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♆poseidon|billy♆
Decreased resistance to invading organisms
Risk factors:• Inability or failure to empty bladder completely• Obstructed urinary flow • Decreased natural host defenses or immunosuppression• Instrumentation of the urinary tract• Inflammation or abrasion of the urethral mucosa• Contributing conditions such as: DM, Pregnancy,neurologic disorders, gout.
Loss of integrity of the mucosal lining
Bacteria enters the urethra
urethritis
• Pain• Swelling,• Discharges• accumulation of
leukocytes
Bacteria Travels from urethra to bladder, attach to and colonize the bladder
Cystitis
Irritation of the lining of the bladder
Attachment & Proliferation of bacteria in the urethra
Urethrovesical reflux
• Acute pain related to infection within the urinary tract
• Deficient knowledge about factors predisposing the pt. to infection & recurrence, detection, & prevention of recurrence &
Urine cultures,Test for WBCs, Test for STDs, CT Scan
Urine stagnation
Cystolithiasis, Pregnancy, Untreated UTI
• oliguria• Passing a cloudy or strong smelling urine• pressure on lower abdomen• low grade fever
Risk for hypertermia
Urinalysis, cystoscopy, Imaging test (ultrasound & x-ray)
• Relieving pain >Antispasmodic agents, Application of heat, Inc. fluid intake, Analgesics, frequent voiding• Monitoring & managing potential complications >Using strict aseptic technique in any procedures Frequent inspection of urine,Performing a meticulous perineal care, maintaining a closed system.• Promoting Home and community-Based care >Good hygiene, increasing fluid intake, urinating regularly & more frequently.
Ureterovesical Reflux
Introduction of bacteria to the ureters
Ureteritis
Infection ascends to the
kidneys
Pyelonephritis
Ultrasound study or ct scan, iv urogram, measurement of creatinine clearance, blood urea nitrogen, creatinine levels.
♆poseidon|billy♆
Activation of the immune response
Release of pyrogens from bacteria
Release of prostaglandin e2
Elevation of the body thermostat
by the hypothalamus
Vasoconstriction
Shivering
• Fever
General feeling of being well
• Malaise
• Flank Pain • Back Pain
Decreased erythropoietin
Decreased Stimulation of bone marrows
Decreased Erythropoiesis
Decreased RBC production
• Anemia
Reduced heat loss through the
skin
• Chillsineffective tissue
perfusion
Acute Pain
• N&VIrritation of the
urinary tract lining/
• Dysuria
• Hematuria
• Relieving pain >Increase fluid intake to decrease burning sensation• Decrease temperature
>loosen clothing
• Adequate tissue perfusion >Monitor v/s, capillary refill, color of skin & mucosa, provide oxygen as needed
Over production of antibodies
Post infections
Acute glomerulonephritis
Microorganisms circulate in the blood stream
Deposition of antigen-antibody complex in glomerulus
Acute inflammation & damage within the nephrons including the glomerulus
♆poseidon|billy♆
Increased production of epithelial cells lining the glomerulus
leukocyte infiltration of the glomerulus
thickening of the glomerular infiltration membrane
Scarring and loss of glomerular filtration membrane
Decreased GFR
• Marked Proteinuria
• Pitting edema• hypoalbuminemia• hyperlipidemia• fatty cast in
the urine
• Hematuria
Excess fluid volume related to accumulation of fluids in the
body
• Elevate edematous extremities, change position frequently
• Encourage bed rest
Chronic glomerulonephritis
Repeated episodes of acute
Glomerulonephritis
Cortex shrinks to a layer 1 to 2 mm thick or less
Bands of scar tissue distort the remaining cortex
Surface of the kidney rough and irregular
Numerous glomeruli and their tubules become scarred
Branches of the renal artery are thickened
Branches of the renal artery are thickened
• Hypertension• elevated BUN & Serum Creatinine• vascular changes• severe nosebleed• pedal edema• loss of weight and strength
Urinalysis, chest x-ray, ECG, CT scan, MRI
Electron microscopy and immunoflourescent analysis
♆poseidon|billy♆
Risk for decreased cardiac output
• Monitor F&E• Give emotional Support• Instruction to the patient include
explanations and scheduling for follow-up evaluations: BP, and blood studies and creatinine levels
Chronic glomerulonephritis progresses
Acute renal Failure
Prerenal failure
Volume Depletion:Renal losses
Intrarenal Failure
Acute pyelonephritisAcute
glomerulonephirtis
Intrarenal Failure
Renal obstruction
Impaired blood flow
Hypo perfusion
Acute parechymal damage to
the glomeruli or
kidney tubules
Problem on osmosis
tubular back leak
Formation of cast/
vasoconstriction
Pressure rises in the kidney
Decrease GFR
• Dry skin• Drowsiness• headache• muscle twitching • seizure• may appear critically ill & lethargic
• Fluid & electrolyte imbalance• Impaired skin integrity
• Monitor fluid & Electrolyte balance• Reducing metabolic pain: Bed Rest• Prevent infection: Asespsis• Provide skin care• Provide psychosocial support
♆poseidon|billy♆
Chronic renal failure
Sodium & water
Hypertension
Increased vascular volume
Heart failure
potassium Balance
Hyperkalemia
Edema
Elimination of
nitrogenous waste
Uremia
Erythropoeitin production
Anemia
Pericarditis
Skin disorder
G.I. Manifestation
Neurologic Manifestation
Sexual Dysfunction
Coagulopathies
Acid-Base balance
Acidosis
Skeletal buffering
Activation of vit. D
Phosphate elimination
HypocalcemiaHyperparathyroidism
Osteodystrophies
• Risk for decreased cardiac output
• Assess degree of hypertension• Assess level of activity• Investigate report of chest pain
Urinalysis, Blood test, renal ultrasound, Ct/MRI scan, ECG, Renal endoscopy, Renal Biopsy,
• Disturbed thought process
Uremic syndrome develops
END STAGE RENAL DISEASE
PATHOPHYSIOLOGY OF
RENAL DISEASES
SUbmitted by:Billy Gayados, BSN-III, BLOCK-M
SUbmitted to: MR. Dennis ramos
LEGEND:
♆poseidon|billy♆
DIAGNOSTICS
SIgns & Symptoms
Disease
Nursing Diagnosis
Nursing Responsibilities