Renal DisordersRenal Disorders

Renal/Urinary Renal/Urinary DisordersDisorders

Renal/Urinary DisordersRenal/Urinary DisordersI.I. Cystitis (lower UTI)Cystitis (lower UTI)A.A. Assessment Assessment 1.1. Definition: inflammation of the bladder Definition: inflammation of the bladder

wallwall2.2. Incidence Incidence a.a. More common in women; pregnancy; More common in women; pregnancy;

position of urethra, proximity to bowelposition of urethra, proximity to bowelb.b. High incidence related to indwelling High incidence related to indwelling

urinary cathetersurinary cathetersc.c. 90 % nosocomial or hospital induced- E. 90 % nosocomial or hospital induced- E.

coli coli

Predisposing/precipitating factorsPredisposing/precipitating factorsa.a. Poor hygiene after urination, defecationPoor hygiene after urination, defecationb.b. Sexual intercourseSexual intercoursec.c. Urological instrumentation of bladderUrological instrumentation of bladderd.d. Urethral obstructionUrethral obstructione.e. Structural or functional urinary Structural or functional urinary

abnormalityabnormalityf.f. Chronic health problems such as Chronic health problems such as

diabetes, strep throat (group A diabetes, strep throat (group A betahemolytic strep)betahemolytic strep)

Signs and symptoms:Signs and symptoms:a.a. 50% may be asymptomatic 50% may be asymptomatic b.b. UrgencyUrgencyc.c. Frequency urination, both day and Frequency urination, both day and

night (nocturia)night (nocturia)d.d. Burning (dysuria) *Burning (dysuria) *e.e. Bladder spasms (tenesmus)Bladder spasms (tenesmus)f.f. Foul-smelling urine (hematuria)Foul-smelling urine (hematuria)g.g. Bloody urine (hematuria)Bloody urine (hematuria)h.h. Increased WBC count Increased WBC count

Diagnostic Tests Diagnostic Tests a.a. Urinalysis: bacterial count more Urinalysis: bacterial count more

than 10,000/ml for catheter than 10,000/ml for catheter specimen specimen

b.b. Urine culture and sensitivity: Urine culture and sensitivity: midstream; obtain before starting midstream; obtain before starting antibiotics; cleanse urethra antibiotics; cleanse urethra

Complications:Complications:a.a. ReinfectionReinfectionb.b. Retrograde pyelonephritis Retrograde pyelonephritis

Implementation Implementation a.a. Medications Medications (1) Single dose antibiotics when (1) Single dose antibiotics when

infection localized to bladder & infection localized to bladder & organism antibiotic sensitive; organism antibiotic sensitive; amoxicillin, ampicillin, amoxicillin, ampicillin, trimethoprim, co-trimethoxazole trimethoprim, co-trimethoxazole (Bactrim, Septra)(Bactrim, Septra)

2. Antimicrobials, antiseptics for 7 to 2. Antimicrobials, antiseptics for 7 to 14 days; sulfisoxazole (Gantrisin), 14 days; sulfisoxazole (Gantrisin), nitrofurantoin (Furadantin), nalidixic nitrofurantoin (Furadantin), nalidixic acid (NegGram), methenamine acid (NegGram), methenamine mandelate (Mandelamine)mandelate (Mandelamine)

3. Combined antiseptics, analgesic; 3. Combined antiseptics, analgesic; phenazopyridine hydrochloride phenazopyridine hydrochloride (Pyridium); stains urine red-orange (Pyridium); stains urine red-orange color color

b. Diet b. Diet (1)(1) Force 3000 cc fluid per day to Force 3000 cc fluid per day to

encourage movement of pathogens encourage movement of pathogens out of urinary tractout of urinary tract

(2)(2) Cranberry juice in large quantities Cranberry juice in large quantities to lower urine pHto lower urine pH

