med-surg ch. 57-59 study guide
Renal failure Diagnostic findings
- Lab blood test reveals elevations in BUN, creatinine, potassium, magnesium, and phosphorus -calcium levels are low - The RBC count, hematocrit, and hemoglobin are decreased. -The pH of the blood is on the acidotic side. -urinalysis reveals a decreased specific gravity. - An IVP provides evidence of renal dysfunction -in client with severe renal failure, dye excretion usually is delayed. - a percutaneous renal biopsy shows destruction of nephrons -imaging and ultrasound demonstrate structural defects in the kidneys, ureters and bladder - renal angiography identifies obstructions in blood vessels.
other reasons for renal angiography
- are to evaluate renal blood flow following trauma to the kidney, differentiate cysts from tumors , and asses hypertension -a catheter is passed up from the femoral artery into the aorta to the level of the renal vessels. -contrast medium is then injected into the catheter, an serial x-rays are taken - the radioplaque dye first outlines the aorta in the area of the renal artery, then enters the renal artery and kidney, - a series of x-rays are taken. the catheter tip also may be passed into each renal artery for additional image. the procedure lasts 30 -90 mins, this procedure is contraindicated if a client is allergic to iodine contrast material.
systemic complications of chronic renal failure--- musculoskeletal
- bone demineralization, muscle cramps, joint pain
Bladder training
-one method of bladder training for the client with an indwelling urethral catheter is to alternately clamp and unclamp the catheter -clamming and unclamping begins to reestablish normal bladder function and capacity. - the catheter may be unclamped for 5 mins, every 1 to 2 hours. -the length of time is gradually increased to every 3 to 4 hours , giving the bladder a chance to fill more completely. -when possible the nurse teaches the client to unclamp at scheduled times. the catheter is eventually removed
s/s of bladder cancer
-painless hematuria -early symptoms include -- UTI with symptoms such as fever, dysuria, urgency, frequency. -later symptoms- include pelvis pain, urinary retention-if tumor blocks the bladder outlet, urinary frequency -if bleeding- symptoms of anemia, fatigue, SOB caused by loss of blood
in addition to evaluating the clients general health, the nurse evaluates for s/s of
-periorbital edema - swelling around the eye -edema of the extremities -cardiac failure -mental changes -may indicate urinary tract disorder. the nurse also obtains Vital signs and weight
nephrolithiasis
-refers to a kidney stone, the size of which may range from microscopic to several centimeters.
radical cystectomy in men
-removal of the bladder, lower third of both ureters, prostate, and seminal vesicles
angiography
-renal angiography - provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries-multiple vessels to the kidney are not unusual) and the patency of each renal artery. if decrease blood flow- kidney is atrophy
renal calculi pt teaching
-review the causes of and methods to prevent renal calculi -drink plenty of fluids , water is one of the best -food restriction- to sm amount if the stones are composed of calcium oxalate -take all antimicrobial and analgesics drugs and , if prescribed and report any side effects. -demonstrate the procedure for catheter or nephrostomy tube care -strain urine if the stone or its fragments have not passed -report signs of acute obstructions immediately, such as inability or difficulty in voiding, or pain -report signs of infection, such as fever, chills, dysuria, frequency, urgency, and cloudy urine because infection may contribute to formation of urinary calculi -review discharge teaching after a treatment precedure that include activity levels , hygiene measures, dietary modifications, goals for oral fluid intake, and wound care -consult with the physician before self administering and OTC medications
urinary and renal calculi medical & surgical management
-sm. calculi are passed naturally with no specific interventions -if the stone is 5 mm or less in diameter and moving, the pain is tolerable, and if there is no obstruction, the client is managed medically with vigorous hydration, analgesics, opioids and NSAIDS, antimicrobial therapy, and drugs that dissolve calculi or eventually alter conditions that promote their formation - for larger stones, extracorporeal shock waves lithotripsy, ESWL, a procedure that uses a 800-2400 shock waves aimed from outside the body toward soft tissue to dense stones. -the stones are shattered into sm particles that are passed from the urinary tract -ESWL is administerd with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation -stones can be pulverized with laser lithotripsy -to do this fine wire, throuh which the laser beam passes, is inserted into the ureter by means of a cystoscope -repeated bursts of laser reduce the stone to fine powder, which is then passed in the urine
24-hour urine collection
-sometimes, the entire 24 - hour vol of urine is collected, such as a 24 hour urine for ketosteroids. -the client is initially instructed to void and discard the urine. -the collection bottle is marked with the time the clients voided. -thereafter, all the urine is collected for the entire 24 hours. -the last urine is voided at the same time the test originally began -the entire specimen is refrigerated to prevent bacterial growth. -to prevent any part of the specimen from being lost or contaminated, the nurse tells the client to use separate receptacles for voiding and defacation --if any urine is discarded by mistake or lost while defacting, the nurse stops the test, because the loss of even a small amount of urine can invalidate the test.
systemic complications of chronic renal failure--- cardiovascular
CHF, Hypertension, cardiac dysrhythmias, edema
systemic complications of chronic renal failure--- integumentary
Dry skin, pruritus
systemic complications of chronic renal failure--- metabolic
ELECTROLYTE imbalances, metabolic acidosis
systemic complications of chronic renal failure--- respiratory
SOB, pulmonary edema
other stone removal procedures
are performed with ureteroscopic approaches in which the endoscope is inserted from the urethra into the upper urinary tract under anesthesia to grasp, crush, and remove stones from the kidney pelvis or ureter -afterwards, a catheter or ureteral stent, a slender supportive device ,is left in place for 3 days to splint the ureter or divert the urine past any possible tear in the uretheral wall. -if the stone cannot be removed, a uretheral catheter is left in place for 24 hours to dilate the ureter in the hope that the stone will pass through it or that it will be pulled into the bladder when the catheter is removed
An IVP is scheduled
before any barium test or gallbladder series that uses contract material -iodine- -if the client already is scheduled for barium studies of the upper GI tract, these diagnostic tests probably will be delayed until urologic studies are complete. -it may take several days for the barium to be removed from the GI, and its presences can distort IVP findings.
physical examination
before beginning the physical examination, the nurse asks the client to void. -Inspection includes observing the abdomen for scars, symmetry, abdominal movements , and pulsation, or scars are important steps.
once a cystectomy is performed
urine must be diverted to another collecting system- this is called urinary diversion - treatment of bladder cancer- also used for extensive pelvic malignancies and server traumatic injury to the bladder - some require external ostomy bags to collect urine. --referred to cutaneous urinary diversion. -catheterization to drain urine - continent urine diversion -urine is diverted to the colon and client voids rectally - continent urine diversion -each procedure has its advantages and disadvantages -each type depends on many factors, such as age, physical condition and the procedure that produce the best results for the client , and the extend pf mestastases
what is peritoneal dialysis?
