Urinary system disorders.

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1. URINARY SYSTEM DISORDERS
2. Objectives:
After 12 hrs. varied teaching learning activities, the students should:
Review the anatomy and physiology of the urinary system.
Explain the role of the urinary system in maintaining homeotasis.
Identify abnormal findings that may indicate impairment of the urinary system.
Implement appropriate nursing management techniques for patients with urinary and
kidney problem
Use the nursing process as framework, for the care of patients undergoing surgery.
Demonstrate compassion when caring for patients with Urinary system problem
3. Overview
4 components
4.
5. Anatomy of the Kidney
Cup-like that collects its urine
6. The Nephron
Basic structural and functional unit of kidney
7. AMOUNT AND COMPOSITION OF BODY FLUIDS
60% of adult’s weight – fluids and electrolytes.
FACTORS THAT INFLUENCE THE AMOUNT OF BODY FLUID
Age Medications
Surgery Stress
Illness Diet
Gender
Body Fat
Climate
8. 2 FLUID COMPARTMENTS
Intracellular – 2/3 of body fluids in the skeletal muscle mass
Extracellular
Intravascular – contains plasma - 3L of the 6L of blood volume
Interstitial – fluids that surrounds the cell = 11–12 L
Transcellular– contains approximately 1L of fluid. Ex. CSF, pericardial, synovial,
intraocular, pleural, sweat
9. FLUID INTAKE
Fluid requirement/day- 2,500 mL
Ave. adult drinks 1,500 mL/day
Remaining 1,000 mL is preformed water.
Thirst is triggered by:
Intracellular dehydration
Excess angiotensin II (potent vasoconstrictor)
Hemorrhage
10. ROUTES OF GAINS AND LOSES
o Kidneys – 1-2 L daily urine volume
 - 1 mL urine/kg/hr

o Skin – 0-1,000 mL or more/hr (varies)

- sensible
-insensible – 600 mL/day

o Lungs – 400 mL/hr

o GI tract – 100-200 mL/day
11. FLUID IMBALANCES
2 BASIC TYPES
Isotonic – occurs when water and electrolytes are lost and gained in equal proportions
Osmolar – loss or gain of only water
4 CATEGORIES OF FLUID IMBALANCE
Isotonic loss of water and electrolytes (Fluid volume deficit)
Osmolar loss of only water (Dehydration)
Isotonic gain of water and electrolytes (fluid volume excess)
Osmolar gain of only water (Overhydration)
12. Formation of Urine
THREE PROCESSES IN URINE FORMATION
Glomerular Filtration
Tubular reabsorption
Tubular secretion
Glomerular Filtration Rate- amount of fluid filtered from the blood into the capsule per
minute.
120-125 ml/min held constant by instrinsic control
Myogenic
Reninangiotensin mechanism
13.
14. CHARACTERISTICS OF NORMAL URINE
Pale to deep yellow, clear
Odor – Aromatic
Specific Gravity – 1.001 – 1.030
pH- 4.5-8.0
Protein – Negative to trace
Glucose – Negative
WBC – 0-5 hpf
RBC – 0-5/hpf
Casts – Negative to occasional
15. Defects of Genitourinary Tract
Inguinal Hernia
Hydrocele- fluid in the scrotum
Phimosis – narrowing or preputial opening of foreskin
Hypospadias – urethral opening located behind the glans penis
Epispadias
Chordee – ventral curvature of penis
16. UTI
a bacterial infection that affects any part of the urinary tract.
The most common type of UTI:
bladder infection (cystitis).
kidney infection (pyelonephritis)
Risk Factors
Female:
Short, straight urethra
Proximity of urinary meatus to vagina and anus
Sexual intercourse
Use of spermicidal compound for birth control
Male:
Uncircumcized
Prostatic hypertrophy
Rectal intercourse
Both:
Aging
Urinary tract obstruction
Neurogenic bladder dysfunction
Vesicoureteral reflux
Genetic factors
Catheterization
17. Symptoms & Signs
For bladder infection
Frequent urination along with the feeling of having to urinate even though there may be
very little urine to pass.
Nocturia
Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout
the urethra with urination (dysuria).
Pain in the midline suprapubic region.
Pyuria
Hematuria
Pyrexia
Cloudy and foul-smelling urine
Some urinary tract infections are asymptomatic
18. For Kidney Infections
Aforementioned symptoms.
Emesis
Back, side (flank) or groin pain.
Abdominal pain or pressure.
Shaking chills and high spiking fever.
Night Sweats.
Extreme Fatigue.
19. Epidemiology
Most common in sexually active women
Diabetes
 anatomical malformations of the urinary tract.
Allergies
Use of urinary catheters as bladder wall is coated with various mannosylated proteins,
such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to
the uroepithelium
20. CYSTITIS
PYELONEPHRITIS
Is inflammation of the urinary bladder
Types
bacterial cystitis most often caused by coliform bacteria being transferred from the bowel
through the urethra into the bladder
interstitial cystitis (IC) is considered more of an injury to the bladder resulting in constant
irritation and rarely involves the presence of infection
radiation cystitis often occurs in patients undergoing radiation for the treatment of cancer.