(3)(3) Discourage caffeine products Discourage caffeine products (coffee, tea, and cola) because they (coffee, tea, and cola) because they exacerbate frequencyexacerbate frequency

c. Teach client health promotionc. Teach client health promotion(1)(1) Teach to:Teach to:(a)(a) Urinate when urge to void presentUrinate when urge to void present(b)(b) Drink at least 8 glasses of water per Drink at least 8 glasses of water per

dayday(c)(c) Cleanse properly after urination and Cleanse properly after urination and

defecation (front to back)defecation (front to back)(d)(d) Identify causes and S/Sx of early UTIsIdentify causes and S/Sx of early UTIs(e)(e) Take medications for prescribed period, Take medications for prescribed period,

usually 10 to 14 daysusually 10 to 14 days(f)(f) Follow up with repeated urine tests, Follow up with repeated urine tests,

cultures cultures

II. Pyelonephritis (Upper UTI)II. Pyelonephritis (Upper UTI)A.A. AssessmentAssessment1.1. Definition: inflammation of kidney Definition: inflammation of kidney

tissue (renal pelvis, parenchyma)tissue (renal pelvis, parenchyma)2.2. Incidence Incidence a.a. Most commonly caused by bacterial Most commonly caused by bacterial

invasion, for example E.coliinvasion, for example E.colib.b. Often diagnosed secondary to Often diagnosed secondary to

cystitis when kidney already affectedcystitis when kidney already affectedc.c. May be retrograde or blood-borne in May be retrograde or blood-borne in

origin origin

3. Predisposing/precipitating factors3. Predisposing/precipitating factorsa.a. May follow cystitis May follow cystitis b.b. In children, associated with urinary In children, associated with urinary

tract abnormalities (vesicourethral tract abnormalities (vesicourethral reflux)reflux)

c.c. In adults, common pre-existing In adults, common pre-existing factors are bladder tumors, factors are bladder tumors, prostatic hypertrophy, strictures, prostatic hypertrophy, strictures, and urinary stonesand urinary stones

d. Instrumentation or trauma to d. Instrumentation or trauma to urinary tracturinary tract

e. Pregnancye. Pregnancyf. Chronic health problems, diabetes, f. Chronic health problems, diabetes,

analgesia abuse, polycystic and analgesia abuse, polycystic and hypertensive kidney disease hypertensive kidney disease

Signs and symptoms: same as cystitis, Signs and symptoms: same as cystitis, plusplus

a.a. FeverFeverb.b. ChillsChillsc.c. MalaiseMalaised.d. Flank painFlank paine.e. Costovertebral (CVA) tendernessCostovertebral (CVA) tendernessf.f. Most common Dysuria Most common Dysuria

Diagnostic TestsDiagnostic Testsa.a. Urinalysis: casts, bacteria, large Urinalysis: casts, bacteria, large

amounts of WBCs, RBCs, pus, high amounts of WBCs, RBCs, pus, high alkaline pHalkaline pH

b.b. Blood: leukocytosis, positive Blood: leukocytosis, positive culturescultures

c.c. IVP: enlargement of involved IVP: enlargement of involved kidney(s) kidney(s)

d.d. Renal biopsy: to confirm diagnosis Renal biopsy: to confirm diagnosis and/or complications and/or complications

ComplicationsComplicationsa.a. Scarring and fibrosis of infected Scarring and fibrosis of infected

part of kidneypart of kidneyb.b. Chronic pyelonephritisChronic pyelonephritisc.c. Chronic renal failure:; 1/3 of cases Chronic renal failure:; 1/3 of cases

have pyelonephritis as original have pyelonephritis as original diagnosisdiagnosis

Implementation Implementation 1.1. Assist with diagnostic tests to Assist with diagnostic tests to

determine underlying cause.determine underlying cause.2.2. Monitor urine for appearance, color, Monitor urine for appearance, color,

and specific gravity; monitor and specific gravity; monitor temperature and administer temperature and administer antipyretics; monitor I&O, weight, antipyretics; monitor I&O, weight, S/Sx of fluid and electrolyte S/Sx of fluid and electrolyte imbalances; provide relief of flank imbalances; provide relief of flank pain with analgesics, rest, and pain with analgesics, rest, and massagemassage

3. Administer orally for 10 to 14 days (if 3. Administer orally for 10 to 14 days (if mild) or IV (if severe) antibiotics such as mild) or IV (if severe) antibiotics such as sulfamethoxazole (Bactrim, Septra), sulfamethoxazole (Bactrim, Septra), tetracycline, ampicillin, cephalosporinstetracycline, ampicillin, cephalosporins

