Chapter 074

Chapter 74 Interventions for Clients with Renal Disorders

Polycystic Kidney Disease 

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Inherited disorder in which fluid-filled cysts develop in the nephrons Etiology and Genetic Risk 

Autosomal dominant form 

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50% chance of inheritance

Autosomal recessive form 

25% chance of inheritance (Continued)

Polycystic Kidney Disease (Continued) 

Key features include:       

Abdominal or flank pain Hypertension Nocturia Increased abdominal girth Bloody or cloudy urine Kidney stones Constipation

Interventions/Complications 

Acute and chronic pain  

NSAIDs and ASA CAUTIOUSLY Lipid soluble antibiotics 

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Bactrim, Septra, Cipro

Constipation 

Fluid, fiber, exercise

Interventions/Complications 

Hypertension and renal failure 

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Nursing interventions to promote self-management and understanding Fluid therapy   

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Drug therapy  

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Drink at least 2 liter of fluid per day Restrict sodium intake to control BP Fluid restriction is not necessary Antihypertensive agents diuretics

Measure and record blood pressure Diet therapy  

Low sodium diet? Protein

Hydronephrosis, Hydroureter, and Urethral  Provide privacy for elimination. Stricture    

Conduct Credé maneuver as necessary. Apply double-voiding technique. Apply urinary catheter as appropriate. Monitor degree of bladder distention.

(Continued)

Hydronephrosis, Hydroureter, and Urethral  Catheterize for residual. Stricture (Continued)  

Intermittently catheterize as appropriate. Follow infection protection measures.

Nephrostomy   

Client preparation Procedure Follow-up care including: 

Assess for   

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amount of drainage. type of urinary damage expected. manifestations of infection.

Monitor nephrostomy site for leaking urine.

Pyelonephritis 

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Bacterial infection in the kidney (upper urinary tract) Key features include:    

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Fever, chills, tachycardia, and tachypnea Flank, back, or loin pain Abdominal discomfort Turning, nausea and vomiting, urgency, frequency, nocturia General malaise or fatigue

Key Features of Chronic Pyelonephritis    

Hypertension Inability to conserve sodium Decreased concentrating ability Tendency to develop hyperkalemia and acidosis

Acute Pain Interventions     

Pain management interventions Lithotripsy Percutaneous ultrasonic pyelolithotomy Diet therapy Drug therapy  

Antibiotics Urinary antiseptics

Surgical Management 

Preoperative care  

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Antibiotics Client education

Operative procedure: pyelolithotomy, nephrectomy, ureteral diversion, ureter reimplantaton Postoperative care for urologic surgery

Potential for Renal Failure 

Interventions include:  

   

Use of specific antibiotics Compliance with therapies and regular followup Blood pressure control Fluid therapy Diet therapy Other interventions

Renal Abscess 

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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

Renal Tuberculosis  

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Diagnosis Antitubercular therapy with rifampin, isoniazid, and pyrazinamide Complications renal failure, kidney stones, obstruction, and bacterial superinfection of the urinary tract Surgical excision possible

Acute Glomerulonephritis 

Assessment 

Onset approximately 10 days from time of infection. 

Streptococcal infection most common

Acute Glomerulonephritis  

Management of infection Prevention of complications  

 

Diuretics Sodium, water, potassium, and protein restrictions Dialysis, plasmapheresis Client education

Chronic Glomerulonephritis  

Develops over a period of 20 to 30 years or longer Assessment

Edema: presacral tissue Pedal Pretibial Adventitious breath sounds Uremic symptoms

Chronic Glomerulonephritis 

Interventions include: 

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Slowing the progression of the disease and preventing complications Diet changes (Continued)

Chronic Glomerulonephritis  Fluid intake (Continued)  

Drug therapy Dialysis, transplantation

Nephrotic Syndrome 

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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)

Nephrotic Syndrome (Continued) 

Treatment involves:    

Immunosuppressive agents Angiotensin-converting enzyme inhibitors Heparin Diet changes 

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If GFR is normal, dietary intake of complete proteins is needed

Mild diuretics and sodium restriction

Nephrosclerosis 

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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

Renovascular Disease   

Profoundly reduces blood flow to the kidney tissue Causes ischemia and atrophy of renal tissue Diagnosis   

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Magnetic resonance angiography Renal vein renin levels Radionuclide imaging

Interventions: drugs to control high blood pressure and procedures to restore the renal blood supply

Diabetic Nephropathy 

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Diabetic nephrophathy is a microvascular complication of either type 1 or type 2 diabetes. First manifestation is persistent albuminuria. Avoid nephrotoxic agents and dehydration. Assess need for insulin.

Cysts and Benign Tumors  

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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.

Renal Cell Carcinoma 

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Paraneoplastic syndromes include anemia, erythrocytosis, hypercalcemia, liver dysfunction, hormonal effects, increased sedimentation rate, and hypertension. PTH produced by tumor cells can cause hypercalcemia (Continued)

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

Surgical Management   

Preoperative care Operative procedure Postoperative care: 

Monitoring 

Assess for hemorrhage and adrenal insufficiency   

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Altered LOC Hypotension Decreased urine output

Surgical Management 

Post-op Care Cont. 

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pain management  Opioid analgesics prevention of complications  Antibiotics  Steroids

Renal Trauma 

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Minor injuries such as contusions, small lacerations Major injuries such as lacerations to the cortex, medulla, or branches of the renal artery Pedicle injuries are lacerations or breaks in the renal artery or renal vein.

Renal Trauma  

Collaborative management Nonsurgical management: drug therapy and fluid therapy  

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Dopamine Clotting

Surgical management: nephrectomy or partial nephrectomy 

Bench surgery