inflammation of the renal pelvis, and kidney tissues.

Acute- bacterial “ascending infection”
Chronic-non bacterial and inflammatory processes
21. Causes, incidence and risk factors
sexually active women ages 20 to 50 but may also occur in those who are not sexually
active or in young girls.
escherichia coli ("E. coli“)
Sexual intercourse
insertion of instruments into the urinary tract
obstruction of the bladder or urethra with resultant stagnation of urine
22. Diagnosis
urine culture and sensitivity
urinalysis.
IVP
Cystoscopy
Manual prostate and pelvic exam
Treatment
oral antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMZ), cephalosporins,
nitrofurantoin, or a fluoroquinolone (e.g. ciprofloxacin, levofloxacin).
23. Nursing Management
increased water-intake
frequent voiding
avoidance of sugars and sugary foods
Avoid caffeinated drinks
drinking unsweetened cranberry juice
as well as taking vitamin C with the last meal of the day
Prevention
Cleaning the urethral meatus after intercourse
urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the
bacteria before specialized extensions anchor the bacteria to the walls of the urethra.
Having adequate fluid intake, especially water.
 Not resisting the urge to urinate.
Bathing in warm water without soap, bath foams, etc.
Practicing good hygiene, including wiping from the front to the back to avoid
contamination of the urinary tract by fecal pathogens.
24. URINARY RETENTION
also known as ischuria is a lack of ability to urinate
Signs and Symptoms
poor urinary stream with intermittence
straining, a sense of incomplete voiding and urgency
25. Causes:
BPH
Prostatic Cancer
Damage to the bladder
Obstruction in the urethra
26. Diagnostic tests
Uroflowmetry may aid in establishing the type of micturition abnormality. A post-void
residual scan may show the amount of urine retained.
Serum prostate-specific antigen (PSA) may aid in diagnosing or ruling out prostate
cancer.
Urea and creatinine determinations may be necessary to rule out backflow kidney
damage.
27. obstruction of the urinary tract may cause:
Bladder stones
Hydronephrosis
Diverticula
28. Treatment
ACUTE :
urinary catheterization
suprapubiccystostomy
CHRONIC:
transurethral resection of the prostate, TURP
29. Benign prostatic hyperplasia
increase in size of the prostate in middle-aged and elderly men
Symptoms:
urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary
retention.
results in:
stasis of bacteria in the bladder residue and an increased risk of urinary tract infections.
Urinary bladder stones, Urinary retention
30. Diagnosis
Rectal examination
blood tests are performed to rule out prostatic malignancy: elevated prostate specific
antigen (PSA) levels
transrectalultrasonography
Ultrasound examination of the testicles, prostate and kidneys
31. Treatment
Lifestyle
Patients should decrease fluid intake before bedtime, moderate the consumption of
alcohol and caffeine-containing products, and follow timed voiding schedules.
Medications
Alpha blockers (α1-adrenergic receptorantagonists) provide symptomatic relief of BPH
symptoms. Available drugs include doxazosin, terazosin, alfuzosin and tamsulosin.
Alpha-blockers relax smooth muscle in the prostate and the bladder neck, and decrease
the degree of blockage of urine flow.
The 5α-reductase inhibitors (finasteride and dutasteride) are another treatment option.
When used together with alpha blockers a reduction of BPH progression to acute urinary
retention and surgery has been noted in patients with larger prostates.
32. Surgery
If medical treatment fails, transurethral resection of prostate (TURP)
Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation
(VLAP), TransUrethral Microwave ThermoTherapy (TUMT), TransUrethral Needle
Ablation (TUNA), ethanol injection
33. KIDNEY STONE ALSO CALLED RENAL CALCULI
are solid concretions (crystal aggregations) of dissolved minerals in urine
nephrolithiasis and urolithiasis
at least 2-3 millimeters can cause obstruction of the ureter.
severe episodic pain, most commonly felt in the flank, lower abdomen and groin a
condition called renal colic
Hematuria
Staghorn calculus (struvite stone)
Star shaped bladder urolith
34. Kidney Stones
Calcium oxalate stones -consumption of low-calcium diets
Other types of kidney stones are composed of struvite(magnesium, ammonium and
phosphate) are always associated with urinary tract infections
uric acid is associated with conditions that cause high blood uric acid levels, such as gout,
leukemias;
calcium phosphate is associated with conditions such as hyperparathyroidism and renal
tubular acidosis.
cystine.
35. Medical Management
non-invasive Extracorporeal Shock Wave Lithotripsy or (ESWL)
Ureteral (double-J) stents
36. HYDRONEPHROSIS
is distention and dilation of the renal pelvis, usually caused by obstruction of the free
flow of urine from the kidney.
Ultrasound picture of hydronephrosis caused by a left ureteral stone.
37. Etiology
The obstruction may be either partial or complete and can occur anywhere from the