4. Rest4. Rest5. Encourage fluid intake at least 3L per 5. Encourage fluid intake at least 3L per

dayday6. Teach clients importance of follow-up 6. Teach clients importance of follow-up

urinalysis every 2 weeks for a month then urinalysis every 2 weeks for a month then monthly until urine is sterilemonthly until urine is sterile

7. Teach client to report chills; symptoms 7. Teach client to report chills; symptoms of UTI such as frequency, burning, of UTI such as frequency, burning, urgencyurgency

III. Glumerulonephritis III. Glumerulonephritis A.A. AssessmentAssessment1.1. Definition: non bacterial inflammation Definition: non bacterial inflammation

of glomeruli of both kidneys, which of glomeruli of both kidneys, which involves an antigen-antibody reaction involves an antigen-antibody reaction

2.2. Incidence Incidence a.a. Most common in preschool and Most common in preschool and

grade-school aged childrengrade-school aged childrenb.b. Commonly follows by 1-3 weeks a Commonly follows by 1-3 weeks a

respiratory infection (sore throat or respiratory infection (sore throat or tonsillitis) or skin infection (impetigo) tonsillitis) or skin infection (impetigo)

Predisposing/precipitating factorsPredisposing/precipitating factorsa.a. Frequently follows Frequently follows group A hemolytic group A hemolytic

strep or staph aureusstrep or staph aureus infection infection b.b. Lupus erythemaLupus erythemac.c. HypertensionHypertensiond.d. Diabetes mellitusDiabetes mellituse.e. Disseminated intravascular Disseminated intravascular

coagulation (DIC)coagulation (DIC)f.f. Exposure to drugs or immunizations Exposure to drugs or immunizations

Signs and symptoms Signs and symptoms a.a. Shortness of breath (SOB)Shortness of breath (SOB)b.b. Headache Headache c.c. Fever, chillsFever, chillsd.d. Fatigue, weaknessFatigue, weaknesse.e. Anorexia, nausea, vomitingAnorexia, nausea, vomitingf.f. Rapidly swelling face and feetRapidly swelling face and feetg.g. Pains in backPains in backh.h. Hypertension Hypertension

i. Smoky brown urinei. Smoky brown urinej. Oliguriaj. Oliguriak. Proteinuriak. Proteinurial. Hematuria l. Hematuria

Diagnostic tests Diagnostic tests a.a. Urinalysis: proteinuria, hematuria, Urinalysis: proteinuria, hematuria,

cell debris, high specific gravity cell debris, high specific gravity b.b. CBC: anemiaCBC: anemiac.c. Serum BUN, creatinine, albuminSerum BUN, creatinine, albumind.d. ASO titersASO titerse.e. Renal biopsy, if indicated Renal biopsy, if indicated

Complications Complications a.a. Chronic glomerulonephritis Chronic glomerulonephritis b.b. Congestive heart failureCongestive heart failurec.c. Pulmonary edemaPulmonary edemad.d. Renal failure Renal failure

Implementation Implementation 1.1. Relieve Sx of headache and fever Relieve Sx of headache and fever

with appropriate analgesics and with appropriate analgesics and massage; monitor temperaturemassage; monitor temperature

2.2. Bedrest, for up to several months, Bedrest, for up to several months, until BP normal, and proteinuria, until BP normal, and proteinuria, hematuria, and edema subsidehematuria, and edema subside

3.3. Reduce edema by restricting fluids Reduce edema by restricting fluids and sodium and by administering and sodium and by administering diuretics- for example, furosemide diuretics- for example, furosemide (Lasix); measure I&O, monitor weight (Lasix); measure I&O, monitor weight

4. Control BP by frequent monitoring and by 4. Control BP by frequent monitoring and by administration of antihypertensives – for administration of antihypertensives – for example, clonidine (Catapress), example, clonidine (Catapress), hydralazine (Apresoline) and methyldopa hydralazine (Apresoline) and methyldopa (Aldomet); also, administer diuretics and (Aldomet); also, administer diuretics and monitor K+monitor K+

5. Dietary 5. Dietary a.a. Na+ restriction for moderate to severe Na+ restriction for moderate to severe

edemaedemab.b. Protein restriction while oliguria, Protein restriction while oliguria,

proteinuria, and elevated BUN/creatinine proteinuria, and elevated BUN/creatinine present present

c. Fluid intake according to urine c. Fluid intake according to urine outputoutput

d. High calories and carbohydrates d. High calories and carbohydrates 6. Administer penicillin treatment 6. Administer penicillin treatment