uses the perironeum, the semipermeable membrane lining of the abdomen, to filter fluid, wastes and chemicals -the dialysate is similar om composition to normal plasma but made hypertonic by dextrose.
sodium bicarbonate - bakind soda
usually in tablet form may be used to alkalize the urine of clients with kidney stones to prevent stone recurrance
the filtrate that is secreted as urine usually contains
water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid. -amino acids and glucose typically are reabsorbed and not excreted in the urine. -protein molecules- except for periodic small amount of globulins and albumin, also are reabsorbed -transient proteinuria in sm amounts <150 mg/dL is not considered a problem. -persistent and elevated proteinuria may indicate glomerular damage. -Glysuria, glucose in the urine, occurs when the glucose concentration in the blood and glomerular filtrate exceeds the ability of the tubules to reabsorb the glucose.
with urolithiasis and nephrolithiasis
with or without renal colic, activity/ ambulation, and increase of fliuds intake helps to relieve pain and discomfort/
calculi tramatize the walls of the urinary tract and irritate the cellular lining
causing pain as voilent contractions of the ureter develop to pass the stones along. But the ureteral spasms may just be easily hold a stone in place. -if a stone totally or partially obstructs the passage of urine beyond its location, pressure increases in the area above the stone. -the pressure contributes to pain, and urinary stasis promotes secondary infection -the retained urine distends the renal pelvis, a condition called hydronephrosis -eventually, there may be compression of the glomeruli and tiny arterioles that supply blood to the kidney, which can result in permanent kidney damage.
urinalysis normal & abnormal characteristics clarity - clear
cloudy, turbid, hazy, smoky, milky, pinkish precipitates.
urinalysis normal & abnormal characteristics color- yellow
colorless, red, pink, dark yellow or orange, Green, brown, dark brown to black
the blood supply to each kidney
consist of a renal artery and renal vein. -the renal artery arises from the aorta and the renal vein empties into the vena cava. -the kidney receives 25 % of the total cardiac output.
the medulla contains
contains calyces, pyramids, cone-shaped structures that open to the renal pelvis, a large funnel-like structure in the center of the kidney. -the renal then empties into the ureter, which carries urine to the bladder for storage.
Renal failure s/s
the client has elevated BP and weight gain. urine output is decreased facial features appear puffy from fluid retention. the skin is pale . ulceration and bleeding of the GI tract may occur -the oral mucous membrane bleeds, and blood may be founf in feces. -vague symptoms such as lethargy, headache, anorexia, and dry mouth. - later other problems may develop such as pruiritus, and dry scaly skin. (uremic frost) -the breath and body may have odor characteristic of urine, -muscle cramps, bone pain and tenderness, and spontaneous fractures can develop. - mental processes progressively slow as electrolytes imbalances become marked and nitrogenous waste accumulates.
the male urethra extends approx. 24 cm - 10 in-
the femal urethra extends about 4 cm - 1.5 to 2 inches -
in acute Pyelonephritis
the inflammation causes the kidneys to grossly enlarge. the cortex and medulla develop multiple absceses. -the renal calyces and pelves also can become involved. -resolution of the inflammation results in fibrosis and scarring
hemodialysis patients that have a vascular access site- AV fistula or AV graft
the nurse assesses for a thrill (palpation) and a bruit (auscultation) to determine patency and that the access is functioning properly -these patients are NOT to have BP or venipuncture on this extremity
After IVP or retrograde pyeloggraphy
the nurse instructs the client to consume an adequate fluid intake. -in addition the client receives IV fluid replacement -the nurse monitors and documents the I&O's is at least 30 mL/hr. -clients who are dehydrated are at high risk for renal failure from the toxic effects of the contrast medium on the kidney tissues. -the nurse also monitor VS -if additional x-rays are needed in the next 24 hour, if the excretory function of the kidney is abnormal, the physician or radiology dept. provides instructions regarding the food and fluid intake -may experience a dull ache caused by distention of the renal pelves with the radioplaque dye -observe for s/s of pyelonephritis -24-48 hours postprocedure because of the istrumentation and injection material. -if any symptoms occur, the nurse reports them to the physician and obtains a urine specimen culture and analysis -antibiotic agents are administered as directed
renal cancer-tumors of the kidney
tumor of the kidney are almost always cancerous -renal cellcarcinome is the most common type of kidney cancer in adults. -a second type of kidney cancer is transitional cell cancer. in both types, men are affected more than women -60 and older
medical treatment of bladder cancer --intravesicular injection of bacillus Calmette-Guerin (BCG)
-live, weakened strain of Mycobacterium bovis also may be used, -appears that BCG causes an inflammatory reaction in the bladder wall that, in turn, destroys malignant cells. -administration of interferon alfa-2a (Roferon-A) injects IV or directly into the bladder -interferon appear to stimulate the production of lymphocytes and macrophages that may destroy malignant cells
Incontinence nursing management
-maintaining continence as much as possible, preventing skin breakdown, reducing anxiety, and initiating a bladder training program -the nurse instructs the client to use soap and water after each episode to clean the skin thoroughly , and apply a skin barrier or moisture sealant to protect the skin
systemic complications of chronic renal failure--- GI
-malnutrition, vitamin deficiencies, anorexia, nausea, bleeding
urethritis causes in women
-may accompany cystitis but may also be secondary to vaginal infections -soaps, bubble baths, sanitary napkins, or scented toilet papers also may cause urethritis
Diagnostic findings for cystitis
-microscopic exam of the urine reveals an increase in the number of red and white blood cells -culture and sensitivity studies are used to identify the causative micro-organisms and appropriate antimicrobial therapy. -if repeated episodes occur, IVP or cystoscopy with or without retrograde pyelgrams may be needed to identify the possible causes, such as chronic prostatititis or a bladder diverticulum which encourages urinary stasis and infection
medical treatment of bladder cancer - topical application
-of an antineoplastic drug may be used after resection amd fulguration of a tumor -liquid for, instilled into the bladder by a catheter -fluid is usually limited before and during the procedure so that the drug remains concentrated and in contact with the bladder mucosa for about 2 hours -client voids, given extra oral fluids to flush the drug from the bladder