urethral meatus to the calyces of the renal pelvis.
The obstruction may arise from either inside or outside the urinary tract or may come
 from the wall of the urinary tract itself.
Intrinsic obstructions (those that occur within the tract) include blood clots, stones,
sloughed papilla along with tumours of the kidney, ureter and bladder.
Extrinsic obstructions (those that are caused by factors outside of the urinary tract)
include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or
neurologicaldeficits.
Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or
schistosomiasis are other causes which originate from the wall of the urinary tract.
38. Acute renal failure
is a rapid loss of renal function due to damage to the kidneys, resulting in retention of
nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally
excreted by the kidney.
Characteristics
1. Abrupt onset
2. Lead to
a.Azotemia = accumulation of nitrogenous wastes in the blood
o b. Oliguria = < 400 ml per 24 hours; 40% of failure is nonoliguric or anuria
39. Causes
Acute Renal Failure
Pre-renal Functional
Post-renal Obstructive
Renal Structural
a. decrease in renal perfusion pressure; no kidney pathology
a. Any obstruction to excretion of normal urine
a. Acute parenchymal changes that damage nephrons
b. Intrarenal = uric acid crystals and methotrexate toxicity
b. Specifically: acute glomerulonephritis, vascular disease, interstitial nephritis, acute
tubular necrosis
b. Hepatorenal syndrome from hemorrhage, dehydration, excessive diuresis or massive
paracentesis]
c. Extrarenal = BPH, renal calculi, and obstruction to flow (more common)
40. Comparing Categories of Acute Renal Failure
41. Pre-renal (causes in the blood supply):
Hypovolemia, usually from shock or dehydration
fluid loss or excessive diuretics use.
hepatorenal syndrome in which renal perfusion is compromised in liver failure vascular
problems, such as atheroembolic disease and renal vein thrombosis (which can occur as a
complication of the nephrotic syndrome)
42. Renal (damage to the kidney itself):
infection usually sepsis (systemic inflammation due to infection),rarely of the kidney
itself, termed pyelonephritis toxins
medication (e.g. some NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium)
rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the
blood affects the kidney; it can be caused by injury (especially crush injury and extensive
blunt trauma), statins, stimulants and some other drugs
 hemolysis - the hemoglobin damages the tubules; it may be caused by various conditions
such as sickle-cell disease
43. Post-renal (obstructive causes in the urinary tract)
due to: medication interfering with normal bladder emptying.
benign prostatic hypertrophy or prostate cancer.
kidney stones. due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer).
obstructed urinary catheter.
44. D. Pathogenesis
1. Loss of renal autoregulation (altered renal blood flow)
2. Initially renal blood flow decrease, but then GFR decreases out of proportion to renal
flow
3. Tubular obstruction may cause tubular reabsorption and (tubular obstruction)
4. Decreased GFR because of hydrostatic pressure (back leak theory)
E. Clinical picture
1. Severe decrease GFR
2. Oliguria or anuria (30-50% no oliguria)
3. Increased BUN & creatinine
45. Type of acute renal failure
Acute tubular necrosis = ARF caused by destruction of tubular epithelial cells
1. ATN = most common cause of ARF
2. Common causes
a.Ischemiaresulting from shock, hemolysis or skeletal muscle breakdown; patchy damage
to tubules with blocking of tubule by cell casts & dilation of Bowman's capsule.
b. Nephrotoxicagents from hemolysis, intravascular coagulation, precipitation of oxalate
and uric acid crystals, and tissue hypoxia; more damage to & casts in distal tubules and
necrosis in all nephrons.
Aging with decrease in nephrons or dehydration can increase toxicity
o Many antibiotics (tetracyclines, aminoglycosides cephalosporins, ampho-B) and
contrast materials with iodine
46. F. Stages of ARF
1. Initiation = inciting event causing tubular necrosis & altered blood flow
2. Maintenance stage (1-3 weeks)
a. Oliguria
b. Electrolyte imbalances
c. Urine specific gravity at 1.010 which = plasma specific gravity
d. Renal blood flow down which = decrease GFR
e. Water excess with dilutional hyponatremia
f. Hyperkalemia from decreased excretion and excessive muscle breakdown; also
increased creatinine, phosphate, and urea
g. Metabolic acidosis
47. h. Anemiabecausesuppressederythropoietin
i. Progressiveazotemia
3. Recovery (begins >24 hrs post onset)
a.Diuresis; gradual increase in output asmuchas 6L/day
b. Tubular function still altered because large amounts of Na+ and K+ still lost in urine
c. Dehydration, hypokalemia
 d. Increased RBC production
e. Continues over 6-12 months; 30% never fully recover renal function
48. G. Treatment principles
o correcting fluid and electrolyte disturbances
o treating infections
o nutrition
o drugs and metabolites aren't excreted