(check for allergies) for up to 2 (check for allergies) for up to 2 months: avoid exposure to infections months: avoid exposure to infections and activities that could potentiate and activities that could potentiate reinfection reinfection

7. Teach client health maintenance 7. Teach client health maintenance a.a. Importance of prompt medical Importance of prompt medical

treatment for sore throats and upper treatment for sore throats and upper respiratory or skin infections; cultures respiratory or skin infections; cultures to be taken and when indicated, to be taken and when indicated, appropriate antibiotics appropriate antibiotics

b.b. Reporting S/Sx of hematuria, elevated Reporting S/Sx of hematuria, elevated BP, edema, and headache BP, edema, and headache

c.c. Importance of compliance with Importance of compliance with treatment including medications, treatment including medications, bedrest, dietary restrictions bedrest, dietary restrictions

Renal Failure Renal Failure Acute Renal FailureAcute Renal Failure1.1. Assessment Assessment A. Definition: sudden loss of kidney’s A. Definition: sudden loss of kidney’s

ability to excrete urine (oliguria) and ability to excrete urine (oliguria) and nitrogenous waste products nitrogenous waste products (azotemia) and to maintain fluid and (azotemia) and to maintain fluid and pH balance; potentially reversible pH balance; potentially reversible disease in which 50% recover with disease in which 50% recover with conservative management conservative management

B. Incidence B. Incidence 1.1. Usually occurs in previously healthy Usually occurs in previously healthy

individualsindividuals2.2. Follows identifiable trauma or Follows identifiable trauma or

contract with nephrotoxic agentcontract with nephrotoxic agent3.3. Often follows surgical proceduresOften follows surgical procedures

Precipitating/predisposing factors Precipitating/predisposing factors 1.1. Prerenal causes: are decrease in renal Prerenal causes: are decrease in renal

blood flow that may include blood flow that may include dehydration, blood loss, shock, dehydration, blood loss, shock, trauma, burnstrauma, burns

2.2. Intrarenal causes: are those that result Intrarenal causes: are those that result from primary damage to kidney, such from primary damage to kidney, such as glomerulonephritis, pyelonephritis, as glomerulonephritis, pyelonephritis, and blood transfusion reactionsand blood transfusion reactions

3.3. Postrenal causes: are related to Postrenal causes: are related to obstructions of urinary tract distal to obstructions of urinary tract distal to kidneys, such as calculi or BPH kidneys, such as calculi or BPH

Signs and symptoms Signs and symptoms 1.1. Initiating/oliguria stage: time from Initiating/oliguria stage: time from

precipitating event to anuria (urine less precipitating event to anuria (urine less than 100 cc per day)than 100 cc per day)

2.2. Oliguria/anuria stage: lasts 1 to 2 weeksOliguria/anuria stage: lasts 1 to 2 weeksa.a. Decreased skin turgor, petechiae, Decreased skin turgor, petechiae,

prurituspruritusb.b. Dried mucous membranesDried mucous membranesc.c. Pallor, discolored skinPallor, discolored skind.d. Weight changes, edemaWeight changes, edemae.e. Acidotic breath odorAcidotic breath odor

f. Anorexia, nausea, vomitingf. Anorexia, nausea, vomitingg. Drowsiness, lethargy, confusion, g. Drowsiness, lethargy, confusion,

comacomah. Restlessness, tetany, seizuresh. Restlessness, tetany, seizures3. Diuretic, early stage3. Diuretic, early stagea.a. BUN stops risingBUN stops risingb.b. Urine output 4 to 5 L per dayUrine output 4 to 5 L per dayc.c. Increase in both mental and Increase in both mental and

physical activity levelphysical activity level

4. Recovery, late stage4. Recovery, late stagea.a. BUN starts falling to within normal limitsBUN starts falling to within normal limitsb.b. Urine output 4 to 5 L per dayUrine output 4 to 5 L per dayc.c. Increase in both mental and physical Increase in both mental and physical

activity levelactivity level5. Convalescent stage 5. Convalescent stage a.a. May take months to recover fully when May take months to recover fully when

