GOOD MORNING !

OBJECTIVES

On completion of this topic the learner will be able to:

 

•  Discuss the principles of management and essential nursing

intervention for patient suffering from fluid and electrolyte
imbalances
•  Discuss principles of management and essential nursing
intervention for patient with urinary disorders
MANAGEMENT
Fluids and Electrolytes
Acid Base,
Urinary
 Pharmacology
• IV Fluids
• Electrolytes
• Diuretics
 Fluids
a. parenteral fluids
• Hypotonic
• Hypertonic
• Isotonic solutions
 Fluids
Hypotonic Fluids—
• Less osmolarity than serum (meaning: less sodium
ion concentration than serum)—
• Water moves from the vascular compartment into
the interstitial fluid compartment ànd interstitial fluid
becomes diluted
 Fluids
Note:
• Caution with use because sudden fluid shifts from
the intravascular space to cells can cause
cardiovascular collapse and increased ICP
• Example : 45% NaCl, 2.5% dextrose
 Fluids
Hypertonic Fluids
• These have a higher osmolarity than serum.
• These fluids pull fluid and sometimes electrolytes
from the intracellular/interstitial compartments into
the intravascular compartments.
• stabilizing blood pressure, increasing urine output,
correcting hypotonic hyponatremia and decreasing
edema
 Fluids
Note
• These can be dangerous in the setting of cell
dehydration.
• Examples: D5W.45% NaCl, D5WLR,
blood products, and albumin
 
 Fluids
Isotonic Fluids-
• These fluids remain intravascularly.
• Osmolarity is similar to that of serum momentarily,
thus expanding the blood volume.
• Helpful with patients who are hypotensive or
hypovolemic
 Fluids
Note
• be careful in patients with left ventricular
dysfunction, history of CHF or hypertension.
• Examples :
dextrose 5% in water (D5W),
Lactated Ringer's solution, and NSS
(0.9% sodium chloride.)
 Electrolytes
• Sodium
• Potassium
• Calcium
• Phosphate
• Magnesium
many medicines lower some
electrolyte levels while raising
other levels.
 Electrolytes
• Sodium – given to treat sodium imbalance

• Potassium - severe CKD and kidney failure can

increase potassium levels
Potassium binders such as sodium polystyrene
sulfonate ( kayexalate) block the absorption of
dietary potassium,
 Electrolytes
• Calcium and phosphate
- kidney failure causes an increased breakdown of bone and
abnormal metabolism of calcium phosphorous, vitamin D,
and PTH
• Calcium-containing phosphate binders.
( calcium carbonate)- raise levels of Ca
lower levels of phosphorus
• Non-calcium phosphate binders- sevelamer and lanthanum
• Calcitriol. This is a vitamin D derivative
 Diuretics
• increase urine excretion of both water and
electrolytes
• “Water tablets”
• inhibit electrolyte reabsorption from the lumen of
the nephron
• increasing osmolarity
• enhancing water excretion
 Diuretics
• Thiazides – treatment of HPN and severe HF
Ex. bendroflumethiazide
• Loop diuretics - treatment of HF and fluid retention in CKD
Ex: furosemide
• Potassium-sparing diuretics - also called aldosterone
antagonists.
• Ex: amiloride,
• Osmotic diuretics – treatment of cerebral edema
Ex: mannitol
• Pharmacologic therapy
• Calcium preparations and Phosphorus
binders
• Anti – HPN agents
• Diuretics
• Vitamins and minerals
• Sodium Bicarbonate
• Antiseizure agents
• Erythropoietin

F&E/Urinary Team
Surgical
Procedure

RENAL
 Major Procedure
• Kidney surgery- done to remove obstructions
calculi), to insert a tube for draining the kidney
; or to remove the kidney involved in unilateral
kidney disease, renal carcinoma or kidney
transplantation.
 Nephrectomy
• Indications
kidney damage
carcinoma
kidney transplant
congenital conditions
 Nephrostomy
• a surgical procedure by which a tube, stent,
or catheter is inserted through the skin and
into the kidney.
Indications of Nephrostomy
• blocked by a kidney stone. / tumor
• hole in the ureter or bladder and urine is leaking into the
body.
• Assess kidney anatomy
and function