II. Chronic renal failure= slowly progressive loss of nephrons and damage to glomeruli
characterized by irreversible reduction in the GFR. Affects all functions normally carried
out by the kidneys.
A. Causes:
1. Glomerulopathies
2. Tubulo-interstitial renal diseases
3. Hereditary diseases
4. Vascular diseases:
5. Obstructive nephropathy

49. B. Problems created by CRF

1. Fluid imbalance
Unable to concentrate urine early so excess H20 loss
Until 25% loss of function maintains solute, then once past threshold osmotic diuresis
with dehydration
As progresses, inability to dilute urine so isosthenuria (urine and plasma have same, fixed
specific gravity 1.010)
2. Na+ imbalance
a. Intact nephrons receive more Na+ so...
b. Osmotic diuresis, so...
c. Reduction in blood volume and GFR
50. 3. K+ imbalance
a. If water balance is maintained and acidosis controlled, not a problem
b. Hyperkalemia if increased acidosis or hyponatremia or catabolism
c. Hypokalemia if diuretic therapy, vomiting, renal tubular disease that prevents
reabsorption.
4. Acid-base imbalance
a. Metabolic acidosis because kidneys can't excrete enough H+
b. Renal tubule dysfunction leads to progressive inability toe excrete H+
c. H+ excretion is proportional to GFR
d. Acids are continuously formed, but glomerulus cannot filer as effectively, production
of ammonia decreases, and tubular damage
51. 5. Anemia - Hct. proportionate to azotemia
a. Short life span of RBCs because of altered plasma
b. Increased loss of RBCs because of GI ulceration, dialysis, and lab draws
c. Reduced erythropoietin because of decreased renal formation and inhibition from
uremia
d. Folate deficiency if dialysis
 e. Iron deficiency
f. Elevated parathyroid which stimulates fibrous replacement of bone marrow
6. Bleeding disorders
a.Thrombocytopenia or platelet dysfunction
b.Nitrogenous wastes increase risk of hemorrhage
52. 7. Urea and creatinine alterations (renal function studies)
a.BUN increases (also increases with shock, protein intake, infection, gout)
b.Creatinine - excretion=production
c.BUN up with nonrenal; hepatorenal then BUN low
F. Uremic syndrome= symptomatic renal failure associated with metabolic events and
multi-organ complications
1. Cardiovascular
a. Fluid and Na+ retention
b. Accelerated atherosclerosis
c. Pericarditis increased without dialysis
d. Heart Failure
53. 2. Hematologic
o severe anemia
o From decreased erythropoietin
o Uremia = decrease RBC life span
o Uremia = inability of cells to pump out Na+ so swelling and hemolysis
o Immunosuppression from reduction of lymphocytes
o Platelet defects = bleeding