BUN and urine both within normal limitsBUN and urine both within normal limitsb.b. May develop chronic renal failure (CRF)May develop chronic renal failure (CRF)

Diagnostic testsDiagnostic tests1.1. Serum tests show elevated BUN, Serum tests show elevated BUN,

creatinine, K+, sodium, pH, and CO2; creatinine, K+, sodium, pH, and CO2; decreased Ca2+ and RBCdecreased Ca2+ and RBC

2.2. Urine tests show output of less than Urine tests show output of less than 20 cc per hour; fixed specific gravity 20 cc per hour; fixed specific gravity of 1.010; excretion of protein, RBCs, of 1.010; excretion of protein, RBCs, WBCs, and castsWBCs, and casts

3.3. Microscopic exams show that Microscopic exams show that basement membrane of tubules basement membrane of tubules destroyed and that glomeruli filter at destroyed and that glomeruli filter at much slower ratemuch slower rate

4. X-rays may show an enlarged or 4. X-rays may show an enlarged or normal-sized kidney on KUB and will normal-sized kidney on KUB and will rule out obstructionrule out obstruction

5. ECG may show peaked T-waves if 5. ECG may show peaked T-waves if there is an elevated K+there is an elevated K+

Complications Complications 1.1. Cardiac failureCardiac failure2.2. Pulmonary edemaPulmonary edema3.3. Septic shockSeptic shock4.4. Chronic renal failure Chronic renal failure

Treatment Treatment 1.1. Reverse cause Reverse cause 2.2. Low protein diet Low protein diet 3.3. Supportive care Supportive care

Low protein foodsLow protein foodsFruits, fresh or cannedFruits, fresh or cannedGreen vegetablesGreen vegetablesCarrotsCarrotsPotatoesPotatoesMargarineMargarineBreadsBreadsFarina Farina SherbetSherbetCorn starchCorn starchWheat starch Wheat starch

High protein foodsHigh protein foodsMeatsMeatsEggsEggsFishFishMilkMilkSoybeansSoybeansGelatin Gelatin Protein supplement Protein supplement YogurtYogurtPeanut butterPeanut butterCheeseCheeseLegumesLegumesProtein-fortified cereals Protein-fortified cereals

Implementation Implementation A.A. Be alert to conditions that may Be alert to conditions that may

precipitate renal failure and prevent precipitate renal failure and prevent themthem

B.B. Assist in determining cause of renal Assist in determining cause of renal failurefailure

C.C. Encourage a low-protein diet to Encourage a low-protein diet to decrease work of kidneys; increase decrease work of kidneys; increase calories, either by mouth or TPN; calories, either by mouth or TPN; restrict Na+ and K+ according to restrict Na+ and K+ according to electrolytes; restrict fluids to equal electrolytes; restrict fluids to equal output output

D. Administer medications to treat symptomsD. Administer medications to treat symptoms1.1. Anti-infectives to treat organismsAnti-infectives to treat organisms2.2. Antacids such as Amphogel to bind Antacids such as Amphogel to bind

phosphates phosphates 3.3. Alkalyzers such as NaHCO3 to treat Alkalyzers such as NaHCO3 to treat

acidosisacidosis4.4. Antihypertensives Antihypertensives 5.5. DiureticsDiuretics6.6. K+-lowering agents such as insulin, K+-lowering agents such as insulin,

glucose, & NaHCO3 by IV, Kayexalate, by glucose, & NaHCO3 by IV, Kayexalate, by NG tube or enema, or dialysis NG tube or enema, or dialysis

E. Supportive careE. Supportive care1.1. Strict monitoring of I&O Strict monitoring of I&O 2.2. Bedrest with side rails upBedrest with side rails up3.3. Oral hygieneOral hygiene4.4. Control for potential infection; skin Control for potential infection; skin

care for dryness and prurituscare for dryness and pruritus5.5. Calm environment Calm environment

Chronic Renal Failure Chronic Renal Failure AssessmentAssessmentA.A. Definition: slow, insidious, Definition: slow, insidious,

irreversible, ongoing deterioration of irreversible, ongoing deterioration of kidney function resulting in uremiakidney function resulting in uremia

