Renal obj 4.txt

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  1. Ureterostomies
    divert urine directly to the skin surface through a ureteral skin opening (stoma); must wear a pouch
  2. Cutaneous
    one ureter one stoma
  3. Cutaneous ureteroureterostomy
    one kidney joined to the other and one stoma
  4. Bilateral cutaneous ureterostomy
    two ureters, two stomas
  5. Conduits
    collect urine in a portion of the intestine which is then opened onto the skin as a stoma; must wear pouch
  6. Ileal conduit
    at the top of small/lg intestine; oldest and most common
  7. Colon conduit
    more down towards large intestine
  8. Sigmoidostomies
    divert urine to the lg intestine so no stoma; excretes urine with poop and bowel incontinence may result
  9. Ileal reservoirs
    divert urine into a surgically created pouch that functions as a bladder; stoma is continent; client removes urine by regular self cath
  10. Pt education prior to surgery for ileal conduit
    select stoma site; make sure pt understands there will be stoma
  11. Complications or ileal conduit
    wound infection, wound dehiscence, urinary leakage, ureteral obstruction, small bowel obstruction, ileus, stomal gangrene
  12. Nursing considerations for ileal conduit
    promote urine output, stoma care, ostomy and skin care, encouraging fluids, relieving anxiety, teaching stoma and appliance care
  13. Urinary diversions nursing considerations
    monitor drains for patency, amount and type of drainage, skin integrity, body image, sexuality issues, monitoring for potential complications, post up similar to ileal conduit
  14. Incisional approaches
    flank, lumbar, thoracoabdominal
  15. Renal transplant
    treatment of choice for ESRD; elective-not emergency; success rate increases survival with a living related donor before dialysis is initiated
  16. Renal transplant contraindications for candidate selection
    active or chronic infection, severe irreversible extra-renal disease, recent malignancy, autoimmune disease, morbid obesity, current ETOH abuse, HX of nonadherence, severe psychosocial problems
  17. Donor selection
    matched on tissue type, blood type, antibody screening; absence of systemic disease or infection; no history of cancer; no HTN or kidney disease; adequate renal functioning
  18. Kidney transplantation
    adrenal gland remains intact; renal artery and vein tied off; donor kidney cradled in ilium; renal artery sutured to iliac artery and renal vein sutured to iliac vein; ureter sutured
  19. Complications of renal transplant
    organ rejection (most common and most serious); infection; bleeding, DVT, thrombosis of major renal vessels
  20. Immunosuppressive drug therapy
    glucocorticoids, cyclosporine, Tacrolimus (Prograf-100 times more potent than cyclosporine), Sirolimus (Rapamune)
  21. Post op nursing management for renal transplant-assessment
    all body systems, pain, fluid and electrolyte, patency and adequacy of urinary drainage system
  22. Potential nursing dx post renal transplant
    ineffective airway, ineffective breathing, acute pain, fear and anxiety, impaired urinary elimination, risk for fluid imbalance
  23. Post operative renal transplant interventions
    pain relief, promote airway clearance and effective breathing pattern, monitor urine output and maintain patency of urinary drainage systems; strict asepsis with catheter, s/s of bleeding, leg exercises and early ambulation to prevent DVT
  24. Renal transplant education post op
    pt and family, drainage care system, strategies to prevent complications, s/s of complications, follow up care, fluid intake, health promotion and screening
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Renal obj 4.txt
Renal obj 4
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