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Y   

 
   
 
  
   
  !"!##Y !Y!
 $   Y%&%%  '
"  $  
  
    
  $     
  (%
)%(*  -These organs
+  (   
   ,these are
also the organs of excretion that
form urine.
-%(  -These tubes
conduct urine from the kidneys to
the urinary bladder.
Lecture note for regular second year
Nursing student, February 2003/2011. 2
V .
/%"     -this
reservoir  
  the
urine brought to it by the two
ureters.
0%"    This tube
      
        for
elimination.

Lecture note for regular second year


Nursing student, February 2003/2011. 3
V .

Lecture note for regular second year


Nursing student, February 2003/2011. 4
 1 
2 V"  3*Y#
§ The kidneys are a $ (  
  located  $   
(behind and outside the peritoneal
cavity) on the $  (of the
abdomen from the ))  &2  'and)- 
&!  '  
    /

  in the  .
§ The two kidneys lie against the muscle of
the back in the upper abdomen.
§ Each kidney is enclosed in a
  $  that is made of
fibrous connective tissue.
Lecture note for regular second year
Nursing student, February 2003/2011. Õ
V .
 $$    1  
Ú vidney get blood supply from  
    1 -4-56  
 V %
Ú ðfter entering the kidney the renal
artery sub divided in to smaller and
smaller branches, which eventually
make contact with the  
   1  called
 $ %

Lecture note for regular second year


Nursing student, February 2003/2011. Ê
V .
O „lood leaves the kidney by vessel
that finally merges to from the
 
%The renal vein carries
blood into the   


for return to the heart.

Lecture note for regular second year


Nursing student, February 2003/2011. 7
V .

Lecture note for regular second year


Nursing student, February 2003/2011. 8
! $    $%

Lecture note for regular second year


Nursing student, February 2003/2011. 9
3   1 
)%!  7
Ú     

Ú    
Ú   
Ú $ 
-%+ 8
Ú   $
Ú     &$   ,    %'
Ú +    &( , '
/%  8
Ú  $ 
Ú ),-5  + 
 Y/ &
 Y
 '
Ú   
Ú $  
0%   %
5%!   %

Lecture note for regular second year


Nursing student, February 2003/2011. 10
!!
The two ureters are   
   that originate at the
lower portion of the renal pelvis and
terminate in the trigone of the bladder
wall.
Their length naturally varies with the
size of the individual &$$+   
-5 //'%
°   
  
  
 
3 7     
$ 
     .

Lecture note for regular second year


Nursing student, February 2003/2011. 11
    
å The urinary bladder is 
 ,( located just
    $  .
å ðdult bladder capacity is about
/44 944of urine.
å rn  , the bladder is found
within the  .

Lecture note for regular second year


Nursing student, February 2003/2011. 12
V .
V     
å hen it is $ ,the urinary
bladder is located  (  $ 
$   and     $ 
:  %
å hen it is filled it $    
$   $(and may
extend well in to the abdominal
cavity.
å The urinary bladder is  $ 
 
 for urine.

Lecture note for regular second year


Nursing student, February 2003/2011. 13
  
§ðt a neck of the bladder that the
urethra leave, there is bundles of

      that
form a portion of the urethral
sphincter known as the  
$      
 
  & 
  
 '%

Lecture note for regular second year


Nursing student, February 2003/2011. 14
V .
Ú The portion of the sphincteric
mechanism that is under
  
 is the external urinary
sphincter at the anterior urethra, the
segment     
 .
Ú The length of urethra varies with
sex;
Ú3   ;%5&/  '%
Ú  )5 -5&9 )4
 '%
Lecture note for regular second year
Nursing student, February 2003/2011. 1Õ
"      
: 
 &   '
O This section discusses the data
related to assessment of urinary
system that a nurse should   
  to obtains a health
history.

Lecture note for regular second year


Nursing student, February 2003/2011. 1Ê
)%V V$ 
 8
* asually flank/loin   
  ,   %
* $    %
* —ain radiate to the iliac fossa, the
testicle or the labia-     
  %
* 2uprapubic region and perineum-
`    %
        
  

Lecture note for regular second year


Nursing student, February 2003/2011. 17
V .
   8
å can be;
 V  
     $    
    $  %%  $
&   $ '%

O    
O $    
O  $ %

Lecture note for regular second year


Nursing student, February 2003/2011. 18
V .
  < 8
Ú   w-passage of A5442urine
per day.
ڗ  
 w     
 
Ú  
 w     
 
ڗ   
 w  
 ` 
* " w-complete absence of urine
flow.
Lecture note for regular second year
Nursing student, February 2003/2011. 19
V .
  8
§$   $  $ 
§  1 
§    
§    
§  
§ $      $ 

Lecture note for regular second year


Nursing student, February 2003/2011. 20
Vont«d
3 =  8
@ +
   1
@     
$ &$   $  $ 
     '%
@ V
@  $    &  
  '

Lecture note for regular second year


Nursing student, February 2003/2011. 21
V .
  8
* $      $   
       $%
*     ( 7
     
$
 Y   
Y  8
Ú $        , 
    %
Lecture note for regular second year
Nursing student, February 2003/2011. 22
V .
  8
O         
$ $       
 (      $   
   $ 
%
   8
O    
  $  
  %
 8
O        
 `   , ( %
Lecture note for regular second year
Nursing student, February 2003/2011. 23
V .
(  ,  
   8
Ú   $    
 =         
( $   $  $ &'%
   8
Ú  
Ú +       
 8
Ú  &$   ',1 ,  ,
 , %
Lecture note for regular second year
Nursing student, February 2003/2011. 24
V .
    $ 
    ,
    ,
   
,
    <,
  1$$ ,
   ,
   ,
    ,
     %%%

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ
-%    
  ullelaboration of all presenting
sign and symptoms in terms of;
 Y 
 2 
 > 
 >
 "
  
 ! 
 
 "      
 E.t.c.
Lecture note for regular second year
Nursing student, February 2003/2011. 2Ê
V .
O
   
        
       
      

 
   ` 
  

 
     
   `  ! ° 
 ` 
 `  
 

Lecture note for regular second year


Nursing student, February 2003/2011. 27
V .
-%    
Ú The client should be questioned about
the +    of the following
disease which have known to be related
to renal problem;
Ú  $   ,
Ú      ,
Ú  ,
Ú  
    ,
Ú  ,
Ú 1     ,
Ú   ,
Ú       %%%%
Lecture note for regular second year
Nursing student, February 2003/2011. 28
V .
å The client should also be questioned
about   $  ?   
  
  %
å The client should questioned if
 <   
    ? 
or      


       
    .
å ðn assessment of the client·s
  $  
    is very important.
Lecture note for regular second year
Nursing student, February 2003/2011. 29
V .
/%3   
The presence of certain  
 $  in a family history
accessed the likelihood of similar
problems occurring in a family member.
The specific disease related to renal
problems to ask the client is about
      
 ,$  1  
  ,       ,
   , $   , ,
 
    , «
Lecture note for regular second year
Nursing student, February 2003/2011. 30
V .
0% $   
O ðreas of importance to be considered
in this category include 1
     .
O 1  e.g.
     @
cause   .
O 2    e.g.      
   cause renal calculi.

Lecture note for regular second year


Nursing student, February 2003/2011. 31
)) $ 
  
3    AAA

Lecture note for regular second year


Nursing student, February 2003/2011. 32
V .
: 
 & $ +'
"% $  
O 1  (pallor, yellowish, changes in
turgor, bruises, crystals, etc...).
O  (2tomatitis and urinous breath
odor).
O 3 (facial edema).
O "  +   (generalized
edema).
O    secondary to edema.
O       (fatigue,
lethargy, diminished alertness, e.t.c«).

Lecture note for regular second year


Nursing student, February 2003/2011. 33
V .
%$ 
Ú The kidney are $   protected
by the a  ,    
 
1  %
Ú ˜ay be the   1   $$ . To
palpate the right kidney the examiner·s left
hand is placed behind and supporting the
right side b/n the rib cage and the iliac
crest.
Ú 2ome disease can be suggestive (e.g.  
 $ , $ $  1  
$ etc«).
Ú The bladder is palpable if it is distended
otherwise not palpable.
Lecture note for regular second year
Nursing student, February 2003/2011. 34
!  1  $$ 

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ
2  1  $$ 

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê
$    

Lecture note for regular second year


Nursing student, February 2003/2011. 37
V .
V%  
*    of the flank area.
* —ercussion of the bladder begins at
the midline just above the umbilicus
and proceeds downward.
* Normally a bladder is  
$    %
* rf the bladder is full  will be
heard above the public symphysis.

Lecture note for regular second year


Nursing student, February 2003/2011. 38
V .
2  
 

Lecture note for regular second year


Nursing student, February 2003/2011. 39
V .
Y<"   
â ðuscultation is      in
the assessment of the urinary system.

Lecture note for regular second year


Nursing student, February 2003/2011. 40
Y    
   
Yiagnostic studies are important in
 and    
problems of the urinary system.
The       at
these studies is influenced byw-
"-"   to the proper procedure
related to the study.
- V$   of the client on
     ,     
$   , =    + 
 , % %.

Lecture note for regular second year


Nursing student, February 2003/2011. 41
)% 
å eneral examination of urine to
establish      or 
$
      
 
  &    
    to be ordered.
å indings give information aboutw
V, ,$ , ,
1  , $   
,
  ,,V,!V, ,
    , %%%
Lecture note for regular second year
Nursing student, February 2003/2011. 42
V .
Ú V       Vreatinine is waste
product of protein (muscle) breakdown.
Ú 
  B5 )/5< %
Ú   V  w Vonfirm suspected   
    and    

  %
Ú       , but urethra
contains bacteria and a few „V. rf properly
collected, stored and handle, it can helps to
minimize false positivity.
Ú > 
 w ð 12 or 24 hrs urine
collection give a more accurate result of the
amount of protein in urine (%!4)5 <
) consisting mainly of  .
Lecture note for regular second year
Nursing student, February 2003/2011. 43
-%V  
&   'most
commonly used to diagnose renal
problems. Voncentration of urea in blood
is determined by the rate at which
kidney excrete urea &!74/4<'%
!3&! 3  'is used to
evaluate the severity of kidney disease
and to follow the patient's clinical
progress.
This test also give information
concerning the kidneys effectiveness in
caring out their execratory function this
is serum creatinine &!74%5 )%5<'
Lecture note for regular second year
Nursing student, February 2003/2011. 44
/%!   
"% *&1  ,  '
C
§ ðn + study of the  
1  ,  , (va„) may
be performed to delineate the ? ,
$ ,$   1  and
to reveal any abnormalities, such as
 &  'in the kidneys or
urinary tract,   $
(distention of the pelvis of the kidney),
 ,  ,1   $  
by abnormalities in surrounding tissues.
Lecture note for regular second year
Nursing student, February 2003/2011. 4Õ
V .
%D +  %
O rt is x-ray that helps to visualize urinary
tract after r.V injection or radio opaque dye
(an organic iodine-containing contrast
medium).
O The bladder should be examined both $ 
$     for abnormalities of
  
 .
<      8
  $     &)6'
     @
  
&4%44/6'
 "    

Lecture note for regular second year


Nursing student, February 2003/2011. 4Ê
V .
O   $   8
Ú"       
    ,
Ú     & %%  
  ',
Ú       $ 

& %%  , ',
Ú    
 $   & %%
 $     '%
Lecture note for regular second year
Nursing student, February 2003/2011. 47
V .
V% $ 
å Ë-ray taken with rotating tubes,
to delineate segments of the
kidney at different levels/degree.
å r.V injection of radio opaque dye is
performed before the procedure.

Lecture note for regular second year


Nursing student, February 2003/2011. 48
V .
Y%!   
Ú rn retrograde pyelography,    
 
     
into the renal pelvis by means of
  $ .
Ú ð contrast agent is then injected.
Ú Retrograde pyelography is usually
performed   
 $ 
$
   = 
 ? 
      .

Lecture note for regular second year


Nursing student, February 2003/2011. 49
V .
Retrograde pyelography is mainly
used;
* to investigate lesions of the ureter
* to define the lower level of ureteral
obstruction shown on excretion
urography or ultrasound plus antegrade
studies.
  Itis invasive, commonly requires a general
anaesthetic, and may result in the
introduction of infection.
Lecture note for regular second year
Nursing student, February 2003/2011. Õ0
V .
Ú Vystoscope and urethral catheter
are insert through it in to renal
pelvis and dye is injected through
catheter .
%!   & '
  rnjecting radiopaque dye in to
artery, to visualize the renal blood
vessel.

Lecture note for regular second year


Nursing student, February 2003/2011. Õ1
V .
3%V$  $ &V'
V  8
Ú   ?   (  
      $ %
Ú     
Ú   E  E 8(   
(    $   & %%  
 '%
Ú 
    $     ,
 $     &$   '  
     %
Ú  
   %
Ú 
 ?      
 %
Ú    $    %

Lecture note for regular second year


Nursing student, February 2003/2011. Õ2
V .%%
%     
&!'
!  7
  to characterize renal masses as an
alternative to VT.
  to stage renal, prostate and bladder
cancer.
  To demonstrate the renal arteries.
   ` "° ` 
#
Lecture note for regular second year
Nursing student, February 2003/2011. Õ3
0% $ 
"% V  $
Ú Vystoscopy (cystourethroscopy) is a diagnostic
procedure that uses an  $ especially designed
for     +     ,( 
    ,$  %
Ú The cystoscope, which is inserted through the urethra
into the bladder, has a self-contained optical lens
system that provides a magnified, illuminated view of
the bladder.
Ú The cystoscope is manipulated to allow complete
visualization of the urethra and bladder as well as the
ureteral orifices and prostatic urethra.
Ú rt can also be used to      $ ,$ 
 $ , 
   %
Ú "  $  $   )4 04  %

Lecture note for regular second year


Nursing student, February 2003/2011. Õ4
V .

