NCM PPT Presentation in Urinary System

NCM 102- NCM 102- Group Group

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February 23- 27, 2009February 23- 27, 2009

BSN 3- FenwickGroup 1

1.) Abool, Gretchen2.) Alayon, Marion Kaz3.) Baria, Charles Noel4.) Dellota, Luri John5.) Diomampo, Ma. Christina6.) Rotulo, Maureen Vi7.) Valbarez, Audrey

Urinary System

• Consist of: – Kidneys– Ureters– Bladder– Urethra

GeneralFunction:

•Excretory•Regulatory•Secretory

Specific Function:

• Urine formation• Excretion of waste products• Regulation of electrolyte excretion• Regulation of acid excretion• Regulation of water excretion• Auto regulation of blood pressure• Regulation of red blood cell production• Renal clearance• Vitamin D synthesis• Secretions of prostaglandins• Urine storage• Bladder emptying

Kidney

• Bean-shaped, brownish-red structures.

• Retroperitoneal, posterior wall of abdomen, 12th thoracic vertebra.

• Filter any products from the blood which has no use in the body.

A. Regions1. Renal parenchyma

a. Cortex• Glomeruli, proximal and distal

convoluted tubules, cortical collecting ducts, and adjacent peritubular capillaries.

b. Medulla• Pyramids

8- 18 pyramids/ kidney

2. Renal Pelvis- it is the concave portion of

the kidney through which the renal artery enters and the renal vein exits

- composed of afferent arteriole and efferent arteriole

B. Nephrons- Functional units of kidney:a) Glomerulusb) Bowman’s capsulec) Proximal tubuled) Distal tubulee) Loop of Henlef) Collecting ducts

C. Calyx• Minor calyx- 4-13 minor calices• Major calyx- 2-3 major calices

D. Glomerulus3 filtering layers:

1. Capillary endothelium2. Basement membrane3. Epithelium

Ureters

• Fibromuscular tube that connect each kidney to the bladder

• Narrow, muscular tubes, 24-30 cm long3 narrowed areas:

• Ureteropelvic junction• Ureteral segment• Ureterovesical junction

- prevents reflux of urine

Urinary Bladder

• Muscular, hollow- sac located just behind the pubic bone

• 300- 600 ml of urine4 layers of the urinary bladder:

1. Adventitia- outermost layer2. Detrusor- beneath the adventitia3. Lamina Propria- interface between

detrusor and urethelium.4. Urothelium- innermost layer

Urethra

• Extends from the bladder to the urinary meatus

• Exit passageway for urine• Lined with mucous membrane• In male, it serves as a passageway

for both semen and urine

Acid- Base RegulationAcid- Base Regulation

Acid Base BalanceAcid Base Balance Homeostasis of the body fluids at a normal Homeostasis of the body fluids at a normal

arterial blood pH ranging between 7.35- 7.45arterial blood pH ranging between 7.35- 7.45

Body fluids are slightly alkaline, metabolic Body fluids are slightly alkaline, metabolic processes of the body generally produced processes of the body generally produced excess acid.excess acid.

Maintained partially through the Maintained partially through the reabsorption of bicarbonate (HCOreabsorption of bicarbonate (HCO33

--) in the ) in the proximal tubuleproximal tubule

AcidsAcids release hydrogen ions (Hrelease hydrogen ions (H++) in solutions) in solutions

Ex. Hydrochloric acid (HCl)- strong acidEx. Hydrochloric acid (HCl)- strong acidCarbonic acid (HCarbonic acid (H22COCO33)- weak acid)- weak acid

Bases or alkalisBases or alkalis decrease hydrogen ion (Hdecrease hydrogen ion (H++) concentration) concentration accept Haccept H+ + in solutionsin solutions• Ex: Sodium Hydroxide (NaOH) – strong Ex: Sodium Hydroxide (NaOH) – strong

basebase Bicarbonate (HCOBicarbonate (HCO33) – weak base) – weak base

Regulation SystemRegulation System1.1. Buffer Regulation SystemBuffer Regulation System - chemicals which neutralizes excess acids - chemicals which neutralizes excess acids

and basesand basesa. a. bicarbonate buffer systembicarbonate buffer system

- controls the pH in ECF of the body- controls the pH in ECF of the bodyb. b. phosphate buffer systemphosphate buffer system

- important ICF buffer system- important ICF buffer systemc. c. protein buffer systemprotein buffer system

- largest buffer system of the body; - largest buffer system of the body; includes Hgb in RBC, histone proteins and includes Hgb in RBC, histone proteins and nucleic acids inside the cells.nucleic acids inside the cells.

