GLOMERULAR NEPHRITIS+URETHRAL STRICTURE+HYDRONEPHROSIS+HYDROURETER.pptx

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1. GLOMERULAR NEPHRITIS URETHRAL STRICTURE HYDRONEPHROSIS HYDROURETER

2. GLOMERULAR NEPHRITIS A condition in which the tissues in the kidney become inflamed and have problems filtering waste from the blood. Glomerulonephritis may be caused by infection, inflammatory conditions (such as lupus), certain genetic conditions, and other diseases or conditions .

3. Types There are two types of glomerular nephritis: Acute glomerular nephritis Chronic glomerular nephritis

4. Acute glomerular nephritis Refers to a group of kidney disease in which there is an inflammatory reactions in the glomeruli. ETIOLOGY: Beta hemolytic streptococcal infection. Bacterial, viral and parasitic infections.

5. Pathophysiology

6. Clinical manifestation Hematuria, proteinuria Fever, chills, weakness Pallor, anorexia, lethargy Nausea, vomiting General edema of facial, periorbital swelling.

7. Diagnostic Evaluation Urinalysis for hematuria and proteinuria. 24 hours urine for protein and creatinine clearance outline the degree of renal function. Elevated BUN and serum creatinine levels, low albumin level, and serum compliment . Needle biopsy of the kidney reveals obstruction of glomerular capillaries from proliferation of endothelial cells.

8. Management Antibiotic therapy to eliminate infection . Corticosteroid and immunosuppressive agents may be used . It is symptomatic and include anti-hypertensive, diuretics drugs for management of hyperkalemia, H2 blockers and phosphate binding agents .

9. Dietary Management Fluid intake is restricted. Protein is restricted. Carbohydrates are increased to provide energy and reduce catabolism of protein. Potassium and sodium intake is restricted in the presence of hyperkalemia, edema or signs of heart failure.

10. Complications Hypertension Heart failure Malnutrition Seizures ESRD (End-stage renal disease) Fluid and electrolyte imbalance Hyperkalemia, hyperphosphathemia and hypervolemia.

11. Nursing management Monitor vital signs, intake and output maintain dietary restrictions during this phase. Encourage rest until the urine clear and BUN, creatinine and blood pressure normalize. Carefully monitor fluid balance, replace fluids, according to the patient’s fluid losses. Monitor pulmonary artery pressure and CVP. Monitor for signs and symptoms, of heart failure, distended neck veins, tachycardia, gallop rhythm, enlarge liver and crepes at bases of lungs Encourage the patient to treat any infection promptly. The patient must have fallow-up evaluation of blood pressure.

12. Chronic glomerulonephritis It refers to repeated episode of acute glomerulonephritis. Kidney become reduce in size and final result is ESRD . Etiology: Same as acute glomerulonephritis .

13. Clinical manifestation Symptoms are variable according to the patient. kidney are reduce as little as one-fifth of their normal size. Cortex layer shrinks 1 to 2 mm in thickness or less. Bands of scan tissue distort remaining cortex . kidney become rough and clear . Glomeruli scarred, branches of renal artery get thickened . Glomerular damage lead to chronic kidney disearey loss. Its is pathophysiology of chronic disease.

14. Conti. First sign is sudden nose bleeding and seizure. Some pt. have loss of weight and strength, Increase irritability. Nocturia, headache, dizziness and digestational disturbances are also common. Pt. Appear poorly nourished, a yellow grey pigmentation of the skin. Peripheral edema. Blood pressure is elevated. Anemia, cardiomegaly, distended neck veins and other signs of congestive heart failure may be present. Crackling sound may be heard in lungs. Neurosensory changes occur in late stage. Diminished tendon reflexes. Pulses paradoxus is present. Pt. become confused.

15. Diagnostic evaluation Hypercalcemia Hypomagnesaemia Increase phosphorus level Anemia Hypoalbuminemia Decrease calcium level during blood and urine analysis. Chest x-ray represents cardiomegaly and pulmonary edema.

16. Medical management Patient weight is monitored daily along with diuretic description. sodium and fluid is restricted along antihypertensive agents. Adequate calorie intake is necessary. Dialysis is initiated to prevent further complications. Antibiotic, anti inflammatory and anticoagulant is used for treatment .

17. Nursing management Nursing assessment Comprehensive history should be taken Physical examination may reveal ascites, pleural effusion and pulmonary edema. Urine examination should be closed, monitor vital sign and blood pressure. 2 Nursing diagnosis Fluid volume excess related to decrease glomerular filtration rate and sodium retention

18. Conti.. Altered renal tissue perfusion related to glomerular malfunction. Altered nutrition pattern less than body requirement related to anorexia, catabolic state and renal malfunction Risk for impaired skin integrity to edema Risk for infection related to altered immune response secondary to treatment.