B.B. IncidenceIncidence1.1. May follow ARFMay follow ARF2.2. More common in womenMore common in women3.3. Often follows glumerulonephritis Often follows glumerulonephritis

Predisposing/precipitating factorsPredisposing/precipitating factors1.1. Recurrent infections, exacerbations, Recurrent infections, exacerbations,

of nephritis, or obstructionsof nephritis, or obstructions2.2. Destruction of blood vessels from Destruction of blood vessels from

long-standing HPN or diabeteslong-standing HPN or diabetes3.3. Direct insult or trauma to kidney Direct insult or trauma to kidney

Signs and symptoms Signs and symptoms 1.1. Same with ARFSame with ARF2.2. Azotemia Sx such as lethargy, Azotemia Sx such as lethargy,

headache, fatigue, weight loss, headache, fatigue, weight loss, irritability, depressionirritability, depression

3.3. F&E Sx such as fluid retention, F&E Sx such as fluid retention, edema, anorexia, nausea, vomiting, edema, anorexia, nausea, vomiting, SOBSOB

4.4. Alterations in urine outputAlterations in urine output

5. Hypertension 5. Hypertension 6. Increased pigmentation of skin6. Increased pigmentation of skin7. Muscular twitching7. Muscular twitching8. Numbness of feet, legs 8. Numbness of feet, legs

Diagnostic testsDiagnostic tests1.1. Same as ARFSame as ARF2.2. Hyperuricemia, elevated serum Hyperuricemia, elevated serum

phosphate and calcium phosphate and calcium

Complications: same as those of ARFComplications: same as those of ARFTreatment Treatment 1.1. HemodialysisHemodialysis2.2. Peritoneal dialysisPeritoneal dialysis3.3. Renal transplant Renal transplant

ImplementationImplementationA.A. Similar to ARFSimilar to ARFB.B. Supportive measures: skin care, Supportive measures: skin care,

oral hygiene, rest, calm atmosphereoral hygiene, rest, calm atmosphereC.C. Fluid and electrolytesFluid and electrolytes1.1. Renal dietary restrictions per lab Renal dietary restrictions per lab

values and S/Sxvalues and S/Sx2.2. Monitor I&O; weigh client dailyMonitor I&O; weigh client daily3.3. Monitor extent of edema Monitor extent of edema

4. Vital signs (VS), including breath 4. Vital signs (VS), including breath soundssounds

5. Restrict fluids5. Restrict fluids6. Diet: high in carbohydrates and 6. Diet: high in carbohydrates and

within prescribed limits for protein, within prescribed limits for protein, Na+, K+, and phosphate Na+, K+, and phosphate

7. Give Basogel or amphojel to bind 7. Give Basogel or amphojel to bind phosphate phosphate

D. Provide treatment for underlying D. Provide treatment for underlying concurrent disorders concurrent disorders

E. Prevent infection, injuryE. Prevent infection, injury

F. Assist with dialysis F. Assist with dialysis 1.1. To correct fluid and electrolyte To correct fluid and electrolyte

problemsproblems2.2. To remove waste products and drugs To remove waste products and drugs

from systemfrom systemG. Discuss possibilities of kidney G. Discuss possibilities of kidney

transplant with client and familytransplant with client and family1.1. Recipient care similar to any major Recipient care similar to any major

surgery surgery 2.2. Donor care as with nephrectomy plus Donor care as with nephrectomy plus

immunosupression management immunosupression management

Nephrotic SyndromeNephrotic SyndromeI.I. Definition: is a a condition of Definition: is a a condition of

increased glomerular permeability increased glomerular permeability that allows larger molecules to that allows larger molecules to pass through the membrane into pass through the membrane into the urine and be removed from the the urine and be removed from the blood.blood.