medical management of incontinece
- correcting the disorder causing incontinence- when possible -providing medications to control incontinence -correcting the situational problem that contributes to the functional incontinence - instituting a bladder retraining program - Pharmacologic agents that can improve bladder retention, emptying and controlling include- anticholinergic drugs such as --- oxybutynin chloride (Ditropan) which can reduce bladder spasticity and involuntary bladder contractions, --tolterpodine tartrate (Deltrol) similar to oxybutynin chloride -phenoxybenzamine hydrochloride (Dibenzaline) may be useful in treating problems with sphincter control -Bethanechol (Urecholine) helps to increase contractions of the detrusor , which assists with emptying of the bladder -some tricyclic antidepressants medications- -amitriptyline ( Elavil) - -nortriptyline (Pamelor) -amoxapine (Asendin) are useful in treating incontinence because they decrease bladder contractions and increase bladder neck resistnace Pseudoephedrine (Sudafed) may help stress incontinence -Estrogen - may be useful in restoring mucosal, vascular, and muscular integrity of the urethra for postmenopausal incontinence, but treatment may only be effective for about a year -sometimes medications to control incontinence results in retention and must be discontinued -clients who can easily perform CIC may opt for medication-induced retention and CIC because it allows them to stay dry
polycystic kidney disease--assessment finding
- hypertension is present in approx. 75% of affected clients at the time of diagnosis -other symptoms such as pain from retroperitoneal bleeding, lumbar discomfort, and abdominal tenderness are caused by the size and effects of the cysts -the client may experience colic-acute spasmodic pain- when there is uretheral passages of clots or calculi. -many clients with this disorder also have hematuria because of UTI's and rupture cysts -renal stones are also common -headache and increased abdominal girth -a family history of affected memers is a presumptive diagnostic indicator -urinalysis shows mild proteinuria, hematuria, an dpyuria -decreased or increased RBC's and hematocrit -increase is seen because erythropoietin production sometimes is accelerated -abdominal ultrasound, CT scan, MRI, and IVP reveal enlarged kidneys with indentations cause by cysts -lab tests such as BUN and serum creatinine indicate the degree of current kidney dysfunction
Pyelonephritis potential risk factors--acute Pyelonephritis
- instrumentation of the urethra and bladder - catheterization , cystoscopy, uroligic surgery - inability to empty bladder -pregnancy -urinary stasis -urinary obstruction - tumors, strictures, calculi, prostatic hypertrophy- -diabetes mellitus -other renal disease-polycystic kidney disease. -neurogenic bladder- - stroke, MS. spinal cord injury -women with increased sexual activity- diaphragm, spermicide use, failure to void after intercourse, history of recent urinary infections -men who perform anal intercourse , infection of HIV
medical treatment of bladder cancer - photodynamic therapy
- involves the IV injections of a photosynthesizing agent that is absorbed in concentrations by malignant cells - a laser inserted througha cystoscope, is used to destroy those cells that have a high concentration of photosynthesizing agents
polycystic kidney disease nursing management
- many clients with polycystic kidney disease are treated as outpatients by primary care physicians or nephrologists, physicians who specialize in the diagnosis and treatment of renal disease. -when hospitalization is necessary, the nurse assesses VS, especially BP, and reports any significant elevations. -he or she monitors lab test results for indicators of renal function. -the nurse inspects the urine for signs of bleeding or infections or infections -he or she measures and documents I&O at least every 8 hrs - the nurse reports any decrease or absence of urine output.
medical treatment of bladder cancer - radiation therapy
- may be done if surgery is planned for the client - this reduces the size and extend of the tumor and decreases the risk of metastasis
urinary incontinence causes
- may result from either bladder or urethral dysfunction or both . -result from neurologic disease, bladder prolapse, bladder outlet obstruction, or trauma, low estrogen levels in women, prostatic enlargement in men -failure of the urethral sphincters to hold urine in the bladder
chronic Pyelonephritis potential risk factors
--recurrent episodes of acute Pyelonephritis --chronic obstruction - stricture and stones -reflux disorder that allows urine to flow backward up the ureters.
cystoscopy nursing considerations
-Blood-tinged urine or blood on toilet tissue may occur for the first few voiding after the procedure. -burning with urination for a few voidings is common following a cystoscopy -urination may be more frequent for several days. -use moist heat-warm washcloth- on the urethra or over the lower abdomen and or warm sitz bath if allowed to relieve discomfort and bladder spasms. -take antispasmodic and antibiotic medications as ordered -drink extra fluids to reduce irritation if not contraindicated -report if there are any problems with urine retention or signs of urinary frequency
surgical treatment of bladder cancer
-a cystectomy - surgical removal of the bladder- and a urinary diversion procedure necessary when the tumor had penetrated the muscle wall - the bladder and lower third of both ureters are removed. -if the tumor has extended through the bladder wall, the surgeon may perform a radical cystectomy
urinary and renal calculi- surgical management --ureterolithotomy, pyelolithotomy, nephrolithotomy
-a suprapubic abdominal or flank incision is made, and the stone is remoed under direct visualizationwhile the client is anesthetized. -a pyeloplasty = surgical repair of the ureteropelvic junction or other anatomic anomalies, may be performed at the same time . -the additional surgery is done to correct condition that contribute to the development of stones and prevent their recurrence
patient teaching for cystitis
-increase fluid intake to 2-3L/ day - avoids coffee, tea, colas, and alcohol -shower rather than bathe in the tub -cleanse perineum after each BM with front-to-back motion - avoid irritating substances such as bubble bath, bath salts, perineal lotions, vaginal sprays, nylon underwear, and scented toilet paper -wear cotton underwear -void every 2-3 hours while awake -empty bladder completely with each voiding - void after sexual intercourse - notify the physician if any of the following- urgency , frequency, burning with urination, difficulty urinating, or blood in the urine, -take medication exactly as prescribed
the urethra is a hollow tube
that begins at the bladder neck and ends at the external meatus. -it serves as a conduit during urination and has a sphincter mechanism to prevent urine leakage.