2.2. Respiratory Regulation SystemRespiratory Regulation System- excretes or retains CO- excretes or retains CO2 2 in the lungsin the lungs

3.3. Renal Regulation SystemRenal Regulation System- excretion or retention of Hydrogen - excretion or retention of Hydrogen ions (Hions (H++) and bicarbonate ions (HCO) and bicarbonate ions (HCO33))

Acid Base ImbalancesAcid Base Imbalances1.1. Metabolic Acidosis (Base Bicarbonate Deficit)Metabolic Acidosis (Base Bicarbonate Deficit)

A.A. DefinitionDefinition- results because of high acid content of the blood, - results because of high acid content of the blood, which also causes loss of sodium bicarbonatewhich also causes loss of sodium bicarbonate- characterized by low pH and low plasma - characterized by low pH and low plasma bicarbonate concentrationbicarbonate concentration- 2 forms:- 2 forms:

1. high anion gap acidosis1. high anion gap acidosis2. normal anion gap acidosis2. normal anion gap acidosis

B.B. Compensatory MechanismCompensatory Mechanism- increased ventilation and renal retention of - increased ventilation and renal retention of bicarbonatebicarbonate- lungs “blow off” CO- lungs “blow off” CO2 2 to raise pH and conserve HCOto raise pH and conserve HCO33

--

C.C. Laboratory Findings (ABG)Laboratory Findings (ABG)- low plasma pH (below 7.35) or a normal pH (if - low plasma pH (below 7.35) or a normal pH (if compensated)compensated)- normal PCO- normal PCO22 or low if compensated in an attempt or low if compensated in an attempt by the lungs to blow off more acidby the lungs to blow off more acid- low plasma bicarbonate:- low plasma bicarbonate:

-below 21 mEq/L in adults-below 21 mEq/L in adults-below 20 mEq/L in children-below 20 mEq/L in children

- low urine pH (below 6)- low urine pH (below 6)D.D. CausesCauses

-DKA or Diabetic Ketoacidosis with starvation-DKA or Diabetic Ketoacidosis with starvation-Salicylate overdose-Salicylate overdose-Lactic Acidosis 2-Lactic Acidosis 2o o hypoperfusionhypoperfusion-Methanol and ethylene Glycol toxicity-Methanol and ethylene Glycol toxicity-uremia-uremia

E.E. ManifestationsManifestationsA. AcuteA. Acute

- headache- headache - drowsiness- drowsiness- nausea and vomiting- nausea and vomiting - confusion- confusion- increased RR and depth- increased RR and depth - shock- shock- peripheral vasodilation- peripheral vasodilation - dysrhythmia- dysrhythmia- cold and clammy skin- cold and clammy skin - decreased BP- decreased BP

B. ChronicB. Chronic-asymptomatic-asymptomatic

F.F. Medical and Nursing ManagementMedical and Nursing Management1. Correct metabolic defect1. Correct metabolic defect2. If resulted from excessive intake of Chloride, eliminate the 2. If resulted from excessive intake of Chloride, eliminate the source source of Chloride.of Chloride.3. Administer bicarbonate if pH < 7.1 and bicarbonate level < 10.3. Administer bicarbonate if pH < 7.1 and bicarbonate level < 10.4. Closely monitor serum potassium level4. Closely monitor serum potassium level5. Correct hypokalemia5. Correct hypokalemia6. Give alkalizing agents, if serum bicarbonate level < 12meq/L6. Give alkalizing agents, if serum bicarbonate level < 12meq/L7. Hemodialysis7. Hemodialysis8. Peritoneal dialysis8. Peritoneal dialysis

2.2. Metabolic Alkalosis (Base Bicarbonate Excess)Metabolic Alkalosis (Base Bicarbonate Excess)

A.A. DefinitionDefinition- marked by the heavy loss of acid from the - marked by the heavy loss of acid from the

body or by increased level of bicarbonatebody or by increased level of bicarbonate- characterized by increased pH and increased - characterized by increased pH and increased

plasma bicarbonate.plasma bicarbonate.

