Showing posts with label genitourinary tract disorder. Show all posts
Showing posts with label genitourinary tract disorder. Show all posts

DISORDERS OF THE GENITOURINARY TRACT

Thursday, May 22, 2008 | Labels: | 0 Comments  

Nephrectomy

  1. General information
    1. Surgical removal of an entire kidney
    2. Indications include renal tumor, massive trauma, removal for a donor, polycystic kidneys
  2. Nursing interventions: preoperative care
    1. Provide routine pre-op care.
    2. Ensure adequate fluid intake.
    3. Assess electrolyte values and correct any imbalances before surgery.
    4. Avoid nephrotoxic agents in any diagnostic tests.
    5. Advise client to expect flank pain after surgery if retroperitoneal approach (flank incision) is used.
    6. Explain that client will have chest tube if a thoracic approach is used.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Assess urine output every hour; should be 30-50 ml/hour.
    3. Observe urinary drainage on dressing and estimate amount.
    4. Weigh daily.
    5. Maintain adequate functioning of chest drainage system; ensure adequate oxygenation and prevent pulmonary complications.
    6. Administer analgesics as ordered.
    7. Encourage early ambulation.
    8. Teach client to splint incision while turning, coughing, deep breathing.
    9. Provide client teaching and discharge planning concerning
      1. Prevention of urinary stasis
      2. Maintenance of acidic urine
      3. Avoidance of activities that might cause trauma to the remaining kidney (contact sports, horseback riding)
      4. No lifting heavy objects for at least 6 months
      5. Need to report unexplained weight gain, decreased urine output, flank pain on unoperative side, hematuria
      6. Need to notify physician if cold or other infection present for more than 3 days
      7. Medication regimen and avoidance of OTC drugs that may be nephrotoxic (except with physician approval)

Monday, May 19, 2008 | Labels: | 0 Comments  

Kidney Transplantation

  1. General information
    1. Transplantation of a kidney from a donor to recipient to prolong the life of person with renal failure
    2. Sources of donor selection
      1. Living relative with compatible serum and tissue studies, free from systemic infection, and emotionally stable
      2. Cadavers with good serum and tissue crossmatching; free from renal disease, neoplasms, and sepsis; absence of ischemia/trauma.
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Discuss the possibility of post-op dialysis/ immunosuppressive drug therapy with client and significant others.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Monitor fluid and electrolyte balance carefully.
      1. Monitor I&O hourly and adjust IV fluid administration accordingly.
      2. Anticipate possible massive diuresis.
    3. Encourage frequent and early ambulation.
    4. Monitor vital signs, especially temperature; report significant changes.
    5. Provide mouth care and nystatin (Mycostatin) mouthwashes for candidiasis.
    6. Administer immunosuppressive agents as ordered.
      1. Cyclosporine (Sandimmune): does not cause significant bone marrow depression. Assess for hypertension; blood chemistry alterations (hypermagnesemia, hyperkalemia, decreased sodium bicarbonate); neurologic functioning.
      2. Azathioprine (Imuran): assess for manifestations of anemia, leukopenia, thrombocytopenia, oral lesions.
      3. Cyclophosphamide (Cytoxan): assess for alopecia, hypertension, kidney/liver toxicity, leukopenia.
      4. Antilymphocytic globulin (ALG), antithymocytic globulin (ATG): assess for fever, chills, anaphylactic shock, hypertension, rash, headache.
      5. Corticosteroids (prednisone, methylprednisolone sodium succinate [Solu-Medrol]): assess for peptic ulcer and GI bleeding, sodium/water retention, muscle weakness, delayed healing, mood alterations, hyperglycemia, acne.
    7. Assess for signs of rejection. Include decreased urinary output, fever, pain/ tenderness over transplant site, edema, sudden weight gain, increasing blood pressure, generalized malaise, rise in serum creatinine, and decrease in creatinine clearance.
    8. Provide client teaching and discharge planning concerning
      1. Medication regimen: names, dosages, frequency, and side effects
      2. Signs and symptoms of rejection and the need to report immediately
      3. Dietary restrictions: restricted sodium and calories, increased protein
      4. Daily weights
      5. Daily measurement of I&O
      6. Resumption of activity and avoidance of contact sports in which the transplanted kidney may be injured.