polycystic kidney disease causes
-adult polycystic kidney disease is inherited as an autosomal dominate trait, which means that an affected parent passes the gene for the disease to his or her children. -each child has a 50;50 chance of acquiring the defensive gene. - a child has a 25% chance of being affected -this disorder is characterized by the formation of multiple bilateral cysts -the cysts interferes with the kidney function and eventually lead to renal failure. -the fluid-filled cysts cause great enlargement of the kidneys, from their normal size of a fist to that of a football, -as the cysts enlarge, they compress the renal blood vessels and cause chronic hypertension -bleeding into cysts cause flank pain. -people with polycystic kidney disease are much more susceptible to kidney infections and kidney stones -besides renal failure, other complications include cysts on the pancreas and liver, an enlarged heart, mitral valve prolapse, and brain aneurysm
renal cancer-tumors of the kidney---risk factors
-age, risk increases with age, most renal cancers occur after age 60 years -Gender-- affects men more than women -tobacco use -occupational exposure to industrial chemicals, such as petroleum products, heavy metals , and asbestos -obesity -polycystic estrogen therapy - treatment for kidney therapy, including clients on dialysis and those receiving a kidney transplant
cystitis treatment
-antimicrobial therapy and correction of contributing factors. ----trimethoprim-sulfamethoxazole (TMP-SMZ) --septra, Bactrim ---nitrofurantoin macrocrystals (Macrodantin) -cranberry juice or vitamin C may be recommended to keep the bacteria from adhearing to the walls of the bladder and thus promoting their excretion and enhancing effectiveness of drug therapy -when there is a partial urethral obstruction, no treatment of cystitisis fully effective until adequate drainage of urine is restored by the removal of the obstruction. in some instances, treatment may be prolonged, and may need to be repeated
urethritis treatment
-appropriate antibiotic therapy, liberal fluid intake , analgesics, warms sitz bath, and improvements on the client's resistances to infection by a good diet and plenty of rest. -if urethritis is due to an STI, treated with appropriate antibiotics -failure to seek treatment for gonococcal urethritis may result in a urethral stricture in men
Pyelonephritis causes
-bacteria ascends to the kidney and kidney pelves by the way of bladder and urethra. -Normal fecal flora such as E.coli, Klebsiella pneumoniae, proteus mirabilis, streptococcus fecalis, Pseudomonas aeruginosa, and staphylococcis aureus are the most common bacteria that cause acute Pyelonephritis -E.coli accounts for about 85% of infections -urinary obstruction is the most common cause of Pyelonephritis in the Older adults when present, the older adult may not experience a fever and difficulty voiding in younger adults. -accurate assessment of urine vol is critical
pt and family teaching to manage incontinence
-be aware of the amount and timing of fluid intake - avoid taking a diuretics after 4 pm -avoid bladder irritants, including caffeine, alcohol, and aspartame ( NutraSweet) -avoid constipation- adequate fluid, fiber, exercise , and stool softeners is recommended, - void regularly - ever 2-3 hours- first thing in the AM, Before each meal, before going to bed, during the night as needed. -Perform kegal exercises as recommended. -stop smoking- frequent coughing increases incontinence -control odor by frequent cleansing of the perineum, changing clothes and incontinence briefs when they become wet, and using an electric room deodorizer - avoid using perfumes or scented powders, lotions, and sprays. mixing a perfume scent with urine odor may intensify the odor, irritate the skin, or cause a skin infection -wash garment as soon as soon as possible in warm, soap water, -use plastic to cover objects, such as a mattress and chairs, to prevent staining and lingering odors. the plastic must be washed with mild, soapy water daily or more often as needed - place a sheet or blanket between the skin and the plastic -follow the recommendations of the physicians about clamping and unclamping the catheter or changing the catheter or cystostomy. -keep a record of fluid intake. drink plenty of fluids during waking hours, drink most of the required fluids in the morning and early afternoon hours and decrease the intake toward evening -follow the recommended bladder training program. time is required to achieve success -contact the physician if any of the following occurs: increase discomfort, rash around the perineal area, pain in the lower abdomen, fever, chills, and cloudy urine
urethritis causes
-by micro-organisms other than gonococci is called nongonococcal urethritis -Gonorrhea, an STI os a specific form of infection that can attack the mucous membrane of the normal urethra
the reason for urinary calculi form is not fully understood/ predisposing factors include
-calciuria-excessive calcium in the urine- as may accompanied hyperparathyroid disease, administration of cal-based antacids, and excessive intake of vitamin D -dehydration -UTI with urea splitting organisms such as P.mirabilis, which make urine alkaline, a condition that promotes precipitation of calcium -obstructive disorder-such as an enlarged prostate gland, which foster urinary stasis -metabolic disorders, such as gout, in which uric acid crystallizes -osteoporosis-in which bones is demineralized -prolonged immobility from paralysis secondary to spinal injuries or other incapacitating conditions that result in sluggish emptying of urine from the urinary tract
urinary and renal calculi- surgical management
-calculi that are large or complicated by obstruction, ongoing UTIs , kidney damage, or constant bleeding require surgical removal. -surgical options include a percutaneous nephrolithotomy, ureterolithotomy, pyelolithotomy, and nephrolithotomy.
urethritis causes in men
-infection with Chlamydia trachomatis or Ureaplasma urealyticum, which causes an STI -bacteria that normally are present cause no difficulty unless these tissues are traumatized, usually after instrumentations such as catheterizations or cystoscopic examination - bateria may gain and cause a nonspecific urethritis--includes irritations with vigorous intercourse , rectal intercourse, and intercourse with a women who has a vaginal infection
what is glomerulonephritis?
-inflammatory renal disorder that occurs most frequently in children and young adults that is preceded by an upper respiratory infection with group A beta-hemolytic strepococci; impetigo- skin infection; or viral infections much as mumps, hepatitis B, or HIV
urinary and renal calculi- surgical management -percutaneous nephrolithotomy
-is an endoscopic procedure. a nephroscope is tunneled into the kidney through a tiny skin incision while the client is under general anesthesia. -ultrasound is used to crush the stones. the fragments are removed through the endoscope
caring for the client undergoing intravenous or retrograde pyelography
-check the clients allergy history, esp to IV contrast dye-iodine- or seafood. Inquire about previous reactions. inquire about previous reactions to x-ray studies that used contrast media. Report allergies to the physician or radiology dept. personnel -instruct the client to fast from food for 8-12 hours before the pyelography. fluids are permitted. -cleanse the bowel per physicians order so that there is no interference with visualization of the kidneys on the radiographic image. it is important that the bowel preparation be effective because poor cleansing of the intestinal tract may require that the test be repeated. clients with a peptic ulcer or ulcerative colitis usually require modification of the bowel-cleansing preparation -document the baseline VS -explain the procedure and its purpose. tell the client that a series of x-rays will be taken after injection or instillation of IV contrast materials and that the entire test requires 1-1 1/2 hours to complete. -caution clients that they may experience burning, hot flushing sensations, unpleasant -metallic- taste in the mouth, N/V as the contrast is given. -encourage adequate fluid intake postprecedure and voiding within 8 hours postprocedure Burning sensation on voiding and small amounts of blood-tinged urine are normal and should disappear after the third voiding. -advise to use a warm bath tub to decrease urethral discomfort or spasms after a retrograde pyelography. these reactions should disappear within 24 hours -instruct the client to abstain from alcohol 48 to avoid irritating the bladder -discuss taking antibiotics for 1-3 days postprocedure. teach the client to report flank pain, chills, fever ,dysuria, or bleeding. Advise client to notify physician if any symptoms present
nutrition notes for clients at risk for kidney stones -- pt teaching
-consume a normal protein diet, a high-protein diet promotes urinary excretion of calcium, oxalate, and uric acids -restrict sodium to 2-3 g/day because sodium competes with calcium for reabsorption in the kidneys -consume a normal calcium intake balance throughout the day. a low-calcium diet may increase the risk of stone formation by increasing urinary oxalate excretion . with less calcium available in the GI tract to combine with oxalate, more oxalate is absorbed and urinary oxalate increases. restrict oxalate - containing foods such as dark, leafy green vegetables; berries, rhubarb, tea, nuts, chocalate, beans-green, wax, and dried, sweet potatoes, wheat bran, and draft beer -avoid vitamin C supplements becuase vitamin C degrades to oxalate.