Lecture note for regular second year


Nursing student, February 2003/2011. ÕÕ
$
â Vystoscopy is performed by
 to +       
    1  $ 
 =    %

Lecture note for regular second year


Nursing student, February 2003/2011. ÕÊ
V .
  7
â      &   '%
â       &    '%
â        %
â         
    %
â  $        %
â  1    %
â    $    $  %
â       &  '%
â Y    :        %
â  $      %

Lecture note for regular second year


Nursing student, February 2003/2011. Õ7
V .
 $ 
* Vystoscopy can be performed in a  $ ,
 E   , $    
  %
* $      may be used
for the procedure.
* Yistension of the bladder with fluid is
particularly painful, and if it needs to be
done, as in the case of evaluating interstitial
cystitis, general anesthesia is required.
* Vystoscopy is typically performed on an
outpatient basis, but $    
 
     $     
 =  %
Lecture note for regular second year
Nursing student, February 2003/2011. Õ8
V .
" 
O —atients who have undergone a
cystoscopy are instructed tow
â 1 (    
$ %
â    


 , $        ( 
  
â +$          $
   ( %
â 
     +    
 %
â $ $  +      
         
$ %

Lecture note for regular second year


Nursing student, February 2003/2011. Õ9
V .
V$  
§   
§  %
§   %
§       %
§: $  %

Lecture note for regular second year


Nursing student, February 2003/2011. Ê0
5%  
*   $
„iopsy of the kidney is used in   

    +  1    %
rndications for biopsy include  +$   
   ,$   $  
   ,  $  :  ,
 $  %
ð small section of renal cortex is obtained either
$     &   $ 'or by $ 
 $   1  %
„efore the biopsy is carried out, coagulation
studies are conducted to identify any risk for post
biopsy bleeding.
Vontraindications to a kidney biopsy include
     ,  
 $   ,   1  %
Lecture note for regular second year
Nursing student, February 2003/2011. Ê1
V .
  <  $ 
Ú rt is an instrument with small
external ultrasound probe and
conductive attached to the patient.
Ú Vomputer interprets tissue density
based on sound wave & displays it
in picture form.
Ú       
      
Lecture note for regular second year
Nursing student, February 2003/2011. Ê2
V .
O rn renal diagnosis it is the method of
choice forw
         $ 
    
 $  %
  1 $ 
      
      ( 
       $  %
   ?     
 
   $  1    %
      <$   $ 
 & %%$ ,'%
       $  
   
  %
Lecture note for regular second year
Nursing student, February 2003/2011. Ê3
Vont«d
Y 
  8
*     (   
$ 
    %
*     
 ?   
  %
*       
      
:    %
*   $   $   %
Lecture note for regular second year
Nursing student, February 2003/2011. Ê4
Y    1 
)%"   $
§ ðcute glomerulonephritis refers to $1  
  in which there is an     in
the glomeruli ( $  '%
§ rt is       1  but rather  
  (           
     .
§ ðcute glomerulonephritis is primarily a disease of
    -   , but it can occur at
nearly any age.
§ ðs a result of antigen antibody reaction,   
  &$ + 'are formed and   
    .
§ 2ome of these complexes       
      1  and induce an
   $ .

Lecture note for regular second year


Nursing student, February 2003/2011. ÊÕ
V .
V
  $"     $ 
  . (˜ost common following -/
(1      ).
  $  (infection of the skin).
  " 
    ($$ 
 $         ,$ ,

  ? 
 ,$ 

 , $ ,D   ).
  "        (eg,
    ,  ).
  *    itself.

Lecture note for regular second year


Nursing student, February 2003/2011. ÊÊ
V .
 $ 

Lecture note for regular second year


Nursing student, February 2003/2011. Ê7
V .

Lecture note for regular second year


Nursing student, February 2003/2011. Ê8
V .
V     
Ú   ?   ,
Ú1   & ',
Ú    ,
Ú  ,
Ú  ,
Ú ,
Ú31$ & 
',
Ú $   ,
ÚVD"   ,
Ú2ome times and  $  
     .
Lecture note for regular second year
Nursing student, February 2003/2011. Ê9
V .
Y 
  Y    %
    +  %
    %
   "
%
  "  $   
%
  VV%
  !  $ %

Lecture note for regular second year


Nursing student, February 2003/2011. 70
V .
    
*  $    until the sign of
glemerular inflammation (heamaturia,
proteinuria, ) relived.
* !       to treat
edema.
* 2$  .
* "  $  
.
* 2($  to reduce nitrogenous
waste ( E.g. elevated „aN ).
* "    (—enicillin or erythromycin).
* V    .
*  $$      .

Lecture note for regular second year


Nursing student, February 2003/2011. 71
V .
   
 
Ú   $     (E.g.
          
   1  ).
Ú "$$$     (usually
penicillin) is administration is essential. (
 $        ).
Ú    concerning  , , 
($ etc...
Ú V   
   to
provide energy and reduce the catabolism of
protein.
Ú  1  $ are carefully measured
and recorded.
Lecture note for regular second year
Nursing student, February 2003/2011. 72
V .
V$  
   $  
  $$  %
  V
    %
     %

Lecture note for regular second year


Nursing student, February 2003/2011. 73
-%V   $
å Vhronic glomerulonephritis is a
syndrome that reflects the   
     
  .
V
 ! $   $   
  $ %
  $  
 $   %
  $  $   %
 V      : %
        
    %
Lecture note for regular second year
Nursing student, February 2003/2011. 74
V .
 $ 
ðntigen-antibody reaction occur repeatedly

kidneys are reduced to as little as      


 ? (consisting largely of     ).
The cortex shrinks to a layer ) -  1or
less.            
 +, making the surface of the kidney 
  . Numerous glomeruli and their
tubules become  , and the    
      1  . The result is
 
       !Y.

Lecture note for regular second year


Nursing student, February 2003/2011. 7Õ
V .
Y 
  +%
  <%
    %
  V + %
     %

Lecture note for regular second year


Nursing student, February 2003/2011. 7Ê
V .
V     
O The symptom of chronic glomerulonephritis are
 
some of them with sever grades of this disease 

$    .
O  &$   $  $ & $   ''%
O 
$  %
O  $   %
O 
 <%
O   %
O Y ??  %
O "  %
O "  %
O   +&3     '%
O    (   %
 7&:  $
  )-  %" (
$  (  $
@    :       %

Lecture note for regular second year


Nursing student, February 2003/2011. 77
V .
  
)%    
 
O Treatment of patient with chronic
glomerulonephritis is entirely, 
$    $  ,
 $      .
O The goal of treatment is tow-
O ! 
  %
O V    $    %
O    $   %
O         %

Lecture note for regular second year


Nursing student, February 2003/2011. 78
V .
Ú rf the patient has  $   , the blood
pressure is reduced with;
Ú  (    ,
Ú "  $  
  , %
Ú rf fluid overload;
Ú Y       $   %
Ú        .
Ú      
 (dairy products,
eggs, meats) are provided to promote good
nutritional status.
Ú " =  are also important to spare
protein for tissue growth and repair.
Ú       promptly to prevent further
renal damage.
Ú "      (—rednisolone).

Lecture note for regular second year


Nursing student, February 2003/2011. 79
V .
-%   
 
O Y  (   %
O "    1  %
O  
   & ,
+   ,  ', 
     ,     
  %
O  $  & =    ',
$     %
O        %
V$  
O V 
   %
O ! $     %
O     %
Lecture note for regular second year
Nursing student, February 2003/2011. 80
/% $  
syndrome is $  
§ Nephritic
   characterized
byw
â 1 $  %
â  $   %
â  %
â  $    < $   %
§ Thesyndrome is apparent in  
        
  $  
  and results in   
 $    .
Lecture note for regular second year
Nursing student, February 2003/2011. 81
V .
* Nephrotic syndrome can occur
with almost       
      that
affects the glomerulus.
* ðlthough generally considered a
   , nephrotic
syndrome does occur  ,
      .

Lecture note for regular second year


Nursing student, February 2003/2011. 82
V .
V
â V   $ ,
â Y     ( 
 $      ,
â "     1  ,
â   $       ,
â  $  ,
â ! 
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 83
V .
 $ 
The nephrotic syndrome occurs in
response to a group of diseases in
which inflammation of the
glomerulus (glomerulonephritis) is
predominant.

Lecture note for regular second year


Nursing student, February 2003/2011. 84
V .

Lecture note for regular second year


Nursing student, February 2003/2011. 8Õ
V .
V     
â 2 ?    ?   & 
&$   ',  $     & ,
1 , ''%
â "  %
â   +%
â   %
â  $$   %
â 2    $ %
â   %
â    %
â   $ %
â 3  < %
â " + %
Lecture note for regular second year
Nursing student, February 2003/2011. 8Ê
V .
Y 
  +%
  <%
  <"%
  VV%

Lecture note for regular second year


Nursing student, February 2003/2011. 87
V .
  
)%  
The objective of management is to $ 
 
 .
asually it is  $   , depends on the cause.
rt includes;
   8
Y   %
"   
  ?  &"V'
   .
"  $   ( $ $ 
[Vytoxan]).
 $$      (?  $ 
[rmuran],   [Leukeran], or
  $  ).
V    ($   ) if relapse occurs.
Lecture note for regular second year
Nursing student, February 2003/2011. 88
Vont«d
Y 8
2(  ,  $   .
   $  (dairy products,
eggs, meats). (—rotein intake should be
about 0.8 g/kg/day).
2(     .
  %
"       %

Lecture note for regular second year


Nursing student, February 2003/2011. 89
V .
-%  
 
   
      
(  %
  1     

  %
        
 
   %
  "    1  $ %
      $     %
     $$ &
   '%
      %
Lecture note for regular second year
Nursing student, February 2003/2011. 90
0%  $
Ú —yelonephritis is   
  of the renal $ 
,
 ,     of
one or both kidneys.
Ú —yelonephritis is frequently
secondary to  

 +, in which an $  
 


allows the
urine to back up (reflux) into the
ureters.
Lecture note for regular second year
Nursing student, February 2003/2011. 91
V .
Ú ˜ore common in     
  , in $  ( 
when there is failure to empty the
bladder on time.
Ú   8
)% " %
-% V %

Lecture note for regular second year


Nursing student, February 2003/2011. 92
0%)%"   $
V
*       %
*    %
*     %
*   $   $ $ %
*     %
V   $   
     $    
  &% '  
$  %
Lecture note for regular second year
Nursing student, February 2003/2011. 93
V .
V     
Ú "   &  '%
Ú V  %
Ú 3
%
Ú 2 1  %
Ú    %
Ú   %
Ú 31$ %
Ú VD"   %
Ú Y  %
Ú 3 =    %
Ú   %
Ú  @
 %
Ú $     ,     %
Lecture note for regular second year
Nursing student, February 2003/2011. 94
V .
"   Y  3  
      %
  V %
       

%

Lecture note for regular second year


Nursing student, February 2003/2011. 9Õ
V .
    
—atients with  $  
$  $ are usually treated as
 $  if they are     ,
  +$    
 ,
and   (    $  
$ %
Other patients, including $  
( , may be hospitalized for at   
-/ of parenteral therapy.
Oral agents may be substituted once the
patient is afebrile and showing clinical
improvement.
Lecture note for regular second year
Nursing student, February 2003/2011. 9Ê
V .
   $
å 3 $  , a -( 1course of antibiotics is
recommended because  $  
            
      %
å Vommonly prescribed agents;
å V $+ ,
å     ( (  $   %
å      $ $ %
å ðfter the initial antibiotic regimen, the patient may
need antibiotic therapy for $ 9( 1  

   $   %
å ð follow-up urine culture is done -( 1  
$      $ to document
clearing of the infection.

Lecture note for regular second year


Nursing student, February 2003/2011. 97
0%-%V $  $

§Repeated bouts of acute


pyelonephritis may lead to chronic
pyelonephritis.
V     
â   ,
â   ,
â $$$ ,
â $  ,
â +
   ,
â (   %
Lecture note for regular second year
Nursing student, February 2003/2011. 98
V .
 $ 
O There are areas of inflammation in the
kidney with interstitial infiltrations of
inflammatory cells which in time may
produce   @  
 %
O Low grade interstitial inflammation may
result in  $   
 and in    ?   
  %
O Eventually when pyelonephritis become
chronic, the kidneys become scarred,
contracted and of little functional value.
Lecture note for regular second year
Nursing student, February 2003/2011. 99
V .
"   Y  3  
(  
 %
(      
      %
( %

Lecture note for regular second year


Nursing student, February 2003/2011. 100
V .
    
O    (e.g. Nitrofurantoin, Oral
antimicrobial drugs (e.g. 2ulfonamide,
ðmpicillin, e.t.c.)).
O 3   1 D00 ml/day.
O 2   .
O   l of severe complete
(hospitalization).
O 3($urine cultures and other
discharges.
O Requires   , e.g. Nephrotomy,
nephrectomy or pyolotomy.
Lecture note for regular second year
Nursing student, February 2003/2011. 101
V .
   
Ú        1  $  
  %
Ú      ,     &/ 
02< '       ,    
  ,$
    %
Ú      $  F  $   
 
0     $     
   $   %
Ú       $     %
Ú      &!'%
Ú     %&    ,  G   
($,        
  '%

Lecture note for regular second year


Nursing student, February 2003/2011. 102
V .
V$  
!Y%
 $   %
3 1    %

Lecture note for regular second year


Nursing student, February 2003/2011. 103
5%! 3 
Ú The term is used to primarily to
denote      +  
   1  , leading to
     ( 
$   %
Ú Various other aspects of renal
function may fail at the same time,
including the    
       ,   
 ,   ,
     %
Lecture note for regular second year
Nursing student, February 2003/2011. 104
V .
O Renal failure is     
and is a  $ ( 
 different kidney and urinary
tract diseases.
O ð wide range of clinical manifestations
may occur.
O The most fundamental categorization of
renal failure is;
)% " !   %
-% V !   %

Lecture note for regular second year


Nursing student, February 2003/2011. 10Õ
5%)%"   
  ðcute renal failure is    
$  1   &   
3!',  
  caused by failure of the
renal circulation or by glemerular or tubular
damage over a period of    <( 1 %
    &  044<   'is the
 clinical situation seen in ðR.
ðnuria (less than 50 ml/day of urine) and normal
urine output are not as common.
  !    
    + , the
patient with ðR experiences rising serum
creatinine and „aN levels and retention of other
metabolic waste products (azotemia) normally
excreted by the kidneys.