3. Dermatologic

o Pallor from anemia and retention of pigmented urochromes

o Dehydration and atrophy of the sweat glands
o Uremic itching = (?) skin deposits, peripheral neuropathy
o Uremic frost = urea deposits from sweat
o Soft tissue calcification from hyperparathyroidism
54. 4. GI - retention of metabolic acids and waste products
a. N&V (nausea and vomiting)
b. Hiccups
c. Anorexia
d. Irritation, inflammation, ulceration of GI tract - mouth to colon
e. Uremic fetor when urea broken down to ammonia
5. Reproductive - Amenorrhea, infertility, decreased libido, decreased testosterone
6. Endocrine
b. Hypothyroidism
a. Hyperparathyroidism
55. 7. Neurologic
Encephalopathy - fatigue, decreased concentration, irritability, depression, drowsiness,
insomnia, personality changes, seizures, and death
Peripheral neuropathy - burning, numbness, delayed sensory and motor responses
Diagnosis
 Creatinine or blood urea nitrogen tests
Urinalysis
Blood test
Medical ultrasonography of the tract ( is essential to rule out obstruction of the urinary
tract)
56. Treatment
There are several modalities of renal replacement therapy (RRT) for patients with acute
renal failure:
Intermittent hemodialysis
Continuous hemodialysis (used in critically ill patients)
57. DIALYSIS
o Is used to substitute some kidney functions during renal failure.
o It is used to remove fluid and uremic waste products from the body when the
kidneys are unable to do so.
o It may be indicated to treat patients with edema that do not respond to treatment.
o Acute dialysis is indicated when there is a high and increasing level of serum
potassium, fluid overload, or impending pulmonary edema, increasing acidosis,
pericarditis and severe confusion. It may also be used to certain medications or
other toxins in the blood.
58. DIALYSIS
o Chronic or maintenance dialysis is indicated in ESRD in the following instances:

Presence of uremic signs and symptoms affecting all body systems (nausea and vomiting,
severe anorexia, increasing lethargy, mental confusion)
Hyperkalemia and fluid overload not responsive to diuretics and fluid restriction.
General lack of well-being.
 An urgent indication for dialysis in patients with CRF is pericardial friction rub.

