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Medicine 2

.
Digestive system.
Signs and symptoms of the disorders
of the digestive system

Pain
Nausea and vomiting
Intestinal gas
. Belching
flatulence
Dyspepsia
Change in bowel habits and stool
characteristics
 Diarrhoea
 constipation
Stomatitis

Definition: Stomatitis is inflammation of the mucus


membrane of the mouth.

Halitosis: refers to the bad smell of the mouth due to poor


hygiene.
Stomatitis
,
CAUSES OF STOMATITIS

Dry mouth / xerostomia.


Viral infection.
Candida albicans infection.
Trauma including surgery.
Smoking tobacco.
Toxicity of chemotherapy drugs – including
methotrexate used for psoriasis and other skin
disorders.
Therapeutic radiation e.g. for oral cancer
SYMPTOMS OF STOMATITIS
.
Red patches.
Mouth ulcers.
Blisters.
Peeling.
Swelling.
Oral dys-aesthesia (numbness)
Burning mouth syndrome – soreness despite normal
appearance.
MANAGEMENT

 pain relievers such as acetaminophen or ibuprofen


 topical medications that help with pain or inflammation
 drinking more fluids to keep the mucous membranes well hydrated
 mouthwashes such as salt water (alcohol-based mouthwash should be avoided)
 antiviral creams for cold stores are available over-the-counter, they should be applied
as soon as you notice the cold sore coming on
 if you have injured the inside of your mouth from braces or dentures there are wax-
based products that can be applied to protect the area
 borax glycerine creates a barrier layer over mouth lesions that can aid in pain relief
 avoiding food that is very spicy, acidic, or very hot in temperature as these may
further inflame the mucous membranes. Prophylactic mouth care like
brushing ,flossing and rinsing , most especially those receiving chemotherapy.
 Educate patient about proper oral hygiene.
 Apply topical anti inflammatory, antibiotics and anaethetic agents as prescribed.
 Like ibuprofen
GASTRITIS
Definition.
Is inflammation of the mucosa of the stomach.
Signs and Symptoms
Acute gastritis :
 Abdominal discomfort
 Headache
 Nausea
 Lassitude; a state of physical or mental weariness; lack of energy
 Anorexia
 Vomiting
 Hicupping
gastritis
.
CONT’N
Chronic gastritis
 Anorexia
 Heart burn after eating
 Belching
 Sour taste in the mouth
 Nausea and vomiting
 Patients with chronic gastritis may not be able to absorb

vitamin B12 because of diminished production of intrinsic


factor by the stomach’s parietal cells, which may lead to
pernicious anemia .
Medical management
.
antibiotics like amoxicillin, metronidazole.
Anti-diarrhoal like bismuth subsalicylate.
H2 receptor antagonists like cimetidine
Proton pump inhibitors like omeprazole
Nursing management
Provide health education on

Diet modification
Promoting of rest
Avoiding alcohol and NSAIDs
Adherence on drugs
PEPTIC ULCERS
Peptic ulcers are open sores that develop on the inside lining
of the stomach and the upper portion of the small
intestine.

Peptic ulcers include:


 Gastric ulcers: that occur on the inside of the stomach
 Duodenal ulcers: that occur on the inside of the upper
portion of your small intestine (duodenum).
Peptic ulcers.
Gastric and duodenal ulcers
Symptoms
 Burning stomach pain
 Feeling of fullness, bloating or belching
 Intolerance to fatty foods
 Heartburn
 Nausea
 Epigastria pain

Less often, ulcers may cause severe signs or symptoms such as:
 Vomiting or vomiting blood — which may appear red or black
 Dark blood in stools, or stools that are black or tarry
 Trouble breathing
 Feeling faint
 Nausea or vomiting
 Unexplained weight loss
 Appetite changes
CAUSES OF PEPTIC ULCERS.
A bacterium.
Helicobacter pylori bacteria in the mucous layer that
lining the stomach and small intestine can cause
inflammation of the stomach's inner layer, producing an
ulcer. It may be transmitted from person to person by close
contact, such as kissing and through food and water.

