NEPHROLITHIASIS – Etiology, Risk Factors, Pathophysiology, Types, Signs and Symptoms, Diagnostic Evaluation and Management

Nephrolithiasis is also called the renal calculi, are hard, usually small stones that form somewhere in the renal structure. The stones are masses of crystals and protein that form when the urine became supersaturated with a salt capable of forming solid crystals.

Symptoms occur when the stone become impacted in the urinary tract. When stones are found in the kidneys, the condition is called nephrolithiasis.

ETIOLOGY

• Hypercalcemia and hypercalciuria caused by hyperparathyroidism
• Chronic dehydration, poor fluid intake and immobility
• Chronic infection with urea-splitting bacteria (proteus vulgaris)
• Chronic obstruction with stasis of urine, foreign bodies within the urinary tract

RISK FACTORS

• Metabolic: abnormalities that result in increased urine levels of calcium, oxaluric acid, uric acid or citric acid
• Climate: warm climate that cause increased fluid loss, low urine volume and increased solute concentration in the urine
• Diet

Large intake of dietary proteins that increases uric acid excretion

Excessive amounts of tea or fruit juices that elevate urinary level

Large intake of calcium and oxalate

Low fluid intake that increases urinary concentration

• Genetic factors: family history of stone formation, cystinuria, gout, or renal acidosis
• Lifestyle: sedentary occupation, immobility

PATHOPHYSIOLOGY

Due to any cause —- slow urine flow —- resulting supersaturation of the urine with the particular element —- first become crystallized —- later become stone

TYPES

• Calcium oxalate, calcium phosphate, or mixture

Incidence: 90%

Feature: account for two-third of stones. Small, rough, and hard. Shaped like needles, colors vary from gray to white

Possible causes:

Excessive calcium. Excessive urea. Hyperparathyroidism, Cushing’s disease, immobility, etc

Predisposing factors: idiopathic hypercalciuria, hyperoxaluria, independent of urinary pH, family history

• Struvite – magnesium ammonium phosphate

Incidence: 2%

Features: second most common type of stone. Calculi crumble easily. Stones have a yellow color

Causes: infection by urea splitting microbes, usually proteus. May cause abscess formation in the kidney

Predisposing factors: urinary tract infection

• Uric acid stones

Incidence: 2%

Features: dye enhancement needed for x-ray visualization. Small, hard and color varies from yellow to red

Causes: gout, high uric acid levels, decreased fluid intake

Predisposing factors: gout, acid urine, inherited condition

• Cystine stones:

Incidence: rare

Feature: small, smooth calculi, waxy stones

Causes: cystine-containing crystals appear in the urine

Predisposing factors: acid urine

SIGNS AND SYMPTOMS

• Costovertebral angle pain
• Groin pain
• Renal colic because renal stones produce an increase in hydrostatic pressure and distention of the renal pelvis and proximal ureters causing renal colic. Pain relief is immediate after stone passage
• Flank pain radiating to genitalia
• Hematuria
• Anuria
• Restlessness
• Pallor
• Temperature
• Nausea vomiting, diarrhea, abdominal discomfort due to renointestinal reflexes

DIAGNOSTIC EVALUATION

• History collection
• Physical examination
• Kidney radiography may show stone
• IVP (intravenous pyelogram), retrograde pyelogram is used to localize the degree and site of obstruction or to confirm the presence of a radiolucent stones, such as uric acid or cystine calculus
• Urinalysis: may indicate gross or microscopic hematuria and could indicate abrasion of the urinary tract
• Ultrasonography can be used to identify a radiopaque or radiolucent calculus in the renal pelvis, calyx, or proximal ureters. But it is less useful when attempting to locate stones trapped in the midureter
• A CT scan may be used to differentiate a non-opaque stone from the tumor
• Lab test: serum calcium, phosphorus, sodium, potassium, bicarbonate, uric acid, BUN and creatinine levels are also measured

MANAGEMENT

Medical Management

• The goals of management are to eradicate the stone, determine the stone type, prevent nephrons destruction, control infection, and relieve any obstruction that may be present
• The immediate objective of treatment of renal colic is to relieve the pain until its cause can be eliminated
• Opioid analgesic agents are administered to prevent shock and syncope that may result from the excruciating pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone
• Hot baths or moist heat to the flank areas may also be helpful

Nutritional Therapy

• Nutritional therapy plays an important role in preventing renal stones
• Fluid intake is the mainstay of most medical therapy for renal stones
• Patient with renal stones should drink eight to ten ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute
• A urine output exceeding 2 L/day is advisable

