Adult health test 2 Urinary part 4

Peritoneal Dialysis

• Typically performed at home.
• Done four times daily, seven days per week.
• Each session lasts 30-40 minutes.
• Uses the peritoneum as a semi-permeable membrane.
• Requires more time per day compared to hemodialysis.
• A catheter is placed in the peritoneal space by a doctor.
• Dialysate dwelling time is 15-45 minutes (typically 30-40 minutes).
• Clients should drain more dialysate than instilled.
• Clients can eat and drink during dialysis.
• Fluid restriction is still necessary due to renal failure.
• Peritonitis is a serious and common complication (60-80% of clients on long-term peritoneal dialysis).
• Signs of infection include elevated temperature, decreased output, and peritoneal tenderness.

Nephrectomy

• Surgical removal of the kidney.
• Careful monitoring is needed for hemorrhage, GI complications, and urinary output.
• Nursing interventions include turning every two hours, deep breathing exercises, pain management, and dressing changes.
• Adequate urinary output from the remaining kidney is crucial post-surgery.

Nephrostomy

• An incision to drain the kidney pelvis using a catheter.
• Ensure catheter patency to prevent obstruction.
• Monitor drainage amount and turn the client to the affected side to detect obstructions.
• Do not clamp a nephrostomy catheter, as this could cause damage.

Kidney Transplant

• The non-functioning kidney remains in place.
• The donor kidney is positioned in the iliac fossa, anterior to the iliac crest, for bone protection.
• The donor kidney ureter is connected to the recipient's ureter or bladder.
• Relatives, particularly siblings with similar genetics, are the best matches for successful transplants.
• Post-operatively, clients require immunosuppressants to prevent rejection.
• Post-transplant nursing care monitors for rejection or infection symptoms (apprehension, generalized edema, fever, increased blood pressure, oliguria, edema, tenderness at the graft site).
• Immunosuppressants (sometimes combined with steroids) are often used post-transplant.
• Post-transplant care includes preventing hemorrhage and shock, educating clients on fluid intake, daily weight tracking, and infection prevention.

Urinary Diversion

• Used for bladder cancer, invasive cervical cancer, neurogenic bladder, and congenital anomalies.
• Cystectomy (bladder removal) may involve an ileal conduit where ureters are implanted into an ileum loop and brought to the abdominal surface, creating a stoma.
• The stoma should be pink to beefy red and moist.
• Teach clients about stoma care and increased fluid intake at home.
• Mucus in urine is normal and does not indicate infection.

Continent Ileal Reservoir

• A pouch created from a segment of the removed small intestine.
• Ureters are implanted into this intestinal segment.
• An anastomosis connects to the abdominal wall.
• A valve prevents urine leakage, and the client inserts a catheter to drain the reservoir.
• This allows the client to be continent of urine.