Regular use of certain pain relievers.


Taking aspirin and non-steroidal anti-inflammatory drugs
(NSAIDs) , can irritate or inflame the lining of the stomach
and small intestine e.g. ibuprofen .
RISK FACTORS FOR PEPTIC ULCERS

Smoke: Smoking may increase the risk of peptic ulcers in


people who are infected with H. pylori
 Alcohol :it increases the gastric acid that's produced.
Having untreated stress.
Eating spicy foods.
TREATMENT

 Medications that block acid production ;these reduce stomach acid by


blocking the action of the parts of cells that produce acid. E.g. omeprazole ,
lansoprazole .

 Medications to reduce acid production ;Acid blockers — also called histamine


(H-2) blockers — reduce the amount of stomach acid released .e.g. cimetidine

 Antacids that neutralize stomach acid ; Antacids neutralize existing stomach


acid and can provide rapid pain relief .

 Drugs that protect the lining of the stomach and small intestine ;In some
cases, your doctor may prescribe medications called cyto-protective agents that
help protect the tissues that line your stomach and small intestine.
Nursing interventions
 Relief of pain;
 medications provided should provide relief of ulcer related pain. The
patient should avoid aspirin.
 Reducing anxiety;
 assess the patients level of anxiety explaining the tests and medications
as scheduled to reduce anxiety.
 interact with the patient in a relaxed manner to identify stressors.
 encourage the patients family toprovide emotional support.
 Maintaining optimal nutritional status.
 Assess the patient for malnutrition and weight loss.
 Advise and explain the importance of adhering to medication and dietary
restrictions
 Monitoring and managing potential complications
 Hemorrhage; assess the patient for faintness, dizziness and nausea
which may precede or accompany bleeding from the ulcer
 Perforation and penetration, watch for any back and epigastric pain not
relieved by medication and report immediately .
Gastric outlet obstruction
 Pass an NG tube to aspirate gastric contents; a residual of
more than 400 ml suggests obstruction, report to doctor for
further intervention.
Promoting home , community based, and transitional
care
 Teach the patient about the factors that relieve or aggravate
the condition.
 Review information about the medication to be taken at
home including name, dosage, frequency , possible side
effects, stressing the importance of completing the dose even
when the symptoms have subsided.
 Reinforce the importance of follow up and give follow up
date.
 Remind the patient and family to participate in health
promotion activities like cessation of use of tobacco, stress
management
COMPLICATIONS

If Left untreated, peptic ulcers can result in:


 Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as
severe blood loss that may require hospitalization or a blood transfusion. Severe blood
loss may cause black or bloody vomit or black or bloody stools.

 A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through
(perforate) the wall of your stomach or small intestine, putting you at risk of serious
infection of your abdominal cavity (peritonitis).

 Obstruction. Peptic ulcers can block passage of food through the digestive tract,
causing you to become full easily, to vomit and to lose weight either through swelling
from inflammation or through scarring.

 Gastric cancer. Studies have shown that people infected with H. pylori have an
increased risk of gastric cancer.
JAUNDICE
Jaundice is a condition in which the skin, sclera (whites of
the eyes) and mucous membranes turn yellow.
 It is also known as icterus.
This yellow color is caused by a high level of bilirubin, a
yellow-orange bile pigment. Bile is fluid secreted by the
liver. Bilirubin is formed from the breakdown of red blood
cells.
CAUSES