International Procedures

If the stone does not pass spontaneously if complications occur, common intervention includes endoscopic or other procedure. For example:

• Ureteroscopy
• Extracorporeal shock wave lithotripsy (ESWL)
• Endourologic (percutaneous) stone removal

Ureteroscopy

• It involves first visualizing the stone and then destroying it
• In this inserting an ureteroscope into the ureter and then inserting a laser, electrohydraulic lithotripter, or ultrasound device through the ureteroscope to fragment and remove the stones

Extracorporeal shock wave lithotripsy

• It is used for most symptomatic, nonpassable upper urinary stones. Electromagnetically generated shock waves are focused over the area of the renal stone
• The high energy dry shock waves pass through the skin and fragment the stone

Endourologic (Percutaneous) stone removal

• It is used for most symptomatic, nonpassable, upper urinary stones. Electromagnetically generated shock waves are focused over the area of the renal stone
• The high energy dry shock waves pass through the skin and fragment the stone

Endourologic (Percutaneous) stone removal

• It is used to treat the larger stones
• A percutaneous tract is formed and a nephroscope is inserted through it. Then the stone extracted or pulverized

Electrohydraulic lithotripsy

• It is a similar method in which an electrical discharge is used to create a hydraulic shock wave to break up the stone
• A probe is passed through the cystoscope and the tip  of lithotripter is placed near the stone
• This procedure is performed under topical anesthesia
• The most common complications are hemorrhage, infection and urinary extravasations

Chemolysis

• Stone dissolution using infusions of chemical solutions (e.g. alkylating agents, acidifying agents)

Surgical Management

• Today surgery is performed in only 1 to 2% of patients. It is indicated if the stone does not respond to other forms of treatment
• If the stone is in kidney, the surgery performed maybe a nephrolithotomy (incision into the kidney with removal of the stone) or a nephrectomy, if the kidney is nonfunctional secondary to infection
• Stones in the kidney pelvis are removed by pyelolithotomy

COMPLICATION

• Obstruction: from remaining stone fragments
• Infection: from dissemination of infected stone particles or bacteria resulting from obstruction
• Impaired renal function: from prolonged obstruction before treatment and removal
• Perirenal hematoma: from bleeding around the kidney caused by trauma of shock waves or laser treatments

Nursing Management

Nursing Assessment

• Obtain history focusing on family history of calculi, episodes of dehydration, prolonged immobility, UTI, dietary, bleeding history, and medication history
• Assess pain location and radiation; assess level of pain using a scale of 1 to 10. Observe for presence of associated symptoms nausea, vomiting, diarrhea, abdominal distension
• Monitor for signs and symptoms of UTI, such as chills, fever, dysuria, frequency. Examine urine for hematuria
• Observe for signs and symptoms of obstruction, such as frequent urination of small amounts, oliguria, anuria

Nursing Diagnosis

• Acute pain related to the presence of, obstruction or movement of a stone with in urinary system
• Impaired urinary elimination related to blockage of urine flow by stones
• Risk for infection related to obstruction of urine flow and instrumentation during treatment
• Anxiety related to hospitalization
• Fear related to deficient knowledge regarding the disease
• Deficient knowledge related to lack of knowledge about prevention of recurrence, diet and symptoms of renal calculi

1. Acute pain related in the presence of obstruction or movement of a stone with in urinary system

Interventions

• Ask severity, location and duration of pain using a pain scale. Pain is typically in the flank or costovertebral angle and may radiate to the pelvic, groin, or abdominal area
• Encourage fluid intake, unless contraindicated, to promote the passage of stone, dilute the urine, and reduce the risk of further stone formation
• Administer pain medication as ordered to promote comfort
• Apply heat to flank pain area to reduce pain and promote comfort

• Impaired urinary elimination related to blockage of urine flow by stones

Interventions

• Monitor total urine output and pattern of voiding. Report oliguria or anuria
• For outpatient treatment, patient may use a coffee filter to strain urine
• Help patient to walk, if possible because ambulation may help move the stone through the urinary tract
• Teach patient to drink eight ounces of liquid with meals, between meals and in early evening to provide fluids for hydration but not to an excess that may increase renal colic

• Risk for infection related to obstruction of urine flow and instrumentation during treatment

Interventions

• Administer parenteral or oral antibiotics, as prescribed during treatment, and monitor for adverse effects
• Assess urine for color, cloudiness, and odor
• Obtain vital signs, and monitor for fever and symptoms of impending sepsis (tachycardia, hypotension)

Health Education

• Encourage fluids to accelerate passing of stone particles
• Teach about analgesics that still may be necessary for colicky pain, which may accompany passage of stone debris
• Warn that some blood may appear in urine for several weeks
• Encourage frequent walking to assist in passage of stone fragments
• Teach patient to strain urine through a coffee filter or stone strainer and to save for analysis
• Teach patient to take alpha-adrenergic blockers to help dilate ureters, thus improve stone passage

DIABETES MELLITUS – Types, Signs and Symptoms, Diagnostic Evaluation and Management

Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Hyperglycemia does not cause symptoms until glucose values are significantly elevated-above 200 milligrams per deciliter (mg/dL).

