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Urinary disorders - watson


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Urinary disorders - watson

  2. 2. PYELONEPHRITIS<br />
  3. 3. PYELONEPHRITIS<br /> A bacterial infection in the kidney and renal pelvis- the upper urinary tract. It is either the presence of active organisms in the kidney of the effects of kidney infections.<br />an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis.<br />
  4. 4. ACUTE PYELONEPHRITIS<br />CHRONIC PYELONEPHRITIS<br />results from repeated or continued upper urinary tract infection or the effects of such infections. <br />involves chronic inflammation and scarring of tubules and interstitial tissues of the kidney.<br />common cause: renal failure<br />other causes: UTI’s, hypertension, severe vesicoureteral reflux, obstruction of the urinary tract.<br />is the active bacterial infection. It involves acute intestinal inflammation, tubular cell, necrosis, and possible abscess formation.<br />results from an infection that ascends to the kidney from the lower urinary tract.<br />risk factors: pregnancy, obstruction, and congenital malformation<br />onset is typically rapid.<br />
  5. 5. P<br />A<br />T<br />H<br />O<br />P<br />H<br />Y<br />S<br />I<br />O<br />L<br />O<br />G<br />Y<br />
  6. 6. ASSESSMENT<br />SYSTEMIC<br />URINARY<br /><ul><li>vomiting
  7. 7. diarrhea
  8. 8. acute fever
  9. 9. chills
  10. 10. malaise
  11. 11. urinary frequency
  12. 12. dysuria
  13. 13. pyuria
  14. 14. hematuria
  15. 15. flank pain
  16. 16. tenderness</li></li></ul><li>DIAGNOSTIC TESTS<br />Urinalysis to assess for pyuria, bacteria, and blood cells in the urine. A bacteria count greater than 100,000 (105) per milliliter is indicative of infection. Rapid tests for bacteria in the urine include using a nitrite dipstick (which turns pink in the presence of bacteria) and the leukocyte esterase test, an indirect method of detecting bacteria by identifying lysed or intact white blood cells (WBC’s) in the urine.<br />Related nursing care:<br />Provide a clean specimen cup for a sample of urine. <br />Note if client is menstruating. <br />Assess medications, fluid status, and foods that might affect the urinalysis results.<br />
  17. 17. Urine culture and sensitivity tests may be ordered to identify the infecting organism and the most effective antibiotic. Culture requires 24 to 72 hours, so treatment to eliminate the most common organism is initiated without culture.<br />Related nursing care:<br />Provide client with sterile container.<br />After cleaning, tell client to begin voiding and collect specimen in a clean container.<br />If client is unable to void, it may be necessary to obtain a specimen with a urinary catheterization.<br />
  18. 18. Intravenous pyelography(IVP), also know as excretory urography, is used to evaluate the structure and excretory function of the kidneys, ureters, and bladder. As the kidneys clear and intravenously injected contrast medium from the blood, the size and shape of the kidneys, their calices and pelvises , the ureters, and the bladder can be evaluated, and structural or functional abnoramilities, such as vesicoureteral reflux, may be detected.<br />Related nursing care before the procedure:<br />Ask about allergy to seafood, iodine, or radiologic contrast dye. Notify physician if allergies are known.<br />Withhold food for 8hours prior to test. Clear liquids are allowed. Laxative and enema or suppositories are use to clear the bowel of feces and gas.<br />Obtain baseline vital signs and record.<br />After the test<br />Monitor vital signs and urine output.<br />Increase fluid intake after the test is completed.<br />
  19. 19. Voiding cystourethrographyinvolves instilling contrast medium into the bladder, then using x-rays to assess the bladder and urethra when filled and during voiding. This study can detect structural or functional abnormalities of the bladder and urethral strictures. This test has a lower risk of allergic response to the contrast dye than IVP. <br />Related nursing care:<br />Tell the client that the bladder will be filled and during filling, he/she will be ask to describe the first urge to void, and the sensation of being unable to delay urination any longer.<br />
