RAJIV GANDHI COLLEGE OF NURSING

SUB: CHILD HEALTH NURSING

LESSON PLAN ON
TOPIC: HYDRONEPHROSIS

SUBMITTED TO
MRS.SUSAN SHEILA ABRAHAM
LECTURER
CHILD HEALTH NURSING
RAJIV GANDHI COLLEGE OF NURSING

SUBMITTED BY
Mrs.sonya godwin
IST year MSC.nursing
Rajiv Gandhi college of nursing
 Lesson plan on
HYDRONEPHROSIS
Name of the student : Mrs.sonya godwin Name of the evaluator: Ms.sheila abraham, pediatric nursing.
Class : 1st yr M.Sc Nursing
Subject : child health nursing
Unit : Unit V
Topic : Hydronephrosis
Placement : 3rd yr B.Sc Nursing Students
No. of students : 50 students
Venue : 3rd yr B.Sc nursing classroom
Date : 20-2-10
Time : 2pm-3pm
AV Aids : Blackboard, Chart, OHP.
Method of teaching : Lecture cum discussion
GENERAL OBJECTIVES : At the end of the class, the students will acquire adequate knowledge regarding Hydronephrosis and its
Management in clinical area.
Specific objectives : At the end of the class, students will be able to;

1. Describe the anatomy and physiology of kidney.

2. Define Hydronephrosis.
3. List out the etiology and risk factors of Hydronephrosis.
4. Discuss the pathophysiology of the Hydronephrosis.
5. Explain the clinical features.
6. Details of diagnostic studies.
7. Describe the prognosis
8. Explain the treatment regimen- medical, surgical managements.
9. State the nursing diagnosis and nursing interventions.
10. Discuss the preventive measures of Hydronephrosis
SL. TIME SPECIFIC CONTENTS AV TEACHERS STUDENTS EVALUATION
OBJECTIVES AIDS ACTIVITY ACTIVITY

HYDRONEPHROSIS
INTRODUCTION
1. 3minutes To introduce Black The teacher Students What is the
the lesson for Hydronephrosis is a condition in which one or board introduces the will listen topic of today’s
the day both of the kidneys become stretched and topic class?
swollen. This is usually because:
 there is a blockage somewhere in the
urinary system (along the urine flow
path), which is the usual cause, or
 urine is flowing from the bladder back to
the kidneys
It can sometimes cause a pain in the side, or
there may be no symptoms at all.

ANATOMY AND PHYSIOLOGY THE KIDNEY

2. 6minutes To explain the Chart -Teacher explains -Students List down the
basic anatomy One of the most complex, beautifully the anatomy and listens functions of the
and physiology “engineered” organs of the human body, the physiology of kidney?
of kidney kidneys perform several essential tasks kidney
including the excretion of waste products, the
maintenance of homeostatic balance in the
body and the release of important hormones.

Location and Basic Structure of the Kidneys

The kidneys lie on the posterior
abdominal, one on each side of the vertebral
column, behind the peritoneum and below the
diaphragm. Extends from the level of the 12 th
thoracic vertebra to 3rd lumbar vertebra. The
left kidney lying a little higher than the right.
Each is identical in structure and function. They
are bean-shaped, about 10 cm long and 6.5 cm
wide. Each kidney comprises an outer cortex
and an inner medulla.

The Nephron
The main functional unit of the kidney is
the nephron. There are approximately one
million nephrons per kidney. The role of
nephrons is to make urine by:
 Filtering blood of small molecules and ions.
 Recycling the required quantities of useful
solutes which then re-enter the
bloodstream. (A process called
reabsorption)
 Allowing surplus or waste molecules/ions
to flow from the tubules/ureter as urine.
Blood supply
The kidney is supplied with oxygenated
 blood via the renal artery and drained of
deoxygenated blood by the renal vein.

-To define OHP -Students

DEFINITION OF THE HYDRONEPHROSIS -Teacher defines
3. 2minutes Hydronephrosis Hydronephrosis is distension and dilation of will listen Define
Hydronephrosis and copies it Hydronephrosis?
the renal pelvis and calyces, usually caused by
obstruction of the free flow of urine from the
kidney, leading to progressive atrophy of the
kidney.

