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1

Nursing Implementation

Voiding diary
Kegels
Medications
Surgery
Teaching

2

UTI: Nursing Assessment

Health history
Assessment
Diagnostics
Recognize those at risk

3

UTI: Drug Therapy

Antibiotic selected on empiric therapy or results of sensitivity testing
Uncomplicated cystitis treated by short-term course of antibiotics
Complicated UTIs require long-term treatment

4

UTI: Drug Therapy

Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin used to treat empiric uncomplicated or initial

5

UTI: Drug Therapy

Pyridium is OTC that provides soothing effect on urinary tract mucosa
Combination agents (e.g., Urised) used to relieve pain
- Preparations with methylene blue tint urine blue or green

6

Nursing Planning

Client will have:
- Relief of pain
- Normal body temperature
- No complications
- Normal renal function
- No recurrence of symptoms

7

UTI: Nursing Implementation

Acute Interventions
- Adequate fluid intake
- Avoid caffeine, alcohol, citrus juices, chocolate, and highly- spiced foods (potential bladder irritants)
- Application of local heat to suprapubic or lower back may relieve discomfort
- Instruct client about drug therapy and side effects
- What to watch for and report

8

Acute Pyelonephritis: Collaborative Care

Hospitalization for clients with severe infections and complications such as N&V with dehydration
Given parenteral antibiotics to establish high serum levels
Relapses treated with 6-week course of antibiotics
Reinfections treated as individual episodes or managed with long-term therapy
- Prophylaxis may be used for recurrent

9

UTI: Nursing Implementation

Health Teaching
- Emptying bladder regularly and completely
- Evacuating bowel regularity
- Wiping perineal area from front to back
- Drinking adequate fluids (35 ml/kg)
- Daily intake of cranberry juice or cranberry essence may help reduce risk
- Avoid unnecessary catheterization and early removal or in-dwelling catheters (Prevents nosocomial infections)

10

UTI: Nursing Implementation

Health Promotion
- Early treatment for cystitis to prevent ascending infections (Client with structural abnormalities at high risk; stress for regular medical care)

11

UTI: Nursing Implementation

Ambulatory and Home Care
- Encourage adequate fluids even after infection
- Rest to increase comfort
- Low-dose, long-term antibiotics to prevent relapses or reinfections
- Explain rational to enhance compliance

12

Urinary Calculi

Assess risk factors:
Family Hx
Dehydration
Excess calcium, oxalate, protein intake
Gout
Hyperparathyroidism
Urinary stasis

13

Urinary Calculi

Medications
Dietary management
Surgery
- Lithotripsy
- ESWL
- Cystoscopy
- Nephrolithotomy
- Nephrectomy

14

Urinary Calculi: Nursing Diagnoses

Pain
Impaired Urinary Elimination

15

Renal Failure

Goals:
- Preserve existing renal function
- Treat clinical manifestations
- Prevent complications
- Provide for the client's comfort

16

Renal Failure: Treatments

Correction of extracellular fluid volume overload or deficit
Nutritional therapy
Erythropoietin therapy
Calcium supplementation, phosphate binders, or both
Measures to lower potassium
Antihypertensive therapy
Adjustment of drug dosages according to degree of renal function
Renal replacement therapy (dialysis, kidney transplant)

17

Drug Therapy: Hyperkalemia

IV glucose and insulin
IV 10% calcium gluconate
Sodium polystyrene sulfonate (Kayexalate)

18

Drug Therapy: Hypertension

Sodium and fluid restriction
Antihypertensive drugs

19

Drug Therapy: Renal osteodystrophy

Phosphate intake restricted to

20

Drug Therapy: Anemia

Erythropoietin
- Epogen
- Procrit

21

Complications of Drug Therapy

Drug Toxicity
- Digitalis
- Antibiotics
- Pain Medication

22

Nutritional Therapy

Protein restriction
- 0.6-0.8 g/kg body weight/ day
Water restriction
- Intake depends on daily output
Sodium and potassium restriction
- Diets vary from 2-4 g depending on degree of edema and HTN
- Sodium and salt should not be equated
Phosphate restriction
- 1000 mg/day
- Foods high in phosphate (dairy products)

23

Nursing Assessment

Complete history of any existing renal disease
Long-term health problems
Dietary habits

24

Nursing Diagnoses

Excess fluid volume
Impaired skin integrity
Risk for injury
Activity intolerance
Imbalanced nutrition: less than body requirements
Anticipatory grieving
Risk for infection

25

Planning

Overall goals:
- Demonstrate knowledge and ability to comply with therapeutic regimen
Participate in decision making
Demonstrate effective coping strategies
Continue with activities of daily living within psychological limitations

26

Nursing Implementations

Health Promotion
Identify individuals at risk for CKD
- History of renal disease
- Hypertension
- DM
- Repeated urinary tract infection

27

Nursing Implementations

Acute Intervention
- Daily weight
- Daily Bps
- Identify S&S of fluid overload
- Strict dietary adherence

28

Nursing Implementation

Ambulatory and Home Care
- When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options

29

Evaluation

Maintenance of ideal body weight
Acceptance of chronic disease
No infections
No edema
No itching or skin dryness
Slowing of bone disease
Hematocrit and hemoglobin levels in acceptable range

30

Dialysis

The movement of fluid and molecules across a semipermeable membrane from one compartment to another
Dialysis is a way to clean blood of wastes, fluids and salts that build up in the body when the kidneys fail
Two methods of dialysis available:
- Peritoneal dialysis (PD)
- Hemodialysis (HD)