59. PERITONEAL DIALYSIS

TYPES:
Intermittent peritoneal dialysis = acute or chronic renal failure
Continuous ambulatory peritoneal dialysis = chronic renal failure
Continuous cycling peritoneal dialysis = prolonged dwelling time
60. PERITONEAL DIALYSIS
Indwelling catheter is implanted into the peritoneum.
A connecting tube is attached to the external end of peritoneal catheter T –tube.
Plastic bag of dialysate solution is inserted to the end of T-tube; the other end is recap.
Dialysate bag is raised to shoulder level and infused by gravity in the peritoneal cavity
Infusion time = 10 minutes/2 liters; dwelling time is 4-6 hours depending on doctor’s
order.
At the end of dwelling time, dialysis fluid is drained from the peritoneal cavity by gravity
Draining time is 10-20 minutes/2 liters
Then repeat the procedure when necessary
61. Peritoneal Dialysis
Usually for patients with absolutely no other options of dialysis
Or as a temporary measure until options of dialysis sorted out
62. Pre and post operative care for Tenckhoff catheter insertion
Pre operative care
Fast for 8 hours
Allow essential medications
Bowel preparation not necessary
Removal of body hair limited to that necessary to facilitate performance of procedure
Empty bladder
Single dose of prophylactic antibiotic
Operating room or well equipped procedure room
63. Pre and post operative care for Tenckhoff catheter insertion
Post operative care
Catheter irrigation with 1 L of heparinized saline performed as an in-and-out flush within
72 hours following surgery and weekly thereafter until PD initiated
Delay PD for a min of 2 weeks to allow wound healing
Change dressings weekly for 2 weeks
Then patient should begin a routine of daily exit-site cleansing with antibacterial soap
Showering only permitted after 1 month if wound healing uncomplicated
Avoid catheter movement at the exit site
Use sterile gauze dressing over exit site
No tub bathing and swimming
64. PERITONEAL DIALYSIS
65. PERITONEAL DIALYSIS
66. PERITONEAL DIALYSIS
NURSING CONSIDERATIONS:
Dialysate must be room-warmed before use ( for better absorption)
Drugs (heparin, potassium and antibiotics) must be added in advance.
Allow the solution to remain in the peritoneal cavity for the prescribed time.
Check outflow for cloudiness, blood and fibrin (early peritonitis).
NEVER PUSH THE CATHETER IN.
Monitor the VS regularly.
Keep a record of patient’s fluid balance (daily weighing)
Monitor blood chemistry
Turn the patient side to side if drainage stop
Observe for abdominal pain (cold solution), dialysate leakage (prevent infection)
Intake must be equal to output.
67. HEMODIALYSIS
Is the process of cleansing the blood of accumulated waste products
Patient’s access is prepared and cannulated surgically
 One needle is inserted to the artery (brachial) then blood flow is directed to dialyzer
(dialysis machine)
o The machine is equipped with semi-permeable membrane surrounded with
dialysis solution
o Waste products in the blood move to the dialysis solution passing through the
membrane by means of diffusion
o Excess water is also removed from the blood by way of ultrafiltration
o The blood is then returned to the vein after it has been cleansed.
68. HEMODIALYSIS
69. HEMODIALYSIS
Patient Access
Vascular catheter
A-V fistula
Synthetic vascular graft
70. HEMODIALYSIS
71. HEMODIALYSIS
NURSING CONSIDERATIONS:
Blood can be heparinized unless it is contraindicated to prevent blood clot.
Dialysis solution has some electrolytes and acetate and HCO3 added to achieve proper
pH balance.
Methods of circulatory access: AV fistula; AV graft or U-tube
Assess the access site for bruit, signs of infections and ischemia of the hand.
Absence of thrill may indicate occlusion
No BP taking on the access site.
Cover the access site with adhesive bandage
Dietary adjustments of CHON, Na and fluid intake.
Monitor VS regularly
Check blood chemistry
Constant monitoring of hemodynamic status, electrolytes and acid-base balance.
72. KIDNEY TRANSPLANT
o Indicated for ESRD

TYPES OF DONOR
Living
Cadaveric

o Rejection and infection remain the major complication after surgery.

o T and B lymphocytes are involved in the rejection response
o To reduce the rejection process, immunosuppressive drugs are given
o Watchout for infection after immunosuppressive medications
73. KIDNEY TRANSPLANT
REJECTION RESPONSE
Hyper acute – occurs in the OR, kidney turns blue and flabby.
Treatment: remove the kidney
2. Accelerated Acute – occurs 48-72 hours post-op; abrupt oliguria is seen.
Treatment: dialysis, steroid and immunsuppressive drugs are initiated; with poor
prognosis.
3. Acute – occurs 1 week to several weeks post-op, weight gain, oliguria, HPN, increased
BUN, enlarged kidney are seen.
Treatment: same with accelerated acute; with good prognosis.
4. Chronic – occurs months to years post-op, progressive decreased renal function is seen.
Treatment: same as above; poor prognosis.
74. end
75. Nursing Diagnosis:
 o Fluid Volume Excess
o Imbalanced Nutrition: less than body requirements
o Risk for Infection

Medical Management:

o Maintaining fluid balance, avoiding fluid excesses, or possibly performing

dialysis.
76.
o Maintenance of fluid balance is based on daily body weight, serial measurements
of central venous pressure, serum and urine concentrations, fluid losses, blood
pressure, and the clinical status of the patient.
o Fluid excesses can be detected by the clinical findings of dyspnea, tachycardia,
and distended neck veins.

Nursing Management:
Monitoring fluid and electrolyte
Reducing metabolic rate
Promoting pulmonary function

77.
o Providing support
o Preventing infection
o Providing skin care