19. Nursing intervention Maintain fluid volume Prevent tissue perfusion Maintain nutritional status Maintain skin integrity Monitor immune response

20. Urethral stricture It is the urethral lumen obstruction. It blocks the flow of urine which can lead to complications. There is usually some scar tissue around the affected part of the urethra that causes the narrowing. The length of stricture varies from less than 1cm to the full length of the urethra. It divided into two categories: Anterior urethra (from the sphincter to the tip the penis) Posterior urethra (from the bladder to the urethral sphincter)

21. Etiology Prostatic Pelvic trauma Cystoscopy Infections of the urethra Congenital malformation of urethra. Transurethral resection of the prostate

22. Clinical manifestations Pelvic pain Dribbling of urine Urinary incontinence Dysuria Reduced ejaculation force UTI Infertility Urinary retention

23. Diagnostic evaluation Urinanalysis Urine culture Urethrography Cystourethroscopy ultrasound of urethra Screening for prostate cancer.

24. Management Surgery is the only treatment for individual with uncontrolled symptoms of urethral narrowing. Urethral plasty( microsurgery and delicate operation) Urethrostomy Urethral stent placement Urethral dilation Urethral stent placement

25. Urethrostomy It is endoscopic procedure Done under general anesthesia A thin tube with a endoscope is inserted into the urethra to visualize the stricture Help of tiny knife is cut stricture lengthwise and open the floe of urine A foley catheter is inserted and kept in place for a few days while the urethral incision is healing.

26. Urethral stent replacement It is another endoscopic procedure aimed at treating urethral strictures. Urethral dilation: This procedure done under local anesthesia. Thin rods of increasing diameters are gently inserted into the urethra from the meatus to open the urethral narrowing without causing any further injury to the urethra.

27. Nursing management Avoid injury to the urethra and pelvis. Appropriate antibiotics to prevent further infection should be given Use a sterile technique, while doing catheter care Maintain intake and output chart Vital sign should be recovered every 4 hourly Check the patient for any bleeding Advise abstinence from sexual activity until treatment is complete and care in established Instruct the patient to avoid sexual activity.

28. HYDRONEPHROSIS Hydronephrosis is dilation of the renal pelvis and calyces of one or both kidneys due to an obstruction.

29. Pathophysiology Obstruction to the normal flow of urine causes the urine to backup, resulting in increased pressure in the kidney. If the obstruction is in the urethra or the bladder, the back pressure affects both kidneys, but if the obstruction is in one of the ureters because of a stone or kink, only one kidney is damaged.

30. Conti.. Partial or intermittent obstruction may be caused by a renal stone that has formed in the renal pelvis but has moved into the ureter and blocked it. The obstruction may be due to a tumor pressing on the ureter or to bands of scar tissue resulting from an abscess or inflammation near the ureter that pinches it. The disorder may be due to an odd angle of the ureter as it leaves the renal pelvis or to an unusual position of the kidney, favoring a ureteral twist or kink.

31. Conti.. elderly men, the most common cause is In urethral obstruction at the bladder outlet by an enlarged prostate gland. Hydronephrosis can also occur in pregnancy because of the enlarged uterus. High pressure in the bladder during the filling phase, generally 15 cm H2O or higher, has been found to result in hydronephrosis, due to the high pressure radiating to one or both kidneys via the ureter.

32. Conti… Whatever the cause, as the urine accumulates in the renal pelvis, it distends the pelvis and its calyces. In time, atrophy of the kidney results. As one kidney undergoes gradual destruction, the other kidney gradually enlarges (compensatory hypertrophy). Ultimately, renal function is impaired.

33. Clinical Manifestations The patient may not have symptoms if the onset is gradual. Acute obstruction may produce aching in the flank and back. If infection is present, dysuria, chills, fever, tenderness, and pyuria may occur. Hematuria and pyuria may be present. If both kidneys are affected, signs and symptoms of chronic renal failure may develop.

34. Medical Management The goals of management are to identify and correct the cause of the obstruction, to treat infection, and to restore and conserve renal function. To relieve the obstruction, the urine may have to be diverted by nephrostomy or another type of diversion. The infection is treated with antibiotic agents because residual urine in the calyces leads to infection and pyelonephritis. The patient is prepared for surgical removal of obstructive lesions (calculus, tumor, obstruction of the ureter). If one kidney is severely damaged and its function is destroyed, nephrectomy (removal of the kidney) may be performed.

35. Hydroureter Hydroureter refers to dilation of the ureter(s) and is most often caused by obstruction of urine outflow due to blockage of the ureter(s) by calculi, chronic inflammation, luminal or intramural neoplasia, or accidental ligation during surgery.

36. Etiology Analogously, hydroureter is defined as a dilation of the ureter. The presence of hydronephrosis or hydroureter can be physiologic or pathologic. It may be acute or chronic, unilateral or bilateral. It can be secondary to obstruction of the urinary tract, but it can also be present even without obstruction

37. TREATMENT OF HYDROURETER Take 2 teaspoons of olive oil and lemon juice, and mix them well. ... Watermelon is the best option for all those who are suffering from kidney stones. Take in a few pomegranate seeds by making a paste of it and have a cup of horse gram soup. ... Make a juice of radish leaves and consume it twice a day.