Chapter 74

Interventions for Clients with

Renal Disorders
Polycystic Kidney Disease

 Inherited disorder in which fluid-filled

cysts develop in the nephrons
 Etiology and Genetic Risk
 Autosomal dominant form
 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
 Bactrim, Septra, Cipro
 Constipation
 Fluid, fiber, exercise
Interventions/Complications
 Hypertension and renal failure
 Nursing interventions to promote self-management and
understanding
 Fluid therapy
 Drink at least 2 liter of fluid per day
 Restrict sodium intake to control BP
 Fluid restriction is not necessary
 Drug therapy
 Antihypertensive agents
 diuretics
 Measure and record blood pressure
 Diet therapy
 Low sodium diet?
 Protein
Hydronephrosis,
Hydroureter, and Urethral
Stricture
 Provide privacy for elimination.

 Conduct Credé maneuver as necessary.

 Apply double-voiding technique.
 Apply urinary catheter as appropriate.
 Monitor degree of bladder distention.
(Continued)
Hydronephrosis,
Hydroureter, and Urethral
Stricture (Continued)
 Catheterize for residual.

 Intermittently catheterize as appropriate.

 Follow infection protection measures.
Nephrostomy
 Client preparation
 Procedure
 Follow-up care including:
 Assess for
 amount of drainage.
 type of urinary damage expected.
 manifestations of infection.
 Monitor nephrostomy site for leaking urine.
Pyelonephritis
 Bacterial infection in the kidney (upper
urinary tract)
 Key features include:
 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
 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 follow-
up
 Blood pressure control
 Fluid therapy
 Diet therapy
 Other interventions
Renal Abscess

 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

 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:
 Slowing the progression of the disease and
preventing complications
 Diet changes
(Continued)
Chronic
Glomerulonephritis
(Continued)
 Fluid intake

 Drug therapy
 Dialysis, transplantation
Nephrotic Syndrome

 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
 If GFR is normal, dietary intake of complete proteins
is needed
 Mild diuretics and sodium restriction
Nephrosclerosis

 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
 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

 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

 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

 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
 Altered LOC
 Hypotension
 Decreased urine output

Surgical Management
 Post-op Care Cont.
 pain management
 Opioid analgesics
 prevention of complications
 Antibiotics
 Steroids
Renal Trauma
 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
 Dopamine
 Clotting
 Surgical management: nephrectomy or
partial nephrectomy
 Bench surgery