Chapter 37
Nursing Care of Patients With Disorders of the Urinary System
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• Polycystic kidney disease is a hereditary disorder. Multiple cysts in the kidney can eventually replace normal kidney structures resulting in CKD. • Diabetic nephropathy is the most common cause of CKD. It is a long-term complication of diabetes mellitus in which the small blood vessels in the kidneys are damaged. Risk factors include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Careful control of blood glucose levels reduces the risk of nephropathy. • Nephrotic syndrome is the excretion of 3.5 grams or more of protein in urine per day in which large amounts of protein are lost in the urine from increased glomerular membrane permeability. As a result, serum albumin, total serum protein, and anticlotting proteins are decreased. • Hypertension damages the kidneys by causing sclerotic changes in the small arteries and arterioles (nephrosclerosis). • Glomerulonephritis, an inflammatory disease of the glomerulus, can be caused by a variety of factors, including immunological abnormalities, toxins, vascular disorders, and systemic diseases. • Kidney disease is diagnosed when waste products (BUN, creatinine) are no longer effectively being eliminated and their blood levels rise. This effects all body systems as a result of imbalances in fluid, electrolytes, and calcium levels, as well as impaired RBC formation and decreased elimination of waste products. Kidney disease can be
acute, due to kidney injury (AKI), or chronic (CKD), occurring gradually over time. • Contrast agents used during diagnostic tests can cause kidney damage, especially when the patient is dehydrated, the glomerular filtration rate is below 60 mL/min, or there is pre-existing renal damage. • CRRT is used to remove fluid and solutes in a controlled, continuous manner in unstable patients with AKI. Unstable patients may not be able to tolerate the rapid fluid shifts that occur in hemodialysis, so CRRT provides an alternative therapy that results in less dramatic fluid shifting. • Hemodialysis uses an artificial kidney to remove waste products and excess fluid from the patient’s blood. The patient must be weighed before and after dialysis, and vital signs must be monitored to detect hypotension. • Peritoneal dialysis provides continuous dialysis treatment and is done by the patient or caregiver in the home. The peritoneal membrane is the semipermeable membrane across which excess wastes and fluids move from blood in peritoneal vessels into a dialysate solution that has been instilled into the peritoneal cavity. The dialysate solution is drained after a prescribed time frame and the process begins again. • A transplanted kidney functions as a normal kidney does. The donated kidney can come from a living family member, a nonrelated donor, or a cadaver donor. The donor kidney is placed in the lower abdomen of the recipient.
SUGGESTED ANSWERS TO CHAPTER EXERCISES Cue Recognition 37.1: Ask the patient to describe and rate the pain from 0 to 10. Administer prescribed pain medication. 37.2: Strain all urine to identify any stones that may have been passed, as that is the patient’s ticket to being discharged! Send all stones or stone fragments for analysis. Critical Thinking & Clinical Judgment Mrs. Milan 1. Sexual intercourse can be a predisposing factor to UTI. 2. The urinalysis will show WBCs, bacteria, RBCs, and posi- tive nitrites. 3. Mrs. Milan should be informed to urinate after inter- course, drink adequate fluids to maintain light-yellow urine color; void regularly; wipe from front to back; wear cotton crotch underwear; avoid constricting cloth- ing such as tight jeans; and avoid perfumed feminine hygiene products, bubble bath and bath salts, scented toilet paper, and tub baths. 4. The teaching plan includes the need to take all the anti- biotics until gone, even if she feels better, to ensure that the infection is resolved so it does not return or create resistant bacteria and to return for a urine culture after the therapy.
Mr. Stevens 1. Weight, I&O, blood pressure. 2. Serum BUN, serum creatinine, and serum potassium levels. 3. Mr. Stevens should learn about his antihypertensive medications, a low-sodium diet, fluid restrictions, and importance of follow-up visits. Mrs. Jackson 1. Collect data beginning with Mrs. Jackson’s breathing and respiratory status. Address the cardiovascular system to see how she is tolerating the arrhythmia. Then obtain Mrs. Jackson’s weight and I&O to monitor fluid balance. 2. Data to report: Shortness of breath and pitting edema (fluid overload); urine output 375 mL yesterday (CKD); premature ventricular contractions (elevated potassium). Decreased serum sodium (dilutional effect of excess fluid). Elevated serum potassium (retained in CKD). Decreased WBCs (low due to CKD). Decreased RBCs, Hgb, and Hct (anemia). Elevated serum creatinine and BUN (not excreted adequately in CKD). Elevated blood glucose (diabetes). 3. Therapeutic communication suggestions: “Mrs. Jackson, would you like to talk about your diagnosis?”“How do you feel about your diagnosis?”“Do you have questions or con- cerns?”“What are your usual coping methods?” Provide explanations for procedures and interventions to her.
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