B.B. Compensatory MechanismCompensatory Mechanism- decreased ventilation to conserve CO- decreased ventilation to conserve CO22 and and

increase the PaCOincrease the PaCO22 - lung retains CO- lung retains CO22 to lower pH to lower pH- kidney conserves H- kidney conserves H+ + to excrete HCO to excrete HCO33

C. Laboratory Findings (ABG)- high plasma pH (above 7.45)- normal or high PCO2 (above 45 mmHg) as a compensatory elevation- high plasma bicarbonate:

- above 28 mEq/L in adults- above 25 mEq/L in children

- high urine pH (above 7)

D. Causes- overzealous administration of sodium bicarbonate- excessive or prolonged vomiting- excessive diuresis- gastric suction with loss of hydrogen and chloride ions- pyloric stenosis

- excessive diarrhea- excessive diarrhea- hyperaldosteronism- hyperaldosteronism- Cushing’s syndrome- Cushing’s syndrome- villous adenoma- villous adenoma- cystic fibrosis- cystic fibrosis- hypokalemia- hypokalemia

E. Manifestationsa. Acute

- tingling of fingers and toes- slow, shallow respiration (compensatory)- hypertonic muscles- tetany- mental dullness- dizziness- respiratory depression- atrial tachycardia may occur- ventricular disturbances- decreased motility and paralytic ileus

b. Chronic- same with acute metabolic alkalosis- PVC (premature ventricular contractions or U-

waves seen in ECG)

F. Medical and Nursing Management:

1. Sufficient chloride must be supplied.2. Restore normal fluid volume by administering sodium chloride fluids.3. In patient with hypokalemia, administer potassium as KCl.4. Administer H2-receptor antagonist such as Cimetidine (Tagamet) to reduce the production of gastric HCl, thereby decreasing the metabolic alkalosis associated with gastric suction.5. Carbonic anhydrase inhibitors are useful in patients who cannot tolerate rapid volume expansion.6. Monitor fluid intake and output.7. Correct the underlying acid-base disorder.

3. 3. Respiratory Acidosis (Carbonic Acid Excess)Respiratory Acidosis (Carbonic Acid Excess) A. A. DefinitionDefinition

- marked by an increased arterial CO- marked by an increased arterial CO2 2

concentration (PaCOconcentration (PaCO22), increased carbonic acid, and ), increased carbonic acid, and increased hydrogen ion concentration (low pH)increased hydrogen ion concentration (low pH)

- may be acute or chronic- may be acute or chronic- due to inadequate excretion of CO- due to inadequate excretion of CO2 2 with with

inadequate ventilationinadequate ventilation

B. B. Compensatory MechanismCompensatory Mechanism- excess hydrogen is excreted in the urine in - excess hydrogen is excreted in the urine in

exchange for bicarbonate ionsexchange for bicarbonate ions- kidney eliminate hydrogen ion and retain HCO- kidney eliminate hydrogen ion and retain HCO33

- kidney will retain increased amounts of HCO- kidney will retain increased amounts of HCO3 3 to to increase pHincrease pH

C. Laboratory Findings (ABG)C. Laboratory Findings (ABG)- low plasma pH (below 7.35) or a normal pH (if compensated)- low plasma pH (below 7.35) or a normal pH (if compensated)- increased PCO- increased PCO2 2 (above 45 mmHg)(above 45 mmHg)- normal or high plasma bicarbonate (HCO- normal or high plasma bicarbonate (HCO33) if compensated) if compensated- above 28 mEq/L in adults- above 28 mEq/L in adults- above 25 mEq/L in children- above 25 mEq/L in children

D. CausesD. Causes- narcotic coma- narcotic coma- respiratory depression (drugs, CNS, trauma)- respiratory depression (drugs, CNS, trauma)- pulmonary diseases (COPD, asthma, pneumonia)- pulmonary diseases (COPD, asthma, pneumonia)- hypoventilation- hypoventilation- cardiac arrest/respiratory arrest- cardiac arrest/respiratory arrest- head and spinal cord injury- head and spinal cord injury- acute pulmonary edema- acute pulmonary edema- aspiration of a foreign object- aspiration of a foreign object- atelectasis- atelectasis