-To list out the ETIOLOGY OHP -Students

4. 4minutes -Teacher lists and
etiology and listens and List down
- The obstruction may arise from either explains the
Risk factors make a note causative factors
inside or outside the urinary tract. etiology and risk
of it of
- Intrinsic obstructions include factors
Hydronephrosis?
 blood clots,
 stones,
 Sloughed papilla along with tumors of
the kidney, ureter and bladder.

- Extrinsic obstructions include

 pelvic or abdominal tumors or masses,
 Retroperitoneal fibrosis or neurological
deficits.
 Strictures of the ureter (congenital or
acquired),
 Neuromuscular dysfunctions.
 PATHOPHYSIOLOGY OF HYDRONEPHROSIS
Chart
-To describe the Due to etiological factors the outward flow of
5. urine is blocked. Students
4minutes pathophysiology
-Teacher copies it Describe the
describes the down pathophysiology?
First shows evidence of hyperactivity and
pathophysiology
hypertrophy dilatation and atony.

muscular loss of peristaltic activity

atrophy of the renal parenchyma

Compression of the arcuate vessels

Ischemic atrophy renal calyces.

Distension and dilation of the renal pelvis and

calyces leads to symptoms.

SIGNS AND SYMPTOMS

The signs and symptoms of hydronephrosis OHP
-To explain the depend upon whether the obstruction is acute Students
6. List out the
4minutes clinical or chronic, partial or complete, unilateral or -Teacher lists listens
manifestations bilateral. Unilateral hydronephrosis may occur down the clinical clinical
of without any symptoms, while acute obstruction manifestations manifestations?
Hydronephrosis can cause intense pain.
 asymptomatic (in some cases)
 pain is felt in the renal area
 hematuria
  urinary infection, dysuria frequency
 renal calculi
 azotemia
 unexplained vague GI symptoms
 some large Hydronephrosis can be
palpable

-DIAGNOSTIC STUDIES Black

Physical examination board -Students
5minutes -To explain the An enlarged kidney may be palpable on -Teacher explains listen and
7.
diagnostic examination. the diagnostic copy it. List out the
studies suprapubic tenderness along with a palpable studies various
bladder are strongly suggestive of acute urinary diagnostic
retention methods for
Blood tests can show raised creatinine and Hydronephrosis?
electrolyte imbalance.
Urinalysis may show an elevated pH due to the
secondary destruction of nephrons within the
affected kidney.
Ultrasound allows for visualisation of the
ureters and kidneys and can be used to assess
the presence of hydronephrosis and / or
hydroureter.
IVU (intravenous urogram) is useful for
assessing the position of the obstruction.
Antegrade or retrograde pyelography will
show similar findings to an IVU but offer a
therapeutic option as well.
CT 99% of stones are visible on CT and
therefore CT is becoming a common choice of
initial investigation. CT is not used however,
when there is a reason to avoid radiation
 exposure, e.g. in pregnancy.

Prognosis
Black
To describe the Left untreated, bilateral obstruction (occurring board Students
2minute to both kidneys rather than one) has a poor
8. prognosis -teacher discuss listens
prognosis.
The prognosis
What is the
-MANAGEMENTS
prognosis of the
MEDICAL MANAGEMENT
10minutes -to explain the OHP Hydronephrosis?
9. Treatment of Hydronephrosis focuses upon
treatment -Students
- the removal of the obstruction
regimen -Teacher explains listen and
- drainage of the urine that has accumulated
behind the obstruction. the treatment copy it.
regimen
- Nephrostomy Mention the
Acute obstruction of the upper urinary medical
tract is usually treated by the insertion of a measures for
Nephrostomy (an artificial opening created Hydronephrosis?
between the kidney and the skin which
allows for the drainage of urine directly
from the upper part of the urinary system)
tube.
- Ureteric Stent
Chronic upper urinary tract obstruction is
treated by the insertion of a ureteric stent
(a thin tube inserted into the ureter to
prevent or treat obstruction of the urine
flow from the kidney)
- Pyeloplasty
pyeloplasty is the surgical reconstruction
or revision of the renal pelvis to drain and
decompress the kidney. Most commonly it
is performed to treat an uretero-pelvic
junction obstruction if residual renal
function is adequate.
- Suprapubic Catheter
Lower urinary tract obstruction is usually
treated by insertion of a urinary catheter or
a suprapubic catheter.