Lecture note for regular second year


Nursing student, February 2003/2011. 10Ê
V .
V " ! 3 
%  3  7      $  
(     $$    
1  %
* D  $   7
(   %
( !  &   ,    '%
(     &
 ,  ,     '%
* $         7
(     %
(     %
( Y    %
( V    1%
* D     7
(  $ %
( "$ + %
( "  $  
             

   %

Lecture note for regular second year


Nursing student, February 2003/2011. 107
V .
%  3  7      
$   %
*        7
(     $$  &   (    1(
     $        1  
  '%
(    & ,  : , '%
(    &     ,    '%
*  $ +     7
( "        &    ,   '
( ! $=     %
(  
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( 
    &     ,
  ,  '%
(        &"Y '
( "   
  ?      &"V    '%
*    $   7
( " $  $ %
( "   $ %
Lecture note for regular second year
Nursing student, February 2003/2011. 108
V .
%  3  7   
       
(      1  ,
 , %
*       ,
 7
( V &  '%
(  %
(   $   $ $ %
(     %
(  %
Lecture note for regular second year
Nursing student, February 2003/2011. 109
V .
" 3"V!"23"2!
§There are four clinical phases of
ðRw
1. rnitiation.
2. Oliguria.
D. Yiuresis.
4. Recovery.

Lecture note for regular second year


Nursing student, February 2003/2011. 110
Vont«d
)%   w-The initiation period begins with
the       (   

$ %
-%   w-The oliguria period is accompanied
by         
  usually excreted by the kidneys
(urea, creatinine, uric acid, organic acids,
and the intracellular cations [potassium and
magnesium]). rn this phase   
$    $$   
   conditions such as
hyperkalemia develop.  $  
$$+   )4 %

Lecture note for regular second year


Nursing student, February 2003/2011. 111
Vont«d
/%Y  w-rn the diuresis period, the
patient experiences  
     $ , which
signals that glomerular filtration has
started to recover.
0%! 
 w-The recovery period signals
  $
    
  1 / )-  . Laboratory
values return to the patient·s normal level.
ðlthough a permanent 1% to D% reduction
in the R is common, it is not clinically
significant.
Lecture note for regular second year
Nursing student, February 2003/2011. 112
Vont«d
V     
â  $   $$    
  %
â     ,
 ,
  %
â   1     
    %
â     
  
  &   '%
â V   
    
$    (  ,
  ,   (  ,
? %
Lecture note for regular second year
Nursing student, February 2003/2011. 113
Vont«d
"   Y  
3  
Ú +%
Ú <%
Ú <"%
Ú   $
Ú % %%

Lecture note for regular second year


Nursing student, February 2003/2011. 114
Vont«d
    
O The objectives of treatment of ðR
are to restore normal chemical
balance and prevent complications
until repair of renal tissue and
restoration of renal function can
take place.
â " $     
   ,   ,    %
â       ,
â 
    + ,
â $    %
Lecture note for regular second year
Nursing student, February 2003/2011. 11Õ
Vont«d
   $
( V  +   (sodium
polystyrene sulfonate [vayexalate]) orally
or by retention enema.
(   is often administered in
combination with vayexalate to induce a
diarrhea-type effect (it induces water loss
in the r tract).
( 2( $  (1 to D g/kg) is often
used to dilate the renal arteries through
stimulation of dopaminergic receptors.
( Y    %

Lecture note for regular second year


Nursing student, February 2003/2011. 11Ê
Vont«d
   
 
å        
 %
å !     %
å  $  %
å 
    %
å 
  1  %
å 
  $$ %

Lecture note for regular second year


Nursing student, February 2003/2011. 117
5%-%V! V!"23"2!
&Y"!"2Y"'
&Y
Vhronic renal failure, or E2RY, is

  
   in renal function in
which the body·s ability to
      
and electrolyte balance fails,
resulting in    $  
Äretention of urea and other
nitrogenous wastes in the blood).
Lecture note for regular second year
Nursing student, February 2003/2011. 118
Vont«d
V 
Ú     ,       
&   '%
Ú  $   %
Ú V   $ %
Ú   $ %
Ú         %
Ú       ,  $  1  
  %
Ú D    %
Ú    %
Ú     %
Ú 
  $  +   
& , ,  , '%
Lecture note for regular second year
Nursing student, February 2003/2011. 119
Vont«d
  V ! Y 
  )7!    

§Vharacterized by a 046 ;56 


 $ % The patient
usually   
 $  
because the     $  
      
    1  .
§   %

Lecture note for regular second year


Nursing student, February 2003/2011. 120
Vont«d
  -7!     
§Occurs when ;56 H46
 $   %
§ðt this point, the     
    , the
kidney loses its ability to concentrate
urine and anemia develops.
§The patient may report $  
  %
§    %
Lecture note for regular second year
Nursing student, February 2003/2011. 121
Vont«d
  /7     
&!Y'
§The final stage of chronic renal failure,
occurs when there is   )46
 $    %
§ðll of the normal    , +  ,
  of the kidney
are severely impaired.
§E2RY is evidenced by 
 
       

  (      
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 122
Vont«d
V     
Ú   7  1   ,
 ,    
   ,    ,
  , ? ,  + ,
     , 
  , 
 %
Ú     7  ?  1 
, 1  1 ,$  ,
  ,$$,  ,  
  ,     %
Lecture note for regular second year
Nursing student, February 2003/2011. 123
Vont«d
Ú V 
 7  $   8$ 
 & , , '8
$     8$     
8   1
 8$   8
$     8$   
$ 8 $ 1  8 
   , $  $   %
Ú  7 V1 8  1,   
$ 8 $   +8
$   $ 8     8
 $ 8*  $ 
 $   8  $  8
I  J%

Lecture note for regular second year


Nursing student, February 2003/2011. 124
Vont«d
Ú    7 " 
   &I   J'8
    8 
     8
 + , ,
 8
 $ 8 $ 
  8  
     %
Ú    7 "  8
 $  %
Lecture note for regular second year
Nursing student, February 2003/2011. 12Õ
Vont«d
Ú! $
7 "  8
 $ 8    8
     %
Ú   1  7   
$ 8      8
   $ 8 
$ 8   8 $%

Lecture note for regular second year


Nursing student, February 2003/2011. 12Ê
Lecture note for regular second year
Nursing student, February 2003/2011. 127
Vont«d
"   Y  3  
* +%
* <%
* <"%
* VD +  %
* ! $    +  %
* % %%

Lecture note for regular second year


Nursing student, February 2003/2011. 128
Vont«d
V$  
â  $ 1  %
â    ,$     ,
$    $ %
â  $   %
â "  %
â       
    %

Lecture note for regular second year


Nursing student, February 2003/2011. 129
Vont«d
    
Ú  V     
&aluminum-based antacids) with food to
be effective calcium carbonate.
Ú "  $  
V 
 
"  %
Ú " ? "  %
Ú  $ &recombinant human
erythropoietin (Epogen)).
Ú     $ %
Ú Y  %

Lecture note for regular second year


Nursing student, February 2003/2011. 130
9%!  $   
ÚY - Renal hypertension is
increment of blood pressure in the
renal system.
"  %&rennin juxtaglamerular cell
tumors, nephroblastomas.

Lecture note for regular second year


Nursing student, February 2003/2011. 131
Vont«d
 $  
  ðny condition which     (through
the kidneys or destroy renal function tissue cause
hypertension. 2uch condition are    
    (nephritis and polycystic
kidney disease).
  The ischemic kidney reacts by secreting a $  
?     %
  rn the blood stream,    $$ 
$       (  
 
   cause wide spread
    
of the arterioles &   $  $   
leading to an elevation of arterial blood pressure.
  ðngiotensin rr is also alleged        
  by the adrenal glands which as
previously ceiled increase the blood pressure through
its influence on  (   %

Lecture note for regular second year


Nursing student, February 2003/2011. 132
Vont«d
V     
â Y   

  
1  %
â "  
  $ %
â   1    %
â V $  $ %
â !     %

Lecture note for regular second year


Nursing student, February 2003/2011. 133
Vont«d
+
â Y $  $   %
â %%"  $  
   
       
    % %.%

Lecture note for regular second year


Nursing student, February 2003/2011. 134
;% $   1 
å Renal tumor may arise from  
$  $   (  
 ',  
  
&  'or    or they
may be    or
 .
å ðlmost H46  are renal
adenocarcinomas, these tumors
occur   =     &
may metastasize early to the  ,
 ,
,  
 1  %
Lecture note for regular second year
Nursing student, February 2003/2011. 13Õ
Vont«d
! 13  ! V 
  7"     
( %
 %
$  +$   
     ,  
$  $ , 
  ,
   %
 %
$$     $ %
  1    %
Lecture note for regular second year
Nursing student, February 2003/2011. 13Ê
Vont«d
V     
(  $     %
(   %
(  1 &   ? '%
( "  %
( 31$ &V 1 $    
    $ (  
 '%
(    $$  %
( " + %

Lecture note for regular second year


Nursing student, February 2003/2011. 137
Vont«d
  
  !  8
  D  $ &    
 
         $ 
   
  $ %"        :  ' 
     $ F     
    & 
    $ 

   ' %%%
  V $ %
  !  &  &+  '
   $  (   ,  
   $      
          %"
      :   $     
   $$ '       
+$  
  

  %
    %

Lecture note for regular second year


Nursing student, February 2003/2011. 138
Vont«d
  
* rf disease is  ?   1  
  $   is performed,
followed by   
   $ %
* rf  $ 
  

    is
removed along with the kidney,
 $     will be done.
* rf the tumor is $   ,   
 $    $ 
  $ %
* Y 7- a normal diet may be given to
these patients as soon as peristaltic
activity is present.
Lecture note for regular second year
Nursing student, February 2003/2011. 139
Vont«d
   
 
O  $ 
  %
O  $ 
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 140
B% $   <  
Ú  $   /   is
the presence of  in the
1  and in the     
respectively.
Ú The term         
 and       
 .
Ú There are many factors involved in
the incidence and type of stone
formation.
Lecture note for regular second year
Nursing student, February 2003/2011. 141
Vont«d
å 3     
$    
  8
å Y  8
å 2   1   $  
     + %
å +
   :  

     + 
%
å 2   1  + %
å +
  1 
 Y%
å +
  1  11 %

Lecture note for regular second year


Nursing student, February 2003/2011. 142
Vont«d
å   8
å 3  +   ,  , 
    %
å 2    8
å     $ ,    
&  /-4,444 $  ? $  '%
å V  8
å    $   $      
    ,(  
 ,
            %
å     &   , ?  
&Y +',
 Y,+
, 
  $  %
å     & $ $    '%
Lecture note for regular second year
Nursing student, February 2003/2011. 143
Vont«d
å   &  $    
$     —  
—    '  
(   ` `` # `   
` 
å   (   & 
     $ 
+ '%

Lecture note for regular second year


Nursing student, February 2003/2011. 144
Vont«d
§Y     $    
         
  $     
      % 
 $ $ <+ 
&;56 ',  &56
)46  ', 
 &)6 -6  '@

&)56   '
(   +      %
Lecture note for regular second year
Nursing student, February 2003/2011. 14Õ
Vont«d

Lecture note for regular second year


Nursing student, February 2003/2011. 14Ê
Vont«d
V     
O The manifestation of renal calculus
depend upon   ?     
    ,   ,
  ,  ,and (  
      .
Ú rt may remain latent over a long
period, producing no symptoms.
Ú 
 1   may be
passed without any disturbance.

Lecture note for regular second year


Nursing student, February 2003/2011. 147
Vont«d
â       $  %
â    &$  $  
(   ,
,  '%
â "   , $    
 
   &     
 $ 
'       
(( (    
    (    
  '%
â    %
â   %
Lecture note for regular second year
Nursing student, February 2003/2011. 148
Vont«d
O    $ (2tones
lodged in the ureter (ureteral
obstruction) cause  ,
+  , 1 ,(
 1 
$ ,  (    
      % Often, the
patient has a desire to void, but
little urine is passed, and it
usually contains blood because of
the abrasive action of the stone.
Lecture note for regular second year
Nursing student, February 2003/2011. 149
Vont«d
"   Y  
3  
Ú+%
Ú<%
ÚC     1  , ,
 &*'
Ú  $ %
Ú 
 $ %
Ú !  $ $ %
Ú   %
Ú"-0   %
Lecture note for regular second year
Nursing student, February 2003/2011. 1Õ0
Vont«d
    
         8
         %
          $ %
  $
  $
  %
      ,
   
   %
   
  $ %
Lecture note for regular second year
Nursing student, February 2003/2011. 1Õ1
Vont«d
   8
Ú $   %
Ú "Y %
Ú          1
  %
Ú      1 %
Ú     $ %

Lecture note for regular second year


Nursing student, February 2003/2011. 1Õ2
Vont«d
Y  !    
 
