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BOWMAN’S/GLOMERULAR
ADH Disorder
CAPSULE SIADH
PROXIMALCONVOLUTED TUBULE –Abnormally high ADH
NEPHRON LOOP concentration
DESCENDING LIMB –urine output is reduced (oliguria)
ASCENDING LIMB –water retention (fluid overload)
DISTAL CONVOLUTED TUBULE –Urine SG is high (normal: 1.005
COLLECTING DUCT – 1.030)
MAJOR CALICES –Hct is low (43-48%)
MINOR CALICES DI
RENAL PELVIS –Abnormally low ADH
URETERS –urine output is increased
URINARY BLADDER (polyuria)
URETHRA –water loss (fluid deficit)
OUT OF THE BODY –Urine SG is low
–Hct is high
Aldosterone Disorders OBSTRUCTION
Weak Stream
Addison’sDisease Hesitancy
(autoimmune process, hemorrhage Terminal Dribbling
into the adrenal gland, Incomplete emptying
adrenalectomy, TB of the adrenals) Nocturia
–Abnormally low aldosterone
–Serum Na is low, serum PAIN
potassium is high Flank or lumbar
–FVD Inguinal or iliac
Initiation of
Cushing’s Disease voiding
(Adrenal hyperplasia, Adrenal End of voiding
Neoplasms, Lung and Pancreatic Painless
Tumor releasing ACTH) hematuria
–Abnormally high aldosterone
–Serum Na is high, serum Incontinence
potassium is low Stress
–FVE Urge
Overflow
NOTE: Total
Functional unit of the kidneys are Mixed
the glomerulus, vasa recta and Enuresis
kidney tubules (nephron
(nephron))
Only the renal tubules can URINE CHANGES
regenerate Pneumaturia
Acidosis—increases
Acidosis—increases hydrogen Proteinuria
secretion (kidney tubules)— Ketonuria
increases HCO3 reabsorption Glucosuria
Alkalosis—decreases
Alkalosis—decreases hydrogen Hematuria
secretion—decreases HCO3 Pyuria
reabsorption Fecaluria
Post-renal Oliguric-anuricPhase
due to obstruction or disruption to may last 7-14 days
urine flow anywhere along the Non-oliguric or high output RF
urinary tract: yet nitrogenous waste
–Cystitis products are still high in the
–Urethritis blood.
–Pyelonephritis DiuresisPhase
–Urolithiasis return to normal urine output
RecoveryPeriod
–Injuries to the bladder and
may take 6 months to 1 year
urethra
from the initial onset
–Cancer of the bladder
–Prostatitis Chronic Renal Failure
–BPH Progressive deterioration of renal
function which end fatally in uremia
Intra-renal Dialysis or kidney transplant is
AGN acute glomerulonephritis necessary
Infection of kidney due to immune Irreversible
response Clinical Course:
Previous infection from group A beta Decreased Renal Reserve 40-
hemolytic streptococcus 70 GFR
S/Sx – proteinuria, hematuria, Renal Insufficiency 20-
oliguria, edema and HPN 40 GFR
CGN chronic glomerulonephritis Renal Failure 10-
slowly developing disease 20 GFR
S/Sx – same with AGN End-Stage Renal Disease ↓
Nephrotic Syndrome 10 GFR
Severely damaged glomerular
Both kidneys are severely affected
activity that leads to increased
and renal function is absent
capillary permeability
S/Sx – proteinuria,
hypoalbuminemia, edema and SIMILARITIES in
hyperlipidemia ARF and CRF
Caused by CGN, DM and SLE ↓ waste product excretion
chaotic acid and base regulation
Acute Renal Failure elevation of electrolytes
Sudden decline in renal function, water retention
usually associated with increased in ↓ production of erythropoietin
BUN, creatinine & elec. ↓ active vitamin D secretions
Causes: ↑ renin activation
intra, pre and post RENAL
s/sx Impaired skin integrity related to
Na and water retention – inc BV- uremic frost
edema – HPN – CHF - ascites Constipation related to fluid
↓ RP – renin activation – restriction and phosphate binding
angiotensin and aldosterone agent administration
production – inc BV – inc BP High risk for injury (fracture)
↓ H ion excretion – metabolic related to osteoclast activity
acidosis Non compliance to therapeutic
↓ nitrogenous excretion – regimen related to restrictions
azotemia – toxic to CNS – imposed by CRF and its treatment
CHANGES IN LOC
↓ formation of active vit D – ARF Management
hypocalcemia I&O
↓ secretion of erythropoietin – Weighing
anemia Infection monitoring
↓ electrolyte excretion – elevation Examine gross and occult blood
of electrolytes in the blood Diet (CHON moderate, increase
CHO)
Let’s Diagnose! Electrolyte management (Pls refer
Serum crea – elevated (normal to Fluids and Electrolytes Study
0.5-1.5 mg/dl) Guide by Sonny M. Moreno)
Serum BUN – elevated (normal Neurologic assessment
20-30 mg/dl)
Serum electrolytes – all CRF Management
electrolytes are elevated except for Restrict water and sodium intake
HCO3 and Calcium ABG monitoring and NaHCO3
CBC – anemia (due to reduced administration
erythropoietin production) Neurologic assessment
Renal Ultrasonography – to Dialysis
estimate renal size and obstruction
Diet (CHON restriction, inc CHO)
Other tests that may help in
Give vit D and calcium supplement
detecting the cause
Give synthetic erythropoietin
(Epogen)
Nursing Diagnosis Manage electrolyte imbalance
FVE related to decreased GFR
and sodium retention
Dialysis
Risk for infection related to
Hemodialysis
reduced host defenses
PeritonealDialysis
Altered Nutrition related to
catabolic state, anorexia
CVVH (removes water from blood)
Risk for internal bleeding related to
EMERGENCY DIALYSIS
stress ulcer
ARTERIOVENOUS FISTULA
Altered thought processes related
to effects of uremic toxins to CNS
Fluids and electrolytes imbalance Kidney Transplant
Rejection and Infection Drugs (Immunosuppresive and
Donor and Recipient Preparation Antibiotics, prophylactically
HLA test, ABO, Rh test Isolation (Reverse)
KIDNEY SURGERY
Donor Living = anemia, prone to
THE TRANSPLANTED KIDNEY
infection,bleeding,Cadaveric KIDNEY TRANSPLANT
Recipient Stages of Rejection URETERAL STENTING
(HA, AA, A, C)
Short Quiz
1. Priority during dwelling time?
A. respiratory B. pain
C. bowel movement D. all
2. palpate for?
A. bruit B. thrill
3. auscultate for?
A. bruit B. thrill
Board Questions
A client is undergoing peritoneal dialysis. The dialysate dwell time is completed,
and the clamp is opened to allow the dialysate to drain. The nurse notes that
drainage has stopped and only 500 ml has drained, the amount of dialysate
instilled was 1,500 ml. Which of the following interventions would be done
first?
A client returns to the room with CBI continuous bladder irrigation following
TURP, the client reports bladder pain, what should the nurse do first?
A. notify the physician
B. give Meperidine 50 mg IM as prescribed
C. assess patency of the drainage system
D. increase the flow rate
The nurse is caring for a client in acute renal failure, the nurse should expect
hypertonic glucose insulin infusion to treat:
A. hypernatremia
B. cerebral edema
C. hyperkalemia
D. hyperglycemia
A. cardiac glycosides
B. insulin
C. antibiotics
D. phosphate binders
A client with GUT problem is being examined in the ER, the nurse should keep in
mind the anatomical fact that: