Renal Failure - Mount Saint Mary College

Renal & Urologic Problems Nephrectomy NUR 302 Post Op Care Nephrectomy Flank incision, side lying position>muscle aches post op Monitor urine output- 30-50cc/hr Monitor resp status

Medicate for pain Monitor for paralytic ileus Urinary Diversion Incontinent urinary diversion Continent urinary diversion Orthotopic bladder substitution Pre-op info, assess readiness to learn, involve family, enterostomal nurse

Post-op complications- shock & atelectesis Urinary Diversion Prevent injury to stoma & good skin care important Maintain urine output- mucous in urine normal, hi fld intake Skin problems- alkaline encrustations

with dermatitis, yeast infections, product allergies, sheering excoriations Properly fitting appliance Urinary Diversion

Address pts concerns- body image, offensive odors, sexual, professional & activity concerns Discharge- teach s/s infection & obstruction, care of ostomy Fitted with appliance 7-10 days post-op & may need to later be refitted Info where to buy supplies, emer phone #, ostomy clubs, MD follow up Chronic Renal

Failure Nur 302 Unit III Chronic Renal Failure Progressive, irreversible destruction Diminished renal reserve Renal insufficiency End-stage renal disease

(ESRD)/uremia Common causes: diabetes, & hypertension Clinical Manifestations Renal insuff->polyuria Renal failure->oliguria then anuria Increased BUN & creatinine->n/v, lethargy,fatigue, headache

Altered CHO metabolism & elevated triglycerides due to insulin resistance Metabolic acidosis, hyperkalemia, Ca, phosphate Na & Mg alterations Clinical Manifestations

Anemia, bleeding tendencies, infection Increased incidence of cancer Hypertension, CHF, arrhythmias Uremic lung, dyspnea, pleural effusion Stomatitis, uremic fetor Neuro changes Renal osteodystrophy, osteomalacia, osteitis fibrosa, soft tissue calcification

Clinical Manifestations Skin yellowish or pale, dry, scaly Pruritus esp when BUN very high Petechiae, ecchymosis, hair falls out Infertility & decreased libido Hypothyroidism Personality & behavior changes

Drug Therapy Hyperkalemia-> IV dextrose & insulin, Kayexelate Hypertension-> Ca channel blockers & ACE inhibitors, Na & fluid restriction Renal osteodystrophy->calcium carbonate (Tums), vit D (calcitrol) Anemia-> erythropoietin

Nursing Care See Nursing Care Plan 47-1 Health promotion report changes in urine appearance or volume, follow up care to monitor renal function When conservative therapy ineffective, explain choices clearly -peritoneal or hemodialysis, transplant

Dialysis: general principles Diffusion Osmosis Ultra filtration Peritoneal Dialysis Catheter

placement in peritoneal cavity Dialysis soln with 1.5, 2.5, 4.25% glucose & electrolytes Cycles inflow, dwell, drain Complications site infection, peritonitis, Abd pain, outflow problems, hernias, low back pain, bleeding pul. problems Hemodialysis Access

sites- internal arteriovenous fistulas & grafts, temporary venous access eg Quinton cath Complications- hypotension, muscle cramps, blood loss, hepatitis, sepsis, disequilibrium syndrome Adaptation to dialysis

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