*    8
Ú !   $  94<  
          + 
   %
Ú "     /G0<  
   %      
         
$ (    $    
1  %
Ú 2(       
   , + $    $

 $   %
Ú !   +     & $ ,
(  , ,$  ,(  '%

Lecture note for regular second year


Nursing student, February 2003/2011. 1Õ3
H% $  
Ú rt is   ,   ,    
 1  due to prolonged hypertension.
 $ 
Ú There are two forms of nephrosclerosisw
Ú  &   '8
Ú     (    $   
&   $     )/4'%
Ú        ,  
   (     ( %
Ú    $ $ $  %  
  ,  $     
 (  %
Ú  8
Ú          
   (      
 $   %

Lecture note for regular second year


Nursing student, February 2003/2011. 1Õ4
Vont«d
"   Y  3  
â +%
â <%
â <"%
â % %%
    
â "
  $  
  $ %
â "V   ,  
  (   
  $  
    %
Lecture note for regular second year
Nursing student, February 2003/2011. 1ÕÕ
)4%  $
 rt is      $ 
  
of one or both kidneys due to an obstruction.
V
 Obstruction to the normal flow of urine due
to;
 !   %
 %
 * 1 %
      &  
  $ 1  '%
   %
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 1ÕÊ
Vont«d
 $ 
O   to the normal flow of urine causes
the urine to 1$, resulting in increased
pressure in the kidney.
O rf the obstruction is in the    
 , the back pressure affects  1  ,
but if the obstruction is in      
only one kidney is damaged.
O hatever the cause, as the urine accumulates in
the renal pelvis,     $ 
 
  . rn time, atrophy of the kidney results.
O ðs one kidney undergoes gradual destruction, the
other kidney gradually  &$    
 $  $ '%
O altimately, renal function is impaired.

Lecture note for regular second year


Nursing student, February 2003/2011. 1Õ7
Vont«d
V     
* "    11
(acute obstruction).
* Y  ,  ,
,
  ,$  (rf
infection is present).
*    $  %
*    $   
   (rf both kidneys are
affected).
Lecture note for regular second year
Nursing student, February 2003/2011. 1Õ8
Vont«d
    
O The goals of management are;
â            
  %
â       %
â    
  %
O rt includes;
â  $     $ 

 %
â "     %
â   
 
  %
â  $   %

Lecture note for regular second year


Nursing student, February 2003/2011. 1Õ9
))%! 
Ú rt is the involvement of renal system by
tuberculosis infection.
 $ 
O Tuberculosis of the urinary tract is caused
by the organism # `  `
`  
O The organism usually travels from the lungs
by means of the   
&     $ ' to the kidneys.
O On arrival in the kidney, the microorganism
may lie    %ðfter the
organism reaches the kidney, ( 
  and the characteristic
tubercles are seen.
Lecture note for regular second year
Nursing student, February 2003/2011. 1Ê0
Vont«d
O rf the organism continues to
multiply `  

  `  with eventual
 `   `  
 
O The organism spreads down the
urinary tract into the  
   ` 
     
 ` 
Lecture note for regular second year
Nursing student, February 2003/2011. 1Ê1
Vont«d
V     
â    
%
â    %
â    (  %
â 2 $$ %
â    %
â    &  $  '
â   %
â  ,  ,   =  
&    

  '%
Lecture note for regular second year
Nursing student, February 2003/2011. 1Ê2
V .
"   Y  3  
O     %
O !%
O V!&$      '
&V!'%
O  
 $ %
O  $ %

Lecture note for regular second year


Nursing student, February 2003/2011. 1Ê3
Vont«d
    
O The goal of treatment is to eradicate the offending
organism.
O Vombinations of  ,  ? , $ 
are used to delay the emergence of resistant organisms.
O 2horter-course chemotherapy &0  'has been
effective in       
$      %
O    
 may be necessary to treat
obstruction and  
 + 
   
1  %
O $   , =  ,   
$  %
O "   $$ may be used by male patients with
genital swelling.

Lecture note for regular second year


Nursing student, February 2003/2011. 1Ê4
Vont«d
   
O — `  to promote effective
self-care at home.
O rnstructions are provided about  

 ``     
`
$
  `  
  
   ` 
` 
 `      
O rnstructions are also



   `  ) `  
   ) `  
  &` 
Lecture note for regular second year
Nursing student, February 2003/2011. 1ÊÕ
V .
O ˜en are instructed   `   

 ! `   
     
  )
     
`    ` 
   `  

 
O The patient is encouraged to
maintain a healthy lifestyle with a
&  `  
    !` 
Lecture note for regular second year
Nursing student, February 2003/2011. 1ÊÊ
V .
O The patient is counseled about the
need for   &!    
(urine cultures, intravenous
urograms), usually for 1 year.
O Treatment is   
   ``   `
 `
  

    `
O ˜onitored for these complications.
Lecture note for regular second year
Nursing student, February 2003/2011. 1Ê7
)-%! 
O Renal cysts are ,   
 that arise from the 1    .
O They may be    in origin, =  ,
or associated with a    
  %
O Vysts of the kidney may be  
 $ &$  ', involving  
 1  %
O —olycystic disease of the adult is
       
 and affects  ( 
= %
Lecture note for regular second year
Nursing student, February 2003/2011. 1Ê8
"    $  
1   
O ðutosomal dominant polycystic kidney
disease is    
 , occurring in between ) 
-44) ),444of the population.
O !   disease is also common,
occurring in -46$  %
O —olycystic renal disease is also
associated with    
   &
,$  , $ '
       
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 1Ê9
V .
O rt has long been recognized that
$     
&    
$     ' develop
multiple cysts on their
  1  %
O ˜any of these cysts contain
   .

Lecture note for regular second year


Nursing student, February 2003/2011. 170
"=   1   

O ðn acquired form of polycystic


disease occurring as a result of
!Y   (   is
called =   1  
  %
O ðcquired cystic kidney disease has
been associated with     ,
   , $   
  , $   
$    1  %
Lecture note for regular second year
Nursing student, February 2003/2011. 171
V .
V     
O " $ %
O    %
O  $   %
O $   %
O !    %
O !        %

Lecture note for regular second year


Nursing student, February 2003/2011. 172
Vont«d
Y   
â  
 $ %
â V %
â     %
â     %

Lecture note for regular second year


Nursing student, February 2003/2011. 173
Vont«d
  
O —atient care focuses on   $ , $  ,
$   %
O  $    are treated aggressively.
O Y  is initiated when   $  
        %
O     is part of management with
polycystic kidney disease that is genetic in origin.
O The patient is advised to 
  $ 
$    $   1  
 1  %
O V   percutaneously for simple cyst.
O !         .

Lecture note for regular second year


Nursing student, February 2003/2011. 174
Y    , 
 
)%    
Ú     of the ureters occurs
  =   than disease of the
  $      %
Ú "     
 $  may occur in ureters.
Ú The most common anomaly is    
   $          
 normally urine can only flow the
ureters in to the bladder.

Lecture note for regular second year


Nursing student, February 2003/2011. 17Õ
Vont«d
Ú The   
    
permits a urinary reflux 
1(    
  from the bladder this
predispose pyelonephritis.
Ú   is carried out to correct
the defect primary neoplasm of the
ureters is quite rare.

Lecture note for regular second year


Nursing student, February 2003/2011. 17Ê
"% 
Ú      
 %
V
Ú  & %%$  $ '%
Ú!   %
Ú $ %
Ú % %
+
*     $  $ %
*   %
Lecture note for regular second year
Nursing student, February 2003/2011. 177
%    
    (     %
V
   %
 3  %
 V   %
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 178
Vont«d
V     
â    (    
$    %
â %%     
$  %
+
â    
 8
(  $ %
( "  %
â "  %
â " $   %
Lecture note for regular second year
Nursing student, February 2003/2011. 179
 Y   of the bladder
"%V
* Vystitis is an acute or chronic
inflammation of the urinary
bladder characterized by
 =  ,    
and abnormal urinary
constituents.
*        
     %

Lecture note for regular second year


Nursing student, February 2003/2011. 180
Vont«d
V 
â "        from
the urethra.
â  
 +(flowing
back of urine from the urethra in the
bladder).
â     
 
discharge can enter easily.
â   (use of catheters and
other examination objects &
administration of some drugs).
Lecture note for regular second year
Nursing student, February 2003/2011. 181
Vont«d
â   $   (e.g. in infective
cystitis are trauma of the tissue,
stagnation of urine and distortion or
compression of the bladder by outer
large neighbor organs).
â V   (e.g.
hypospadiasis).
â rn male $   $ $ 
  may cause cystitis.

Lecture note for regular second year


Nursing student, February 2003/2011. 182
Vont«d
V     
( "    $ &  ,
 =    '%
( $$ $ %
( Y  @3    %
( rn 2ome rndividuals    %
( The —resence of 3
, ,

 @1   
usually indicate $  $ %

Lecture note for regular second year


Nursing student, February 2003/2011. 183
Vont«d
   
â +%
â <%
â   %
â     

%
â !   +  %
â V  $ %
Lecture note for regular second year
Nursing student, February 2003/2011. 184
Vont«d
+
Ú" &" $   '.
Ú   relives bladder
irritation.
Ú     1 %
Ú"    )4)0
 %E.g. 2ulfonamides and
antibiotics.
Ú    e.g. about use of
fluid intake, regular emptying of
bladder etc.
Lecture note for regular second year
Nursing student, February 2003/2011. 18Õ
%   &V '
§rtis the formation of stone in the
bladder.
V
â     (in prostate
hypertrophy).
â     or injury that
hat resulted in the loss of voluntary
bladder control or interruption of the
sacral reflex arc.
â  
 F .

Lecture note for regular second year


Nursing student, February 2003/2011. 18Ê
Vont«d
â      $ 
  %
â Y   ( increased urine
concentration).
â (    for a prolonged
period of time.
â   %

Lecture note for regular second year


Nursing student, February 2003/2011. 187
Vont«d
V     
â      (%
â    %
â 
$     %
   
( V  $
( !  +  8
( D%
( <%
Lecture note for regular second year
Nursing student, February 2003/2011. 188
Vont«d
+
        
        $ %
    &    '%
  2     $
(    %
  V      & %%
$   $  $ '%

Lecture note for regular second year


Nursing student, February 2003/2011. 189
V%   
* rt is 1 1(   ( 
 when the bladder is full.
* rn     : if urinary
bladder causing perforation and
ensuring + 
     
  (escape of urine from the
bladder) is common.
* rt may occur when the $ 
 
  %
* rf the bladder is   
at the time of accident it is more
vulnerable.
Lecture note for regular second year
Nursing student, February 2003/2011. 190
Vont«d
V 
â %
â "      1 1(%
â % %%%%
V     
O  $   $  7
$   due to escape of urine in
to the peritoneal cavity (necrosis).
O 
$ of abdomen.
O    of abdomen.
O Y   abdomen.

Lecture note for regular second year


Nursing student, February 2003/2011. 191
Vont«d
O 1.
O + $   $  w- urine
escapes in to the surrounding
tissue cause cellulites, infection
and necrosis of tissue.
O " $    
develops.

Lecture note for regular second year


Nursing student, February 2003/2011. 192
Vont«d
 Y 
â   %
â V  $ %
+
O 2hock and hemorrhage should be
treated with    
D  %
O ðn (        
in to the bladder and prepare patient
for abdominal surgery.
Lecture note for regular second year
Nursing student, February 2003/2011. 193
Vont«d
   
 
O The site of injury is repaired and
temporary cystostomy &  
     
$$   'done 
     @
$
   $   $  
   $      %
O rf the rupture was in  $   
the + 
    
 $      %
Lecture note for regular second year
Nursing student, February 2003/2011. 194
Vont«d
O      
  
1&  '%
O "    1  
$    %
O "      
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 19Õ
Y%& $ '  
 
O Neoplasm in the bladder may
develop at any age but have more
frequently after the  54
 and have a      
     &/7)'%

Lecture note for regular second year


Nursing student, February 2003/2011. 19Ê
Vont«d

â V   1 %
â V   in the work environment
such as dyes, rubber, leather ink or
paint.
â V $     that
irritates the bladder (E.g. schistosmasis).
â V    $ 
(prostate, colon and rectum in and from
the lower gynecologic tract in female)
may metastasize to the bladder.

Lecture note for regular second year


Nursing student, February 2003/2011. 197
Vont«d
V     
â  $     %
â V l frequency, urgency &
dysuria.
â  
and 1$ may be due
to metastasis.
â !   due to obstruction of
ureter cause hydronephrosis.
â "   may be develop as a result
the patient manifests ( 1 @
  (  %
Lecture note for regular second year
Nursing student, February 2003/2011. 198
Vont«d
 Y 
O arinalysis.
O Vystoscopy.
O Vystogram
O „iopsy.
O VT scans.
O altrasound examination.

Lecture note for regular second year


Nursing student, February 2003/2011. 199
Vont«d
+
O Treatment of bladder cancer depends on  
 (    ,  $  
 ,$ ,  @     are
considered in determining treatment modalities.
O 2urgical interventions = V   $ 
   %
O !  %
O V   $ %
O V     ,  @
V   $ %
O     1 %
O  ? %
O      $$ %

Lecture note for regular second year


Nursing student, February 2003/2011. 200
%Y
 E   
 
§ð pouch or sac protruding from
the wall of the bladder.
§rt results from $  

      
  at the   1
or in   and    
( 1      
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 201
Vont«d
§V  due to the
hypertrophy of prostate.
§The condition is frequently
complicated by $ ,  
     
 (  ( %
+
*      %
* +   
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 202
/%Y     
"% 
* rt is an inflammation of the urethral
mucosa usually an ascending.
* There is gonorrheal and non
gonorrheal urethritis.
V 
â   &   $ ,
% %%%'
â D %
â  ?&  '%
â 3%
â %

Lecture note for regular second year


Nursing student, February 2003/2011. 203
Vont«d
V     
O Y  , =  %
O      
   %
O Y  & (  
   $ ,  
    1$  '%

Lecture note for regular second year


Nursing student, February 2003/2011. 204
Vont«d
 Y 
O   %
O     &    
&  (   '%
+
O "    depending on to
causative microorganisms.
O "      %
O      ( 
  %
O    $  %
O    1$   
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 20Õ
%    
O rt is a (      
 due to   
  %
V
O : - insertion of surgical instruments
during transurethral surgery, indwelling
catheter or cystoscopic procedure.
O    : %
O "   "   %
O     %
O V  " %

Lecture note for regular second year


Nursing student, February 2003/2011. 20Ê
Vont«d
V     
â The force & size of urinary stream is
diminished and    
  `   
occur.
â 2tricture cause urine to back up
resulting in `      
    

Lecture note for regular second year


Nursing student, February 2003/2011. 207
Vont«d
+
Ú Y     (  %
Ú $      
  
   (surgical removal of the
stricture).
Ú   ?   
  are given to control pain.
Ú "    are given for several
days after dilatation to minimize infection.
Ú   +  $ may be
necessary for sever cases.
Ú !  a $    is
necessary, b/c of sever retention.