Jaundice can be caused by a problem in any of the


three phases in bilirubin production.
Before the production of bilirubin, one may have
what's called un-conjugated jaundice due to
increased levels of bilirubin caused by:
Re-absorption of a large hematoma (a collection of
clotted or partially clotted blood under the skin).
Hemolytic anemias (blood cells are destroyed and
removed from the bloodstream before their normal
lifespan is over.
During production of bilirubin, jaundice can be
caused by:
Viruses, including Hepatitis A, chronic Hepatitis B
and C, and Epstein-Barr virus infection (infectious
mononucleosis).
Alcohol.
Autoimmune disorders.
Rare genetic metabolic defects.
Medicines, including acetaminophen toxicity,
penicillins, oral contraceptives, chlorpromazine
(Thorazine®) and estrogenic or anabolic steroids
After bilirubin is produced, jaundice may be caused by
obstruction (blockage) of the bile ducts from:

 gall stones.
 Inflammation (swelling) of the gallbladder.
 gall bladder cancer.
 Pancreatic tumor.
TYPES OF JAUNDICE

Hemolytic jaundice
Is the result of an increased destruction of the red blood cells. The
plasma is rapidly flooded with bilirubin, though the liver is
functioning well, it cannot excrete the bilirubin as quickly as it is
being formed. It is commonly asymptomatic.
Hepato-cellular jaundice.
Is caused by the inability of damaged liver cells to clear normal
amounts of the bilirubin from the blood. The damage may be caused
by hepatitis viruses and other viruses like yellow fever or chemical
toxins.
Obstructive jaundice
May be due to occlusion of the bile duct by gall stone, an inflammatory
process or a tumor or pressure from an enlarged organ. it makes bile
unable to reach the intestine, it remains in the liver then it is
reabsorbed in the blood and Carried through out the body
stainnning the skin, mucous membranes and scelera. it is excreted in
urine making it deep orange.
SIGNS AND SYMPTOMS OF JAUNDICE.

 fever
 Chills.
 abdominal pain
 Flu-like symptoms.
 Change in skin color.
 Dark-colored urine and/or clay-colored stool.
 If jaundice isn't caused by an infection, you may have symptoms such
as weight loss or itchy skin (pruritus). If the jaundice is caused by
pancreatic or biliary tract cancers, the most common symptom is
abdominal pain. Sometimes, you may have jaundice occurring with
liver disease if you have:
 Chronic hepatitis or inflammation of the liver.
 Pyoderma gangrenosum (a type of skin disease)..
 Polyarthralgias (inflammation of the joints
MANAGEMENT OF JAUNDICE

Treatment will depend on the underlying cause.


Jaundice treatment targets the cause rather than the jaundice
symptoms.
The following treatments are used:
Anemia-induced jaundice may be treated by boosting the amount of
iron in the blood by either taking iron supplements or eating more
iron-rich foods. Iron supplements are available
Hepatitis-induced jaundice requires antiviral or steroid medications.
Doctors can treat obstruction-induced jaundice by surgically
removing the obstruction.
If the jaundice has been caused by use of a medication, treatment for
involves changing to an alternative medication.
HEPATITIS
Hepatitis refers to an inflammatory condition of the liver.
It’s commonly caused by a viral infection, but there are
other possible causes of hepatitis.
These include autoimmune hepatitis and hepatitis that
occurs as a secondary result of medications, drugs, toxins,
and alcohol.
Auto immune hepatits is a disease that occurs when your
body makes antibodies against your liver tissue.
hepatitis cause management
A Hepatitis A virus Vaccine if given a
soon as possibl
Most people get w
on there own.
B Hepatitis B virus Tenofovir disproxi
fumerate,lamiv
C Hepatitis C virus A combination of
piginterferon a
riboflavin and
transplant
D Hepatitis D virus Liver transplant
E Hepatitis E virus Most people get w
on there on the
own
Alcoholic Drinking excessive alcohol over many Refrain from alco
years.
Auto immune The white blood cells attack the liver
causing inflammation and damage.
bacterial Bacteria like anaplasia ,norcadia
Ischemic Circulatory insufficiency
SYMPTOMS OF HEPATITIS

Fatigue
flu-like symptoms
Dark urine
Pale stool
Abdominal pain
Loss of appetite
Unexplained weight loss
Yellowish skin and eyes as signs of jaundice
PREVENTION

Get hepatitis vaccine


Do not use items for the infected ,maintain infection
prevention and control.
Maintain good hygiene
Practice safe sex by use of condoms and dental dams
 improve the nutrition intake
Avoid too much alcohol consumption.
Do not share items like needles , toothbrushes,
COMPLICATIONS
Liver cirrhosis
Cancer of the liver
Liver failure/ hepatic failure
Glomerulonephritis; an uncommon disease when a cluster of
proteins that blocks small blood vessels.
Hepatic encephalopathy; due to brain inflammation
Portal hypertension; as the liver is unable to filter
blood,blood can’t return to the liver from the digestive
system increasing pressure.
Porphyria; this is a group of diseases caused by problems
processing important chemicals in the body called porpyrins
Viral co-infection; by lowering your immune system.
CHOLESTYTIS
This is the inflammation of the gall bladder
 A Gallbladder is a small organ at inferior surface of the
liver that stores bile and it plays a part in digestion.
Gall stones are small, hard, crystalline mass/particles
formed abnormally in the gall bladder or bile ducts from
bile pigments, cholesterol and calcium salts. A gallstone
stuck in the cystic duct, a tube that carries bile from the
gallbladder, is most often the cause of sudden (acute)
cholecystitis
CHOLESTYTIS
Cholestytis is the
inflammation of the gall
bladder.
CAUSES
 Gallstones. Most often, cholecystitis is the result of hard particles that develop
in the gallbladder (gallstones). Gallstones can block the tube (cystic duct)
through which bile flows when it leaves the gallbladder. Bile builds up, causing
inflammation.

 Tumor. A tumor may prevent bile from draining out of your gallbladder
properly, causing bile buildup that can lead to cholecystitis.

 Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages
that lead to cholecystitis.

 Infection. AIDS and certain viral infections can trigger gallbladder


inflammation.

 Blood vessel problems. A very severe illness can damage blood vessels and
decrease blood flow to the gallbladder, leading to cholecystitis.
SYMPTOMS

Severe pain in your upper right or center abdomen


Pain that spreads to your right shoulder or back
Tenderness over your abdomen when it's touched
Nausea
Vomiting
Fever
MANAGEMENT
It is an emergency
Note: Treatment for cholecystitis will depend on your symptoms and
your general health.
People who have gallstones but don't have any symptoms may
need no treatment.
Hospitalization for close monitoring
Pain medications to reduce abdominal pain
Intravenous fluids to prevent dehydration
I.V Antibiotics to treat infections
Oral dissolution therapy using medications to help dissolve
gallstones (this is a last resort, reserved for individuals who cannot
undergo surgery)
Surgery may be recommended to remove the gall bladder if
cholesystitis keeps recurring. This is called cholecystectomy. It is
the main treatment for acute cholecystitis
Complications

Infection within the gallbladder. If bile builds up within


your gallbladder, causing cholecystitis, the bile may
become infected.
Death of gallbladder tissue. Untreated cholecystitis can
cause tissue in the gallbladder to die (gangrene).
Torn gallbladder. A tear (perforation) in your gallbladder
may result from gallbladder swelling, infection or death of
tissue.
Prevention
Lose weight slowly. Rapid weight loss can increase the
risk of gallstones. If you need to lose weight, aim to lose 1
or 2 pounds (0.5 to about 1 kilogram) a week.
Maintain a healthy weight. Being overweight makes
you more likely to develop gallstones. Maintain a healthy
weight by continuing to eat well and exercise.
Choose a healthy diet. Diets high in fat and low in fiber
may increase the risk of gallstones. To lower your risk,
choose a diet high in fruits, vegetables and whole grains.
Urinary system
 The urinary system's function is to filter blood and create urine as a waste
by-product. The organs of the urinary system include;
 the kidneys,
 renal pelvis,
 ureters,
 bladder and
 urethra.

 The body takes nutrients from food and converts them to energy. the body
has takes the food components that it needs, waste products are left behind.

 The kidney and urinary systems help the body to eliminate liquid waste
called urea, and to keep chemicals, such as potassium and sodium, and water
in balance .
.

.
Structure of the kidney
.
PHYSIOLOGY

Two kidneys.Their function is to:


 Remove waste products and drugs from the body
 Balance the body's fluids
 Release hormones to regulate blood pressure
 Control production of red blood cells
 The kidneys remove urea from the blood through tiny filtering units called nephrons.

 Two ureters. These narrow tubes carry urine from the kidneys to the bladder

 Bladder. The bladder's walls relax and expand to store urine, and contract and
 flatten to empty urine through the urethra.

 Two sphincter muscles. These circular muscles help keep urine from leaking by closing tightly the opening of the bladder.

 Nerves in the bladder. The nerves alert a person when it is time to urinate, or empty the bladder.

 Urethra. This tube allows urine to pass outside the body.


GENERAL SYMPTOMS

Common urinary symptoms include:

 Abdominal cramping
 Abdominal, pelvic or back pain that can be severe
 Bloody or pink-colored urine ( hematuria)
 cloudy urine
 Fever and chills
 Foul-smelling urine
 frequent urination
 General ill feeling
 Leaking of urine
 Pain during sexual intercourse
 Pain or burning with urination ( dysuria)
 unexplained weight loss
 Urgent need to urinate
GENERAL CAUSES

 benign prostatic hyperplasia (enlargement of the prostate)


 Cancers or benign tumors
 dehydration
 Infections of the urinary tract
 interstitial cystitis (conditions involving chronic inflammation
of the bladder)
 Kidney diseases
 Kidney or urinary tract stones
 Post-vasectomy syndrome
 Sexually transmitted infections
 Trauma or injury
Urethritis
This is the inflammation of the urethra.

SIGNS AND SYMPTOMS


Men
 burning sensation while urinating
 itching or burning near the opening of the penis
 presence of blood in the semen or urine
 discharge from the penis
In women
 more frequent urge to urinate.
 discomfort during urination
 burning or irritation at the urethral opening
 abnormal discharge from the vagina may also be present along with the urinary
symptoms
CAUSES

bacteria associated with urethritis include:


Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium
The same pathogens that cause STIs can also cause
urethritis.
 Also viruses cause urethritis. These include
 Human papilloma virus (HPV),
 Herpes simplex virus (HSV),
the cytomegalovirus (CMV).
MANAGEMENT.

Antibiotics
Azithromycin (Azuthromax) 1g single dose
Erythromycin 500mg 6 hourly for 7 days
Levofloxacin (Levaquine) 500mg once daily
for 7 days.
COMPLICATIONS

Women may develop


 pelvic inflammatory disease, which is painful and can
result in
 infertility, ongoing pelvic pain, or
 pain during sex. Women with untreated STIs are also at a
higher risk for
 ectopic pregnancies, which can be life-threatening.
Men may develop
 painful inflammation or
 inflammation of the prostrate gland, or the
 painful urination narrowing of a section of the urethra due
to scarring.
Cystitis
Cystitis is an infection of the
bladder that almost always follows
(is secondary to) bacterial infection
in the urine.
RISK FACTORS

Women who;
Are sexually active.
Use certain types of birth control.
Are pregnant.
Have reached menopause.
Interference with the flow of urine. .
Changes in the immune system.
Prolonged use of bladder catheters.
CAUSES

 Bacterial ;The most common bug or bacterium causing urinary tract infection is Escherichia coli (E.
coli).

 interstitial cystitis. ;also called painful bladder syndrome, cause is unclear.

 Drug-induced cystitis.; particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can
cause inflammation

 Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder
tissue.

 Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to
tissue damage, and cause inflammation.

 Chemical cystitis. hypersensitivity to chemicals contained in certain products, such as bubble bath,
feminine sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder,
causing inflammation.

 Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other
disorders, such as diabetes, kidney stones, an enlarged prostate or spinal cord injuries.
SIGNS AND SYMPTOMS

Cystitis can be mild to severe. The symptoms


include:
 frequent urge to urinate, if only to pass a few
drops
 burning pain or a ‘scalding’ sensation on urination
 strong-smelling urine
 cloudy or bloody urine
 pain in your lower abdomen
 blood in your urine.
MANAGEMENT OF CYSTYTIS

Drink plenty of liquids.


Take a commercial urinary alkalizes like one
teaspoon of sodium bicarbonate in water.
Avoid acidic foods or drinks as they cancel out the
effect of urinary alkalizes and can aggravate the
burning when passing urine.
Maintain hygiene
Treat any infection like Urethritis early to prevent
ascending infection.
COMPLICATIONS

Kidney infection. An untreated bladder infection can lead


to kidney infection, also called pyelonephritis
Young children and older adults are at the greatest risk of
kidney damage from bladder infections because their
symptoms are often overlooked or mistaken for other
conditions.
Blood in the urine. With cystitis, you may have blood
cells in your urine that can be seen only with a microscope
(microscopic hematuria) and that usually resolves with
treatment. If blood cells remain after treatment, your
doctor may recommend a specialist to determine the cause.
PREVENTION

 Go to the toilet to pass urine as soon as you feel the urge, rather than
holding on.
 Drink plenty of water every day to flush your urinary system.
 Wipe yourself from front to back (urethra to anus) after going to the toilet.
 Wash your genitals before sex and encourage your partner to do the same.
 Urinate after sex.
 Wear cotton rather than nylon underwear.
 Avoid wearing nylon pantyhose, tight pants or tight jeans.
 Don’t use perfumed soaps, talcum powder or any type of deodorant around
your genitals.
 Avoid bubble baths.
 Treat vaginal infections such as thrush or trichonomiasis promptly, since
these organisms can encourage cystitis.
Pyelonephritis( kidney infection)
Inflammation of the kidney.
Causes
 Due to a certain type of
Glomerulonephritis
 Glomerulonephritis is inflammation of the tiny filters in the kidneys
(glomeruli).

 Glomeruli remove excess fluid, electrolytes and waste from the


bloodstream and pass them into urine. Glomerulonephritis can come
on suddenly (acute) or gradually (chronic).

 Glomerulo-nephritis occurs on its own or as part of another disease,


such as lupus or diabetes. Severe or prolonged inflammation
associated with glomerulo-nephritis can damage your kidneys.
Treatment depends on the type of glomerulo-nephritis .
Glumerulonephriti
s

.
SIGNS AND SYMPTOMS

Pink or cola-colored urine from red blood cells in


your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in
your face, hands, feet and abdomen.
CAUSES
 Post-streptococcal glomerulonephritis. Glomerulonephritis may develop a week
or two after recovery from a strep throat infection or, rarely, a skin infection
(impetigo). To fight the infection, your body produces extra antibodies that can
eventually settle in the glomeruli, causing inflammation
 Bacterial endocarditis. Bacteria occasionally can spread through your
bloodstream and lodge in your heart, causing an infection of one or more of your
heart valves.
 Viral infections. Viral infections, such as the human immunodeficiency virus
(HIV), hepatitis B and hepatitis C, can trigger glomerulonephritis.
 Lupus. A chronic inflammatory disease, lupus can affect many parts of your body,
including your skin, joints, kidneys, blood cells, heart and lungs.
 Goodpasture's syndrome. A rare immunological lung disorder that can mimic
pneumonia, Goodpasture's syndrome causes bleeding in your lungs as well as
glomerulonephritis.
 IgA nephropathy. Characterized by recurrent episodes of blood in the urine, this
primary glomerular disease results from deposits of immunoglobulin A (IgA) in
the glomeruli. IgA nephropathy can progress for years with no noticeable
symptoms.
.
Vasculitis
 Polyarteritis. This form of vasculitis affects small and medium
blood vessels in many parts of your body, such as your heart,
kidneys and intestines.
 Granulomatosis with polyangiitis. This form of vasculitis,
formerly known as Wegener's granulomatosis, affects small and
medium blood vessels in your lungs, upper airways and kidneys
Conditions
 High blood pressure. This can damage your kidneys and impair
their ability to function normally.
 Diabetic kidney disease (diabetic nephropathy). Good control of
blood sugar levels and blood pressure might prevent or slow kidney
damage.
 Focal segmental glomerulosclerosis. Characterized by scattered
scarring of some of the glomeruli.
mgt
COMPLICATIONS