@ Nephrostomy drainage
@ Stents
 Preparation / Nursing Responsibilities

• Blood exam
• Diagnostics- CT Scan UTZ
• NPO
• IV Line
• Antibiotics
• Medications taken
 Ureterostomy
• procedure that detaches one
or both ureters from the
bladder, and brings them to
the surface of the abdomen
with the formation of an
opening (stoma) to allow
passage of urine
 Indications of Ureterostomy

•spinal cord injury

•malfunction of the bladder
•birth defects, such as spina bifida
•bladder cancer
 Preparation/ Nursing Responsibilities

• Renal function tests; blood, urea, nitrogen

(BUN); and creatinine.
• Blood tests, and electrolytes.
• Imaging studies of the ureters and renal pelvis.
• assessment of overall patient stability
 Cystectomy
• surgical procedure that removes all or part of
the urinary bladder, the muscular organ that
collects urine from the kidneys for excretion at
a later time
partial cystectomy
simple cystectomy
radical cystectomy
cystectomy
 Urinary Diversion
• Once the bladder is removed, a new method
for excreting urine must be created.
• One commonly used approach is the ileal
conduit
F&E/Urinary Team
 Kidney/ Renal Transplant
• becomes the treatment of choice for most
patients with ESRD
• Living donor / cadaver
• Compatible ABO and HLA

• Note: A nephrectomy of the

patient’s own native kidneys may
be performed before transplantation.
 Post- Kidney Transplant
• Immunosuppresive Therapy
• Rejection concerns
• Teaching patient’s self-care in renal
transplantation
 Special Procedures
• Bladder Training
form of behavior therapy that can be
effective in treating urinary incontinence .

The goals are to increase the amount of time

between emptying the bladder and the
amount of fluids the bladder can hold.
 Bladder Training Instruction
• Empty bladder as soon as patient get up in the
morning
• Go to the bathroom at the specific times the patient
and the health care provider have discussed.
• use "urge suppression" techniques or try relaxation
techniques like deep breathing.
• Try to increase your interval each week
• It should take between six to 12 weeks to accomplish
your ultimate goal.
 Cystoclysis
• continuous irrigation of the bladder with normal
saline solution

• purpose is to wash the bladder continuously to

remove blood clots after prostatic surgery.

• determine the degree of hemorrhage

 Cystoclysis
Nursing Responsibilities
• Saline flasks for bladder irrigation
• Continue irrigation as necessary depending on the
degree of hematuria
• After each flask is complete, empty urine drainage
bag and record urine output
• Regular catheter care
• Catheter care provided should be documented
 GENERAL MANAGEMENT OF
URINARY DISORDERS

A. Health Promotive and Preventive

1.Voiding habits
2.Hygiene
3.Fluid intake

F&E/Urinary Team
B. Curative
 Pharmacologic Management
 Anticholinergic
 TCA
 Parasympathomimetics
 Antibacterial agents
 Corticosteriods
 Immunosuppressive agents
 Kayexalate
 Diuretics

F&E/Urinary Team
  Atrial natriuretic peptide
 Sodium bicarbonate
 Aluminum Hydroxide
 Aluminum based antacid
 Antihypertensive and
Cardiovascular agents
 Anticonvulsant
 Erythropoietin
 Opioid analgesics
F&E/Urinary Team
  NON Pharmacologic Management
 Timed or habit voiding
 Kegel’s exercise
 Assess patient and the catheter system
 Prevent infection
 Minimize trauma
 Bladder training
 Self catheterization
 I & O monitoring
 Monitor fluids and electrolytes balance

F&E/Urinary Team
  DIET: decrease in CHON;
increase in CHO;
decrease in Na;
Vitamin supplementation
 BED REST
 Promote pulmonary function
 Provide skin care
 Hot baths or moist heat to the flank
areas
 Monitor and manage potential
complications
F&E/Urinary Team
C. Rehabilitative
 Teaching patient on self care
 For patient who underwent kidney
transplantation: assess for signs of
rejection and kidney infection.
 Monitor urinary functions
 Monitor laboratory exams
 Follow up care

F&E/Urinary Team
• REFERENCES

• Smeltzer S. Bare, B ( 2010) Brunner and Suddarth’s Textbook of

Medical- Surgical Nursing, 12th edition Lippincott, William and
Wilkins Philadelphia
• Hinkle,J. Cheever,K. (2018). Brunner and Suddarth’s Textbook of
Medical- Surgical Nursing, 14th edition Wolters Kluwer
THANK YOU !