  20. 20. Manual pelvic or prostate examinations are done to assess for structural changes of the genitourinary tract, such as prostatic enlargement, cystocele, or rectocele.<br />
  21. 21. Complications of Pyelonephritis<br />Sepsis<br />Infection<br />Acute kidney failure<br />Recurrent pyelonephritis<br />
  22. 22. Nursing Diagnosis<br />Acute pain related to infection and inflammatory process in the urinary tract.<br />Rationale:<br /> Pain is a common manifestation of both lower and upper UTI. Urinary tract pain is caused by distention and increase pressure within the tract. The inflamed bladder wall and urethra causes dysuria, pain and burning on urination. Bladder spasms develop causing severe, stabbing discomfort. Pain associated with pyelonephritis is often steady and dull, localized to the outer abdomen or flank region.<br />
  23. 23. Nursing Diagnosis<br />Impaired urinary elimination related to inflammation as evidenced by: frequency, urgency and dysuria.<br />Rationale:<br />Inflammation of the bladder and urethral mucosa affects the normal process and patterns of voiding, causing frequency, urgency, and dysuria.<br />
  24. 24. Nursing Diagnosis<br />Deficient knowledge related to lack of information about risk factors for pyelonephritis.<br />Rationale:<br /> Clients with pyelonephritis is at an increase risk for future UTI and needs to understand the disease process, risk factors, measures to prevent the current infection, diagnostic procedures and home care. Failure to complete the full course of therapy and follow-up could lead to continued bacteriuria and recurrent infections.<br />
  25. 25. Nursing Interventions:<br />MEDICAL<br /> 1. urinary anti-infectives– use prophylactically to prevent recurrence of UTI.<br />Examples: Nitrofurantoin, Trimethoprim<br />Nursing Responsibilities:<br /><ul><li>Ensure adequate fluid intake
  26. 26. Administer with meals
  27. 27. Do not administer Trimethoprim to pregnant woman
  28. 28. Have the client rinse mouth thoroughly after administering Nitrofurantoin.</li></li></ul><li>Nursing Interventions:<br />2. Urinary Analgesic – use to relieve urinary tract pain, burning sensation, frequency & urgency associated with UTI.<br />Example: Phenazopyridine<br />Nursing Responsibilities:<br /><ul><li>Monitor urine output, weight, serum creatinine & BUN
  29. 29. Stop the drug if the sclera or skin become yellow pinch
  30. 30. Take with meals & increase fluid intake</li></li></ul><li>Nursing Interventions:<br />3. Antibiotics<br />Example: Ciprofloxacin, Gentamicin & Ceftriaxone, Ampicillin<br />Nursing Intervention:<br /><ul><li>Follow urine culture is scheduled following completion of antibiotic therapy
  31. 31. It requires 7-10 day course of antibiotic therapy</li></li></ul><li>Nursing Interventions:<br />B. Surgical<br /> 1.Ureteroplasty– surgery of choice<br /><ul><li>Surgical repair of a ureter
  32. 32. Maybe indicated for structural abnormality or stricture of a ureter
  33. 33. The client returns from these surgeries with an indwelling catheter & a ureteral stent (a thin catheter inserted into the ureter to provide for urine flow & ureteral support), which remains in place for 3-5days.</li></li></ul><li>Nursing Interventions:<br />C. NURSING CARE<br />Encourage increase fluid intake especially during hot weathers & strenuous activities<br />Discuss the need to empty the bladder every 3-4 hours & avoid urinary retention<br />Teach to void every after sexual intercourse<br />Avoid bubble baths, feminine hygiene sprays & douches<br />Wear cotton underwears & avoid synthetic materials<br />Drink 2glasses of cranberry juice daily unless contraindicated<br />
  35. 35. ACUTE GLOMERULONEPHRITIS<br />Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. <br />Inflammation of the glomerular capillary membrane. It can result from systemic diseases or primary glomerular diseases.<br />Most common form: Acute streptoccocalglomerulonephritis.<br />