- ventricular fibrillation (in anesthesized person)- ventricular fibrillation (in anesthesized person)- increased ICP- increased ICP- papilledema- papilledema- dilated conjunctival blood vessels- dilated conjunctival blood vessels- hyperkalemia- hyperkalemia

E. E. ManifestationsManifestationsa. a. AcuteAcute- increased RR, PR and BP- increased RR, PR and BP- mental cloudiness- mental cloudiness- feeling of fullness in head- feeling of fullness in head- hypoventilation, shallow respiration- hypoventilation, shallow respiration- poor exhalation- poor exhalation- mental alertness and disorientation- mental alertness and disorientation- cerebrovascular vasodilation- cerebrovascular vasodilation- increased cerebral blood flow- increased cerebral blood flow

b. b. ChronicChronic- cerebral vasodilation will increase ICP- cerebral vasodilation will increase ICP- cyanosis and tachypnea will develop- cyanosis and tachypnea will develop- pneumothorax- pneumothorax- overdose of sedatives- overdose of sedatives- sleep apnea syndrome- sleep apnea syndrome- ARDS- ARDS- muscular dystrophy- muscular dystrophy- myasthenia gravis- myasthenia gravis- Guillain-Barre Syndrome- Guillain-Barre Syndrome

F. F. Medical and Nursing ManagementMedical and Nursing Management1. Improve ventilation1. Improve ventilation2. Bronchodilators2. Bronchodilators3. Antibiotics3. Antibiotics4. Thrombolytics4. Thrombolytics5. Pulmonary hygiene measures5. Pulmonary hygiene measures

6. Adequate hydration6. Adequate hydration7. Supplemental oxygen PRN7. Supplemental oxygen PRN8. Mechanical ventilation, use appropriately8. Mechanical ventilation, use appropriately9. Semi-Fowler’s position9. Semi-Fowler’s position

4. 4. Respiratory Alkalosis (Carbonic Acid Deficit)Respiratory Alkalosis (Carbonic Acid Deficit)A. A. DefinitionDefinition

- marked by decreased PaCO- marked by decreased PaCO22 and increased and increased pHpH

- clinical condition in which the arterial pH is - clinical condition in which the arterial pH is greater than 7.45 and the PaCOgreater than 7.45 and the PaCO2 2 is is

less less than 38 mmHgthan 38 mmHg- acute and chronic condition may occur- acute and chronic condition may occur

B. B. Compensatory MechanismCompensatory Mechanism- renal excretion of bicarbonate increase, and - renal excretion of bicarbonate increase, and

hydrogen ion is retainedhydrogen ion is retained- kidneys will excrete increased amounts of HCO- kidneys will excrete increased amounts of HCO3 3 to to lower pHlower pH- kidneys conserve H- kidneys conserve H++

and excrete HCOand excrete HCO33

C. C. Laboratory Findings (ABG)Laboratory Findings (ABG)- high plasma pH (above 7.45)- high plasma pH (above 7.45)- decreased PCO- decreased PCO2 2 (below 35 mmHg)(below 35 mmHg)- decreased plasma bicarbonate as a - decreased plasma bicarbonate as a compensatory compensatory measuremeasure

- below 21 mEq/L in adults- below 21 mEq/L in adults- below 20 mEq/L in children- below 20 mEq/L in children

- high urine pH (above 7)- high urine pH (above 7)

D. D. CausesCauses- extreme anxiety- extreme anxiety- “panic” attack- “panic” attack- hypoxemia- hypoxemia- early phase of salicylate intoxication- early phase of salicylate intoxication- gram-negative bacteremia- gram-negative bacteremia- inappropriate ventilator setting- inappropriate ventilator setting- chronic respiratory alkalosis results from chronic - chronic respiratory alkalosis results from chronic hypercapniahypercapnia- low serum bicarbonate level- low serum bicarbonate level