urethritis s/s
-discomfort on urination, varying from aslight tickling sensation to burning or severe discomfort and urinary frequency -fever is not common -fever in male client may be due to further extension of the infection to the prostate, testes, and epididymis
angiography pt teaching
-drink extra fluids on the day before the test; do not eat any food or fluids-per protocols-before testing. -IV fluids will be given to promote relaxation, local anesthesia is administered. -expect a burning sensation of feeling of heat, pain or nausea while contrast material is injected, these reactions are normal and transient -remain on strict bed rest for 4-8 hours or more as per protocol. a urinal or bedpan must be used in the meantime -drink extra fluids 2000mL-3000mL over the 24-hour post procedure period.
Pyelonephritis s/s
-flank pain or tenderness, chills, fever, and malaise occurs in clients with acute Pyelonephritis -frequency and burning on urination are present if there is accompanying cystitis- bladder infection - -some client with chronic Pyelonephritis are asymptomatic -other have low-grade fever and vague GI complaints -polyuria and nocturia develop when the tubules of the nephrons fail to reabsorb water efficiently
renal failure dietary restriction and pt teaching
-follow the diet and fluid intake recommended by the physician. Do not use salt substitutes- which often contains potassium- unless allowed by the physician -take medications exactly as prescribed by the physician -do not use any nonprescription drugs unless use is approved by the physician - measure and recod fluid intake and urine output. limit fluid as recommended -avoid exposure to those with any type of infection such as colds, and sore throats, and flu -monitor BP as recommended by the physician -keep skin clean and dry. take brief showers with tepid waterl pat skin to dry, and use moisturizing lotions or creams like Eucerin, Nivea, Alpha Keri, or Lubriderm. -avoid scratching -when doing laundry, use a mild laundry detergent. use an extra rinse cycle to remove all detergents or add 1 tsp of vineger per quart of water to the rinse cycle to remover detergent residue -keep a record of daily wt, and report any rapid wt gain to the physician -take frequent rest periods, avoid heavy exercise -if any of the following occur, contact the physician immediately- inability to urinate, slow decrease in daily urine output, wt gain-more than 5 lbs or amount recommended by physician, chill, fever, sore throat, cough, blood in the urine or stool. easy bleeding or bruising, lethargy, extreme fatigue, persistent headache, N/V and diarrhea
polycystic kidney disease medical/ surgical management
-has no cure, but some interventions reduce the rate of progression -hypertension is treated with antihypertensive , diuretic medications, and sodium restrictions -despite these interventions, hypertension is difficult to control -if urinary infections develop, they are treated with antibiotics -low RBCs counts are treated with iron supplement, injections of erythropoietin (Epogen) , or blood transfusion -Nephrotoxins medications, such as NSAIDS and cephalosporin antibiotics, are AVOIDED. -Dialysis substitutes for kidney function when renal failure occurs and while the client awaits an organ transplant. -surgical removal of one or both kidneys may be required.
acute Pyelonephritis treatments-
-includes relieving fever and pain, prescribing antimicrobial drugs such as trimethoprim-sulfamethoxazole. -TMP-SMZ gentamycin with w/out ampicillin, cephalosporin, or ciprofloxacin -Cipro-for 14 days -two weeks after the client completes initial treatment, a follow-up urine culture is done -antispasmodics and anticholinergics such as oxybutynin -Ditropan- propantheline -Pro-Banthine are additional pharmacologic interventions that relax the smooth muscles of the ureters and bladder, promote comfort, and increase bladder capacity symptoms usually disappear within a few days of antibiotic therapy. -four to 6 weeks of drug therapy are prescribed for clients with a history of frequent relapsing infections with the same mircroorganism
radical cystectomy in women
-includes removal of the bladder, lower third of both ureters, uterus, fallopian tube, ovaries, anterior vaginal wall, and urethra
systemic complications of chronic renal failure--- neurologic
-lethargy, confusion, depression, seizures, coma
renal cancer-tumors of the kidney- causes
-the cause of kidney tumors is unknown. -the incidence is higher in older adults, which suggest chronic exposure to carcinogen whose metabolites involve renal excretion -bladder cancer is associated with the carcinogenic effects of long term cigarette smoking. - it is possible that renal tumor is similarily initiated through this mechanism or exposure to some other environmental toxin-ex- asbestos or volatile-ex-gasoline. -because the kidneys are deeply protected in the body, tumors can become quite large before causing symptoms. as the tumor enlarges, it occupies space, extending into adjacent renal structures and interfering with urine outflow. -tumor cells tend to metastasize by way of the renal vein and vena cava to the lungs, bones, lymph nodes, liver, and brain - lung metastases predominate -sometime the first symptoms occur when the tumor has metasasized to other organs
bladder training for clients who have not had an indwelling catheter
-the nurse instructs the client to try to void every hours. - usually, the client is not able to retain urine longer than an hour, and frequent voiding is necessary to prevent incontinence -gradually the client lengthens the intervals between voiding, 2,3, or 4 hrs. -many clients do not empty the bladder, and they must be catheterized after voiding to remove residual urine -when the client is catheterized for residual urine, the nurse records the amount removed.
urinary incontince s/s
-urgency, frequency, leaking sm amount when coughing or sneezingm complete inability to control urine, -test such as a urine culture and sensitivity, cystoscopy, or urodynamics are used to determine the type of incontinece.