Diabetes mellitus is a group of chronic disorder of endocrine pancreas. This disease characterized by increased levels of glucose in blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, both.

There are three main types of diabetes mellitus (Type-1 DM)

1. TYPE-1 Diabetes Mellitus: Type 1 DM results from the body’s failure to produce insulin, and currently requires the person to inject insulin or wear an insulin pump. It is also called ‘insulin-dependent diabetes mellitus’ (IDDM) or ‘juvenile diabetes’. The immune system mistakenly manufactures antibodies and inflammatory cells that are directed against and cause damage to patients’ own body tissues. In persons with type 1 diabetes, the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. Exposure to certain viral infections (mumps and coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies
2. TYPE-2 Diabetes mellitus: Type 2 DM results from insulin resistance, also referred to as non-insulin-dependent diabetes mellitus (NIDDM) or ‘adult-onset diabetes.’ In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body’s needs. In many cases the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells)
3. Gestational diabetes: gestational diabetes, occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during their third trimester)

SIGNS AND SYMPTOMS

• Increased thirst (polydepsia)
• Frequent urination (polyuria)
• Increased hunger (polyphagia)
• Weight loss
• Fatigue
• Blurred vision
• Slow-healing sores or frequent infections
• Dark skin

DIAGNOSTIC EVALUATION

• Glycated hemoglobin test: this blood test indicates average blood sugar for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. A normal level is below 5.7 percent
• Random blood sugar test: a blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmmol/L) or higher suggests diabetes, a blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
• Fasting blood sugar test: a blood sample will be taken after an overnight fast. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it is 126 mg/dL (7 mmol/L) or higher on two separate tests, indicates diabetes.
• Oral glucose tolerance test: it is rarely used test for hyperglycemia, patient is asked to fast overnight, and the fasting blood sugar level is measured. Then drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
• Urine glucose and ketone levels: these are not as accurate in monitoring, changes in blood glucose as serum or blood levels. The presence of glucose in urine indicates hyperglycemia.

COMPLICATIONS

• Cardiovascular disease
• Nerve damage (neuropathy)
• Kidney damage (nephropathy) or kidney failure
• Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness
• Clouding of the normally clear lens (cataract)
• Feet problems caused by damaged nerves or poor blood flow that can lead to serious infections
• Bone and joint problems, such as osteoporosis
• Skin problems, including bacterial infections, fungal infections and non healing wounds
• Teeth and gum infections
• Dawn phenomenon: It is rise of blood glucose between 4 am to 8 am that is not a response to hypoglycemia. This condition occurs in people both DM1 and DM2. Cause is unknown but due to hormone variation.
• Diabetic ketoacidosis: diabetic ketoacidosis develops when there is too little insulin in body. Without enough insulin, sugar cannot enter in cells for energy. Blood sugar level rises and body begins to break down fat for energy. This process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually ‘spill over’ into the urine. Diabetic ketoacidosis can lead to diabetic coma that can be life-threatening.
• Diabetic hyperosmolar syndrome: this condition occurs when production of insulin is normal, but it does not work properly. Blood glucose levels may become very high-greater than 600 mg/dL (33 mmol/L). Because insulin is present but not working properly, the body cannot use either glucose or fat for energy. Glucose is then dumped in the urine, causing increased urination. If left untreated, diabetic hyperosmolar syndrome can lead to coma and life-threatening dehydration

MANAGEMENT

Nutritional Therapy

Nutrition, meal planning and weight control are the foundation of diabetes management.

The main objective is to control dietary caloric intake to maintain normal weight. Medical nutrition therapy (MNT), nutritional management of diabetes is complex, a registered dietician who understand dietary management has major responsibilities for designing and teaching aspect of therapeutic plan.

