Definition Hydronephrosis
Hydronephrosis is dilatation of the renal and peripheral trophies in one or both kidneys caused by obstruction to the normal flow of urine causing the urine to flow back so the pressure increases kidney's (Smeltzer and Bare, 2002).
Hydronephrosis is obstruction of urine flow proximal to the bladder can lead to accumulation of fluid pressure within the kidneys and ureter pelviks which can lead to severe absorption of the renal parenchyma (Sylvia, 1995).
When this obstruction occurs in the ureter or bladder, back pressure will affect both kidneys but if it happens at one ureteral obstruction due to stones or stiffness then only one kidney is damaged.
Etiology of Hydronephrosis
-Scarring kidney / ureter.
-Stone
-Neoplasma/tomur
-Prostate Hypertrophy
Konginetal-Abnormalities on the neck of the bladder and urethra
-Narrowing of the urethra
-Enlargement of the uterus in pregnancy (Smeltzer and Bare, 2002).
Pathophysiology Hydronephrosis
Whatever the cause of hydronephrosis, caused by either partial or intermittent obstruction resulted in the accumulation of urine in the kidney cup. Causing dissertation trophy and renal colic. At this time renal atrophy occurs when one kidney is undergoing a gradual decay then the other kidney will enlarge gradually (compensatory hypertrophy), resulting in impaired renal function (Smeltzer and Bare, 2002).
Clinical Manifestations Hydronephrosis
-Patients may be asymptomatic if the onset is gradual. Acute obstruction can cause pain and draped waist. If an infection maja dysuria, chills, fever and tenderness and pyuria will occur. Hematuri and pyuria may also exist. If both kidneys in contact with the signs and symptoms of chronic kidney failure will arise, such as:
-Hypertension (due to fluid retention and sodium).
-Congestive heart failure.
-Pericarditis (due to irritation by toxic uremi).
-Pruritis (itchy skin).
Grain-uremic (urea crystals on the skin).
-Anorexia, nausea, vomiting, hiccups.
-Decrease in concentration, muscle twitching and convulsions.
Amenorrhea, testicular atrophy.
(Smeltzer and Bare, 2002)
Management
The goal is to activate and fix the cause of hydronephrosis (obstruction, infection) and to maintain and protect the function ginjal.Untuk reduce obstruction of urine is diverted through acts of nephrostomy or other type of dissertation. Infection treated with anti-microbial agent for residual urine in the Calix will cause infection and pyelonephritis. The patient is prepared for surgery raised lesions obstrukstif (stones, tumors, ureteral obstruction). If one kidney is badly damaged and destroyed it nefrektomi (removal of kidney) do (Smeltzer and Bare, 2002).
Nursing Diagnosis and Intervention
1). Impaired balance of fluid volume associated with fluid restriction.
Objective: Volume of fluid seimbangKriteria results:
TTV-RR and normal / stable
Well-turgor, moist mucous
-Intake and output seimbangIntervensi:
BB-Weigh every three days.
-Observation TTV
-Give trendelenberg position
-Monitor intake and output
Diuresis-administration collaboration
-Check full blood lab / routine
2). Resti infection associated with access haemodialise
Objective: Infection is not terjadiKriteria results:
-No signs of infection
-No sepsis and pussy
Action:
-Wash your hands before and after the action
-Cover the wound with aseptic technique
-Monitor when there is inflammation
-Monitor TTV
-Collaboration of antibiotics
3). Impaired sense of comfort: pain related to acute obstruction.
Goal: Pain is reduced to hilangKriteria results:
-The patient looked relaxed
-The patient expressed pain berkurangIntervensi:
-Assess the level of pain
-Give an explanation of the cause of pain
-Teach relaxation and distraction
-Collaboration of analgesic
4). Activity intolerance related to anemia
Objective: The need terpenuhiKriteria activity results:
-Improve mobility
-Reporting decrease symptoms of activity intolerance interventions:
-Assess the individual response to activity, pain, dyspnea, vertigo
-Increase activity gradually client
-Collaboration with Physiotherapists
5). Nutrition less than the needs associated with nausea, vomiting
Goal: Nutrition terpenuhiKriteria results:
-Put up oral
-Weight loss in the range normalIntervensi
-Explain the importance of adequate nutrition.
-Give small portions but frequently
-Create a fun suasanya
-Encourage clients to eat with family members
Bibliography
• Doenges, Marilynn E. 1999. Nursing care plans: guidelines for planning and documenting patient care. Jakarta: EGC.
• Price, Sylvia. 1992. Pathophysiology fourth edition. Jakatya: EGC.
• Smeltzer, Suzanne C. and Brenda G Bare. Books aajar 8 issue of medical-surgical nursing. Jakarta: EGC.