s/s of cystitis
-urgency, frequency, low back pain, dysuria, perineal and suprpubic pain, and hematuria esp at the termination of the stream., -if bacteria is present, the client may feel chills, fever, -chronic cystitis-usually less severe symptoms
function of the kidney
-urine formation -excretion of waste products -regulation of electrolytes -regulation of acid-base balance -control over water balance -control of blood pressure -renal clearance -regulation of RBC production -synthesis of Vitamin D to active form -risk for fractures, soft tissue get hard. -secretion of prostaglandins - cause contriction of blood vessels the vascular smooth muscles. -regulates calcium and phosphorus balance -activates growth hormone,
urologic endoscopic procedure
-urologic endoscopic procedure use cystoscopy, which is the direct visual examination of the inside of the urethra and bladder using an instrument called a cystoscope. - the procedure can also be used to examine ereteral orifices, the prostatic urethra in males, and the ureters and pelvis of the kidneys. -sm. catheters are passed through the cystoscope to accomplish this. -the cystoscope consists of a lighted tube with a telescopic lens. a video camera can be placed over the lens to get still or moving images.
medical treatment of bladder cancer
-varies according to the grade and stage of the tumor -matastases usually have not occurred as long as the tumor has not penetrated the muscle wall of the bladder - small, superficial tumorsmay be removed by cutting - resection- or coagulation (fuluration) with a transurethral resectoscope - the same instrument used in a transurethral resection of the prostate- -bladder removed in this manner have a high incidence or reoccurrence- a cystoscope examination is performed every 2 to 3 months -clients with no recurrence of the tumor for at least 1 year require cystoscopic examination every 6 months for the rest of their lives so that recurrences pf the tumor or a new malignant growth can be detected early. -
s/s of urinary and renal calculi
-vary in size, location, and cause. -sm stones may pass unnoticed, however sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi - the pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone -the pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicles or tip of the penis in men, or the urinary meatus or labia in women -the severity of the pain is usually inversely proportional to the size of a stone -smaller stones travel more rapidly down the ureter, causing more forceful ureteral spasms- greater pain -the severity of the pain cause cause N/V, and shock - if any infections occur, the client may experience chills, fever, and serious hypotension -urinary retention or dysuria may accompany obstruction -the kidney pelvis and ureter may become remarkedly enlarged as a consequence of urinary obstruction , and a mass may be palpated -the client may also experience renal tenderness
the nurse collects information about the following
-voiding changes or disturbances -urine vol changes -irritative voiding symptoms - frequency, urgerncy, nocturia, dysuria. -abstructive voiding symptoms- hesitancy, straining, residual urine, retention, urinary stream force and size. - urinary incontinence- total overflow, stress, urge, functional. -urine characteristics changes- color, hematuria, clarity, odor, pH. -systemic manifestation- fever, weight loss -GI s/s - N/V diarrhea, abdominal cramping, distention. -pain- type, location, severity, local, referred, colic, spasms. -masses of the flank, abdomen, or genital area-polycystic kidneys, hydronephrosis, renal cell carcinoma. -abnormal abdominal or genital appearances. -sexual or reproductive dysfunction
urine culture and sensitivity
-when infection is suspected, a urine specimen may be taken by culture by collecting a clean-catch medistream specimen or by urinary catheterization. it is important that the urine specimen not be contaminated by skin bacteria. the container is labeled with the client's name and the time and date of the voiding. to prevent growth of the bacteria in the urine and decomposition, the nurse ensures delivery of urine specimen immediately to the laboratory or refrigerate it promptly until it can be taken to the lab.
Normal creatinine
0.6-1.2
normal serum K+ level
3.5-5.0
in general, adult bladders hold
300-500 ml of urine
Normal BUN
7-20 can be affected by dehydration - elevated result or overhydration- lower than normal result
in chronic Pyelonephritis
=develops after recurrent episodes of acute Pyelonephritis -the kidneys manifest irreversible degenerative changes and become small and atrophies. -if destruction of nephrons is extensive, renal failure develops. -renal dysfunction may not occur for 20 years or more years after the onset of the disease. -about 10 % to 15 % of clients with chronic Pyelonephritis requires dialysis
IVP
Intravenous (IV) urogaphy includes --- intravenous pyelography (IVP and excretory urography -these procedures are radiologic studies used to evaluate the structure and function of the KUB -it locates the site of any urinary tract obstruction and is helpful is the investigation of the causes of flank pain, hematuria, and renal colic. -it is based on the ability of the kidneys to excrete a radioplaque dye- contrast medium- in the urine. -the IV radioplaque dye outlines the kidney pelves, ureters, and bladder as the blood containing the dye passes through the urinary tract. -after the IV injection the contrast material, multiple x-rays of the urinary tract are taken after 1 min. -kidney visualization- at 3 to 5 mins, renal collecting system visualization -at 10 mins- ureters visualization at 20 to 30 mins-bladder filling visualization -a postvoiding x-ray -- shows emptying of the bladder
clean catch specimen collection
a clean catch midstream specimen from the first voiding of the morning is perferred -wash your hands and removes the lid from the specimen container without touching the inside of the lid -open antiseptic towelette packages and cleanse the urethral area. - females- hold labia apart with one hand. Wipe down one side of the urethra with the first towelette and discard, wipe the other side towelette and discard, and wipe down the center with the third towelette and discard. wipe one time only with each towelette one time. -males- retract foreskin if uncircumcised. clean the urethral meatus in a circular motion using each towelette one time -begin voiding into the toilet, urinal, or bedpan, females, continue to hold apart while voiding -void 30-50mL of the midstream urine into the collection container and then finish urinating into the toilet, bedpan, or urinal. be careful not to contaminate the container - carefully replace the lid, dry the container if necessary, and wash your hands.