Regular blood sugar monitoring

Regular exercise

Regular diabetes medication or insulin therapy

Alcohol: alcohol and the substances use to make mixed drinks can cause either high or low blood sugar

Stress: the hormones body may produce in response to prolonged stress may prevent insulin from working properly

For women, fluctuations in hormone levels: as hormone levels fluctuate during menstrual cycle, so cans blood sugar level also, particularly in the week before period. Menopause may trigger fluctuations in blood sugar level as well

Pharmacological Management

• Biguanides
• Sulfonylureas
• Meglitinide derivatives
• Alphaglucosidase inhibitors
• Thiazolidinediones (TZDs)
• Glucagon like peptide-1 (GLP-1) agonists
• Dipeptidyl peptidase IV (DPP-4) inhibitors
• Selective sodium-glucose transporter-2 (SGLT-2) inhibitors
• Insulins
• Amylinomimetics
• Bile acid sequestrants
• Dopamine agonists

Insulin Therapy

Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Insulin injections involve using a fine needle and syringe or an insulin pen injector – a device that looks like an ink pen, except the cartridge is filled with insulin

Types of insulin are many and include rapid-acting insulin, long-acting insulin and intermediate options. Examples include:

• Insulin lispro (Humalog)
• Insulin aspart (Novolog)
• Insulin glargine (Lantus)
• Insulin detemir (Levemir)
• Insulin isophane (Humulin N, Novolin N)

Life Style and Home Remedies

• Commit to managing your diabetes: Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it
• Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency and make sure your friends and loved ones know how to use it.
• Schedule a yearly physical exam and regular eye exams
• Keep your immunizations up-to-date. Get a flu shot every year, and get a tetanus booster shot every 10 years
• Take care of your teeth. Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day, floss your teeth once a day, and schedule dental exams at least twice a year
• Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes and moisturize with lotion. Check your feet everyday for blisters, cuts, sores, redness or swelling
• Keep your blood pressure and cholesterol under control
• Quit smoking
• If you drink alcohol, do so responsibly
• Take stress seriously

NURSING MANAGEMENT

Nursing Diagnosis

1. Fluid volume deficit related to osmotic diuresis, gastric loss, excessive diarrhea, nausea and vomiting, limited input

Intervention

• Monitor vital signs, note the presence of orthostatic blood pressure
• Assess breathing and breathe patterns
• Assess temperature, color and moisture
• Assess peripheral pulses, capillary refill, skin turgor and mucous membranes
• Monitor intake output. Record the urine specific gravity
• Measure body weight everyday
• Collaboration fluid therapy as indicated
• Imbalanced nutrition, less than body requirements related to insulin insufficiency.

Intervention

• Measure body weight per day as indicated
• Determine the diet program and diet of patients compared with food that can be spent on the patient
• Auscultation of bowel sounds, record the presence of abdominal pain/abdominal bloating, nausea, vomiting, keep fasting as indicated
• Observation of the signs of hypoglycemia, such as changes in level of consciousness, cold/humid, rapid pulse, hunger and dizziness
• Collaboration in the delivery of insulin, blood sugar tests and diet.
• Risk for infection related to inadequate peripheral defense, changes in circulation and high blood sugar levels

Intervention

• Observation for signs of infection and inflammation such as fever, redness, pus in the wound, purulent sputum, urine color cloudy and foggy
• Increase prevention efforts by performing good handwashing, each contact on all items related to the patient, including his or her own patients
• Maintain aseptic technique in invasive procedures(such as infusion catheter foley, etc)
• Attach catheter/perineal care do well
• Give skin care with regular and earnest. Massage depressed bone area, keep skin dry, dry linen and tight (not wrinkled)
• Position the patient in semifowler position
• Collaboration antibiotics as indicated
• Knowledge deficit: About condition, prognosis and treatment needs related to misinterpretation of information; do not know the source of information

Intervention

• Assess the level of knowledge of the client and family about the disease
• Give an explanation to the client about diseases and conditions now
• Encourage clients and families to pay attention to her diet
• Ask the client and reiterated family of materials that have been given

GLOMERULONEPHRITIS – Etiology, Types, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management

INTRODUCTION

Immunological processes involving the urinary tract predominantly affect the renal glomerulus, the disease process results in glomerulonephritis. It means inflammation of glomeruli, which affects both kidneys equally. It is a type of kidney disease in which the part of kidney (glomeruli) that helps in filter waste and fluids from blood is damaged.

DEFINTION

Glomerulonephritis means inflammation of glomeruli. It is an inflammation of tiny filters of kidney (glomeruli) that helps to remove excess fluid, and waste from bloodstream and pass them into the urine

TYPES

It is of two types acute glomerulonephritis and chronic glomerulonephritis

ACUTE GLOMERULONEPHRITIS

It means active inflammation in glomeruli. Acute glomerulonephritis is most common in children and young adults, but all ages can be affected.

Each kidney is composed of about 1 million filtering screens called glomeruli that remove uremic waste products. The inflammatory process usually begins with the immune system fights off the infection scars tissue forms

There are many diseases that cause an active inflammation within glomeruli. When there is active inflammation occur within the kidney scar tissue may replace normal functional kidney tissue and cause irreversible renal impairment

ETIOLOGY

It is caused when there is problem with immune system or diseases like HIV and lupus that affect immune system. Disorders that attack several organs and can cause glomerulonephritis

It occurs after an infection elsewhere in the body or may develop secondary to systemic disorders

An infection with group A streptococci bacteria

PATHOPHYSIOLOGY

Due to etiological factors, antigen (group A beta hemolytic streptococcus) —- throat infection —- deposition of antigen antibody complex in glomerulus —- increased production of epithelial cells lining the glomerulus —- leukocytes infiltrate the glomerulus —- thickening of the glomerular filtration membrane —- scarring and loss of glomerular filtration membrane —- decreased glomerular filtration rate

SIGNS AND SYMPTOMS

The primary presenting feature of acute glomerulonephritis is hematuria. The urine may be cola, coffee colored because of RBCs and protein plugs

• Proteinuria and elevated (BUN) blood urea and nitrogen and serum creatinine

Other Manifestations

• Oliguria
• Edema fever
• Shortness of breath or dyspnea. Possible flank pain
• Nausea and vomiting
• Abdominal pain
• Back pain, fatigue, weight gain
• Headache, loss of appetite
• Weakness, fatigue
• High blood pressure

DIAGNOSTIC EVALUATION

• History: assess and collect history from patient regarding change in pattern of urination frequency, color or volume

Ask patient for signs and symptoms like headache, nausea, vomiting and loss of appetite

Ask for any history of flank pain

Physical examination: in physical examination assess for adequate intake output

Check vital signs

Monitor weight of patient

Assess patient for edema and any signs and symptoms of infection

• Urinalysis: for the presence of hematuria. A urinalysis may show red blood cells in urine an indicator of damage to the glomeruli. Urinalysis results may also show white blood cells, a common indicator of infection and inflammation and increased protein which results nephron damage.
• Check patient BUN and serum creatinine level. There is an increase in BUN and serum creatinine level
• Needle biopsy: it reveals obstruction of glomerular capillaries from proliferation of endothelial cells. It is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination with a microscope. In this we collect a sample of kidney tissue, to check any unusual deposits, scarring, or infecting organisms that would explain a person’s condition

MANAGEMENT

• Management includes:

Antihypertensive’s to treat high blood pressure and diuretics, they increase the renal blood flow by decreasing renal vascular resistance.

Provide antibiotics if infection is still present usually penicillin. Helps to reduce infection and prevent further spread of infection

Steroids and other medicines will suppress the immune system. Prednisolone and methylprednisolone is useful and most commonly prescribed drug. It can suppress the inflammatory response in kidney and reduce the permeability of renal blood vessels and reducing the proteinuria

Nutritional Therapy

Dietary protein should be restricted if BUN level is increased

Potassium and sodium should be avoided if edema is present

Dietary protein should be restricted if there is evidence of an increase in nitrogenous wastes

Fluid intake should be restricted

Provide low protein diet to the patient

Provide vegetables, rice, cereals, dried beans, breads

Advise to avoid animal products they are rich source of protein

Eat healthy foods

Get proper rest and sleep

CHRONIC GLOMERULONEPHRITIS – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management

Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scaring of tiny blood filters in the kidneys. These filters known as glomeruli, remove waste products from the blood.

• In  chronic glomerulonephritis, scarring of glomeruli impedes the filtering process, trapping waste products in the blood while allowing red blood cells or protein to escape into the urine, eventually producing the characteristic signs of high blood pressure and swelling in legs and ankles
• The disorder may first come to one’s attention because of high blood pressure. In other, fluid retention or urine may be first signs. Long-term inflammation and scarring of the kidneys may lead to kidney failure in severe cases. Damage may progress without symptoms for months or years by the months or year, by the time symptoms appear, the course of the disorder maybe irreversible

ETIOLOGY

Specific cause is unknown

• Viral infections such as Hepatitis B, C, HIV leads to chronic glomerulonephritis
• Autoimmune disorder such as systemic lupus erythematosus, vasculitis may cause chronic glomerulonephritis
• Acute glomerulonephritis may after a symptom less period of many years, reappear as chronic glomerulonephritis