E. E. ManifestationsManifestationsa. a. AcuteAcute

- lightheadedness- lightheadedness- inability to concentrate- inability to concentrate- numbness and tingling from decreased - numbness and tingling from decreased

calcium ionizationcalcium ionization- tinnitus- tinnitus- loss of consciousness at times- loss of consciousness at times- tachycardia- tachycardia- ventricular and atrial dysrhythmias- ventricular and atrial dysrhythmias- deep or rapid breathing- deep or rapid breathing- paresthesias- paresthesias- mental restlessness and agitation - mental restlessness and agitation

progressing to hysteriaprogressing to hysteria

F. F. Medical and Nursing ManagementMedical and Nursing Management1. Instruct patient to breathe more slowly to allow CO1. Instruct patient to breathe more slowly to allow CO2 2 to to accumulate or breathe into a close system (such as a accumulate or breathe into a close system (such as a paper bag)paper bag)2. Sedative may be required2. Sedative may be required3. Correct underlying problems3. Correct underlying problems

HYDRONEPHROSISHYDRONEPHROSIS

• Is distention of the renal pelvis and calices caused by an obstruction of normal urine flow.

Etiology

• congenital or acquired• stricture from ulceration of the ureter, or may be

due to a calculus. • thickening of the bladder walls from cystitis• enlarged prostate• urethral stricture• Pressure from a pregnant or displaced uterus• ovarian tumors

PRESENCE OF CALCULUS, TUMORS, SCAR TISSUE, CONGENITAL DEFECTS, KINK IN THE URETER

URINE FLOW OBSTRUCTION

URINE ACCUMULATION & STASIS

PRESSURE IN THE KIDNEY WALLS

DISTENTION OF THE KIDNEYS

SUSTAINED/INTERMITTENT INCREASE PRESSURE

IRREVERSIBLE NEPHRON DESTRUCTION

Assessment

Acute• Renal colic• Severe back pain

Chronic• Dull, aching discomfort in the flank on the

affected side• Painful hydronephrosis that occurs intermittently

General• Vague intestinal symptoms such as:

– nausea– vomiting– abdominal pain

• Pain in the sides • Abdominal mass• Nausea and vomiting • Very high Fever • Dysuria (Painful urination) • Increased urinary frequency • Hematuria (blood in the urine)• High number of white blood cells in the urine

• Feel fatigued• Appear pale• Diarrhea• Respiratory distress• Foam in the toilet water, which may be caused by

excess protein in your urine • Weight gain due to excess fluid retention • High blood pressure• Thromboembolism

• severe pain and swelling in arm or leg • changes in color or temperature of arm or leg

Diagnostics:• Ultrasonography

– Intravenous pyelogram (IVP)• Abdominal magnetic resonance imaging (MRI)• Urine tests• Blood Test• Endoscopy• Kidney (Renal) Scan• Bladder catheterization (insertion of a hollow,

flexible tube through the urethra

Complications

• kidney infection (pyelonephritis)• urinary tract infection

Nursing Diagnosis

• Excess Fluid Volume related to Sodium Retention• Impaired Urinary Elimination related to Inflammation• Risk for Infection• Pain related to infection• Deficient Knowledge related to Factors of Development of

the Disease

Pain relief Analgesics Antispasmodic Antibiotics administration

Pyeloplasty• Pre operative• ensure optimal renal function• encourage to recognize and express feelings of anxiety

• Post operative• VS• permit oral fluids after passage of flatus• maintain sterility of nephrostomy tube• ensure unobstruction in the nephrostomy tube or catheter• never clamp nephrostomy tube• MIO

• In case of ureteral stent• Monitor for bleeding• MIO• Assess for signs of UTI• monitor colicky pain & decrease urine output (stent displacement)

NEPHROTIC SYNDROMENEPHROTIC SYNDROME

• Is a set of clinical manifestations caused by protein wasting secondary to diffuse glomerular damage.

Nephrotic syndrome is a protein wasting disease

Caused by: glomerulonephritis diabetes mellitus Lupus erythematosus Amylodidosis Carcinoma

Membranous glomerulonephritis

Glomerular basement membrane damage

Glomerular permeability to plasma protein

Albumin depletion in the blood

Alteration in osmotic pressure in the vessels

Fluid moves to interstitial spaces Increase synthesis of LDL, HDL in the liver with decrease lipid catabolism