Nitrate - always mean infection, bacteria -treated with antibiotic NONE
abnormal findings +
RBC none, 0 0-3 rbc
abnormal findings 2+ >3 RBC
WBC -trace, small amount, +1 0-4 wbc
abnormal findings 3+ , moderate, larger >4 wbc
pH 4.5- 7.5
abnormal findings >7.5
Glucose None
abnormal findings glycosuria
ketones: none
abnormal findings ketonuria
crystals - none to few
abnormal findings many- risk for kidney stones
urinalysis normal & abnormal characteristics urine osmolality 50-1200 mOsm/kg normal 500-800 mOsm/kg average
abnormal findings normal is elevated average is decreased
protein none
abnormal findings proteinuria
Bacteria moderate, large negative
abnormal findings positive
angiography- the nurse ask the client
about allergy to iodine or seafood and any previous dye reactions. A laxative may be given prior to the procedure to empty the colon and ensure an unobstructed image. -reviews pertinent lab tests-blood urea nitrogen(BUN), creatinine. to assess renal function, record VS, peripheral pulses -instructs the client to void before the procedure. -if ordered he or she administers a sedative to promote relaxation before the procedure, -after the procedure the physician applies pressure dressing to the femoral area ,which remains in place for several hours. -palpate the pulses in the legs and feet at least every 1 to 2 hours for signs of aterial occlusion. -monitoring the pressure dressing is important to note frank bleeding or hematoma formation. -if either conditions occur, the nurse immediately notifies the physician. another important assessment is for hypersensitivity responses to contrast materials. the nurse also monitors and documents I&O's
urinary incontinence
affect many clients and is a major healthcare concern -not only a psychosocial problem but also a physical problem in skin breakdown and UTIs may result.
acute glomerulonephritis usually occurs
as a result of bacterial infection, which include group A beta-hemolytic streptococcal infections, bacterial endocarditis, or impetigo -viral infection such as Hepatitis B or C, HIV, varicella-zoster virus, or Epstein_Barr virus can also cause glomerulonephritis -the relationship between the infection and acute glomerulonephritis is not clear. - Microorganisms are not present in the kidney when symptoms appear, but the glomeruli are acutely inflamed. -most believe that the inflammatory response is from antigen-antibody stimulationin the glomerular capillary membrane -the disruption of membrane permeability causes RBC's amd protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine
surgical management of incontinece
bladder augmentation - a procedure that increases the storage capacity of the bladder. Periurethral bulking- placement of sm amounts of collagen in urethral walls to aid the closing pressure -implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination -retropubic suspension - an open abdominal procedure that involves lifting and anchoring the bladder and the urethra to the pelvis wall through the vagina and pubic ligaments - usually done in conjunction with another open abdominal surgery such as a hysterectomy -anterior repair- a procedure that increases support to the bladder by tightening the vaginal wall under the urethra -transvaginal needle suspension -- a procedure in which the bladder and urethra are attached to the pubic bone or fibrous tissue of the rectum through two vaginal incisions and a midline suprapubic incision -sling procedure- a procedure in which a small vaginal incision is used to place a piece of synthetic or natural ( harvested from the inner thigh or abdomen) material under the bladder neck; it is secured to the abdominal wall or pelvis bone to create a hammock -type lifting of the urethra - Sacral nerve stimulator implantation- implamentation of of a sm device similar to a pacemaker that acts on nerves that control bladder and pelvis floor contractions. it is implanted under the skin in the abdomen. the wire connected to the sacral nerve emits electrical pulses to stimulate the nerve and help control the bladder. The client does not experience pain and is relieved from heavy leaking in many cases -surgical correction of anatomic problems - Urethroplasty- surgery to repair structures damaged by trauma
use of tobacco products is the cause of
bladder cancer
urinalysis normal & abnormal characteristics specific gravity- 1.003- 1.030
dilute (1.00-1.010) or concentrated -(1.029-1.030)
urinary and renal calculi- surgical management -- after any of these surgical procedure
drainage of urine from the affected kidney is accomplished with a nephrostomy tube during the healing process -a nephrostomy tube, also called the pyelostomy tube, is a catheter inserted through the skin into the renal pelvis. -a nephrostomy tube is used to manage any obstruction of urine flow above the bladder -the tube is kept in place with a suture through the skin -unlike the bladder, the kidney pelvis can hold only 5 - 8 mL of urine if a blood clot pr kinking or compression of the tubing impairs urinary drainage for even a short time. hydronephrosis and damage to surgically repair tissue can result -the client complains of pain if the renal pelvis become distended with urine
within each cortex are microscopic nephrons that carry out the functions of the kidney
each kidney contains about 1 million nephrons, which are the smallest functioning units of the kidney. -Each nephron consists of glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, the loop of Henle, and the collecting tubules.
physical examination symptoms that indicate renal or urinary tract disorder-
ex- periorbital edema
the bladder, urethra, and pelvic floor muscles
form the urethrovesical unit.
glomerulonephritis s/s
have no symptoms. -early symptoms may be so slight that the client does not seek medical attention -the onset is sudden, with pronounced symptoms such as fever, nausea, malaise, headache, generalized edema, or periorbital edema, puffiness around the eyes pink-or cola-colored urine from RBC's being excreted in the urine- hematuria -foamy-appearing urine from proteinuria - excess serum albumin excreted in the urine. -hypertension -edema with evidence of swelling in the hands, feet, abdomen, and periorbital edema -fatigue related to anemia or kidney failure - some clients experience pain or tenderness over the kidney area and mild to moderate hypertension -their appetite may be poor, and nocturia may be present -irritability, SOB -as the condition progresses, obvious hematuria, anemia, convulsions associated with hypertension, CHF, oliguria, anuria -fluid retentionand hypertension contribute to visual disturbances, often as a result of papilledema or hemorrhage in the eye, and epistaxis
cystoscopy is used to
identify the cause of painless hematuria, urinary incontinence, or urinary retention. It is useful in the evaluation of structural and functional changes in the bladder. -is either inserted through the urethra into the bladder or is inserted percutaneously through a sm. abdominal incision. -urologist may obtain urine specimens, biopsy specimens-tissue examination,cell washing o cytologic analysis-or remove calculi-stones- -local anesthesia is used when the client is having a lower tract cystoscopy
how to perform post-void residuals
immediate catherization. if catherter cannot be inserted through the urethra, special urologic instruments that dilate the urethra may be used CIC - clean intermittent catherization - is preferred treatment - use of crede maeuver - manual -use of valsalva maneuver
systemic complications of chronic renal failure--- immunologic
impaired immune function, decreased antibody production, increased incidence of hep B and other infections.
kegal exercise
increase muscle tone and aid in voluntary control of bladder.
what is urethritis?
inflammation of the urethra is seen more commonly in men than in women
calculus
is a precipitate of mineral salts that ordinarily remain dissolved in urine -about 70-80 % of renal calculus in the US are composed of calcium oxalate, calcium phosphate, or both -others are composed of calcium phosphate, uric acid, cystine, and magnesium ammonium phosphate, or struvite. -stones can be smooth, jagged, or staghorn-shaped -can occur anywhere in the urinary tract from the kidney pelvis and beyond.
ureterolithiasis
is a stone in the ureter -ureteral stones are usually small, some may be no larger than a grain of sand.
