Chapter 37
Nursing Care of Patients With Disorders of the Urinary System
719
Impaired Skin Integrity related to dryness, excess fluid, and crystal deposits EXPECTED OUTCOME: The patient will maintain intact skin. • Observe skin for open areas and signs of infection to detect problems . • Bathe with tepid water, oils, or oatmeal and apply lotion afterwards to reduce skin crystals to decrease itching and promote comfort . Risk for Infection related to impaired immune system function EXPECTED OUTCOME: The patient will not develop infec- tion, as evidenced by WBCs and temperature within normal limits as well as no signs and symptoms of infection. • Monitor for signs and symptoms of infection to report promptly to HCP . • Protect patient from sources of active infection, including caregivers, roommates, or visitors and ensure vaccinations are up to date to reduce risk for infection . • Reinforce teaching of handwashing techniques to patient and caregivers to help control spread of infection . • Reinforce teaching of signs and symptoms of infection to patient and family to promptly report to HCP . Risk for Injury related to bleeding tendency from platelet dysfunction, use of heparin during dialysis, or gastrointestinal (GI) bleeding EXPECTED OUTCOME: The patient will be free from bleeding, or it is detected and stopped quickly. • Observe for blood in stool or emesis, easy bruising, or bleeding from mucous membranes or puncture sites to report immediately . • Monitor Hgb, Hct, clotting studies, and platelets, and report abnormal values to detect bleeding . • Reinforce teaching for patient to prevent injury to prevent bleeding . Imbalanced Nutrition: Less Than Body Requirements related to restricted diet, anorexia, nausea, vomiting, and stomatitis secondary to effect of excessive urea on the GI system EXPECTED OUTCOME: The patient will maintain ideal weight, and serum protein and albumin levels will be within normal limits. • Monitor weekly weight and serum protein and albumin levels to detect levels to report . • Renal diets may have restrictions such as low-protein to decrease formation of waste products (urea, creatinine) .
years. I had just begun the training for home dialysis when I got the call that a kidney was available. I was overjoyed, but sad for the donor, who was on life support. My transplant surgery went smoothly. My own kidneys were left in place. The new kidney began making urine right away. In the recov- ery room, my urinary catheter bag was nearly full! It was liquid gold to me! The morning after surgery, I felt wonderful. I had so much energy and was walking up and down the halls, outpacing the nurses. They told me to slow down, but I felt so good for the first time in years that nothing slowed me down. The registered nurse transplant coordinator, phar- macist, and dietitian all taught me about follow-up care, my two antirejection medications that I must take for the life of the transplanted kidney, and healthy eating. I no longer had a daily 1,000 mL fluid limit (which is not much!) or dietary restrictions, which was fantastic! My recovery progressed with no complications. I had frequent follow-up laboratory work and clinic visits in the beginning. Seven years later, all is well. I take my antihypertensive, statin, and antirejection medications faithfully, and I have yearly nephrology clinic vis- its and monthly laboratory work. I am grateful to the donor and the donor’s family for the gift I received.
Nursing Process for the Patient With Kidney Disease Data Collection
Kidney disease progressively affects all body systems. With short-term AKI, some effects do not have time to develop. Nursing care for AKI is similar to CKD nursing care for the effects that have occurred. In CKD, more effects are seen because the disease has time to progress. Signs and symp- toms vary depending on the severity of CKD and its cause (Fig. 37.6). Data should be collected for signs and symptoms in all body systems. Family history of kidney disease and patient history of health problems such as hypertension, dia- betes, systemic erythematous lupus, or urinary disorders are noted in the history. Also noted are medications the patient takes because they may be nephrotoxic and require adjust- ments. Recent changes in weight are documented.
Nursing Diagnosis, Planning, Intervention, and Evaluation
Decreased Activity Tolerance related to anemia secondary to impaired synthesis of erythropoietin by the kidneys EXPECTED OUTCOME: The patient will be able to perform activities important to him or her. • Monitor hemoglobin (Hgb) and hematocrit (Hct) and for presence of pale mucous membranes, dyspnea, or chest pain to detect anemia to report . • Schedule rest periods for patient between activities to reduce fatigue and increase energy .
Powered by FlippingBook