II.II. Cause: immune or inflammatory Cause: immune or inflammatory processprocess

III. Signs and symptomsIII. Signs and symptomsa. massive proteinuriaa. massive proteinuriab. hypoalbuminemiab. hypoalbuminemiac. edema (ascites, scrotal, ankle)c. edema (ascites, scrotal, ankle)d. hyperlipidemiad. hyperlipidemiae. Anorexia, vomiting and e. Anorexia, vomiting and

diarrheadiarrheaf. pallor, lethargyf. pallor, lethargyg. hepatomegalyg. hepatomegaly

IV. Pathophysiology IV. Pathophysiology a.a. Proteinuria occurs because increased Proteinuria occurs because increased

glomeruli permeability leads to protein glomeruli permeability leads to protein loss. This results in hypoalbuminemia. loss. This results in hypoalbuminemia. With a low level of protein in the With a low level of protein in the bloodstream, osmotic pressure causes bloodstream, osmotic pressure causes fluid to shift from the bloodstream into fluid to shift from the bloodstream into interstitial tissue, causing edema.interstitial tissue, causing edema.

b.b. The hyperlipidemia occurs because the The hyperlipidemia occurs because the liver increases production of liver increases production of lipoproteins to try to compensate for lipoproteins to try to compensate for protein loss.protein loss.

c. Lipids are too large to be lost in c. Lipids are too large to be lost in urine and thus rise to high levels in urine and thus rise to high levels in the blood serum.the blood serum.

IV. Medical managementIV. Medical managementa.a. Corticosteroids to resolve edemaCorticosteroids to resolve edemab.b. Antibiotics for bacterial infectionsAntibiotics for bacterial infectionsc.c. Thiazide diuretics in edematous Thiazide diuretics in edematous

stagestage

V. Nursing interventionsV. Nursing interventionsa.a. Provide bed restProvide bed restb.b. Provide high protein, low sodium diet Provide high protein, low sodium diet

during edema phase onlyduring edema phase onlyc.c. Maintain skin integrityMaintain skin integrityd.d. Turn frequentlyTurn frequentlye.e. Avoid IM injections (medication is not Avoid IM injections (medication is not

absorbed into edematous tissue)absorbed into edematous tissue)f.f. Monitor intake and output, vital signs Monitor intake and output, vital signs

& weigh daily& weigh daily

Polycystic Kidney DiseasePolycystic Kidney Disease Hereditary disorder Hereditary disorder Two types: childhood and adult Two types: childhood and adult In adults usually manifested by age 40 years In adults usually manifested by age 40 years Grapelike cysts in place of normal kidney Grapelike cysts in place of normal kidney

tissuetissue Cysts enlarge, compress functional renal Cysts enlarge, compress functional renal

tissue, and result in renal failure tissue, and result in renal failure Signs and symptoms Signs and symptoms

Dull, aching abdominal, lower back or flank pain, Dull, aching abdominal, lower back or flank pain, or colicky pain that begins abruptlyor colicky pain that begins abruptly

Polycystic Kidney DiseasePolycystic Kidney Disease Medical treatment Medical treatment

Supportive treatment is recommended Supportive treatment is recommended to preserve kidney function, treat UTI, to preserve kidney function, treat UTI, and control hypertension and control hypertension

Infections treated promptly with Infections treated promptly with antibiotics antibiotics

Dialysis, nephrectomy, and Dialysis, nephrectomy, and transplantation once end-stage renal transplantation once end-stage renal disease developsdisease develops

Bladder CancerBladder Cancer Most common malignancy of urinary Most common malignancy of urinary

tracttract Ureteral orifices and bladder neck Ureteral orifices and bladder neck

are the most common sitesare the most common sites Tars in smoking tobacco, aniline dyes Tars in smoking tobacco, aniline dyes

in industrial compounds, and in industrial compounds, and tryptophan have been implicated in tryptophan have been implicated in development of bladder cancerdevelopment of bladder cancer

Bladder CancerBladder Cancer Signs and symptoms Signs and symptoms

Painless, intermittent hematuriaPainless, intermittent hematuria Other signs and symptoms: bladder Other signs and symptoms: bladder

irritability; infection, with dysuria, irritability; infection, with dysuria, frequency, and urgency; and decreased frequency, and urgency; and decreased stream of urine stream of urine

Medical diagnosis Medical diagnosis Urinalysis, IVP, CT scan, and cystoscopyUrinalysis, IVP, CT scan, and cystoscopy

Bladder CancerBladder Cancer Medical treatment Medical treatment

Surgery is the treatment of choiceSurgery is the treatment of choice Cystoscopic resection and fulguration or Cystoscopic resection and fulguration or

laser photocoagulationlaser photocoagulation Segmental bladder resection and radical Segmental bladder resection and radical

cystectomy cystectomy Urinary diversionUrinary diversion

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