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Chapter 74

Interventions for Clients with

Renal Disorders

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Polycystic Kidney Disease

Inherited disorder in which fluid-filled

cysts develop in the nephrons

Etiology and Genetic Risk Autosomal dominant form

50% chance of inheritance

Autosomal recessive form

25% chance of inheritance(Continued)

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Polycystic Kidney Disease(Continued)

Key features include: Abdominal or flank pain Hypertension

Nocturia Increased abdominal girth Bloody or cloudy urine Kidney stones Constipation

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Interventions/Complications

Acute and chronic pain NSAIDs and ASA CAUTIOUSLY

Lipid soluble antibiotics Bactrim, Septra, Cipro

Constipation Fluid, fiber, exercise

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Interventions/Complications

Hypertension and renal failure Nursing interventions to promote self-management and

understanding Fluid therapy

Drink at least 2 liter of fluid per day

Restrict sodium intake to control BP Fluid restriction is not necessary

Drug therapy Antihypertensive agents diuretics

Measure and record blood pressure Diet therapy

Low sodium diet? Protein

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Hydronephrosis,

Hydroureter, and UrethralStricture Provide privacy for elimination. Conduct Cred maneuver as necessary.

Apply double-voiding technique.

Apply urinary catheter as appropriate.

Monitor degree of bladder distention.(Continued)

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Hydronephrosis,Hydroureter, and UrethralStricture(Continued) Catheterize for residual. Intermittently catheterize as appropriate.

Follow infection protection measures.

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Nephrostomy

Client preparation

Procedure

Follow-up care including: Assess for

amount of drainage.

type of urinary damage expected.

manifestations of infection. Monitor nephrostomy site for leaking urine.

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Pyelonephritis

Bacterial infection in the kidney (upper

urinary tract)

Key features include: Fever, chills, tachycardia, and tachypnea Flank, back, or loin pain

Abdominal discomfort

Turning, nausea and vomiting, urgency,frequency, nocturia

General malaise or fatigue

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Key Features of ChronicPyelonephritis Hypertension

Inability to conserve sodium

Decreased concentrating ability

Tendency to develop hyperkalemia and

acidosis

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Acute Pain Interventions

Pain management interventions

Lithotripsy

Percutaneous ultrasonic pyelolithotomy

Diet therapy

Drug therapy Antibiotics

Urinary antiseptics

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Surgical Management

Preoperative care Antibiotics

Client education

Operative procedure: pyelolithotomy,

nephrectomy, ureteral diversion, ureter

reimplantaton

Postoperative care for urologic surgery

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Potential for Renal Failure

Interventions include: Use of specific antibiotics

Compliance with therapies and regular follow-

up Blood pressure control

Fluid therapy

Diet therapy Other interventions

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Renal Abscess

A collection of fluid and cells caused by

an inflammatory response to bacteria

Manifestations: fever, flank pain, general

malaise

Drainage by surgical incision or needle

aspiration

Broad-spectrum antibiotics

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Renal Tuberculosis

Diagnosis

Antitubercular therapy with rifampin,

isoniazid, and pyrazinamide

Complications renal failure, kidney

stones, obstruction, and bacterial

superinfection of the urinary tract

Surgical excision possible

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Acute Glomerulonephritis

Assessment Onset approximately 10 days from time of

infection.

Streptococcal infection most common

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Acute Glomerulonephritis

Management of infection

Prevention of complications Diuretics

Sodium, water, potassium, and protein

restrictions

Dialysis, plasmapheresis

Client education

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ChronicGlomerulonephritis Develops over a period of 20 to 30 years

or longer AssessmentEdema:

presacral tissue

Pedal

Pretibial

Adventitious breath

sounds

Uremic symptoms

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Chronic Glomerulonephritis

Interventions include: Slowing the progression of the disease and

preventing complications

Diet changes(Continued)

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ChronicGlomerulonephritis(Continued) Fluid intake

Drug therapy

Dialysis, transplantation

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Nephrotic Syndrome

Condition of increased glomerular

permeability that allows larger molecules

to pass through the membrane into the

urine and be removed from the blood Severe loss of protein into the urine

(Continued)

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Nephrotic Syndrome(Continued)

Treatment involves: Immunosuppressive agents

Angiotensin-converting enzyme inhibitors

Heparin Diet changes

If GFR is normal, dietary intake of complete proteins

is needed

Mild diuretics and sodium restriction

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Nephrosclerosis

Thickening in the nephron blood vessels,

resulting in narrowing of the vessel lumen

Occurs with all types of hypertension,

atherosclerois, and diabetes mellitus Collaborative management: control high

blood pressure and preserve renal

function

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Renovascular Disease

Profoundly reduces blood flow to the kidneytissue

Causes ischemia and atrophy of renal tissue Diagnosis

Magnetic resonance angiography Renal vein renin levels Radionuclide imaging

Interventions: drugs to control high bloodpressure and procedures to restore the renalblood supply

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Diabetic Nephropathy

Diabetic nephrophathy is a microvascular

complication of either type 1 or type 2

diabetes.

First manifestation is persistentalbuminuria.

Avoid nephrotoxic agents and

dehydration. Assess need for insulin.

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Cysts and Benign Tumors

Thorough evaluation for cancer is needed.

Cyst can fill with fluid and cause local

tissue damage as it enlarges.

Many cysts cause no symptoms.

Cysts are a structural birth defect that

occur in fetal life.

Simple renal cysts are drained by

percutaneous aspiration.

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Renal Cell Carcinoma

Paraneoplastic syndromes include

anemia, erythrocytosis, hypercalcemia,

liver dysfunction, hormonal effects,

increased sedimentation rate, andhypertension.

PTH produced by tumor cells can cause

hypercalcemia (Continued)

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Renal Cell Carcinoma(Continued)

Nonsurgical management includes: Radiofrequency ablation, although effect is

not known

Chemotherapy: limited effect Biological response modifiers and tumor

necrosis factor: lengthen survival time

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Surgical Management

Preoperative care

Operative procedure

Postoperative care:

Monitoring Assess for hemorrhage and adrenal insufficiency

Altered LOC

Hypotension

Decreased urine output

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Surgical Management

Post-op Care Cont. pain management

Opioid analgesics

prevention of complications

Antibiotics Steroids

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Renal Trauma

Minor injuries such as contusions, small

lacerations

Major injuries such as lacerations to the

cortex, medulla, or branches of the renalartery

Pedicle injuries are lacerations or breaks

in the renal artery or renal vein.

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Renal Trauma

Collaborative management

Nonsurgical management: drug therapy

and fluid therapy Dopamine

Clotting

Surgical management: nephrectomy or

partial nephrectomy Bench surgery