PATHOPHYSIOLOGY

It is an autoimmune disease caused by the loss of tolerance to self-antigens —- glomeruli have varying degree of hypercellularity and become sclerosed (hardened) —- size of kidney is decreases, and eventually tubular atrophy, chronic interstitial inflammation occur —- kidney’s ability to regulate the internal environment begins to decrease as glomeruli become scarred and resulting in fewer functional nephrons —- results into various symptoms of renal dysfunction that leads to edema, weight loss, irritability, poorly nourished, high blood pressure, nocturia

SIGNS AND SYMPTOMS

Patient with severe disease has no symptoms at all for many years. There condition may be detected when BUN level and serum creatinine level are detected

• Blood or protein in the urine
• Swelling of legs or ankle and other parts of body due to fluid accumulation (edema)
• Shortness of breath due to less blood
• Headache or blood pressure high
• Fatigue, nausea, vomiting, loss of appetite, abdominal pain
• Nocturia (increased need to urinate at night)
• Crackles sound in the lungs, poorly nourished, pale skin color

DIAGNOSTIC EVALUATION

• History: collect any history of acute glomerulonephritis if present

Ask patient for the history of urination changes in patient

Ask for the presence of signs and symptoms

Ask patient for history of abdominal pain, etc

Physical examination: assess patient for edema and swelling, check patient body weight

Monitor patient blood pressure

• Urinalysis and blood tests to know about the elevated level of for the presence of hematuria. A urinalysis may show red blood cells in urine an indicator of damage to the glomeruli. Urinalysis results may also show white blood cells, a common indicator of infection and inflammation and increased protein which results nephron damage
• A blood test to measure protein and creatinine level. Level of creatinine and protein is elevated
• An ultrasound of kidneys maybe performed to evaluate the size of kidneys and any blockages
• CT scan or abdominal ultrasound can be performed to show the damage to the glomeruli
• Renal biopsy maybe performed, under local anesthesia, to extract a small sample of tissue from kidney, to determine the exact cause and the nature of the glomerulonephritis

MANAGEMENT

• Antihypertensive drugs (propranol) maybe prescribed to reduce high blood pressure
• Diuretics (frusemide) may be prescribed to reduce excess fluid retention and increase urine production
• Steroid medications, if immunosuppressive drugs (prednisolone and methyl prednisolone), maybe prescribed for some patients. Prednisolone and methylprednisolone is useful and most commonly prescribed drug. It can suppress the inflammatory response in kidney and reduce the permeability of renal blood vessels and reducing the proteinuria
• In severe cases, where kidney failure occurs, dialysis maybe necessary. Dialysis performs the function of the kidney by removing waste products and excess fluid from the blood when kidney cannot
• A kidney transplant is also an alternative in case of kidney failure. A kidney transplant is a surgical procedure performed to replace a diseases kidney with a healthy kidney from another person

DIET MANAGEMENT

• Provide low salt diet and provide low protein diet, because it reduces the workload on the kidney
• Nuts, dried beans, cereals, vegetables, rice, breads are low in protein
• Limit the amount of animal products
• Take vitamin supplements
• Fluid intake should be restricted
• Provide adequate diet and fruits
• Get proper rest
• Take medication regularly

PREVENTION

• In prevention it can be prevented by limit the salts, fluids, protein
• Control blood pressure, controlling high blood pressure is the most important part of treatment
• Maintain good hygiene practices
• Practicing safe sex helps in preventing the viral infection such as HIV infection and hepatitis which leads to this illness
• Take calcium supplements

NURSING MANAGEMENT

Nursing Assessment

• Observe patient for changes in fluid and electrolyte status and for the signs and symptoms
• Monitor vital signs of patient blood pressure
• Anxiety levels are often extremely high for both the patient and family
• Throughout the course of disease and treatment, the nurse should gives emotional support by providing opportunities for the patient and family to verbalize their concerns, have their questions answered, and explore their options

Nursing Diagnosis

• Ineffective renal tissue perfusion related to damage of glomerular infiltration
• Excess fluid volume related to compromised renal function
• Imbalanced nutrition less than body requirement related to anorexia, nausea, vomiting
• Deficient knowledge regarding condition and treatment
• Activity intolerance related to fatigue, retention of waste products

