY DISEASE
- An inherited disorder in which fluid-filled cyst develops in the nephrons - Two inherited forms: Autosomal dominant (Chromosome 16) and Autosomal recessive

Diagnostic test: - Urinalysis - Blood test - MRI - CT scan - Renal sonography

Management: Surgery: - Measure of - Laparoscopic abdominal girth - Control HTN: limit Na, limit CHON

TRAUMATIC DISORDERS
1. BLADDER TRAUMA
Injury to the bladder may occur with pelvic structures and multiple trauma or from a blow to the lower abdomen when the bladder is full

BLUNT TRAUMA
- May result in contusion evident on an ecchymosis - A large, discolored bruise resulting from escape of blood into the tissues and involving a segment of the bladder wall in rupture of the bladder: extraperitoneally, interperitoneally, or both TRIAD of SYMPTOMS: 1. Blood at urinary meatus 2. Distended bladder 3. Unable to void Complications: - Hemorrhage - Shock - Sepsis - Extravasation of the blood into the tissues

2. URETERAL TRAUMA
- Penetrating trauma and unintentional injury during surgery are the major cause of trauma to the ureters - Causes: gunshot wounds, hysterectomy, and urologic surgery

Diagnostic test: - IV urography

Management: - Control of bleeding - Pain - Infection - Care of incision

3. URETHRAL TRAUMA
- Usually occur with blunt trauma to the lower abdomen/ pelvic region Clinical manifestations: - Fever - Hematuria - Flank pain Nursing Management: - Assess patient with genitourinary trauma - Adequate fluid intake - Monitor BP Surgical Management: - Urethrography - Surgical repair RENAL FAILURE TYPES: 1. Acute - Sudden loss of renal function; reversible 2. Chronic - Gradual, progressive loss of renal function; irreversible Causes: - PRERENAL Decreased renal tissue perfusion - INTRARENAL Toxic substances affecting the kidneys - POSTRENAL Stages of Chronic Renal Failure - Renal Impairment: GFR= 40-50% - Renal Insufficiency: GFR= 20-40% - Renal Failure: 10-20% - ESRD/ Uremia= GFR= less than 10% Assessment - Inability of the kidneys to excrete metabolic waste products of protein

Mechanical obstruction to urine flow below the level of the kidneys Stages of Acute Renal Failure OLIGURIC PHASE Urine output = 400 ml/day Increased BUN, creatinine Edema, HPN Hyperkalemia Hyponatremia Hypermagnesemia Hyperphosphatemia Metabolic acidosis Lasts 1 to 3 weeks DIURETIC PHASE - Urine output= 3-5 L/day - Initially BUN, creatinine elevated BP elevated Metabolic acidosis - Later Normalize - Hypokalemia - Last 1 week RECOVERY PHASE - Takes 3 to 12 months

through urine formation 1. Oliguria 2. Increased BUN, creatinine (AZOTEMIA) 3. Uriniferous odor of breath 4. Stomatitis and GI bleeding- urea is converted back into ammonia which irritates mucous membrane 5. Destruction of RBC, WBC, platelets 6. Renal encephalopathy 7. Uremic frost Causes pruritus and dryness of the skin 8. Decreased libido, impotence, infertility 9. CAUSED BY HORMONAL IMBALANCES - Inability of the kidneys to maintain fluid- electrolyte, acid-base balance 1. Edema 2. Hyperkalemia 3. Hypo/herpernatremia 4. Hypermagnesemia 5. Metabolic acidosis The kidneys are unable to buffer H ions; unable to regenerate bicarbonate and unable to excrete waste products which are mostly acidic. - Inability of the kidneys to secrete ERYTHROPOIETIN 1. Anemia - Inability of the kidneys to metabolize

- Avoid nephrotoxic drugs

vit. D 1. Hypocalcemia 2. Hyperphosphatemia 3. Renal osteodystrophy - Altered biochemical environment 1. Glucose intolerance

