Management-of-Patients-With-Renal-Disorders课件.ppt

《Management-of-Patients-With-Renal-Disorders课件.ppt》由会员分享，可在线阅读，更多相关《Management-of-Patients-With-Renal-Disorders课件.ppt（42页珍藏版）》请在得力文库 - 分享文档赚钱的网站上搜索。

1、Copyright 2008 Lippincott Williams&Wilkins.Management of Patients With Renal Disorders 1Copyright 2008 Lippincott Williams&Wilkins.Functions of the KidneyUrine formationExcretion of wastesRegulation of electrolytesRegulation of acid-base balanceControl of water balanceControl of blood pressureRenal

2、clearanceRegulation of red blood cell formationSynthesis of vitamin D to active formSecretion of prostaglandinsRegulates calcium and phosphorus balanceActivates growth hormone2Copyright 2008 Lippincott Williams&Wilkins.Common Fluid and Electrolyte Disturbances in Renal Disorders Fluid volume loss or

3、 excessProtein deficitElectrolyte abnormalities including Na+,K+,Ca+,Mg+,bicarbonate,and phosphorusSee table 47-33Copyright 2008 Lippincott Williams&Wilkins.Glomerular DiseasesAn inflammation of the glomerular capillariesThe glomerulus is a tuft of capillaries forming part of the nephron through whi

4、ch filtration occursThe nephron is the functional unit of the kidney responsible for urine formation and removal of unnecessary substances Antigen-antibody complexes form in the blood and become trapped in the glomerulus and induce inflammatory responseAcute glomerulonephritisChronic glomerulonephri

5、tisNephrotic syndrome4Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Acute GlomerulonephritisComplications includeHypertensive encephalopathyHeart failurePulmonary edemaRenal failurePrognosis-Most recover fully6Copyright 2008 Lippincott Williams&Wilkins.Acute G

6、lomerulonephritisMedical management includes supportive care-treat hypertension,edema,rest,sodium and fluid restriction Dietary modifications(high carb,low protein;Treat cause,if appropriate,using antibiotics,possibly corticosteroids 7Copyright 2008 Lippincott Williams&Wilkins.Sequence of Events in

7、Acute Glomerulonephritis 8Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Chronic GlomerulonephritisCauses include repeated episodes of acute glomerular nephritis,hypertensive nephrosclerosis,hyperlipidemia,and other causes of glomerular damageSecondary causes m

8、ay include diseases with systemic effects(eg,SLE,Goodpatures,diabetes)Some patients are asymptomatic for years;as glomerular damage increases,signs and symptoms of renal insufficiency and renal failure develop Abnormal laboratory test results include urine with fixed specific gravity,casts,and prote

9、inuria;electrolyte imbalances;and hypoalbuminemia 10Copyright 2008 Lippincott Williams&Wilkins.Chronic GlomerulonephritisMedical managementHTN managementSodium/water restriction,diureticsAdequate nutrition intake,high value proteinEarly initiation of dialysis11Copyright 2008 Lippincott Williams&Wilk

10、ins.Copyright 2008 Lippincott Williams&Wilkins.Nephrotic Syndrome Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins Results in hypoalbuminemia and anasarcaHallmark proteinuria(3.5 g/day)Causes include chronic glomerulonephritis,diab

11、etes mellitus with glomerulosclerosis,amyloidosis,lupus,multiple myeloma,and renal vein thrombosis(table 46-10)Medical management includes drug and dietary therapy13Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.15Copyright 2008 Lippincott Williams&Wilkins.Sequ

12、ence of Events in Nephrotic Syndrome16Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Causes of Acute Renal Failure(ARF)table 47-1PrerenalThe result of impaired blood flow,leading to hypoperfusion of kidneyVolume depletion,impaired cardiac function,vasodilation(

13、eg,shock)IntrarenalResult of actual parenchymal damage to glomeruli or tubules-impaired nephron functionNephrotoxic agents,infectious process,renal ischemia18Copyright 2008 Lippincott Williams&Wilkins.Causes of Acute Renal FailurePostrenalDue to mechanical obstruction somewhere distal to the kidney(

14、eg,calculi,tumors,strictures)19Copyright 2008 Lippincott Williams&Wilkins.Phases of ARFInitiationOliguriaDiuresisRecovery20Copyright 2008 Lippincott Williams&Wilkins.ARF Assessment and FindingsUrine output scant to normal,low specific gravityUltrasound may show anatomic changesElevated BUN and creat

15、inineCreatinine increases as in conjunction with decrease in GFRIf oliguric,risk of hyperkalemiaProgressive metabolic acidosisChanges in calcium and phosphate21Copyright 2008 Lippincott Williams&Wilkins.ARF preventionCareful history to assess for risk factorsBUN/Creatinine monitoring for patients on

16、 nephrotoxic agentsAdequate hydrationPrompt treatment of shockPrompt treatment of hypotensionPrompt treatment of infectionsTo prevent toxic drug effects,monitor renal function,drug dose and durationRecognize potential for radiocontrast-induced nephropathy22Copyright 2008 Lippincott Williams&Wilkins.