1. Excess fluid volume related to compromised renal function, decreased urine output, retention of sodium and water

Interventions

• Assess the fluid status of patient
• Check weight daily and record
• Maintain intake output chart
• Monitor vital signs
• Limit fluid intake to the patient
• Explain the rationale for restriction of fluid
• Assist patient to cope up with the discomforts results from fluid restriction
• Provide and encourage oral hygiene, it minimizes the dryness of oral membranes

• Imbalanced nutrition pattern less than body requirements related to anorexia, nausea, vomiting

Interventions

• Assess the nutritional status of the patient
• Monitor weight of patient daily and record it
• Assess the patient nutritional dietary patterns-diet history, food preferences
• Provide patients food preference within dietary restrictions
• Provide low salt and protein diet
• Restrict fluids rich diet to the patient
• Encourage for proper rest
• Provide pleasant surroundings at the meal time

• Deficient knowledge related to disease condition and treatment

Interventions

• Assess the understanding of patient regarding disease condition and treatment
• Provide explanation regarding renal function and consequences of disturbed renal function at the level of patient understanding and guided by patient’s readiness to learn
• Assist patient to identify ways to incorporate changes related to illness and its treatment into lifestyle
• Provide oral and written information as appropriate about: renal function, fluid and dietary restrictions
• Clear all the doubts of the patient
• Provide psychological support to the patient

RESPIRATORY FAILURE – Classification, Etiology, Pathophysiology, Clinical Manifestation, Diagnostic Evaluation and Management

INTRODUCTION

The most important function of the respiratory system is to provide oxygen to the body tissues and remove the carbon dioxide. The body relies primarily on the central nervous system, the pulmonary system, the heart, and the vascular system to accomplish the effective respiration. Respiratory failure develops when one or more of these systems or organs fail to maintain optimal functioning.

Respiratory failure is a sudden and life-threatening deterioration of the gas exchange functions of the lung and indicates failure of the lungs to provide adequate oxygenation or ventilation for the blood. Acute respiratory failure is defined as the decrease in the arterial oxygen tension to less than 50 mm Hg (hypoxemia) and increase in the arterial carbon dioxide tension, i.e. (hypercapina) to greater than 50 mm Hg, with the arterial pH of less than 7.35. it is a condition in which there is inadequate gas exchange by the respiratory system, with the result that arterial O₂ and CO₂ levels cannot be maintained within their normal ranges.

DEFINITION

• Acute respiratory failure is a condition in which the patient’s breathing apparatus fails in the ability to maintain arterial blood gases within the normal range.
• Ventilatory failure is the inability of the body to sustain respiratory drive or the inability of the chest wall and muscles to mechanically move air in and out of the lungs. The hallmark of ventilator failure is an elevated CO₂ level.
• A sudden inability of the lungs to maintain normal respiratory function. The condition may be caused by an obstruction in the airways or by failure of the lungs to exchange gases in the alveoli.
• Acute respiratory failure is defined as the decrease in the arterial oxygen tension to less than 50 mm Hg (hypoxemia) and increase in the arterial carbon dioxide tension, i.e. (hypercapnia) to greater than 50 mm Hg, with an arterial pH of less than 7.35.

CLASSIFICATION OF RESPIRATORY FAILURE

It is divided into two types:

• Acute respiratory failure
• Chronic respiratory failure

Acute Respiratory Failure

Acute respiratory failure is characterized by hypoxemia (PaO₂ less than 50 mm Hg) and academia (pH less than 7.35). acute respiratory failure occurs rapidly, usually in minutes to hours or days

Types of Acute Respiratory Failure

It is divided into two:

1. Type 1 acute respiratory failure
2. Type 2 acute respiratory failure

• Type 1 acute respiratory failure: Type 1 respiratory failure is defined as hypoxia without hypercapnia and indeed the PaCO₂ may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch, the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs.
• Type 2 acute respiratory failure: Type 2 respiratory failure is caused by inadequate ventilation, both oxygen and carbon dioxide are affected and buildup of carbon dioxide levels (PaCO₂) that has been generated by the body.

Chronic Respiratory Failure

Chronic respiratory failure is characterized by hypoxemia and hypercapnea with the normal pH (7.35 to 7.45). chronic respiratory failure occurs over a period of months to a year – allows for activation of compensatory mechanism.