Decreased plasma volume

Stimulates aldosterone secretion

Sodium & water retention

Decreased glomerular filtration rate

edema

edema

Hyperlipidemia

lipiduria

proteinuria

hypoalbuminemia

Assessment• Proteinuria• Hypoalbuminemia (low level of albumin in the

blood)• Edema (swelling)• Hypercholesterolemia (high level of cholesterol

in the blood)• High blood pressure • Susceptibility to infections• Oliguria• Hematuria

Diagnostics:

• Complete medical history and physical examination

• Urinalysis• Blood analysis• Kidney biopsy

Complications• kidney infection (pyelonephritis)• urinary tract infection • Blood clots• High blood cholesterol and elevated blood

triglycerides• Poor nutrition• High blood pressure• Acute kidney failure• Chronic kidney failure

Nursing Diagnosis

• Altered Nutrition: Less Than Body Requirements related to Increased Metabolic Demands

• Fluid Volume Excess related to Reduced Urine Output• Potential Impairment of Skin Integrity related to Edema• Fatigue related to Increased Metabolic Demands• Risk for Infection Related to Altered Immune Response

Secondary to Treatment

URINARY TRACT INFECTIONURINARY TRACT INFECTION

• Inflammation of the bladder or the urethra caused by gram-negative bacteria, with Escherichia coli causing most cases.

Etiology

• Caused by gram-negative bacteria Escherichia coli Kleibshiella Proteus Pseudomonas

• Obstruction of the urine flow• Benign Prostatic Hyperplasia

Assessment• Lower Urinary Tract

Infection (Cystitis)- pain on urination- Frequent urination- Nocturia- Incontenence- Suprapubic pain- Hematuria

` - dysuria- foul-smelling urine- increased WBC, pus and bacteria in urine

• Upper Urinary Tract Infection (Pyelonephritis)- Fever- Chills- Flank or Low Back Pain- Nausea and Vomiting- Headache- Malaise- Painful Urination

Diagnostics:• Antibiogram• Urinalysis• Urine culture and Sensitivity• Nitrate testing• Intravenous pyelography• Computed tomography (CT Scan)• Ultrasonography (Ultrasound)• Retrograde Urethrogram (Infants)• X-ray and Intravenous Urography (X-rays of the urological

system following intravenous injection of iodinated contrast material)

Complications

• Damage and scarring of the urinary tract lining

• Pyelonephritis• Chronic Renal Failure due to extensive

kidney damage• Sepsis

Nursing Diagnosis

• Acute Pain related to Inflammation and Infection of Urethra, Bladder and Other Urinary Tract Structures

• Altered Urinary Elimination related to Irritation and Inflammation of the Bladder Mucosa

• Altered Health Maintenance related to Prevention of Recurrent Infections

• Deficient Knowledge related to Factors Predisposing the Patient to Infection and Recurrence, Detection and Prevention of Recurrence and Pharmacologic Therapy

• Risk for Fluid Volume deficit related to Fever, Nausea, Vomiting and Possible Diarrhea

Nursing Interventions• Promotive

Eat well-balanced diet. Good hygiene practice.

• Preventive Do not delay urination. Empty bladder regularly. Clean the urethral meatus after intercourse. Increase fluid intake. Careful sexual practice. Intake of grape juice.

• Curative Medications given:

cholinergics to relieve urinary retentionanti-cholinergics to decrease bladder muscle spasmantibiotics: Ciprofloxacinphenazopyridine for pain

Revision of abnormalities in urinary tract.• Rehabilitative

Education about importance of completing medication cycle. Evaluation and instruction about voiding patterns, sexual practices, and

hygiene practices.

ACUTE ACUTE GLOMERULONEPHRITISGLOMERULONEPHRITIS

• A specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium

Etiology

• Beta-hemolytic Streptococcal infection• Viral or parasitic infection

A ntigen (group a beta-hemolytic streptococcus

Antigen- antibody product

Deposition of antigen-antibody complex in glomerulus

Increased production of epithelial cells lining the

glomerulus

Leukocytes infiltrate the glomerulus

Thickening of the glomerular filtration membrane

Scarring and loss of glomerular filtration

membrane

Decreased glomerular filtration rate

Assessment• Hematuria• Oliguria• Edema (peripheral or

periorbital)• Headache• flank pain • Shortness of breath or • Dyspnea• Hypertension • Skin rashes • Arthritis• Pharyngitis • Impetigo

• Respiratory infection • Pulmonary hemorrhage • Heart murmur may indicate

endocarditis • Scarlet fever • Weight gain • Abdominal pain • Anorexia • Skin pallor • Palpable purpura in patients

with Henoch-Schönlein purpura

• Oral ulcers

Diagnostics:• Complete blood cell count • Electrolytes, including BUN and creatinine (to estimate the glomerular

filtration rate [GFR]): The BUN and creatinine levels will exhibit a degree of renal compromise.