Surgical Management
Fetal surgery for congenital
Hydronephrosis.
- Fetal surgical treatment is done for the
correction of posterior urethral valve
obstruction and ureteropelvic junction
 obstruction.

NURSING MANAGEMENT Black

State the ASSESSMENT board
12minutes nursing Teacher discusses
History the nursing Student
10. diagnosis and
management of listens
nursing Elicit a careful history about urinary patterns
interventions to determine a history of burning sensations, the patient with
Describe the
abnormal color, and frequency of urination. Hydronephrosis
nursing care of
Determine any recent history of mild or severe the client with
renal or flank pain that radiates to the groin. Hydronephrosis?
Ask about vomiting, nausea, or abdominal
fullness. Ask a male patient if he has had
prostate difficulties and urinary difficulties.
Physical Examination
Inspect the flank area for asymmetry, which
indicates the presence of a renal mass.
Inspect the male urethra for stenosis, injury, or
phimosis.
Inspect and palpate for vaginal, uterine, and
rectal lesions in females. When the flank area is
palpated, you may feel a large fluctuating soft
mass in the kidney area that represents the
collection of urine in the renal pelvis.
Palpate the abdomen to help identify tender
areas.
If the Hydronephrosis is the result of bladder
obstruction, markedly distended urinary
bladder may be felt.
Gentle pressure on the urinary bladder may
result in leaking urine from the urethra because
of bladder overflow.
NURSING DIAGNOSIS
Risk for infection related to urinary stasis and
instrumentation

NURSING INTERVENTIONS
Temporary urinary drainage may be achieved
by a nephrostomy or ureterostomy. Other
options are ureteral, urethral, or suprapubic
catheterization. When no infection is present,
immediate surgery is not necessary even if
there is complete obstruction and anuria.
Urologists often place a ureteral stent, which is
performed along with a cystoscopy and
retrograde pyelography.
Stents can bypass an obstruction and dilate the
ureter for further evaluation and treatment
such as a percutaneous Nephrostomy tube,
which may be placed when a retrograde stent
cannot be passed because of an obstruction in
the ureter.
Advances in endoscopic and percutaneous
instrumentation have reduced the surgical role,
although some cases of Hydronephrosis still
require treatment with open surgery. Many
surgeons will wait until acid-base, fluid, and
electrolyte balances are restored before
operating. Surgery includes options such as
prostatectomy for benign prostatic
hypertrophy, tumor removal, and dilation of
 urethral strictures.

Psychosocial
Although Hydronephrosis is a treatable
condition, the patient is likely to be upset and
anxious. Many find GU examinations
embarrassing.
Urinary catheterization can also be a stressful
event, particularly if it is performed by
someone of the opposite gender.
If the patient’s renal condition has been
permanently affected, determine the patient’s
ability to cope with a serious chronic condition.

Black
PREVENTION.
Discuss about board
2mins the preventive Teach the importance of adequate fluids. Teacher discusses
measures of Explain the importance of notifying the the preventive Student
11. Hydronephrosis physician at the first signs of inability to void or measures of participates
Hydronephrosis. in How will you
of urinary infection, such as burning or painful
urination, cloudy urine, rusty or smoky urine, discussion prevent the
Hydronephrosis?
blood-tinged urine, foul odor, flank pain, or
fever.

Black
Summarize and SUMMARY board
4minutes clarifies doubts Hydronephrosis is distension and dilation of Teacher
the renal pelvis and calyces, usually caused by summarizes the Students
12. topic asks doubts
obstruction of the free flow of urine from the
kidney, leading to progressive atrophy of the
kidney.
Treatment of Hydronephrosis focuses upon the
 removal of the obstruction and drainage of the
urine that has accumulated behind the
obstruction.
Black
Give the board
ASSIGNMENT
2 minutes assignment to Teacher dictates
students List out the etiological factors of the assignment Student
13. Hydronephrosis and write the nursing care takes down
plan for a patient with Hydronephrosis.