Lecture note for regular second year


Nursing student, February 2003/2011. 208
4. Yisorder of Male reproductive system
A Prostatitis
is inflammation of
  —rostatitis
prostate gland caused by infections
agent.
V 
â      G   &% ,
1  ', @ $ %
â      %
â  $ $ $  &'%
O ˜icroorganisms usually are carried
to the prostate from the urethra.
Lecture note for regular second year
Nursing student, February 2003/2011. 209
Vont«d
V     
â    $   .
â   -argency, frequency and
dysuria.
â      (pain in the prostate)
on voiding.
â ðcute bacterial prostatitis may
produce a sudden on set of 
@
  %
â    ,  ,(1$ 
  %
Lecture note for regular second year
Nursing student, February 2003/2011. 210
Vont«d
   Y 
â V   %
â V  $     %
â     %
â Y   +  %
+
O The goal of treatment is 
   
$     
$   %
O " $      
)4 )0 ,%D   
 may be necessary to achieve
high serum and tissue level.
Lecture note for regular second year
Nursing student, February 2003/2011. 211
Vont«d
O   , $   ,+
to
soften stool and sitz bath.
O     
â 3  =    
  
      $  
  ,  , , ,
 ,, $  ,  

  %
â "
   +    
   %
â     
  %
â   ($   9  
) %

Lecture note for regular second year


Nursing student, February 2003/2011. 212
Õ Benign prostatic hyperplasia
(hypertrophy)--BPH
(hypertrophy)
å rt is the  problem of
the    $

%
å This problem occurs in  54
$    
54  
 ;56 
;4  %
å The prostate gland enlarges
extending up ward in to the bladder
and obstructing the outflow of urine
by encroaching on the vesicle orifice.

Lecture note for regular second year


Nursing student, February 2003/2011. 213
Vont«d
V
Ú     but evident suggests a
&    
 ' cause as initiating
hyperplasia of the supporting
stromal tissue and a glandular
element in the prostate.
Ú Other factors that cause over
production of this responsible
hormone, such as infection.
Lecture note for regular second year
Nursing student, February 2003/2011. 214
Vont«d
V     
    $    %
    ,  %
          
          $ 
    ( %
      $  $   
 %
          %
  "     &   '%
  3      + , 

    $    %
  $          %
     ,        %

Lecture note for regular second year


Nursing student, February 2003/2011. 21Õ
Vont«d
Y  
 
* !   +  %
* V$    

 &VV'%
* C %
* V  $  +  %
* !3%

Lecture note for regular second year


Nursing student, February 2003/2011. 21Ê
Vont«d
+
O The plan of treatment depends on  
 ,  
   ,  
   $  , %
O V   ?  to treat an acute
urinary retention.
O 2ome times a $$   
to give adequate drainage.
O       $   in
necessary.
O "    may be necessary
to treat aTr.

Lecture note for regular second year


Nursing student, February 2003/2011. 217
Vont«d
O "$     $ 1  ( %,
?  [Hytrin]) relax the smooth
muscle of the bladder neck and prostate.
O 5$         
    
   
 
$
   
 
        
&Y'%
O     w-surgery to remove the
hyper plastic prostate tissue to provide
permanent relief of the obstruction.
Lecture note for regular second year
Nursing student, February 2003/2011. 218
Vont«d
)%  !  %
 Not require abdominal incision; it is a
removal of prostatic tissue by instrument
introduced through urethra.
-%$$     %
 Require open surgery, an opening made in
the bladder.
/%   $    %
 Require open surgery-an incision made in
the perineum.
0%! $     %
  Requires open surgery-a low abdominal
incision is made.

Lecture note for regular second year


Nursing student, February 2003/2011. 219
Vont«d
 $ 
 
â "     $   
     %
â " =   %
â " =   
 $ 
      %
â "$$$      
 1   %
â 3        %
â !  "+ %

Lecture note for regular second year


Nursing student, February 2003/2011. 220
Vont«d
 $ 
 
â 3 =   
  $  
1@  %
â 3 =   
    @
 %
â       
  $ $ 
 %
â V  $   =  $  %
â !   $   ,    
     
  %
â    $    &(   
+ $      '

     
$

 %
Lecture note for regular second year
Nursing student, February 2003/2011. 221
Vont«d
â Y     =   
    %
â     1 %
â  1  $     %
â   $      
  
& 1  , =   
$ 1 $   $    % %.'%
â 3(    $  
        ( %
â 3    
    $ 
$ 
   1 $    
$  %

Lecture note for regular second year


Nursing student, February 2003/2011. 222
Vont«d
â V 1D<%
â "  %
â    %
(   (1   
 %
( * $( 
    %
(  
     
         %
( "
  
 +    %
( $  ,,   
 
      %
(    1  %
Lecture note for regular second year
Nursing student, February 2003/2011. 223
V%V   $  

O Vancer of the prostate is the
second most common cause of
cancer.
O The  $
   

 1 ( 
       
 $%
O Yue to this greater attention will
be focused on this condition .
Lecture note for regular second year
Nursing student, February 2003/2011. 224
Vont«d
! 1 
* "
* "  $  $ 
* "       %
V
* anknown/rdiopathic.

Lecture note for regular second year


Nursing student, February 2003/2011. 22Õ
Vont«d
V     
O  V  $    
  $  $  if the
neoplasm is large enough to
encroach on the bladder neck and
cause obstruction of urine.
O There are signs and symptoms of
obstruction namely;
â Y   @ =    %
â     %
â Y    ?    
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 22Ê
Vont«d
 Y 
Ú 3     +  ; palpable of it is
advanced, stony hard.
Ú    +  by surgically
transurethral resection, open prostatectomy
or needle biopsy perennial or trans rectal.
Ú   $ $ 
is frequently
increased.
Ú 1  + to revel osteoblastic
metastasis.
Ú to demonstrate changes from
urethral obstruction.
Ú !3%

Lecture note for regular second year


Nursing student, February 2003/2011. 227
Vont«d
+
å Radical —rostatectomy.
å !   as a palliative therapy.
å   $ maybe selected to
suppress all androgenic stimulation to the
prostate due to orchiectomy or
administration of estrogen.
å    %
å "  %
å     
 %
å D< 1$%
å    , 1,   etc...
2hould be checked.
Lecture note for regular second year
Nursing student, February 2003/2011. 228
Y Hydrocele
O ð hydrocele is    
        
  
%
O The tunica vaginalis become widely
distended with fluid.
V 
â Occurs in association with acute
infectious disease of the $    ,
 $ %
â The cause of chronic hydrocele is
1(%
Lecture note for regular second year
Nursing student, February 2003/2011. 229
Vont«d
+
O asually therapy is not required.
O Treatment is necessary only of the
hydrocele become  
$    
        ,
    %
O ithdrawing the fluid through a
    
   
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 230
Vont«d
O    through the
wall of the scrotal down to the
distended tunica vaginalis.
O 2ome time       
:   in to the sac after
aspirating fluid to cause the wall
of hydrocele to become inflamed
and disappear.
O Eventually $ $ 
  
$$ is done.
Lecture note for regular second year
Nursing student, February 2003/2011. 231
Y Varicocele
O ð
   is an abnormal
dilation of the veins of the
$$  
 $ + in
the scrotum (the network of veins
from the   
$    that constitute part of
the spermatic cord).
O Varicoceles usually occur in the
veins on the $$ $   
      %
Lecture note for regular second year
Nursing student, February 2003/2011. 232
Vont«
O rn some men, a varicocele has
been associated with
   %
O ew, if any, subjective
symptoms may be produced
by the enlarged spermatic
vein.

Lecture note for regular second year


Nursing student, February 2003/2011. 233
Vont«d
V<
O  %
O    %
O Y     
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 234
Vont«d
+
O      is required unless
fertility is a concern.
O rt is corrected    
     +  $  

       %
O "  $1may be applied to the
scrotum for     ( 
after surgery to  
  %
O The patient then (    
$$ %
Lecture note for regular second year
Nursing student, February 2003/2011. 23Õ
= =pididymitis
Ú $    is an   
  $    that usually
descends from an   
$      %
V
Ú V$   %
Ú V     
   /5'%

Lecture note for regular second year


Nursing student, February 2003/2011. 23Ê
Vont«d
V/˜
O   $    in the
inguinal canal along the course of the
vas deferens.
O   (   in the scrotum and
the groin.
O The $       ( 
+    $ %
O  $   is elevated.
O       %
O V  
%
Lecture note for regular second year
Nursing student, February 2003/2011. 237
Vont«d
    
Ú rf the patient is seen (      -0  
 $ , the spermatic cord may be infiltrated
with a  `    `
to relieve pain.
Ú rf the epididymitis is from      ,
the $    +$    
  (     %
Ú The patient is observed for    as
well.
Ú  $
   (  -( 1 , an
    should be considered.
Ú " $      (excision of the epididymis
from the testis) may be performed for patients with
   , $   $   $   
  (  ,$   %

Lecture note for regular second year


Nursing student, February 2003/2011. 238
V .
   
O   %
O    
 (     
  ( to prevent traction on the
spermatic cord and to promote venous
drainage and relieve pain.
O "     are administered as
prescribed until the acute inflammation
subsides.
O    $    
 may help ease the pain. Later,
local heat or sitz baths may help resolve the
inflammation.

Lecture note for regular second year


Nursing student, February 2003/2011. 239
V .
O "     are administered
for pain relief as prescribed.
O     8
â 
    ,  ,
+     
     %
â    1    
     $   
â    $1      
 
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 240
3% 
        
&  '%
V 
*    &  '%
* D %
* $  %
*  %
*  %
* V  %
* 1(  %

Lecture note for regular second year


Nursing student, February 2003/2011. 241
Vont«d
    
O Y       $      
 %
O ! %
O 
     %
O  $1        %
O "    %
O "   %
O "        %
Lecture note for regular second year
Nursing student, February 2003/2011. 242
% $ $  $ $ 
O Hypospadias and epispadias are
     
 $  %
O rn  $ $  , the urethral
opening is a groove on the    
  $  %
O rn $ $  , the urethral opening
is    %
O These anatomic abnormalities may
be  $   
   $ 
$    , usually when  
  
  %
Lecture note for regular second year
Nursing student, February 2003/2011. 243
%  $  
  $  
)%  , a condition in which
the foreskin is constricted so that
it cannot be retracted over the
glans.
V
ÚV   %
Ú %
Ú %

Lecture note for regular second year


Nursing student, February 2003/2011. 244
V .
O ith the trend away from routine
circumcision of newborns,  
    

     $ $ %
O rn elderly men, penile carcinoma
may develop.
+
 —himosis is corrected by
  %
Lecture note for regular second year
Nursing student, February 2003/2011. 24Õ
V .
-%$  is a condition in
which   1    
     and, because of
narrowness and subsequent
edema, cannot be returned to its
usual position (covering the glans).

Lecture note for regular second year


Nursing student, February 2003/2011. 24Ê
V .
+
â   7by firmly
compressing the glans to reduce
its size and then pushing the
glans back while simultaneously
moving the prepuce forward.
â V   is usually
indicated after the inflammation
and edema subside.
Lecture note for regular second year
Nursing student, February 2003/2011. 247
%V   $ 
O —enile cancer occurs  
 