  36. 36. ACUTE GLOMERULONEPHRITIS<br />Post streptococcal AGN.<br />Primary glomerular diseases include IgA nephropathy, mesangial proliferative disease, membroproliferative disease, and antiglomerular basement membrane disease. Infectious causes include staphylococcus bacteremia, pneumococcal bacteremia, meningococcemia, and mycoplasma. <br />Viral causes include hepatitis A, Influenza A and B, Adenovirus, EBV, cytomegalovirus, measles, and mumps. <br />Multi-system diseases include SLE, Henoch-Schonleinpurpura (HSP), necrotizing fasciitis, Goodpasture syndrome, Wegener granulamatosis, TTP, hemolytic uremic syndrome, and cryoglobunemia.<br />
  37. 37. P<br />A<br />T<br />H<br />O<br />P<br />H<br />Y<br />S<br />I<br />O<br />L<br />O<br />G<br />Y<br />
  38. 38. ASSESSMENT<br />
  39. 39. Diagnostic<br />Erythrocyte sedimentation rate (ESR) – is a general indicator of inflammatory response. It maybe elevated in acute post-streptococcal glomerulonephritis.<br />KUB (kidney, ureter, bladder abdominal x-ray) – may be done to evaluate kidney size & rule out other causes of manifestations. The kidneys maybe enlarged in acute glomerulonephritis. <br />kidney scan – a nuclear medicine procedure, allows visualization of the kidney after intravenous administration of a radioisotope. In glomerulonephritis, the uptake & excretion of radioactive material are delayed.<br />
  40. 40. Related nursing care:<br /> - assess the client for allergies to iodine, x-ray dye & seafood<br /> - tell the client to remain NPO for 4hrs. Prior to test<br /> - laxative or enemas to remove gas or fecal material from the bowel<br />Biopsy – most reliable diagnostic procedure for glomerular disorders. It helps to determine the type of glomerulonephritis, the prognosis, & the appropriate treatment. It is done percutaneously by inserting a biopsy needle through the skin into the kidney to obtain a tissue sample.<br />
  41. 41. Related nursing care before the procedure:<br /> - NPO status from midnight before the procedure<br /> - inform consent is required for kidney biopsy<br /> - instruct the patient not to breathe when the needle is inserted to prevent kidney motion<br />After the procedure:<br /> - monitor closely for bleeding during the first 24hours.<br /> - monitor urine output for quantity.<br /> - avoid coughing & strenuous activities after the procedure.<br />
  42. 42. Blood Urea Nitrogen (BUN) – measures urea nitrogen, the end product of protein metabolism. Normal BUN values: 5-25mg/dl.<br />Urinalysis – shows RBC & proteins in the urine of clients with glomerular disorder. A 24hr urine specimen is use to determine the amount of protein in the urine. Normal value: <2-3/HPF, no RBC casts<br />
  43. 43. Complications<br />Hypersensitive encephalopathy<br />Heart failure<br />Pulmonary edema<br />End stage <br />
  44. 44. Nursing Diagnosis<br />Excess fluid volume related to plasma protein deficit in sodium & water retention <br />Rationale:<br />When proteins are lost in the urine, the oncotic pressure of plasma falls, fluid shifts into the interstitial spaces. The body response to this fluid shift by any sodium & water to maintain intravascular volume, leading to excess fluid volume.<br />
  45. 45. Nursing Diagnosis<br />Fatigue related to plasma protein loss & anorexia<br />Rationale:<br />Fatigue is a common manifestations of glomerular disorders. Anemia , loss of proteins, anorexia compound this fatigue. The ability to maintain usual physical & mental activities are impaired.<br />
  46. 46. Nursing Diagnosis<br />Risk for infection related to compromised immune system secondary to medical treatment<br />Rationale:<br />The effects of both glomerular & treatment with anti-inflammatory & cytotoxic drugs can depress the immune system, increasing the risk for infection. The anti-inflammatory effects of corticosteroid may also mask early manifestations of infections.<br />
  47. 47. Nursing Interventions<br />A. MEDICAL<br /><ul><li>Penicillin for residual streptococcal infection
