Interventions for
Clients with
Renal Disorders
Pyelonephritis
 Bacterial infection in the kidney (upper
urinary tract)
 Key features include:
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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
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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
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
 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
 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
 Mild diuretics
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
 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.
(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, pain
management, and prevention of
complications
Renal Trauma
 Minor injuries such as contusions, small
lacerations
 Major injuries such as lacerations to the
cortex, medulla, or branches of the renal
artery
 Collaborative management
 Nonsurgical management: drug therapy and
fluid therapy
 Surgical management: nephrectomy or
partial nephrectomy
Polycystic Kidney Disease
 Inherited disorder in which fluid-filled
cysts develop in the nephrons
 Key features include:
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Abdominal or flank pain
Hypertension
Nocturia
Increased abdominal girth
Polycystic Kidney Disease
(Continued)
 Constipation
 Bloody or cloudy urine
 Kidney stones
Interventions
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Pain management
Bowel management
Medication management
Energy management
Fluid monitoring
Urinary retention care
Infection protection
Interventions/Complicatio
ns
 Acute and chronic pain
 Constipation
 Hypertension and renal failure
 Nursing interventions to promote selfmanagement and understanding
 Fluid therapy
 Drug therapy
 Measure and record blood pressure
 Diet therapy
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.
Interventions for Clients
with Acute and Chronic
Renal Failure
Acute Renal Failure
 Pathophysiology
 Types of acute renal failure include:
 Prerenal
 Intrarenal
 Postrenal
Phases of Acute Renal
Failure
 Phases of rapid decrease in renal function
lead to the collection of metabolic wastes in
the body.
 Phases include:
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Onset
Diuretic
Oliguric
Recovery
 Acute syndrome may be reversible with
prompt intervention.
Assessment
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History
Clinical manifestations
Laboratory assessment
Radiographic assessment
Other diagnostic assessments such
as renal biopsy
Drug Therapy
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Cardioglycides
Vitamins and minerals
Biologic response modifiers
Phosphate binders
Stool softeners and laxatives
Monitor fluids
Diuretics
Calcium channel blockers
Treatment
 Diet therapy
 Dialysis therapies
 Hemodialysis
 Peritoneal dialysis
Continuous Renal
Replacement Therapy
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Standard treatment
Dialysate solution
Vascular access
Continuous arteriovenous
hemofiltration
 Continuous venovenous
hemofiltration
Posthospital Care
 If renal failure is resolving, follow-up
care may be required.
 There may be permanent renal
damage and the need for chronic
dialysis or even transplantation.
 Temporary dialysis is appropriate for
some clients.
Chronic Renal Failure
 Progressive, irreversible kidney
injury; kidney function does not
recover
 Azotemia
 Uremia
 Uremic syndrome
Stages of Chronic Renal
Failure
 Diminished renal reserve
 Renal insufficiency
 End-stage renal disease
Stages of Chronic Renal
Failure
Changes
• Kidney
• Metabolic
– Urea and creatinine
• Electrolytes
– Sodium
– Potassium
• Acid-base balance
• Calcium and phosphorus
Stages of Chronic Renal
Failure
Changes (Continued)
• Cardiac
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Hypertension
Hyperlipidemia
Congestive heart failure
Uremic pericarditis
• Hematologic
• Gastrointestinal
Clinical Manifestations
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Neurologic
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Urinary
Skin
Hemodialysis
 Client selection
 Dialysis settings
 Works using passive transfer of toxins
by diffusion
 Anticoagulation needed, usually
heparin treatment
Hemodialysis Nursing
Care
 Postdialysis care:
 Monitor for complications such as
hypotension, headache, nausea, malaise,
vomiting, dizziness, and muscle cramps.
 Monitor vital signs and weight.
 Avoid invasive procedures 4 to 6 hours
after dialysis.
 Continually monitor for hemorrhage
Complications of
Hemodialysis
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Dialysis disequilibrium syndrome
Infectious diseases
Hepatitis B and C infections
HIV exposure—poses some risk for
clients undergoing dialysis
Peritoneal Dialysis
 Procedure involves siliconized rubber
catheter placed into the abdominal
cavity for infusion of dialysate.
 Types of peritoneal dialysis:
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Continuous ambulatory peritoneal
Automated peritoneal
Intermittent peritoneal
Continuous-cycle peritoneal
Complications
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Peritonitis
Pain
Exit site and tunnel infections
Poor dialysate flow
Dialysate leakage
Other complications
Nursing Care During
Peritoneal Dialysis
 Before treating, evaluate baseline vital
signs, weight, and laboratory tests.
 Continually monitor the client for
respiratory distress, pain, and discomfort.
 Monitor prescribed dwell time and initiate
outflow.
 Observe the outflow amount and pattern of
fluid.
Renal Transplantation
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Candidate selection criteria
Donors
Preoperative care
Immunologic studies
Surgical team
Operative procedure
Postoperative Care
 Urologic management
 Assessment of urine output hourly for
48 hours.
 Complications include:
 Rejection
 Acute tubular necrosis
Postoperative Care
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Thrombosis
Renal artery stenosis
Other complications
Immunosuppressive drug therapy
Psychosocial preparation