*+
O 2ince most penile cancers occur in
``` , it has been
suggested that the etiology of this
cancer may be the  

    $
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 248
V .
O Vancer of the penis appears 
  1   $  as a
$  ,(  1 ( 
 %
O Vancer of the penis can involve
the  ,    
   $ $ ,  $
 ,   ,  
   $ %
Lecture note for regular second year
Nursing student, February 2003/2011. 249
Vont«d
    
O +  (for smaller lesions involving only
the skin).
O $    $  with 5-fluorouracil
cream.
O !    $ is used to treat small
squamous cell carcinomas of the penis or
for palliation in advanced tumors or lymph
node metastasis.
O  $     (removal of the some
part of penis).
O  $     is indicated when the
tumor is not amenable to conservative
treatment.
Lecture note for regular second year
Nursing student, February 2003/2011. 2Õ0
V   
    
)%  1 
    1   
   ( $   
1  during  
$  %
  rt is often associated with other
anomalies.
  The two kidneys are normally
separated.
  The condition is  $   but
it can      1
1    $   %

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ1
Vont«d
V
O Vongenital disorder.
O ilm's tumour.
O Transitional cell carcinoma.
O Turner syndrome.
O Vesicourethral reflux.

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ2
Vont«d
V<
* ðsymptomatic.
* usion of kidney.
Y+
 Hx.
 —/E.
+
Úrt depends on the renal problem that
occur following this problem.

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ3
-%Y$     
O Y$    is a congenital
condition in which the ureteric bud
(the embryological origin of the
ureter), splits (or arises twice),
resulting in two ureters draining a
single kidney.
O rt is the most common renal
abnormality, occurring in
approximately 1% of the population.
O The additional ureter may result in a
ureterocele, or an ectopic ureter.
Lecture note for regular second year
Nursing student, February 2003/2011. 2Õ4
V .
V   
areteral duplication is eitherw
â  
(   (        

   %
( —artial, or incomplete, ureteral duplication
is rarely clinically significant.

Lecture note for regular second year


Nursing student, February 2003/2011. 2ÕÕ
V .
â V$
( The two ureters drain separately.
( Vomplete ureteral duplication
may result in one ureter opening
normally into the bladder, and the
other being ectopic, ending in the
vagina, the urethra or the vulval
vestibule.
( These cases occur when the
ureteric bud arises twice (rather
than splitting).

Lecture note for regular second year


Nursing student, February 2003/2011. 2ÕÊ
Vont«d
V<
O          
   
 
 +%
O         
     $  
    
 , 

 %

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ7
Vont«d

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ8
V .
+
Ú rt depends on the renal problem
associated to this congenital
problem.

Lecture note for regular second year


Nursing student, February 2003/2011. 2Õ9
Yialysis
  Yialysis also defined as 
  
 $     
$      
$      %
  Yialysis is the process of separating
crystalloids and colloids in solution
by the difference in their rates of
diffusion through a semi permeable
membranew    $ 
   ,  
 
(   %
Lecture note for regular second year
Nursing student, February 2003/2011. 2Ê0
V .
O ased to  
   
( $ from the body
when the kidneys cannot do so.
O The two methods used as an
artificial membrane & $ 
$$ 'as the   ? 
 which is in contact with
the client·s blood.

Lecture note for regular second year


Nursing student, February 2003/2011. 2Ê1
V .
O Yialysis in general, used to correct
 @      ,
 
( $ 
 , $  
 in   
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 2Ê2
Vont«d
O ˜ethods of therapy include
   ,   
 $     $ &V!!) and
various forms of $   
  %
O       
 or  %

Lecture note for regular second year


Nursing student, February 2003/2011. 2Ê3
Vont«d
"   8
â rt is indicated when there is 
  
 
$  , 
,
$  $   ,
    ,
$   ,
 
 %

Lecture note for regular second year


Nursing student, February 2003/2011. 2Ê4
Vont«d
O rt may also be used  

         
+  &$     

 'from the blood.

Lecture note for regular second year


Nursing student, February 2003/2011. 2ÊÕ
Vont«d
V      8
* rt is indicated in     ,
1(       &!Y',
in the following instancesw the presence of
     $  affecting all
body systems ( 
 ,

  + ,     ,
   ),  $ 1  , 

  $
    
    , and a general lack of well-
being.
* ðn      for dialysis in
patients with chronic renal failure is
$     %

Lecture note for regular second year


Nursing student, February 2003/2011. 2ÊÊ
Hemodialysis
O The   used method of
dialysis which is used for patients who
are    and  =     
  &  ( 1 'and for
patients with !Y( =  
$     $ %
O ð   ? (once referred to as an
   1  ) serves as    
 $     , $ 
      as the
filter for the impaired kidneys.

Lecture note for regular second year


Nursing student, February 2003/2011. 2Ê7
Vont«d
O or patients with chronic renal
failure,    $
 
  ,      
     
$      
    

of the kidneys.
O    
   
       for the
rest of their lives or    
   1  
 $  %
Lecture note for regular second year
Nursing student, February 2003/2011. 2Ê8
Vont«d
    7
⠄lood from an    $$   
  ?  where it flows through the
 $   ,(     
 $     ( 
â The dialysate, which has the  
  $    
+ $  ( $ ,
(      %
â The waste products in the blood diffuse
through the  $     
      %
Lecture note for regular second year
Nursing student, February 2003/2011. 2Ê9
Lecture note for regular second year
Nursing student, February 2003/2011. 270
Vont«d
V$     
   $  %
     $ %
  Y    %
  "   %
  V $     
$ (        
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 271
    
O —eritoneal dialysis may be the
      $  
(    who are unable or
(       
   $  %
O rn peritoneal dialysis,  
$   ,    
that covers the abdominal organs
and lines the abdominal wall, 

     $     %
Lecture note for regular second year
Nursing student, February 2003/2011. 272
Vont«d
O        is introduced into
the peritoneal cavity through an
abdominal catheter at intervals.
O      ,   
$   +    
1  , are cleared from the blood by
diffusion and ossmosis as waste
products move    
   &  $   
$$ '  ( 
   &  $   
'
   $     
&  $     '%

Lecture note for regular second year


Nursing student, February 2003/2011. 273
Lecture note for regular second year
Nursing student, February 2003/2011. 274
V .
V$      
Y  8
     %
  2 1     %
    %
  2 $   
    &   ',
  
 %

Lecture note for regular second year


Nursing student, February 2003/2011. 27Õ
  $   
$  ( V   
  ð cystotomy is  
`  
` 
       
  This procedure allows the surgeon to look
inside the bladder.
   
Ú         
    `  
Ú            
 
Ú         
    
Ú         
  

Lecture note for regular second year


Nursing student, February 2003/2011. 27Ê
V .
 $ 

Ú Lab test
* Radiographs (x-rays)
* abdominal ultrasound
* complete blood count
* serum biochemical test
* urinalysis
* Ev
Ú eneral anesthesia
Lecture note for regular second year
Nursing student, February 2003/2011. 277
V .
 $ 

* safe and effective  ` .
*   `  will have been placed at
surgery.
* ` requires reduced activity until
the stitches are removed in 10 to 14 days.
* inspect the suture line daily for signs of
redness, discharge, swelling, or pain and
monitor your pet's urinary habits.
* 2ome blood-tinged urine is expected for the
first few days, but obvious pain, straining or
a lack of urination is not normal and should
prompt a call to your
veterinarian/physician.
Lecture note for regular second year
Nursing student, February 2003/2011. 278
V .
V$  
§general anesthesia
§bleeding (hemorrhage)
§postoperative infection
§urine leakage
§wound breakdown (dehiscence)

Lecture note for regular second year


Nursing student, February 2003/2011. 279
  $   
$  (  $  
  $   is the surgical removal of
a kidney.
rndications
Ú!   %
Ú"  1  %
Ú"    1  %
ÚNephrectomy is also performed for the
purpose of living  1  
 $  %
ڗartial Nephrectomy has also been
performed  $  : e.g. rupture,
caused by trauma such as falls and motor
vehicle accidents.

Lecture note for regular second year


Nursing student, February 2003/2011. 280
Vont«d
Vare after the procedure
â       
   
$          
$         %
â "D (       %
â        
    %
â "$          $ 
 ( -;  $  
 $  $   %

Lecture note for regular second year


Nursing student, February 2003/2011. 281
3 
   


Lecture note for regular second year


Nursing student, February 2003/2011. 282
3  V $
ð  `      
 )
Ú        
 ,      
     `
Ú ðpproximately 946of a typical adult·s
weight consists of  &( 
   '%
Ú actors that influence the amount of
body fluid are;
Lecture note for regular second year
Nursing student, February 2003/2011. 283
V .
Ú" w-younger people have a higher
percentage of body fluid than older
people,
Ú  w-men have proportionately
more body fluid than women.
Ú  w-Obese people have less
fluid than thin people because fat
cells contain little water.

Lecture note for regular second year


Nursing student, February 2003/2011. 284
V .
    is located in ( $   7
     $ (fluid in the cells)-two thirds
of body fluid primarily in skeletal muscle mass.
  +   $ (fluid outside the cells).
  
 w-the fluid within the blood
vessels (6L). E.g. $    %
   w-fluid that surrounds the cell (11
to 12 L). E.g. 2 $.
   w- the smallest division (1L). E.g.
   $ ,$   , 
,
 ,$   8 (  8
 
   %

Lecture note for regular second year


Nursing student, February 2003/2011. 28Õ
V .
O Loss of EV into a space that does
not contribute to equilibrium
between the rV and the EV is
referred to as a   $  
  ,I   $ J%
O Third-space shifts occur in
  , ,$   ,( 
  ,

    :   

.
Lecture note for regular second year
Nursing student, February 2003/2011. 28Ê
V .
=`  
O Electrolytes in body fluids are 

   (cations, which carry
positive charges, and anions, which
carry negative charges).
O Electrolyte concentration in the body
is expressed in terms of
  =
  &='$  , 
     
%
O a milliequivalent is defined as  
=
          

)  .
Lecture note for regular second year
Nursing student, February 2003/2011. 287
:     
  

Lecture note for regular second year


Nursing student, February 2003/2011. 288
!  
 $  
* V$    separates
intravascular and interstitial space.
* ater and molecules move in both
direction across the semipermable
membrane.
* „ody fluid compartments are regulated
by two mechanisms;
* 
  $
*  
* Y  
* 3   
* "
  $

Lecture note for regular second year


Nursing student, February 2003/2011. 289
V .
   is      

     
` `    
 ` `  
 ` 

Lecture note for regular second year


Nursing student, February 2003/2011. 290
V .
  Y          
 `  `    
  
` `    
` `   ` 

Lecture note for regular second year


Nursing student, February 2003/2011. 291
V .
  3    is the movement of
water and solute occurs by force of
pressure (    
$   (   
$  '%
  ðctive transport is the movement
of ions by using energy (ðT—). E.g.
K *K $$%

Lecture note for regular second year


Nursing student, February 2003/2011. 292
!    

O ð healthy person gains fluids by;
â Y 1 
â  
O rn patients with some disorders,
fluids may be provided by;
â    (intravenously
or subcutaneously)
â      in the
stomach or intestine.
Lecture note for regular second year
Nursing student, February 2003/2011. 293
"
 Y   1 
 $   "

Lecture note for regular second year


Nursing student, February 2003/2011. 294
V .
å * 
â The usual daily urine volume in the
adult is 1 to 2 L with )2<1<
formula in all age groups.
å 1 
â   
( 2weatingw- 4 ),4442 . The chief solutes
in sweat are sodium, chloride, and potassium.

   $   & 'increases
the value.
â    &9442< '%3
 and
 increases its value.
Lecture note for regular second year
Nursing student, February 2003/2011. 29Õ
V .
å 2
â 0442
  . The loss is much
greater with    $   
  $ & $ $ 
 $  ',    %
å 
â )44 -442   . Y  
  cause large losses.
N.„. rn healthy people, the daily average
intake and output of water are
approximately equal.
Lecture note for regular second year
Nursing student, February 2003/2011. 29Ê
2   

    
 8
O rt is a measure of   F   
    $    
 
  ( %
O ˜ost often used in clinical pratice.
O Osmolality is reported as milliosmoles
per kilogram of water (mOsm/kg).
O rt also measures the solute
concentration per kilogram in blood
and urine.
Lecture note for regular second year
Nursing student, February 2003/2011. 297
V .
â   
(            
 %
( 
  -B4 /44 <1%
( 3    8

Lecture note for regular second year


Nursing student, February 2003/2011. 298
V .
â    
( Y     ,    ,
  %
( 
 -54 H44
 <1%
    
         
  `   
` `  

Lecture note for regular second year


Nursing student, February 2003/2011. 299
V .

Lecture note for regular second year


Nursing student, February 2003/2011. 300
V .
Types of solution
   w- the same osmolality with
EV. E.g. N/2.
 $   w- concentrated/greater
osmolality than EV.
 $  w- dilute/lower osmolality
than EV.
° `        
`    `
 ` 
 
Lecture note for regular second year
Nursing student, February 2003/2011. 301
V .
   $   
8
O rt measures the kidneys·    
+  
( %
O ˜easured by    
 $ 1with a reagent for this purpose.
O Normal value is )%4)4 )%4-5.
8
O rt is made up of urea, an end product of
metabolism of protein (from both muscle
and dietary intake) by the liver.
O The normal „aN is )4 -4<2
&/%5G;<2'%

Lecture note for regular second year


Nursing student, February 2003/2011. 302
V .
O 3       8
â      
â   
â    
â   $   1 
â 

â $
O 3       8
â   
  ,
â ($ 
â 
 
â         +$  

 & %,$  '%

Lecture note for regular second year


Nursing student, February 2003/2011. 303
V .
V    8
  rt is the $   
  %
  rt is a      of renal function
than „aN because   
 ( 
$   1     %
  The normal serum creatinine is
approximately 4%; )%5<2.
  rts concentration depends on   
 
 $   $  %
  (`  `  
 ` `  

Lecture note for regular second year


Nursing student, February 2003/2011. 304
V .
   8
O rt measures the volume percentage
of red blood cells (erythrocytes) in
whole blood.
O normally ranges from 006 5-6
 /H6 0;6
  %
O Vonditions that;
â rncrease-   $    %
â Yecrease-
     %

Lecture note for regular second year


