Coordinating Care for Patients With Renal Disorders
Chapter 62: Coordinating Care for Patients With Renal Disorders
Learning Outcomes
Epidemiology: Describe the epidemiology of renal disorders.
Clinical Manifestations and Pathophysiology: Correlate clinical manifestations to pathophysiological processes of different renal conditions:
Polycystic Kidney Disease (PKD)
Pyelonephritis
Glomerulonephritis (GN)
Renal Cancer
Renal Trauma
Acute Kidney Injury (AKI)
Chronic Kidney Disease (CKD)
Diagnostic Results: Describe the diagnostic results used to confirm renal disorders.
Interprofessional Management: Discuss management protocols for various renal disorders, specifically:
Polycystic Kidney Disease
Pyelonephritis
Glomerulonephritis
Renal Cancer
Renal Trauma
Acute Kidney Injury
Chronic Kidney Disease
Comparison: Compare and contrast acute and chronic renal failure.
Nursing Care Plan: Develop a comprehensive nursing care plan for patients with renal disorders, incorporating pharmacological, dietary, and lifestyle considerations.
Renal Replacement Therapies: Describe the indications, management, and complications associated with renal replacement therapies and transplantation.
Concepts Covered
Acid-Base Balance
Caring
Elimination
Fluid and Electrolytes
Infection
Medication
Essential Terms
Acute kidney injury (AKI)
Arteriovenous (AV) fistula
Arteriovenous (AV) graft
Chronic kidney disease (CKD)
Cold ischemia time
Continuous renal replacement therapies (CRRTs)
End-stage renal disease (ESRD)
Glomerular filtration rate (GFR)
Glomeruli
Glomerulonephritis
Hemodialysis (HD)
Nephron
Nephrotic syndrome
Oliguria
Peritoneal dialysis (PD)
Polycystic kidney disease (PKD)
Renal cancer
Renal replacement therapies (RRTs)
Renal transplantation
Renal trauma
Finding Connections
Case Study: Episode 1 - Doris Flood
Patient Description: Doris Flood, 35 years old, presents with
Abdominal and left flank pain.
Increased frequency and urgency to void.
Cloudy urine.
Abdominal distention.
Vital Signs:
Temperature: 101°F (38.3°C)
Blood Pressure: 180/100 mm Hg
Introduction
Kidney Functions:
Removal of waste.
Maintenance of fluid and electrolyte balance.
Regulation of acid-base balance.
Renal Compromise:
Clinical manifestations vary; prompt treatment essential to prevent acute illness and death.
Discussion Focus: Specific disorders affecting the kidneys and renal system.
Polycystic Kidney Disease (PKD)\n### Epidemiology
Global Prevalence:
Affects 1 in 600,000 individuals in the U.S.
12.5 million globally.
Relation to Chronic Renal Disorders:
Constitutes 10%-15% of chronic renal disorders.
Forms:
Childhood PKD: Autosomal-recessive (ARPKD), severe and progressive, leads to ESRD by infancy.
Adult PKD: Autosomal-dominant (ADPKD), appears usually between the ages of 30-40, affects both kidneys, equally prevalent among sexes.
Pathophysiology
Cysts Formation:
Manifest primarily in renal cortex and medulla, thin-walled, fluid-filled, range from millimeters to centimeters.
Cysts form via repeated cell divisions (cystogenic process).
Size increases lead to renal tissue compression, reducing blood flow and nutrient supply.
Clinical Manifestations
Early Stage: Typically asymptomatic.
Symptoms: Hypertension, hematuria due to cyst rupture, flank pain, frequent UTIs, and pain attributed to urinary stones.
Physical Findings: Enlarged kidneys, abdominal girth, tenderness upon palpation.
Progression to ESRD: Common by age 60 for 50% of cases.
Interprofessional Management
Diagnosis:
Based on history and clinical manifestations.
Laboratory tests (urinalysis showing blood/bacteria), imaging (ultrasound, CT).
Treatment Goals:
Manage UTIs, pain, hypertension.
Medications: Pain relief (avoid NSAIDs), antibiotics for infections, ACE inhibitors for hypertension.
Complications: Severe hypertension, recurrent UTIs, renal failure, life-threatening aneurysms.
Nursing Management
Assessment & Analysis
Manifestations:
Hypertension and hematuria
Persistent flank pain, headaches.
Laboratory findings (CBC, renal function tests).
Nursing Diagnoses/Problem List
Excess fluid volume due to renal dysfunction.
Risk for infection due to altered urinary elimination.
Ineffective management related to knowledge deficit about the disease.
Interventions
Actions:
Vital sign monitoring (BP, temp)
Administer medications as ordered (antibiotics, antihypertensives).
Encourage lifestyle modifications (diet, fluid balance).
Education for the patient on disease and treatment adherence.
Pyelonephritis
Epidemiology
Commonality:
Incidence in females: 12-13 cases per 10,000, males: 2-3 cases.
Most prevalent in young females; infants and elderly also at heightened risk.
Risk Factors:
Multiple or recurring UTIs, anatomical variations, hormonal changes (pregnancy).
Pathophysiology
Inflammation: Inflammatory process occurs due to bacterial infections, primarily E. coli.
Clinical Manifestations
Symptoms: Fever, chills, back/flank pain, dysuria, hematuria.
Diagnosis
Method:
History, physical examination, lab studies (urinalysis, CBC).
Interprofessional Management
Treatment: IV antibiotics for severe cases, oral antibiotics for mild cases, supportive hydration, monitoring for complications.
Glomerulonephritis
Epidemiology
Third leading cause of renal failure; caused by autoimmune disorders or infections.
Pathophysiology
Mechanism: Overall decrease in GFR, increased permeability.
Clinical Manifestations
Symptoms include edema, hypertension, hematuria.
Diagnosis & Treatment
Diagnostic tests focus on urine analysis and imaging to assess kidney function and identify underlying conditions.
Renal Cancer
Epidemiology
63,000 new cases in the U.S. annually. Higher incidence in males, especially those aged 50-70.
Pathophysiology
Tumors may compromise renal function through compression.
Clinical Manifestations
Symptoms include hematuria, flank pain, mass or weight loss.
Diagnosis & Treatment
Multiple methods such as ultrasound and CT scans; often involves surgical intervention.
Renal Trauma
Epidemiology
High incidence in young males, often from blunt trauma or accidents.
Pathophysiology
Injury gradation: from contusion to laceration or complete renal failure.
Clinical Manifestations
Symptoms including gross hematuria, flank pain.
Management
Diagnosis through imaging; treatment focused on stabilization and possible surgery.
Acute Kidney Injury (AKI)
Epidemiology
Increasing incidence, particularly among hospital patients.
Pathophysiology
Rapid accumulation of nitrogenous wastes; classified into prerenal, intrarenal, postrenal causes.
Management
Identification and treatment of underlying causes; may involve dialysis for severe cases.
Chronic Kidney Disease (CKD)
Epidemiology
Affects millions globally, risk factors include diabetes and hypertension.
Pathophysiology
Gradually loss of function leading to ESRD.
Management
Focus on prevention of complications, renal replacement therapies, and treatment of symptoms.
Renal Replacement Therapies
Overview
Techniques include hemodialysis, continuous renal replacement therapies, and peritoneal dialysis.
Indications for Dialysis
Severe electrolyte imbalances, GFR <10 mL/min, significant clinical manifestations.
Complications
Monitor for infections, thrombosis, and electrolyte imbalances.
Conclusion
Effective coordination of care for patients with renal disorders is crucial. Attention to epidemiology, clinical manifestations, diagnostics, and appropriate management strategies can significantly improve patient outcomes.