Timby's Introductory Medical-Surgical Nursing, 13e - Chapter 58 Vocabulary Flashcards

INFECTIOUS AND INFLAMMATORY DISORDERS OF THE KIDNEY: PYELONEPHRITIS

  • Pathophysiology and Etiology     * Pyelonephritis is an inflammation of the renal pelvis and the kidney.     * Common Bacteria: The most common causative organism is Escherichia coli. Detailed information on common bacteria can be found in Box 58-1.     * Effect of Inflammation: The inflammatory process can lead to structural damage or functional impairment of the kidney tissue.

  • Assessment Findings (Signs and Symptoms)     * Acute Pyelonephritis: This form presents with moderate to severe symptoms. These symptoms typically persist for a duration of 11 to 22 weeks.     * Chronic Pyelonephritis: This condition develops when treatment for acute pyelonephritis is unsuccessful or when there occurs a recurrence of the infection.

  • Diagnostic Findings     * Several diagnostic tools and tests are utilized to confirm pyelonephritis, as outlined in Box 58-2:         * Urinalysis and specific laboratory tests.         * Computed Tomography (CT) scan.         * Cystoscopy.         * Intravenous Pyelogram (IVP).         * Voiding Cystourethrogram (VCUG).         * Dimercaptosuccinic Acid (DMSA) scan.

  • Medical and Surgical Management     * Treatment: Involves pharmacological interventions; refer to Drug Therapy Table 58-1.     * Follow-up: A follow-up urine culture is essential to ensure the infection is completely cleared.     * Nephrectomy: Surgical removal of the kidney may be necessary in severe or chronic cases where the kidney is non-functional or severely damaged.

  • Nursing Management     * Focuses on clinical care and providing Client and Family Teaching 58-1.

INFECTIOUS AND INFLAMMATORY DISORDERS OF THE KIDNEY: ACUTE GLOMERULONEPHRITIS

  • Pathophysiology and Etiology     * This is a bacterial infection resulting in the inflammation of the glomeruli within the kidneys.     * It is categorized into Primary and Secondary forms.     * Prevalence: It is 22 times as common in males as it is in females. It occurs most frequently in children and young adults, though it can affect individuals of any age.

  • Assessment Findings (Signs and Symptoms)     * Early Stages: Often there are no early symptoms.     * Sudden Onset: Symptoms appear suddenly and can be quite pronounced.     * Specific Symptoms:         * Hematuria: Blood in the urine.         * Proteinuria: Protein in the urine.         * Oliguria: Significantly decreased urine output.         * Periorbital Edema: Swelling around the eyes.

  • Diagnostic Findings     * Laboratory findings are used to evaluate kidney function and presence of infection.     * Percutaneous Renal Biopsy: A definitive diagnostic procedure to examine the kidney tissue.

  • Medical Management     * There is no specific treatment for the underlying disease itself.     * Symptomatic Treatment: Focus is on managing the specific symptoms presented by the client.     * Prognosis: Most clients recover spontaneously or require only minimal therapy.

INFECTIOUS AND INFLAMMATORY DISORDERS OF THE KIDNEY: CHRONIC GLOMERULONEPHRITIS

  • Pathophysiology and Etiology     * Nature of Disease: It is a slow, progressive disease.     * Autoimmune Connection: Often linked to autoimmune connective tissue disorders such as Goodpasture syndrome or Lupus.     * Development: Leads to the formation of scar tissue bands and eventually results in renal failure.

  • Assessment Findings (Signs and Symptoms)     * Anasarca: Generalized, severe edema/swelling throughout the body.     * Renal Failure Symptoms: Various systemic manifestations of declining kidney function.

  • Diagnostic Findings     * Laboratory and urine tests.     * Chest radiography (X-ray).     * Electrocardiogram (ECG).     * Percutaneous kidney biopsy.

  • Medical Management     * Blood Pressure Control: Strict management of hypertension.     * Fluid and Electrolytes: Correction of imbalances in body fluids and minerals.     * Edema Reduction: Utilization of diuretic therapy.     * Complication Prevention: Strategies to prevent congestive heart failure.     * Infection Control: Elimination of any concurrent urinary tract infections.

  • Nursing Management     * Reference Client and Family Teaching 58-2 for education protocols.