Nursing student, February 2003/2011. 30Õ
V .
    8
â Normal urine sodium levels range
from 54 --4=<-0&54G--4
<-0'%

Lecture note for regular second year


Nursing student, February 2003/2011. 30Ê
     
O Organs involved in homeostasis
include;
â 1  
â 
â  
â   
â $   
â $   
Lecture note for regular second year
Nursing student, February 2003/2011. 307
V .
*  8
O Regulation of EV volume and
osmolality   ` 
!`     
O Regulation of electrolyte levels in the
EV   `  
   `  !` 
   ` .
O Regulation of -  =". 
   
  
O Excretion   `   
 !`   ` 
Lecture note for regular second year
Nursing student, February 2003/2011. 308
V .
  D 8
â The pumping action of the heart
circulates blood through the kidneys
under sufficient pressure to allow for
urine formation.
2
â The lungs also have a major role in
  
 `/   `
â The lungs remove approximately D++
0       

Lecture note for regular second year
Nursing student, February 2003/2011. 309
V .
   
O The hypothalamus   ` ð -, which is stored in
the posterior pituitary gland and released as needed.
O unctions of ðYH include maintaining the osmotic pressure
of the cells by controlling the retention or excretion of water
by the kidneys and by regulating blood volume
" 
O ðldosterone, a mineralocorticoid secreted by the zona
glomerulosa (outer zone) of the adrenal cortex, has a
profound effect on fluid balance
   
O 
 ` `     `by means of
parathyroid hormone (—TH).
O —TH influences bone resorption, calcium absorption from the
intestines, and calcium reabsorption from the renal tubules.

Lecture note for regular second year


Nursing student, February 2003/2011. 310
ïther Mechanisms
  $  8
O The baroreceptors are  

  $  that detect changes in pressure
within blood vessels and transmit this
information to the central nervous system.
â ($    $  w-in  
  ,$        .
â  $    $  w-    
,   ,   
     :+  
$$     $%
Lecture note for regular second year
Nursing student, February 2003/2011. 311
V .
!  G   G  8
"Y   8
  $  8
â Located on the surface of the hypothalamus,
osmoreceptors sense changes in sodium
concentration. ðs osmotic pressure increases, the
neurons become dehydrated and quickly release
impulses to the posterior pituitary, which increases
the release of ðYH.
"      $ $  8
O released by cardiac cells in the atria of the heart
in response to increased atrial pressure.
O The ðN— measured in plasma is normally 20 to 77
pg/mL (20³77 ng/L).

Lecture note for regular second year


Nursing student, February 2003/2011. 312
3  volume imbalance
Ú Various types of Vr could occur.
Ú The variation is the result of which
component the fluid is excess or deficient.
Ú Types of Vr;
)%  $    w- water in EV
is less than the solute proportion normally
expected.
-%  $   w- water in EV
is excess.
/%    
    w- whole deficit in
EV (electrolyte and water).
0%    
  + w- whole excess.

Lecture note for regular second year


Nursing student, February 2003/2011. 313
3 
    
& $
  '
O Occurs when   +  
 &(     '

      $$ 
+      1  %
O The ratio of serum electrolytes to
water remains the same.
O    DY%
O    &    
   `  
   
Lecture note for regular second year
Nursing student, February 2003/2011. 314
V .
V
O  =   1
â          
O   8
â
 ,  ,   , (  ,
O   $    
! 1  
      $ 
       
     
   
  

Lecture note for regular second year


Nursing student, February 2003/2011. 31Õ
V .
V     
O can be mild, moderate, or severe
â 1 -` `  `  


â VD-      )  
    ) `
 )`  )
` `    
â 1(& 
 )` ` 
â  - `  
â   - `
 )  )
 ! )   ) ) `
  ) `  
Lecture note for regular second year
Nursing student, February 2003/2011. 31Ê
V .
"       
O  
  $$    
    
&   
-47)'%
O    
    %
O    $   
    %
O         054
 <*%
O  $ 1  %
O Y     
 $  
(  
  %
Lecture note for regular second year
Nursing student, February 2003/2011. 317
V .
    
    8
     1   =   $%
  3 =    %
  
    %
" 
 8
O D   =  %
O           & %,  !  F 
4%H6    '%
O "     $     
,
 $        & ,4%056  
  '%
O "  =       1  $ ,
(  ,
  ,  
 $  ,

    ,    , 1   
$    
 
  $  %

Lecture note for regular second year


Nursing student, February 2003/2011. 318
V .
   
Ú       
 1  $ at least every 8
hours, and sometimes hourly.
Ú      (  %
Ú  +2
2++0
 
Ú   
    %
Ú 1     is
monitored on a regular basis.
Lecture note for regular second year
Nursing student, February 2003/2011. 319
V .

 
O rdentify patients at risk.
O Takes measures to minimize fluid
losses.
O or example, if the patient has
diarrhea, diarrhea use
antidiarrheal medications and
small volumes of oral fluids at
frequent intervals.
Lecture note for regular second year
Nursing student, February 2003/2011. 320
3 
  + 
& $ 
  '
O an isotonic expansion of the EV caused
by the abnormal retention of water and
sodium in approximately the same
proportions in which they normally exist
in the EV.
O is always secondary to an increase in the
total body sodium content, which, in
turn, leads to an increase in total body
water.
O related to simple fluid overload or
diminished function of the homeostatic
mechanisms responsible for regulating
fluid balance.
Lecture note for regular second year
Nursing student, February 2003/2011. 321
V .
V
O V     8
â     ,
â    ,
â     
%
â  $  +
 
        %
â +
   
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 322
V .
V     
O  
O    1

O 1 &  '
O   8   
O $  ,$ $  ,
  
 $ 
O   (  
O      $
O     
O ( ? %
Lecture note for regular second year
Nursing student, February 2003/2011. 323
V .
"   Y  
3  
O O     

 
O     
O      
   
 

Lecture note for regular second year


Nursing student, February 2003/2011. 324
V .
    
O Yirected at the causes.
O —  ` 
`)
â Yiuretics are prescribed when dietary
restriction of sodium alone is
insufficient to reduce edema.
â The choice of diuretic is based on
(
    $ 
    %
(     $    
 %
( $      %
Lecture note for regular second year
Nursing student, February 2003/2011. 32Õ
V .
â °  $` )
( 56 )46      + %
( "    %
(       
 $ 
  %
â 0 ` )
( " $  %
( -46 /46      
+ %
(   
  $ 
  %

Lecture note for regular second year


Nursing student, February 2003/2011. 32Ê
V .
O -         )
â ð choice when renal function is
severely impaired that ` 
`   `` 
â ased to remove;
( 
    
( `    
( `/   `
(     
Lecture note for regular second year
Nursing student, February 2003/2011. 327
V .
O   8
â ðn average daily diet not restricted in
sodium contains 6 to 15 g of salt.
â The restriction vary from mild to 250
mg of sodium per day.
â rt is the sodium salt, sodium chloride,
rather than sodium itself that
contributes to edema.

Lecture note for regular second year


Nursing student, February 2003/2011. 328
V .
   
â      
â      
â     
   
       
`      
        ` 

   
â #  
     
â .  

â ° ` 
    

Lecture note for regular second year


Nursing student, February 2003/2011. 329
   
 
Ú sodium is the $     V3
  %
Ú ˜ost abundant electrolyte in EV.
Ú Vontrols water distribution throughout the
body.
Ú The $    V3
 as
its movement coupled with water.
Ú Necessary for       
   
 $ %
Ú rts normal concentration ranges from )/5
)05=<2&)/5L)05<2'%

Lecture note for regular second year


Nursing student, February 2003/2011. 330
V .
 $$   $    
8
å 2(   ( (( (    
         
$$ %
å    (    
  ( %
å     ( 
   
(  %
å     (  ( 
      ( %

( ` !`     


`     ` 

Lecture note for regular second year


Nursing student, February 2003/2011. 331
    
& $   '
 '
O 2erum sodium level that is below normal
(  3D2= 043D2  05.
O Van be superimposed on an existing
VY or VE.
O Occurs when;
â            
 `      
â        `  
!`      
â !`         

 !`       

Lecture note for regular second year


Nursing student, February 2003/2011. 332
V .
V
O     
 ,
  ,  , (  %
O Y    %
O (   %
O "     

Lecture note for regular second year


Nursing student, February 2003/2011. 333
V .
  !`        )
Ú No loss of sodium but excess amount of water in
EV (hyper osmolar state is created).
Ú —redisposing factors are;
â (ð -
â - 
 ` 
â `  &    
â    &    
  

`      
     
â !`        
!      
â `   
 `
`
    

Lecture note for regular second year


Nursing student, February 2003/2011. 334
V .
V     
O depend on the `  
  
with which the deficit occurs.
â  1  
â   
â     
$ ,
â     $  ,
â  
â  $ 
â       
â  + ,  $ ,  
+       (  
   

Lecture note for regular second year
Nursing student, February 2003/2011. 33Õ
V .
O hen the serum sodium level
drops  332= 0332
  0;
â  

â "     
â  `` 
   
â  `      
â -   $ 
â  
â ($
Lecture note for regular second year
Nursing student, February 2003/2011. 33Ê
V .
ð    
 `.

O 2erum sodium level is   3D2
= 0
   `  
O 2erum sodium level 3++= 03++
  0  (ð -
O 2erum osmolality is also decreased.
O arinary sodium content is   6+
= 06+  0(  
O arinary sodium content is
  6+
= 0(ð -
O arine specific gravity is 3++6 3++7
(  
O arine specific gravity 3+36(ð -

Lecture note for regular second year


Nursing student, February 2003/2011. 337
V .
    
O 2odium replacementw-  
â or patients (   1,  
   `   
â or those  `  `   ,
 ` 
8      ` 
+9: `     
 `   
â The maximum serum sodium replacement is 36
= 067  to avoid neurologic damage
due to osmotic demyelination.
â    `  37+= 0
 `       `  
         
  
`  

Lecture note for regular second year


Nursing student, February 2003/2011. 338
V .
O "Y
â ðdministration of  `
    `  
` 
    
` `  
â `  0 !
O     
O rn a patient with    !` 
 
O restricting fluid to a    ;++
0 67  
Lecture note for regular second year
Nursing student, February 2003/2011. 339
V .
   
O rdentification of      
  `   of to
avoid complication.
O ˜onitor     
    
 
O Note        

         
`    !     

   ` 

O ðlert for `    
` 
 , such as lethargy, confusion,
muscle twitching, and seizures.

Lecture note for regular second year


Nursing student, February 2003/2011. 340
  + 
& $    '
* 2erum sodium level !`

372= 04372  05
* Occurs when;
* 
  !`  
 
*    !`  

* rt can occur in patients with
normal fluid volume or in those
with .<  .<=
Lecture note for regular second year
Nursing student, February 2003/2011. 341
V .
V &'
Ú .  `  `    
Ú ð      ` 

Ú <       `  !` 
   `   
Ú       
  `   
  
   
` 
 
Ú     
2   8
     1
   (   ( &(    
    $$+   544
=<2',
        $   
  $$    %
Lecture note for regular second year
Nursing student, February 2003/2011. 342
V .
V     
O —   
`      
`  ` `    
â   7   ( 1
â 
 7     ,   ,
  
O ï  
 )
â     

â (` `    
â .  
⠗      
⠗      
â `  `   ! 
â #    
Lecture note for regular second year
Nursing student, February 2003/2011. 343
V .
"   Y  
3  
O ( !` 
372= 0372  0
O (    !` 692
ï  
692  0
O °  ``
   
     ` 
   !` `  
  
Lecture note for regular second year
Nursing student, February 2003/2011. 344
V .
    
O rnfusion of a  $      
 & %,4%/6    '
       & ,
 +  56 ( MY5 '%
O Y5 is indicated     
 `  
O  $          
Y5because it    
  
`    
and       1  
 %
Lecture note for regular second year
Nursing student, February 2003/2011. 34Õ
V .
O  $      is the solution of
choice in
  $    ( 
 $    %
O Y   also may be prescribed to treat the
sodium gain.
O Y $    &YY"D'may be
prescribed to treat     $  if it is the
cause of hypernatremia.
- `  `
°    ` 
    +2 3= 0 
  `  , 
  
   ` 
`   

Lecture note for regular second year


Nursing student, February 2003/2011. 34Ê
V .
   
O    
  `  
  
O ð            
     

   
O ï  `      `   
 ` `      

` 
O    8       
        
 ``  
 
O °      ` 
   
`         
 


Lecture note for regular second year


Nursing student, February 2003/2011. 347
V .

 
O (    
   
   
O    
    `   
   `    
     
  
   
   
O .      
      
  
Lecture note for regular second year
Nursing student, February 2003/2011. 348
   
O 9;: of the body·s potassium is  
 ` (major intracellular electrolyte).
O Normal serum potassium concentration
ranges from D2 22= 0D2/22
  0
O rmportant in    
&   -6    V3'%
O ander the influence of the &
   and based on the
body·s needs, potassium is constantly
moving in and out of cells.

Lecture note for regular second year


Nursing student, February 2003/2011. 349
     
& $1  '
O 2erum potassium concentration
level is less than D2= 0D2
  0
O iypokalemia may occur in patients with
normal potassium stores; however, when
alkalosis is present, a temporary shift of
serum potassium into the cells occurs.
O iypokalemia is a common imbalance .

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ0
V .
"   
O r loss of potassium (most common).
â < 

â    
⠗  

` ` 
â 0 ! 
O Recent ileostomy
O Villous adenoma
O ðlkalosis
O Hyperaldosteronism
O High-carbohydrate parenteral fluids.
O ˜agnesium depletion

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ1
V .
O ˜edication
⠗  & 
`  `  
  $ 
`     $
â " `   
⠗` 
 `
" `
â ð ` 
O —oor potassium diet intake;
â    
â ð` ` 
â ð ! 
O „ulimia.
Lecture note for regular second year
Nursing student, February 2003/2011. 3Õ2
V .
V     
O (&  through cardiac or respiratory
arrest.
â    ð ! 
â    < 

â # `  0
`  
â `    . 

â `   `—     
â `     
 
O rf prolonged
⠗  
â  ` 
â =!`   

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ3
V .
"       
O Electrocardiographic (EV) changes
â . °    ° 
â  (° 
 
â ð 1 
O rncreased sensitivity to digitalis
O arinary potassium excretion
exceeding 20 mEq/24 h with
hypokalemia suggests that renal
potassium loss is the cause.
Lecture note for regular second year
Nursing student, February 2003/2011. 3Õ4
V .
    
O ðdministration of 7+ ;+=     
         
O Yietary intake of potassium in the average adult  
2+ 3++=        
O oods high in potassium;
â .  `         `  
  
 
â <
  
  
   
 .
O Oral potassium supplements &     
  54 94=$  $ 
 $'%
O hen oral administration of potassium is not
feasible, the rV route is indicated.

Lecture note for regular second year


Nursing student, February 2003/2011. 3ÕÕ
V .
O The <          
    (e.g., a serum level of 2
mEq/L). E.g.   `    
`      
O .    ` , potassium is
suitably diluted and administered at a rate no
faster than 3+= 
O =!    , however,
potassium should be administered no faster than
6+ 7+= (suitably diluted).