Monday, May 19, 2008 | Labels: | 0 Comments  

Chronic Renal Failure

  1. General information
    1. Progressive, irreversible destruction of the kidneys that continues until nephrons are replaced by scar tissue; loss of renal function gradual
    2. Predisposing factors: recurrent infections, exacerbations of nephritis, urinary tract obstructions, diabetes mellitus, hypertension
  2. Medical management
    1. Diet restrictions
    2. Multivitamins
    3. Hematinics
    4. Aluminum hydroxide gels
    5. Antihypertensives
  3. Assessment findings
    1. Nausea, vomiting; diarrhea or constipation; decreased urinary output; dyspnea
    2. Stomatitis, hypotension (early), hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub, CHF
    3. Diagnostic tests: urinalysis
      1. Protein, sodium, and WBC elevated
      2. Specific gravity, platelets, and calcium decreased
  4. Nursing interventions
    1. Prevent neurologic complications.
      1. Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).
      2. Assess for changes in mental functioning.
      3. Orient confused client to time, place, date, and persons; institute safety measures to protect client from falling out of bed.
      4. Monitor serum electrolytes, BUN, and creatinine as ordered.
    2. Promote optimal GI function.
      1. Assess/provide care for stomatitis
      2. Monitor nausea, vomiting, anorexia; administer antiemetics as ordered.
      3. Assess for signs of GI bleeding.
    3. Monitor/prevent alteration in fluid and electrolyte balance.
    4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel, AlternaGEL) as ordered.
    5. Promote maintenance of skin integrity.
      1. Assess/provide care for pruritus.
      2. Assess for uremic frost (urea crystallization on the skin) and bathe in plain water.
    6. Monitor for bleeding complications, prevent injury to client.
      1. Monitor Hgb, hct, platelets, RBC.
      2. Hematest all secretions.
      3. Administer hematinics as ordered.
      4. Avoid IM injections.
    7. Promote/maintain maximal cardiovascular function.
      1. Monitor blood pressure and report significant changes.
      2. Auscultate for pericardial friction rub.
      3. Perform circulation checks routinely.
      4. Administer diuretics as ordered and monitor output.
      5. Modify digitalis dose as ordered (digitalis is excreted in kidneys).
    8. Provide care for client receiving dialysis.

Monday, May 19, 2008 | Labels: | 0 Comments  

Acute Renal Failure

  1. General information
    1. Sudden inability of the kidneys to regulate fluid and electrolyte balance and remove toxic products from the body
    2. Causes
      1. Prerenal: factors interfering with perfusion and resulting in decreased blood flow and glomerular filtrate, ischemia, and oliguria; include CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, burns, septicemia, hypotension
      2. Intrarenal: conditions that cause damage to the nephrons; include acute tubular necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, acute glomerulonephritis, tumors, blood transfusion reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes, pesticides, anesthetics)
      3. Postrenal: mechanical obstruction anywhere from the tubules to the urethra; include calculi, BPH, tumors, strictures, blood clots, trauma, anatomic malformation
  2. Assessment findings
    1. Oliguric phase (caused by reduction in glomerular filtration rate)
      1. urine output less than 400 ml/24 hours; duration 1-2 weeks
      2. manifested by hypernatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesemia, and metabolic acidosis
      3. diagnostic tests: BUN and creatinine elevated
    2. Diuretic phase (slow, gradual increase in daily urine output)
      1. diuresis may occur (output 3-5 liters/day) due to partially regenerated tubule's inability to concentrate urine
      2. duration: 2-3 weeks; manifested by hyponatremia, hypokalemia, and hypovolemia
      3. diagnostic tests: BUN and creatinine elevated
    3. Recovery or convalescent phase: renal function stabilizes with gradual improvement over next 3-12 months
  3. Nursing interventions
    1. Monitor/maintain fluid and electrolyte balance.
      1. Obtain baseline data on usual appearance and amount of client's urine.
      2. Measure I&O every hour; note excessive losses.
      3. Administer IV fluids and electrolyte supplements as ordered.
      4. Weigh daily and report gains.
      5. Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed (see Tables 4.5 and 4.6).
    2. Monitor alteration in fluid volume.
      1. Monitor vital signs, PAP, PCWP, CVP as needed.
      2. Weigh client daily.
      3. Maintain strict I&O records.
      4. Assess every hour for hypervolemia; provide nursing care as needed.
        1. maintain adequate ventilation.
        2. decrease fluid intake as ordered.
        3. administer diuretics, cardiac glycosides, and antihypertensives as ordered; monitor effects.
      5. Assess every hour for hypovolemia; replace fluids as ordered.
      6. Monitor ECG and auscultate heart as needed.
      7. Check urine, serum osmolality/ osmolarity, and urine specific gravity as ordered.
    3. Promote optimal nutritional status.
      1. Weigh daily.
      2. Maintain strict I&O.
      3. Administer TPN as ordered.
      4. With enteral feedings, check for residual and notify physician if residual volume increases.
      5. Restrict protein intake.
    4. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, contractures, atelectasis; see Table 4.21).
    5. Prevent fever/infection.
      1. Take rectal temperature and obtain orders for cooling blanket/antipyretics as needed.
      2. Assess for signs of infection.
      3. Use strict aseptic technique for wound and catheter care.
    6. Support client/significant others and reduce/relieve anxiety.
      1. Explain pathophysiology and relationship to symptoms.
      2. Explain all procedures and answer all questions in easy-to-understand terms.
      3. Refer to counseling services as needed.
    7. Provide care for the client receiving dialysis if used.
    8. Provide client teaching and discharge planning concerning
      1. Adherence to prescribed dietary regime
      2. Signs and symptoms of recurrent renal disease
      3. Importance of planned rest periods
      4. Use of prescribed drugs only
      5. Signs and symptoms of UTI or respiratory infection, need to report to physician immediately

Monday, May 19, 2008 | Labels: | 0 Comments  

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