  48. 48. Diuretics & anti-hypertensive agents
  49. 49. Corticosteroid & immunosuppresants for rapidly progressing disease
  50. 50. Plasma exchange(plasma pheresis) in treatment with immunosuppresant, corticosteroid & cytotoxic drugs
  51. 51. Dialysis</li></li></ul><li>Nursing Management<br />Restrict diatary protein with renal insufficiency & BUN<br /> Sodium intake<br /> CHO for energy<br />MIO + Weight<br />Control & prevention of infection<br />Patient teaching<br />Bed rest – Provide ROM exercises<br />
  53. 53. Chronic Glomerulonephritis<br /> Typically the end stage of other glomerular disorder.<br />Slow, progressive distraction of the glomeruli & a gradual decline in renal function are characteristics of chronic glomerulonephritis.<br />Kidneys decrease in size symmetrically & their surfaces become granular. Eventually, entire nephrons are lost.<br />
  54. 54. Etiology<br />No evidence of predisposing infection can be found<br />The course of chronic glomerulonephritis is extremely varied.<br />
  55. 55. P<br />A<br />T<br />H<br />O<br />P<br />H<br />Y<br />S<br />I<br />O<br />L<br />O<br />G<br />Y<br />
  56. 56. Assessment<br />Common signs & symptoms – not oftenly recognized until s/sx of renal failure develop.<br />Neck vein distention from fluid overload<br />Periorbital and peripheral edema<br />Feet slightly swollen at night<br />Weightloss and nocturia<br />Headache especially in the morning, dizziness and GI disturbances – most common <br />Dyspnea on excertion (DOE)<br />Blurring of vision<br />
  57. 57. Diagnostics<br />Urinalysis – fixed specific gravity of 1.010, variable proteinuria and urinary casts<br />Blood studies related to renal failure progression : hyperkalemia, metabolic acidosis, anemia, hypoalbuminemia, electrolyte – imbalances<br />Chest X-ray: cardiac enlargement and pulmonary edema<br />ECG: may reflect left ventricular hypertrophy<br />Impaired nerve conduction; mental status changes<br />
  58. 58. Complications<br />Renal failure<br />Heart failure<br />Pulmonary complications<br />
  59. 59. Nursing Diagnosis<br />Excess fluid related to destruction of glomeruli and decrease renal funtion<br />Rationale:<br />In chronic glomerulonephritis, kidneys cannot excrete adequate urine to maintain a normal extracellular fluid balance. Rapid weight gain and edema indicate fluid retention. In addition, heart failure and pulmonary edema may develop.<br />
  60. 60. Nursing Diagnosis<br />Imbalance nutrition: Less than body requirements related to inability to absorb CHON and nutrients secondary to renal insufficiency<br />Rationale<br />Anorexia associated with chronic glomerulonephritis often interere with food intake and nutrition. Nutrition needs is further aggravated because of the progressive destruction of the glomeruli. Kidneys decrease in size and their surfaces become roughened, impairing renal function.<br />
  61. 61. Nursing Diagnosis<br />Ineffective role performance related to fatigue & muscle weakness<br />Rationale:<br />Manifestations and treatments of glomerular disorders can affect the ability to maintain usual roles and activities. Fatigue and muscle weakness may limit physical and social activities.<br />
  62. 62. Nursing Interventions<br />MEDICAL<br /><ul><li>Diuretics are administered to reduce fluid overload
  63. 63. Sodium intake
  64. 64. Protein diet
  65. 65. Bed rest with HOB elevated
  66. 66. Dialysis – to minimize the risk of complications of renal failure</li></ul> - to keep patient in optimal physical condition<br /> - to prevent fluid and electrolyte imbalances<br />
  67. 67. Nursing Interventions<br />B. Nursing Management<br />Record inatake and output q4-8 hrs<br />Report changes in fluid and electrolyte status, and in cardiac and neurologic status<br />Educate patient about prescribed treatment plan and risk of non-compliance<br />Instruct recommended diet and fluid modifications; provide medication teaching.<br />Provide patient and family assistance about dialysis and long-term implications.<br />
  69. 69. Thank you….<br /><br />