Medical Management: - Conservative Management: 1. Fluid control 2. Electrolyte control Hyperkalemia Metabolic acidosis Hypocalcemia/ hyperphosphatemia Dietary control 3. Treatment of intercurrent disorders Anemia Gastrointestinal disturbances Other conditions: hyprtension, CHF, pulmonary edema, hypocalcemia, hyperphosphatemia, etc. Guidelines for the Care of the Person with Chronic Renal Failure - Maintain fluid and electrolyte balance 1. Monitor for fluid and electrolyte balalance Assess I/O every 8 hours Weigh patient daily Assess presence and extent of edema Auscultate breath sounds Monitor cardiac rhythm and BP every 8 hours 2. Encourage patient to remain within prescribed fluid restrictions. 3. Provide small quantities of fluid spaced over the day to stay within fluid restrictions. 4. Provide a diet high in CHO and within the prescribed sodium,

potassium, phosphorus, and CHON limits. 5. Administer phosphate- binding agents with meal as prescribed (amphogel/ AL- OH) - Prevent infection and injury 1. Promote meticulous skin care 2. Encourage activity within prescribed limits but avoid fatigue. 3. Protect confused person from injury. 4. Protect person from exposure to infectious agents. 5. Maintain good medical/ surgical asepsis during treatments and procedures. 6. Avoid aspirin products. 7. Encourage use of soft toothbrush. - Promote comfort 1. Medicate patient as needed for pain 2. Medicate for prescribed antipruritic, no emollient baths, keep skin moit and control environmental temperature to relieve pruritus. 3. Encourage use of damp cloth to keep ips moist; give goo oral hygiene. 4. Encourage rest for fatigue; however, encourage self-care as tolerated. 5. Provide calm, supportive environment. - Assist with coping in life- style and self-concept 1. Promote hope 2. Provide opportunity for patient to express feelings about self. 3. Identify available community resources

Guidelines for Teaching the Person with Chronic Renal Failure - Relationship between causes and their symptoms. - Relationships among diet, fluid restriction, medication, and blood chemistries. - Preventive health care measures: good oral hygiene, prevention of infection, avoidance of bleeding - Dietary regimen, including fluid restrictions

1. Prescribed sodium, potassium, phosphorus, and protein restrictions. 2. Means of identifying contents of food 3. Use of small, frequent feedings to maintain nutrient intake when anorexic or nauseated. 4. Fluid prescription and sources of fluid in diet 5. Avoidance of salt substitutes containing potassium. - Medications for fluid excess 1. Accurate measurement and recording of I and O. 2. Monitoring for weight gain and edema. - Medications 1. Actions, doses, purposes and side effects of prescribed medications. 2. Avoidance for over-the-counter drugs, especially aspirin, cold medications, and non-steroidal anti-inflammatory drugs - Planning for gradual increase in physical activity, including rest periods to conserve energy. - Measures to control pruritus. - Planning for follow-up healthcare. 1. Symptoms requiring immediate medical attention: changes in urine output, edema, weight gain, dyspnea, infection, increased symptoms of uremia 2. Need for continual medical follow-up

Medical Management: - Dialysis 1. Physiologic Principles of Dialysis Diffusion Osmosis Ultrafiltration - Hemodialysis 1. Vascular access: Arteriovenous fistula Arteriovenous graft

External arteriovenous shunt Femoral vein catheterization Subclavian vein catherterization Practice ARM PRECAUTION as needed Assess for patency: auscultate for bruit, palpate for thrill Tourniquet be always available if A-V shunt is present. A-V shunt may be used immediately. A-V fistula may be used after 4-6 weeks to wait for healing. It can be used for 3 to 4 years.

Nursing Interventions: - Facilitating fluid and electrolyte imbalance 1. Preventing hypovolemia and shock. Administer blood transfusions as ordered Omit dose of hypertensive drug 2. Preventing disequilibrium phenomenon Initial hemodialysis be done for 30 minutes only. Disequilibrium syndrome is caused by more rapid removal of waste products from the blood than from the brain. This is due to the presence of blood brain barrier, cerebral edema causes signs and symptoms of increased ICP, e.g. restlessness, headache, dizziness, nausea and vomiting, hypertension, etc. 3. Preventing blood loss - Promoting comfort 1. Provide hygienic measures - Maintaining activity and nutrition - Facilitate learning. Evaluation - Successful achievement of patient outcomes for the patient receiving hemodialysis is indicated by the following: 1. Lacking of excessive fluid weight gain between dialysis treatments 2. States that no pain is present and that discomfort experienced during dialysis is decreased. 3. Participates in a program to maintain prescribed level of activity. 4. Eats according to preference during therapy.