CONGENITAL KIDNEY DISORDERS: POLYCYSTIC RENAL DISEASE

  • Pathophysiology and Etiology     * Genetic Basis: Inherited as an autosomal dominant trait.     * Forms: Exists in an infantile form (which is rare) and an adult form.     * Defining Characteristic: The formation of multiple bilateral kidney cysts that compress and eventually replace functional renal tissue.

  • Assessment Findings (Signs and Symptoms)     * Hypertension (high blood pressure).     * Pain and renal colic.     * Hematuria (blood in urine).     * Formation of renal stones.

  • Diagnostic Findings     * Abdominal ultrasound, CT scan, and Magnetic Resonance Imaging (MRI).     * Intravenous Pyelogram (IVP).     * Laboratory tests for kidney function.

  • Medical and Surgical Management     * Drug therapy and modifications to diet.     * Dialysis: Required if renal failure occurs.     * Nephrectomy: Removal of the affected kidney(s).

OBSTRUCTIVE DISORDERS: KIDNEY AND URETERAL STONES

  • Introduction and Terminology     * Urolithiasis: General term for stones in the urinary tract.     * Nephrolithiasis: Specifically refers to kidney stones.     * Ureterolithiasis: Specifically refers to stones in the ureters.

  • Pathophysiology and Etiology     * Includes various predisposing factors; refer to Table 58-2 for details.     * Hydronephrosis: A condition caused by the backup of urine due to obstruction.

  • Assessment Findings (Signs and Symptoms)     * Severe flank pain is a hallmark feature.     * Symptoms vary depending on the stone's size, location, and underlying cause.

  • Diagnostic Findings     * Urinalysis and urine culture.     * Radiography (X-rays) and Intravenous Pyelogram (IVP).     * Kidney ultrasonography.

  • Medical Management     * Vigorous hydration to flush the system.     * Drug therapy for pain and stone dissolution.     * ESWL: Extracorporeal Shock Wave Lithotripsy.     * Laser Lithotripsy: Use of lasers to break up stones.     * Stent Placement: To keep the ureter open.

  • Surgical Management     * Nephrostomy Tube Placement: Direct drainage from the kidney.     * Percutaneous Nephrolithotomy: An endoscopic procedure to remove stones.     * Direct Removal Procedures: Ureterolithotomy, pyelolithotomy, or nephrolithotomy.     * Pyeloplasty: Surgical repair of the renal pelvis.     * Nephrectomy: Removal of the kidney.

  • Nursing Management References     * Nursing Process for the Client With Renal Calculi.     * Client and Family Teaching 58-3.     * Nutrition Notes 58-1 and Nursing Guidelines 58-1.

OBSTRUCTIVE DISORDERS: URETERAL STRICTURE

  • Pathophysiology and Etiology     * Often caused by chronic ureteral stone formation.     * May result from compressive congenital anomalies or other conditions that narrow the ureter.

  • Assessment Findings (Signs and Symptoms)     * Flank pain, discomfort, and tenderness.

  • Diagnostic Findings     * Voiding Cystourethrogram (VCUG).     * Ultrasonography.

  • Medical and Surgical Management     * Treatment is determined by the specific characteristics of the stricture.     * Dilation: Stretching the narrowed area.     * Ureteroplasty: Surgical repair or reconstruction of the ureter.

OBSTRUCTIVE DISORDERS: KIDNEY TUMORS

  • Pathophysiology and Etiology     * Kidney tumors are typically malignant (cancerous).     * Renal Cell Carcinoma: The most common type of renal cancer in adults.     * Demographics: Men are affected more frequently than women.     * For risk factors, see Box 58-3.

  • Assessment Findings (Signs and Symptoms)     * Painless Hematuria: The most common initial sign.     * Flank pain.     * Palpable abdominal or renal mass.

  • Diagnostic Findings     * Physical examination and radiography.     * IVP and cystoscopy combined with retrograde pyelogram.     * Ultrasonography, MRI, and CT scans.     * Renal angiography.

  • Medical and Surgical Management     * Nephrectomy: Removal of the kidney.     * Nephroureterectomy: Removal of the kidney and the ureter.     * Other Therapies: Radiation therapy and chemotherapy.     * Palliative Care: Treatment to manage symptoms of metastases.     * Nursing Management: Refer to Client and Family Teaching 58-4.