Acute kidney failure. Loss of function in the filtering part of the


nephron can result in rapid accumulation of waste products. You might
need emergency dialysis — an artificial means of removing extra fluids
and waste from your blood — typically by an artificial kidney machine.
Chronic kidney disease. Your kidneys gradually lose their filtering
ability. Kidney function that deteriorates to less than 10 percent of
normal capacity results in end-stage kidney disease, which requires
dialysis or a kidney transplant to sustain life.
High blood pressure. Damage to your kidneys and the resulting buildup
of wastes in the bloodstream can raise your blood pressure.
Nephrotic syndrome. With this syndrome, too much protein in your
urine results in too little protein in your blood. Nephrotic syndrome can
be associated with high blood cholesterol and swelling (edema) of the
eyelids, feet and abdomen.
PREVENTION
Seek prompt treatment of a streptococcus infection with a
sore throat or impetigo.
To prevent infections that can lead to some forms of
glomerulo-nephritis, such as HIV and hepatitis, follow safe-
sex guidelines
Avoid intravenous drug use.
Control high blood pressure, which lessens the likelihood of
damage to kidneys from hypertension.
Control blood sugar to help prevent diabetic nephropathy.
NEPHROTIC SYNDROME

 Nephrotic syndrome is a collection of symptoms due to kidney damage. This


includes
 protein in the urine,
 low blood albumin levels,
 high blood lipids, and
 significant swelling.
 Other symptoms may include
 weight gain,

 feeling tired, and

 foamy urine.

 Nephrotic syndrome is a kidney disorder that causes your body to pass too much
protein in your urine.

 Nephrotic syndrome is usually caused by damage to the clusters of small blood


vessels in your kidneys that filter waste and excess water from your blood. The
condition causes swelling, particularly in your feet and ankles, and increases the
risk of other health problems
CAUSES
Primary; the cause is not known
Secondary; due to:
autoimmune conditions (e.g., systemic lupus
erythematosus
infections (e.g., syphilis, malaria, hepatitis B, hepatitis
C, HIV).
drugs (e.g., captopril, NSAIDs, penicillamine, probeneci
d, Bucillamine, Anti-TNF therapy, Tiopronin).
inorganic salts (e.g. gold, mercury).
tumors, frequently solid tumors of t
 Diabetic kidney disease. Diabetes can lead to kidney damage (diabetic nephropathy) that
affects the glomeruli.
 Minimal change disease. This is the most common cause of nephrotic syndrome in children.
Minimal change disease results in abnormal kidney function, but when the kidney tissue is
examined under a microscope, it appears normal or nearly normal. The cause of the abnormal
function typically can't be determined.
 Focal segmental glomerulosclerosis. Characterized by scarring of some of the glomeruli,
this condition can result from another disease, a genetic defect or certain medications or occur
for no known reason.
 Membranous nephropathy. This kidney disorder is the result of thickening membranes
within the glomeruli. The thickening is due to deposits made by the immune system. It can be
associated with other medical conditions, such as lupus, hepatitis B, malaria and cancer, or it
can occur for no known reason.
 Systemic lupus erythematosus. This chronic inflammatory disease can lead to serious
kidney damage.
 Amyloidosis. This disorder occurs when amyloid proteins accumulate in your organs.
Amyloid buildup often damages the filtering system.
SIGNS AND SYMPTOMS