5. Correctly explains dialysis. Care of venous access, common side effects and recommended work/ activity schedule. - PERITONEAL DIALYSIS 1. The major advantages of peritoneal dialysis include the following: It provides a state of blood chemistries. Patient can dialyze alone in any location without need for machinery. Patient can be readily taught the process. Patient has few dietary restrictions; because of loss of CHON in dialysate, the patient is usually placed in high CHON diet. Patient has much more control over daily life. Peritoneal dialysis can be used for patients that are hemodynamically unstable. - Care During Peritoneal Dialysis 1. Regulating fluid volume and drainage. 2. Promoting comfort. 3. Preventing complications. Monitor urine/ blood glucose levels. 4. Facilitate learning The teaching plan should include the following: The process of dialysis and how the dialysis relates to the patients own body needs. Signs and symptoms of infection of the peritoneal cavity or catheter site and when to obtain care if these occur. Appropriate care for the permanent peritoneal catheter. Common side effects of treatment, means of controlling mild symptoms, means of obtaining medical attention for severe or persistent complications. Changes in medication schedule required before and after dialysis. A work and activity schedule as physical capabilities permit, with minimal interference

from scheduled dialysis time. - Other Approaches to Peritoneal Dialysis 1. Continuous Ambulatory Peritoneal Dialysis (CAPD) 2. Continuous Cyclic Peritoneal Dialysis (CCPD)

NURSING CARE FOR CLIENTS WITH ALTERATION IN URINARY ELIMINATION

Magno, Charity Grace M.
BSN IV

URETHRITIS
Is an inflammation of the urethra that causes symptoms similar to UTI

URETERITIS
Inflammation of the ureters

PYELONEPHRITIS
Is either the presence of active organisms in the kidney or the effects of kidney infections Bacterial infection in the kidneys

1. Acute Pyelonephritis
-the active bacterial infection

2. Chronic Pyelonephritis
-resulted from repeated/ continued upper urinary tract infection

GLOMERULONEPHRITIS
- Inflammation of the kidneys glomerular capillaries - Acute Post Streptococcal Glomerulonephritis (APSGN) - Inflammation of the kidneys, may occur as a separate entity but usually occurs as an immune complex disease after infection with nephritogenic streptococcal

NEPHROSLEROSIS
Is a problem of thickening in nephron blood vessels, during in narrowing of the vessel lumen Hardening of the renal arteries

HYDRONEPHROSIS
-problem of the urine outflow obstruction -dilation of the renal calyces

RENAL CALCULI
Urolithiasis -is the presence of calculi (stones) in the urinary tract Nephrolithiasis -the formation of stones in the kidney Ureterolithiasis -the formation of stones in the ureter; urinary stones

URINARY RETENTION
Inability to empty the bladder completely during attempts to void

URINARY INCONTINENCE
Continence - Control over the time and place of urination Incontinence - Is an involuntary loss of urine severe enough to cause social/ hygienic problems

POLYCYSTIC KIDNEY DISEASE (PKD)

Is an inherited disorder in which fluid-filled cysts develop in the nephrons

ACUTE RENAL FAILURE (ARF)

Is a rapid decrease in renal function; leading to collection of metabolic wastes in the body Reversible deterioration of renal function

CHRONIC RENAL FAILURE (CRF)

Is a progressive, irreversible kidney injury, kidney function does not recover End result of progressive irreversible loss of renal tissue

HEMODIALYSIS (HD)
One of the several replacement therapies used for the treatment of renal failure

Extracts by-product of protein metabolism, creatinine and excess water

PERITONEAL DIALYSIS
-occurs in the peritoneal cavity -slower than HD. However, more time is needed to achieve the same effect.