KIDNEY FAILURE: ACUTE AND CHRONIC

  • Acute Renal Failure (ARF)     * Causes involve nonurologic conditions categorized as Prerenal, Intrarenal, or Postrenal (refer to Table 58-3).     * The RIFLE classification system is used for staging.     * Phases of Acute Renal Failure:         1. Initiation: Occurs with acute tubular necrosis.         2. Oliguric: Characterized by a significant decrease in urinary volume.         3. Diuretic: Indicates recovering nephrons and increased output.         4. Recovery: Can take 11 or more years for full function to return.

  • Chronic Renal Failure (CRF)     * Caused by intrarenal conditions or systemic diseases.     * Progression occurs through five stages, moving from reduced renal reserve to full renal insufficiency.

  • Assessment and Diagnostic Findings     * Symptoms: Elevated blood pressure, weight gain, fluid retention, bleeding, and various vague symptoms as detailed in Table 58-4.     * Tests: Blood laboratory tests, urinalysis, IVP, percutaneous renal biopsy, radiography, ultrasonography, and renal angiography.

  • Management Strategies     * Medical: Preventive measures, hemodialysis, Continuous Renal Replacement Therapy (CRRT), peritoneal dialysis, and dietary management (see Nutrition Notes 58-2).     * Surgical: Kidney transplantation and the mandatory use of immunosuppressive drugs post-transplant.     * Nursing Resources: Nursing Care Plan 58-1 and Client and Family Teaching 58-5.

KIDNEY TRANSPLANTATION

  • Donor Selection:     * Donors includes compatible living donors (relatives or non-relatives).     * Organ donors who are brain dead (requires permission from next of kin for harvesting).

  • Exclusion Criteria: Potential donors with histories of hypertension, malignant disease (cancer), or diabetes are excluded from donation.

  • Matching: Recipients are matched with donors using a national computerized transplant waiting list.

DIALYSIS MANAGEMENT AND METHODS

  • Hemodialysis     * Uses a Dialyzer to filter blood.     * Vascular Access Types:         * Arteriovenous (AV) Fistula: A surgical anastomosis (connection) between an artery and a vein.         * Arteriovenous (AV) Graft: A synthetic tube connecting a vein and an artery in the arm.     * Alternative Forms:         * Continuous Arteriovenous Hemodialysis.         * Continuous Venovenous Hemofiltration (CVVH).         * Continuous Venovenous Hemodialysis (CVVHD).

  • Peritoneal Dialysis     * Uses the client's peritoneum (abdominal lining) as the semipermeable membrane and dialysate fluid.     * Types:         * Continuous Ambulatory Peritoneal Dialysis (CAPD): Involves instilling 2000 mL2000\,mL of dialysate via gravity.         * Automated Peritoneal Dialysis (APD): Utilizes a machine connected to the dialysis catheter.

NURSING MANAGEMENT FOR DIALYSIS AND PRURITUS

  • Vascular Access Care     * Inspect skin over the fistula or graft for signs of infection.     * Palpation: Check for a Thrill (a vibration).     * Auscultation: Listen for a Bruit, which is a loud sound caused by turbulent blood flow. If either is absent, the nurse must postpone dialysis use and report findings immediately.     * Monitor the color of skin and nailbeds and confirm the mobility of fingers.     * Wash the access site skin with soap and water or an antiseptic.     * Puncture Precautions: Avoid puncturing the exact site used in the previous treatment session.

  • Post-Dialysis Procedures     * Injections: Do not administer injections for 22 to 44 hours after dialysis to allow for the metabolism and excretion of heparin (administered during the procedure).     * Monitoring: Observe for Disequilibrium Syndrome, a potential post-dialysis complication.

  • Management of Pruritus (Itching)     * Limit bathing time to prevent drying.     * Ensure the environment is humidified.     * Instruct the client to avoid scratching.

QUESTIONS & DISCUSSION

  • Question #1: Is the following statement true or false? Pyelonephritis is a disorder that can occur acutely or chronically.     * Answer: True. Acute pyelonephritis presents with moderate to severe symptoms lasting 11 to 22 weeks; unsuccessful treatment or recurrence leads to the chronic form.

  • Question #2: Is the following statement true or false? Acute glomerulonephritis is twice as common in males as in females.     * Answer: True. It is more frequent in children and young adults but can affect any age. Most recover spontaneously or with minimal therapy.

  • Question #3: Is the following statement true or false? Renal tumors are rarely cancerous.     * Answer: False. Renal tumors are almost always cancerous. Renal cell carcinoma is the most common type in adults, and it affects men more than women.