Most people will present as nephrotic syndrome,


with the triad of albuminuria,
edema and
low serum albumin (with or without kidney failure).
High blood pressure and
high cholesterol are often also present. Others may not
have symptoms and may be picked up on screening,
with urinalysis finding
 high amounts of protein loss in the urine
TREATMENT
 Blood pressure medications. Drugs called angiotensin-converting enzyme
(ACE) inhibitors reduce blood pressure and the amount of protein released in
urine. Medications in this category include captopril
 Another group of drugs that works similarly is called angiotensin II receptor
blockers (ARBs) and includes losartan.
 Water pills (diuretics). These help control swelling by increasing your kidneys'
fluid output. Diuretic medications typically include furosemide
(Lasix),spironolactone and thiazides, such as hydrochlorothiazide or metolazone
 Cholesterol-reducing medications. Statins can help lower cholesterol levels.

 Blood thinners (anticoagulants). These are prescribed to decrease blood's


ability to clot, especially if you've had a blood clot. E.g. heparin, warfarin
 Immune system-suppressing medications. Medications to control the immune
system, such as corticosteroids, can decrease the inflammation that accompanies
some of the conditions that can cause nephrotic syndrome. Medications include
cyclosporine
NURSING MANAGEMENT
COMPLICATIONS

 Blood clots. The inability of the glomeruli to filter blood properly can lead to loss of blood
proteins that help prevent clotting. This increases your risk of developing a blood clot in your
veins.
 High blood cholesterol and elevated blood triglycerides. When the level of the protein albumin
in your blood falls, your liver makes more albumin. At the same time, your liver releases more
cholesterol and triglycerides.
 Poor nutrition. Loss of too much blood protein can result in malnutrition. This can lead to weight
loss, which can be masked by edema. You may also have too few red blood cells (anemia), low
blood protein levels and low levels of vitamin D.
 High blood pressure. Damage to your glomeruli and the resulting buildup of excess body fluid
can raise your blood pressure.
 Acute kidney injury. If your kidneys lose their ability to filter blood due to damage to the
glomeruli, waste products can build up quickly in your blood. If this happens, you might need
emergency dialysis — an artificial means of removing extra fluids and waste from your blood —
typically with an artificial kidney machine (dialyzer).
 Chronic kidney disease. Nephrotic syndrome can cause your kidneys to lose their function over
time. If kidney function falls low enough, you might need dialysis or a kidney transplant.
 Infections. People with nephrotic syndrome have an increased risk of infections.
Renal failure
MANAGEMENT FOR ACUTE RENAL FAILURE

 Treat the underlying cause and associated complications


 In case of oliguria and no volume, overload is noted, a fluid challenge
may be appropriate with diligent monitoring for volume overload
 In the case of hyperkalemia with ECG changes, IV calcium, sodium bi-
carbonate, and glucose with insulin should be given. These measures
drive potassium into cells and can be supplemented with polystyrene
sulfonate, which removes potassium from the body. Hemodialysis is also
an emergency method of removal.
 Oliguric patients should have a fluid restriction of 400 mL + the
previous day's urine output (unless there are signs of volume depletion
or overload).
 If acidosis: Serum bicarbonate intravenous or per oral, versus
emergency/urgent dialysis based on the clinical situation
 If obstructive etiology present treat accordingly and or if bladder outlet
obstruction secondary to prostatic hypertrophy may benefit from Flomax
or other selective alpha-blockers
NURSING MANAGEMENT
 Always review the drug list.
 Stop nephrotoxic drugs and renally adjust others. Many
supplements not approved by the FDA can be nephrotoxic.
 Always record input and output in a fluid balance chart.
 Monitor daily weights
 Watch for complications, including hyperkalemia, pulmonary
edema, and acidosis-all potential reasons to start dialysis
 Ensure good cardiac output and subsequent renal blood flow.
 Pay attention to diet: total caloric intake should be 35 to 50
kcal/kg per day to avoid catabolism. Potassium
intake restricted to 40 mEq per day; phosphorus restricted to
800 mg per day. If it becomes high, treat with calcium
carbonate or other phosphate binder. Magnesium compounds
should be avoided.
 Treat infections aggressively.

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