• Urinalysis • Streptozyme test: This test includes many streptococcal antigens that are

sensitive for screening but are not quantitative. • Antistreptolysin O (ASO) • Erythrocyte sedimentation ratio (ESR) usually is increased. • Urine or plasma creatinine level greater than 40; decreased renin level is

noted. • Blood cultures • Ultrasonography• Abdominal radiographic imaging (ie, computed tomography)• Renal biopsy

Complications• Sclerosis progressing toward renal failure • Other complications can develop in patients who

present with severe hypertension, encephalopathy, and pulmonary edema. It includes the following: – Hypertensive retinopathy – Hypertensive encephalopathy – Rapidly progressive glomerulonephritis – Chronic renal failure

• Nephrotic syndrome

Nursing Diagnosis

• Alteration in Nutrition due to Compromised Renal Function

• Fluid Volume Excess due to Reduced Urine Output• Activity Intolerance due to Need to Rest the Kidney• Potential Impairment of Skin Integrity due to Edema• Potential for Infection due to Reduction in Natural

Defense Mechanisms

Nursing Interventions• Promotive

eat balanced diet teach client to live healthfully

• Preventive prompt treatment of URTI or sore throat culture and sensitivity test; antibiotics as indicated

• Curative bed rest dietary sodium restrictions low protein diet sufficient carbohydrate to prevent muscle wasting and nitrogen

imbalance antibiotic: Penicillin anti-hypertensive drugs diuretic therapy

• Rehabilitative maintain follow-up healthcare report any exacerbation in signs and symptoms

CHRONIC CHRONIC GLOMERULONEPHRITISGLOMERULONEPHRITIS

• Is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of glomeruli.

Etiology

• Acute glomerulonephritis• Immunologic reactions in the body

AssessmentSymptoms:• Headache• Dyspnea• Blurring of vision• Lassitude• Weakness or fatigue

Signs:• Hypertension• Edema• Nocturia• Weight loss• Hematuria• Proteinuria• Casts and blood in the

urine

Diagnostics:

• Serum chemistry • CBC• Urinalysis• Renal ultrasonogram• Biopsy• Kidney

Complications• Metabolic acidosis • Pulmonary edema • Pericarditis • Uremic encephalopathy • Uremic gastrointestinal bleeding • Uremic neuropathy • Severe anemia and hypocalcemia • Hyperkalemia

Nursing Diagnosis

• Altered Nutrition: Less Than Body Requirements related to Increased Metabolic Demands

• Fluid Volume Excess related to Reduced Urine Output

• Fatigue related to Increased Metabolic Demands• Risk for Impaired Skin Integrity• Risk for Infection related to Altered Immune

Response Secondary to Treatment

Nursing Interventions•Promotive

eat balanced dietteach client to live healthfully

•Preventiveavoid infections, especially respiratory and urinary tract

infection•Curative

high calorie, low protein, sodium restricted dietprovide/assist in hygienemonitor signs of pulmonary edema and congestive heart failurerest is essentialtake prescribed medications appropriately

•Rehabilitativemaintain follow-up healthcarereport any exacerbation in signs and symptoms

REFERENCES:REFERENCES:Textbooks:• Joyce M Black

Medical Surgical Nursing6th Editionp.805-806, 856-867

• Langford & ThompsonHandbook of Diseases3rd Editionp.674-676

• Brunner and SmeltzerMedical Surgical Nursing3rd Editionp. 310-315

• Josie Quiambao-UdanMastering Fundamemntals of Nursing1st Editionp. 303-304, 312-314

Links:• http://

emedicine.medscape.com/article/777272-followup

• http://emedicine.medscape.com/article/777272-treatment

• http://emedicine.medscape.com/article/777272-diagnosis

• http://emedicine.medscape.com/article/777272-overview