17、Copyright 2008 Lippincott Williams&Wilkins.Nursing ManagementDaily weights,strict I/OsMonitor fluid and lyte balanceReducing metabolic ratePromoting pulmonary functionPreventing infectionProviding skin careTechnical aspects of care24Copyright 2008 Lippincott Williams&Wilkins.Dialysis for ARFUsed to

18、remove fluid and uremic wastes when kidneys cannotIndicated in hyperkalemia,fluid overload,increasing acidosis,severely elevated BUN or severe confusionHemodialysisIf patient can tolerate large volumes of fluid removal at a timeContinuous renal replacement therapiesIndicated for patients who are too

19、 clinically unstable for hemodialysisDoes not produce rapid fluid shiftsManaged by critical care nurse25Copyright 2008 Lippincott Williams&Wilkins.Treatment Options for Acute Renal FailureHemodialysisContinuous renal replacement therapies(CCRT)26Copyright 2008 Lippincott Williams&Wilkins.Copyright 2

20、008 Lippincott Williams&Wilkins.Hemodialysis Catheter28Copyright 2008 Lippincott Williams&Wilkins.Internal Arteriovenous Fistula and Graft 29Copyright 2008 Lippincott Williams&Wilkins.Copyright 2008 Lippincott Williams&Wilkins.Nursing Management of the Hospitalized Patient on DialysisProtect vascula

21、r access;assess site for patency and signs of potential infection,and do not use it for blood pressure or blood drawsMonitor fluid balance indicators and monitor IV therapy carefully;keep accurate I&O and IV administration pump records Assess for signs and symptoms of uremia and electrolyte imbalanc

22、e;regularly check lab data Monitor cardiac and respiratory status carefullyMonitor blood pressure;antihypertensive agents must be held on dialysis days31Copyright 2008 Lippincott Williams&Wilkins.Nursing Management of the Hospitalized Patient on DialysisMonitor all medications and medication dosages

23、 carefully;avoid medications containing potassium and magnesiumImplement stringent infection control measuresMonitor dietary sodium,potassium,protein,and fluid;address individual nutritional needs Provide skin care:prevent pruritus;keep skin clean and well moisturized;trim nails and avoid scratching

24、Provide catheter care32Copyright 2008 Lippincott Williams&Wilkins.Kidney TransplantationTreatment of choice for ESRDLiving or deceased donorPreoperative managementPhysical exam(including lower urinary tract)Tissue/blood typing,antibody screeningAbility to tolerate immunosuppresive medicationPsychoso

25、cial evaluationPreop teaching33Copyright 2008 Lippincott Williams&Wilkins.Kidney TransplantationPostoperative medical managementHemostasisImmunosuppressionSide effects of immunosuppressivesNephrotoxicity,HTN,HLD,tremor,cancers,infection,accelerated coronary artery disease34Copyright 2008 Lippincott

26、Williams&Wilkins.Kidney TransplantationNursing managementAssessment for transplant rejectionOliguria,fever,HTN,weight gain,new tendernessPrevention of infectionMonitoring urinary functionLiving vs cadaver donorMay require dialysis until kidney begins functioningAddress psychological concernsMonitor

27、for postoperative complications35Copyright 2008 Lippincott Williams&Wilkins.Kidney TransplantationNursing managementAssessment for transplant rejectionOliguria,fever,HTN,weight gain,new tendernessPrevention of infectionMonitoring urinary functionLiving vs cadaver donorMay require dialysis until kidn

28、ey begins functioningAddress psychological concernsMonitor for postoperative complications36Copyright 2008 Lippincott Williams&Wilkins.37Copyright 2008 Lippincott Williams&Wilkins.Kidney SurgeryPostoperative managementPotential hemorrhage and shockPotential abdominal distention and paralytic ileusPo

29、tential infectionPotential thromboembolism38Copyright 2008 Lippincott Williams&Wilkins.Renal Transplantation39Copyright 2008 Lippincott Williams&Wilkins.InterventionsPain relief measures and analgesic medicationsPromote airway clearance and effective breathing pattern by appropriate pain relief,deep

30、-breathing coughing exercises,and incentive spirometry and positioning Monitor UO and maintain potency of urinary drainage systemsUse strict asepsis with catheter and appropriate techniques in providing all careMonitor for signs and symptoms of bleedingGeneral post op measures40Copyright 2008 Lippin

31、cott Williams&Wilkins.Renal CancerAccounts for 3%of U.S.cancer deaths(MW)Risk factors include male sex,increased BMI,tobacco useManifestations include hematuria,pain,and mass in flankOften asymptomatic;detected on routine examsSymptoms of metastases may be first symptoms presentTreatments Surgery:ra

32、dical nephrectomy,laparoscopic nephrectomy,and partial nephrectomy Renal artery embolization-tumor infarctionPalliative radiation therapy Use of chemotherapy is limited41Copyright 2008 Lippincott Williams&Wilkins.Renal CancerNursing ManagementPostoperative careIncision care,pain management,early ambulation,pulmonary hygieneTeaching self-careIncision careActivity instructionsMonitoring urine outputEncourage follow-up care42