Pyelonephritis
is an acute or chronic bacterial infection of the kidney and the lining of the collecting system (kidney pelvis)
what is cystitis?
is an inflammation of the urinary bladder -the inflammation is usually caused by bacterial infection. -bacteria can invade the bladder from the infection in the kidneys, lymphatic, and urethra. -infection is women is more common because the urethra is short. -causes of cystitis include urologic instrumentals, fecal contamination, prostatititis or benign prostatic hyperplasia, indwelling catheters, pregnancy and sexual intercourse.
acute nephritic syndrome
is another term that is used to describe the clinical manifestations of glomerular inflammation -primary glomerulonephritis can progress tp chronic glomerulonephritis, and there is a risk of kidney failure in some clients
acute renal failure
is characterized by a sudden or rapid decrease in renal function, is potentially irreversible with early, aggressive treatment of its contributing etiology
chronic renal failure
is characterized by progressive and irreversible damage to the nephrons. it may take months to years for CRF to develop
urinary and renal calculi- surgical management - nephrectomy
is indicated if a stone has permanently and severely damaged a kidney beyond adequate function. the other kidney must be fully functional
renal failure
is the inability of the nephrons in the kidney to maintain fluid, electrolytes, and acid-base balances; excrete nitrogen waste products , and perform regulatory functions such as maintaining calcification of bones and producing erythropoietin. there are two types of renal failure- acute and chronic
urinary retention
is the inability to urinate or effectively empty the bladder. -can be either acute or chronic -acute- complete urethral obstruction, after general anesthesia, administration of certain drugs- atropine or phenothiazine. -chronic retention- client with disorders- prostatic enlargment, or neurologic disorders that resilt in a neurogenic bladder. -usually cannot void -client with chronic urinary retention may be able to void but does not completely empty the bladder, retention with overflow- and has a large residual vol. -the residual urine is urine retained in the bladder after the client voids. the amount varyh from 30 mL to several hundred mL
acute glomerulonephritis
is the inflammation of the glomeruli in the kidneys -the glomeruli are capillaries that filter substances from the plasma
congenital kidney disorder- polycystic kidney disease-
is the result of a heredity trait -the two manifestations of polycystic kidney disease are the infantile and adult form -the infantile form is rare -it may cause fetal death-before delivery- -early neonatal death, or renal failure during childhood. -the adult form generally has its onset between 30 and 40 years of age, but it can occur at any age. -it insidiously progresses to renal insufiiciency. -once renal failure develops, polycystic disease usually is fatal within 4 years, unless the client receives dialysis treatment or an organ transplant -the kidneys are the primary organs involved, but the polycysts can also occur in the liver or other organs -women and men are affected equally -death usually results from renal failure or the complications of hypertensive cardiovascular disease.
glomerulonephritis treatment
no specific treatment exists for acute glomerulonephritis. perserving kidney function and preventing complications are the primary goals -treatment is guided by the symptoms and the inderlying abnormality -treatment may consist of bed rest, a sodium restricted diet- if edema or hypertension is present. -antimicrobial drugs to prevent superimposed infection -pinicillin may be used to abolish any remaining streptococci from the recent infection -diuretics to reduce edema and antihypertension agent for severe hypertension may be necessary -vitamins are added to the diet to improve general resistance, or oral iron supplements by be added to counteract anemia. -corticosteroids and immunosuppressive agents may be given to treat a rapidly progressive inflammatory process -any increase in hemturia, proteinuria, or BP indicates a need for aggressive treatment -the client is not considered cured until the urine is free of protein and RBCs for 6 months. -return to full activity is usually not permitted until the urine is free of protein for 1 month.
Primary glomerulonephritis
occurs when independently of other chronic conditions but usually is an acute postinfectious process
when a client is unable to control the storage and passage of urine
or when the bladder training fails , the client may exhibit varying degrees of anxiety and depression. - the nurse needs to offer constant encouragement throughout the bladder training program reducing anxiety may contribute to success of the bladder training program
systemic complications of chronic renal failure--- sensory
peripheral neuropathies
risk factors for urinary incontinence
pregnancy- vaginal delivery, episiotomy -menopause, -Genitourinary surgery -pelvic muscle weakness -incompetent urethra as a result of trauma or sphincter relaxation -immobility -high-impact exercises -Diabetes mellitus -stroke -age-related changes in the urinary tract -morbid obesity - cognitive distubances- dementia, Parkison's disease -medication - diuretics, sedatives, hypnotics, opioids -caregiver or toilet unavailable
acute Pyelonephritis
presents with moderate-to-severe symptoms that usually lasts 1 to 2 weeks. -if the treatment of acute Pyelonephritis is unsuccessful and the infection recurs; it is term chronic Pyelonephritis
Chronic Pyelonephritis treatment
prevent progressive kidney damage -when possible, any urinary tract obstruction is relieved to save the kidney from destruction -an effort is made to improve the client's overall health. -a nephrectomy, the surgical removal of a kidney, is performed if severe hypertension develops and if the other kidney has adequate function
renal cancer-tumors of the kidney - treatment
radical nephrectomy, including removal of the tumor, adrenal gland, surrounding perinephric fat, and fascia, is the treatment for a malignant renal tumor. for clients have early stage renal cancer or only have one kidney, the tumor may be removed from the kidney, leaving the kidney and surrounding tissues intact. -a laparoscopic nephrectomy may be done on clients with early stage carcinome. -when a tumor arises in the collecting system or the ureter, a complet nephroureterectomy - removal of the kidney or ureter is done. - a cuff or bladder tissue is removed as well because the recurrence rate in any stump of ureter left behind is high -surgery may be followed by radiation therapy, chemotherapy, hormonal therapy, and or immunotherapy while the client is still in the hospital or on a postdischarge basis -for some clients, surgery may be too risky. - in these cases, treatment may involve embolization or cryoablation. -Embolization involves occlusion of the renal artery to kill the tumor cells -Cryoablation uses special needles called cryoprobes to freeze and then thaw cancer cells, eventually destroying the cancerous cells. Ct scans are used to monitor the process -if extensive metastases are found, only palliative treatment is given -in this case, the physician explains to the client and family that the treatment measures are not curative
kidney and ureteral stones -- urolithiasis
refers to a condition of stones -calculus- plural calculi - in the urinary tract -when a stone forms
what is hemodyalysis?
requires transporting blood from the client through a dialyzer, a semipermeable membrane filter in a machine -the dialyzer contains many tiny hollow fibers. -blood moves through the hollow fibers. -water and wastes from the blood move into the dialysate fluid that flows around the fibers, but protein and RBCs do not, -the filtered blood is returned to the client. -the entire cycle takes 4 to 6 hours and is performed three times a week
secondary glomerulonephritis
results from other conditions, such as lupus erythematosus or diabetes.