O rn critical situations,  ` ` 
   `  7+= 0may be
administered through a central line.
Lecture note for regular second year
Nursing student, February 2003/2011. 3ÕÊ
V .
   
O ˜onitor for its early presence in patients at risk.
O ˜onitoring of fluid intake and output is necessary
because 7+=       
  
O hen available, the EV may provide useful
information.
O —atients receiving digitalis who are at risk for
potassium deficiency   
`    
  
   !` 
O —hysicians usually prefer to keep the serum
    D2= 0D2  0
in patients receiving digitalis medications such as
digoxin.

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ7
V .
—
   
O Encouraging the patient at risk to
eat foods rich in potassium, such
as fruit and fruit juices (bananas,
melon, citrus fruit), fresh and
frozen vegetables, fresh meats,
and processed foods. (when the
diet allows).

Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ8
   + 
& $ 1  '
O 2erum potassium concentration greater than 22
= 022  0
O —    
â alsely high level of potassium
â Vauses;
( 1   
    
!` 
! 
( -          
( #  `     `
` !`
6+++++ 
   `    ` !`
3
 
(  
      
    


Lecture note for regular second year


Nursing student, February 2003/2011. 3Õ9
V .
"   
O Yecreased renal excretion of potassium.
O rnfection.
O Excessive intake of potassium in food or
medications.
O Hypoaldosteronism.
O ðddison·s disease.
O ðcidosis.
O ˜edications (in more than 60% )
⠗  `    ð"=
   `  (ð  
  &  
` 
Lecture note for regular second year
Nursing student, February 2003/2011. 3Ê0
V .
V     
O   
`   ` `   == 0=  0
           ;
= 0;  0 
 
â Yisturbances in cardiac conduction occur.
( —   ° 
( (°& 
  )
( ( >° 
( — `    

(    `  —  
( `      
   >(` !
O Ventricular dysrhythmias and cardiac arrest
O 2keletal muscle weakness and even paralysis
O r manifestations,
(  
(       
(   

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê1
V .
"   Y  
3  
O 2erum potassium levels.
O EV changes.
O ðrterial blood gas analysis
(metabolic acidosis).

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê2
V .
    
O ðn immediate EV should be obtained to
detect changes.
O Obtain a repeat serum potassium level from a
vein.
O rn non-acute situations;
â  `       
  &`  
`    
`
O ðdministration of either orally or by retention
enema, of cation exchange resins (eg,
vayexalate) may be necessary in patients with
renal impairment. "      ` 
 
    ` `  
    
Lecture note for regular second year
Nursing student, February 2003/2011. 3Ê3
V .
Emergency pharmacologic therapy
O <` `
`  
O #  
   
O ° =" `    
  

   
O =! `    
  ?
 $@

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê4
V .
O rV administration of sodium.
O rV administration of regular
insulin and a hypertonic dextrose
solution.
O „eta-2 agonists such as
salbutamol, salmeterol,
terbutaline, and eformoterol shifts
ptassium into the cells.

Lecture note for regular second year


Nursing student, February 2003/2011. 3ÊÕ
V .
   
O —atients at risk for potassium excess
monitored closely for signs of
hyperkalemia.
O Observes for signs of muscle
weakness and dysrhythmias.
O The presence of paresthesias, r
symptoms such as nausea and
intestinal colic should be noted.
O or patients at risk, serum
potassium levels are measured
periodically.
Lecture note for regular second year
Nursing student, February 2003/2011. 3ÊÊ
V .
O ð   
    
!` 
O      
         
—reventing hyperkalemia
O Encouraging the     to the
prescribed potassium restriction.
O —  &` foods to be avoided include
coffee, cocoa, tea, dried fruits, dried beans, and
wholegrain breads.
O "         
` include butter, margarine, cranberry
juice or sauce, ginger ale, gumdrops or jellybeans,
hard candy, root beer, sugar, and honey.

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê7
V .
" `
  
O hen potassium is added to   
      ! 
  
    
 
O —otassium chloride should  
   

  because the potassium
might be administered   
&$      
  
        '%
O ˜ost salt substitutes contain approximately
2+/*+=   per teaspoon.

Lecture note for regular second year


Nursing student, February 2003/2011. 3Ê8
V  
    
O #  99:    8 ` ` 
 `     )it is a
major component of bones and teeth.
O ð 3:   ` `   
!` 
   ` `; the
rest is more stable and only slowly
exchanged.
O      
           ,
$   $ $  
 ? %
O The normal total serum calcium level B%5
)4%5<2 &-%)G-%9<2'%
Lecture note for regular second year
Nursing student, February 2003/2011. 3Ê9
V .
O .` ;
â °  
  
â 
  ``  `  
 !  `
`  `
 `
â ð` 
$     
    ` `  `  
   
â  `
  

Lecture note for regular second year


Nursing student, February 2003/2011. 370
V .
O rt exists in plasma in three formsw
â  $w-ðbout 50% (4.5 to 5.1
mg/dL (1.1l1.D mmol/L)) and
physiologically active and clinically
significant.
â  w-Less than half of the plasma
calcium is bound to serum proteins,
primarily albumin. The remainder is
combined with non-protein anionsw
phosphate, citrate, and carbonate.
â " !.
Lecture note for regular second year
Nursing student, February 2003/2011. 371
V .
O Valcium is absorbed from foods in
the presence of   
`
`    
O Valcium is excreted   
 `   

O The serum calcium level is
controlled by —°- 
` ` 
Lecture note for regular second year
Nursing student, February 2003/2011. 372
V    & $  '

O 0 & &   


concentration of calcium.
O ð patient may have     
` `` 
        
` `

Lecture note for regular second year


Nursing student, February 2003/2011. 373
V .
V
O —         
O (
`        
 `  
O #     
`    
 ` ` 
O — ` 

Lecture note for regular second year


Nursing student, February 2003/2011. 374
V .
O   
O     `   
O #
 `` 
O #    ` `  
O 0    
O ð   
O ð`   
O #`   
ð&`  

 ` ð
 `  " 
"  " `      `
     $  
` 

Lecture note for regular second year


Nursing student, February 2003/2011. 37Õ
V .
V     
O °   
O (    

   
 
      
 `    
O (     `   
!   `  ``
O — 
O °   8  
 

Lecture note for regular second year


Nursing student, February 2003/2011. 37Ê
V .
°   8  


Lecture note for regular second year


Nursing student, February 2003/2011. 377
V .
O "  8  
 
O ($
O # ` 
  `  
     
`    
`   
O ð  
>° 
O —  
(° 


Lecture note for regular second year


Nursing student, February 2003/2011. 378
V .
"   Y  3  
O Yetermination of serum calcium level, by
this formula as follows;

O ðrterial blood gas analaysis.


O Yetermination of serum albumin level. or
every decrease in serum albumin of 1 g/dL
below 4 g/dL, the total serum calcium level
is underestimated by approximately 0.8
mg/dL.
Lecture note for regular second year
Nursing student, February 2003/2011. 379
V .
    
O ð`   `
 ` `  &
  
and requires prompt
treatment with rV administration
of calcium.
O —arenteral calcium salts include
` `
`  ` `
`   ` `

` 
Lecture note for regular second year
Nursing student, February 2003/2011. 380
V .
O <  therapy
O ð  !` `
`  ` ``   
 ` 
O or the patient with chronic renal
failure. ` 
   
  ` `   
3+++ 32++
  
is recommended (eg, milk
products; green, leafy vegetables;
canned salmon; sardines; fresh
oysters).
Lecture note for regular second year
Nursing student, February 2003/2011. 381
V .
   
O Observe for hypocalcemia in patients at risk.
O 2eizure precautions.
O Health education about;
â ð   ` ` ` `
      
    
â 
 
& 
!` 
â =` `    ` ` 
`
  
    .  !
    ð`   ! =  
` ` 
â ° ` 
       
  
`    

Lecture note for regular second year


Nursing student, February 2003/2011. 382
V  + & $
& $   '
 '
O =!`  ` `in the plasma.
O rt is a dangerous imbalance when severe.
O Hypercalcemic crisis has a mortality rate
 
 2+:if not treated promptly.
O The   symptoms tend to
appear when the serum calcium level is
 !  3*
0 7  0 
 However, some patients become
      
` `    36
0 D
  0

Lecture note for regular second year


Nursing student, February 2003/2011. 383
V .
V 
O # 
 `  
      
`  
O   
O °  $ ` 
O #&    
O < ð   !`  
O 0  

Lecture note for regular second year


Nursing student, February 2003/2011. 384
V .
V     
â # `  
â `   
â ð ! 
â "    
â "  `   3;
0 72
  0
â 
   !`
â   
â < 

â    
â ð     
Lecture note for regular second year
Nursing student, February 2003/2011. 38Õ
V .
Ú =!`   
Ú ð    
Ú —   `
Ú (  
Ú —``     
Ú "   
Ú   
Ú  ` 
Ú  

Ú ð` ` `  
Ú "  

Lecture note for regular second year


Nursing student, February 2003/2011. 38Ê
V .
O iypercalcemic crisis refers to an acute
rise in the serum calcium level to 17
mg/dL (4.3 mmol/L) or higher.
O It has the same clinical presentation with
varying degree.

Lecture note for regular second year


Nursing student, February 2003/2011. 387
V .
"   Y  3  
O The serum calcium level is
 
 3+2
0 6*  0
O EV changes;
â 
  >°  (°


⠗      

O The double-antibody —TH test.
O Ë-rays
O The 2ulkowitch urine test
Lecture note for regular second year
Nursing student, February 2003/2011. 388
V .
    
  
â ð 
   
` `    !`  
  
â # $
  
â  `
  ` ` .
—  ` 
`  
â <     +9: 
`    
â ð 
<  
â .  0 !
Lecture note for regular second year
Nursing student, February 2003/2011. 389
V .
â #   `
â      —   
ð 
â  
`   
â <  
â " `    
â " `  
O .    ` `)
â 
 
â `      
â       
Lecture note for regular second year
Nursing student, February 2003/2011. 390
V .
   
O #       
O =` 
  $   
O . `  
    
 `  ` 
O —   ` 
 D 7   
  
O ð    
O (  `      `   
      ` `  
O °          
 ` 
     
O ð    
      
   !` 
O "  `          
   

Lecture note for regular second year


Nursing student, February 2003/2011. 391
"  
" 
å ð`;
å ð solution with a 
` `  
 
  than hydroxide ions.
å ðn acid separates into one or more
hydrogen ions and one or more negative
ions.
å  )
å ð solution with a 
` `  
  !  than hydrogen ions.
å ð base separates into one or more
hydroxide ions and one or more positive
ions.

Lecture note for regular second year


Nursing student, February 2003/2011. 392
V .
O -;
â The unit of measurement used to
describe       `  
   `
â rt stands for the    


⠘easured on a ` +&37
â 2cale represents the 
 
` `  
â $ ;%/5G ;%05%
Lecture note for regular second year
Nursing student, February 2003/2011. 393
V .
14
     1D
&"1  ' 12
11
10
9
8

   7
6
5
4
D
2
   "   1
0

Lecture note for regular second year


Nursing student, February 2003/2011. 394
V .
§ðs the value or -`   

 ` `  
`      
` `  
§ðs the value or -`   

 ` `  
`      
` `  

Lecture note for regular second year


Nursing student, February 2003/2011. 39Õ
!  " 
 "   

â   /
`  ` `&
`    
â     ( 
â  ( 

Lecture note for regular second year


Nursing student, February 2003/2011. 39Ê
V .
"  `ð`&`   
( 
 —rimary +    
%
 ˜aintains a ratio of 6+  
`    3 `  `
`
 ases the process of hydration of VO2
to break it down so it can be
neutralized.
Lecture note for regular second year
Nursing student, February 2003/2011. 397
V .
    
  
â Respiratory 2ystem 
   
, 
    
    
⠄y ` 
   
more VO2 will be blown off.
⠄y ` 
   
"ï6`  

Lecture note for regular second year


Nursing student, February 2003/2011. 398
V .
 
  
â orks ( than respiratory
compensation.
â Effects are   
 

⠗rimarily regulates amount of
`      
!`
â ðlso regulates    
`    ` ` `
`& 
Lecture note for regular second year
Nursing student, February 2003/2011. 399
"  
" 
O ð  
â Respiratory
⠘etabolic
O ð` 
â Respiratory
⠘etabolic

Lecture note for regular second year


Nursing student, February 2003/2011. 400
! $   "1
  Yeficiency of carbon dioxide.
  Too much carbon dioxide is
released.
Vausesw
â -   
â -  !
â -
 
â ( `    
Lecture note for regular second year
Nursing student, February 2003/2011. 401
V .
Vlinical ˜anifestations
* Numbness/tingling in extremities
* Lightheadedness
* Vonfusion/ agitation
* Heart palpitations
* ˜uscle cramping
* Yeep rapid respirations
* pH high (>7.45)
* pVO2 low (< D5)

Lecture note for regular second year


Nursing student, February 2003/2011. 402
V .
˜anagement
â ° `  
â ï!

â &  
"ï6
â "   /  
 `   
!`
 `   

Lecture note for regular second year


Nursing student, February 2003/2011. 403
V .
 
" 
â  !
â (  
â   `
⠗ 

â  

Lecture note for regular second year


Nursing student, February 2003/2011. 404
! $   " 
Ú Excess acid (VO2)
Vausesw
â -    
â ð   
â ( 
â "ï—
â     ` 
â      
 

â =!` "ï6 ` 

Lecture note for regular second year


Nursing student, February 2003/2011. 40Õ
V .
V     
â `     
   
â -  !
â -    
â - ` ``   
â - A=D2
⠗"ï6 
B72

Lecture note for regular second year


Nursing student, February 2003/2011. 40Ê
V .
   
â ° `  
â <     
⠗   

â =     

Lecture note for regular second year


Nursing student, February 2003/2011. 407
  "1
OExcess of base
Vausesw
â ain of base
â Excretion of too much acid

Lecture note for regular second year


Nursing student, February 2003/2011. 408
V .
V     
â (    

â     
  
â "   
â   


â -  ` `
â -   
â - 
B=72
â -"ïD 
B6*
Lecture note for regular second year
Nursing student, February 2003/2011. 409
V .
  
â Replace fluids and electrolytes.
â Yiamox (ðcetazolamide) enhances
excretion of bicarbonate.
⠗roper functioning kidneys will
excrete excess bicarbonate with
adequate fluid volume and
appropriate potassium.

Lecture note for regular second year


Nursing student, February 2003/2011. 410
V .
 V 
⠘onitor vital signs closely.
⠘onitor fluid status.
â 2afety measures ( change in level of
consciousness).
â rf nasogastric suction, irrigate with
N2, not water.

Lecture note for regular second year


Nursing student, February 2003/2011. 411
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excess or base deficit
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Vausesw
   
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Lecture note for regular second year


Nursing student, February 2003/2011. 412
V .
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Lecture note for regular second year
Nursing student, February 2003/2011. 413
V .
  
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â ð `   !
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Lecture note for regular second year


Nursing student, February 2003/2011. 414
° 

Lecture note for regular second year


Nursing student, February 2003/2011. 41Õ