Chronic respiratory failure may also be divided into:

• Hypoxemic respiratory failure: when a lung disease causes respiratory failure, gas exchange is reduced because of changes in ventilation (the exchange of air between the lungs and the atmosphere), perfusion (blood flow), or both. Activity of the respiratory muscles is normal. This type of respiratory failure which results from a mismatch between ventilation and perfusion is called hypoxemic respiratory failure. Some of the alveoli get less fresh air than they need for the amount of blood flow, with the net result of a fall in oxygen in the blood. These patients tend to have more difficulty with the transport of oxygen than with removing carbon dioxide. They often overbreathe (hyperventilate) to make up for the low oxygen, and this results in a low CO₂ level in the blood (hypocapnia). Hypocapnia makes the blood more basic or alkaline which is injurious to the cells.
• Hypercapnic respiratory failure: respiratory failure due to a disease of the muscles used for breathing (‘pump or ventilatory apparatus failure’) is called hypercapnic respiratory failure. The lungs of these patients are normal. This type of respiratory failure occurs in patients with neuromuscular diseases, such as myasthenia gravis, stroke, cerebral palsy, poliomyelitis, amylotrophic lateral sclerosis, muscular dystrophy, postoperative situations limiting ability to take deep breaths, and in depressant drug overdoses. Each of these disorders involves a loss or decrease in neuromuscular function, inefficient breathing and limitation to the flow of air into the lungs. Blood oxygen falls and the carbon dioxide increases because fresh air is not brought into the alveoli is needed amounts. In general, mechanical devices that help move the chest wall help these patients.

ETIOLOGY

Brain Disorders

• Stroke: a stroke is sudden loss of brain function resulting from a disruption of blood supply to a part of the brain
• Brain tumors: a brain tumor is a localized intracranial lesion that occupies space within the skull and tends to cause a rise in intracranial pressure
• Depression of respiratory drive with drugs, e.g. narcotic tranquilizer

Chest Wall Dysfunction and Neuromuscular Factor

• Anesthetic blocking agent
• Cervical spinal cord injury
• Neuromuscular disorder
• Neuromuscular blocking agent

Airway Obstruction

• Airway inflammation
• Tumor
• Foreign bodies
• Asthma
• COPD

Interstitial Lung Diseases

• Pneumonia
• Pulmonary tuberculosis
• Pulmonary edema
• Pulmonary fibrosis

Pulmonary Dysfunction

• Asthma
• Emphysema
• Chronic obstructive pulmonary disease
• Pneumonia
• Pneumothorax
• Pulmonary contusion
• Hemothorax
• Acute respiratory distress syndrome (ARDS)

Cardiac Dysfunction

• Pulmonary edema
• Cerebrovascular accident
• Arrhythmia
• Congestive heart failure
• Valve pathology

Other

• Fatigue due to prolonged tachypnea in metabolic acidosis
• Intoxication with drugs (e.g. morphine, benzodiazepines, alcohol) that suppress respiration.

Traumatic Causes

• Direct thoracic injury may result in a number of abnormalities that can lead to respiratory failure
• Direct brain injury can result in loss of respiration

PATHOPHYSIOLOGY

In alveolar ventilation —- nerves and muscles of respiration drive breathing —- failure in alveolar ventilation —- ventilation-perfusion mismatch —- hypercapnia and acidosis during obstructive forms: the residual pressure in the chest impairs inhalation —- increase in workload of breathing —- develops true intrapulmonary shunt —- decreased lung compliance

Mechanism of Pathophysiology

• Respiratory failure can arise from an abnormality in any of the components of the respiratory system, including the airways, alveoli, central nervous system (CNS), peripheral nervous system, respiratory acidosis, and chest wall. Patients who have hypoperfusion secondary to cardiogenic, hypovolemic, or septic shock often present with respiratory failure
• Ventilatory capacity is the maximal spontaneous ventilation that can be maintained without development of respiratory muscle fatigue. Ventilatory demand is the spontaneous minute ventilation that results in a stable PaCO.
• Normally, ventilatory capacity greatly exceeds ventilatory demand. Respiratory failure may result from either a reduction in ventilatory capacity or an increase in ventilatory demand (or both). Ventilatory capacity can be decreased by a disease process involving any of the functional components of the respiratory system and its controller.

CLINICAL MANIFESTATIONS

• Paroxysmal nocturnal dyspnea
• Orthopnea
• Pulmonary edema
• Confusion and reduced consciousness may occur
• Neurological features may include restlessness, anxiety, confusion, seizures or coma
• Tachycardia and cardiac arrhythmias
• Cyanosis
• Polycythemia
• Cor pulmonale
• Pulmonary hypertension
• Right ventricular failure
• Hepatomegaly
• Peripheral edema

DIAGNOSTIC EVALUATION

• Arterial blood gas analysis: confirmation of the diagnosis
• Renal function tests and LFTs: may provide clues to the etiology or identify complications associated with respiratory failure. Abnormalities in electrolytes such as potassium, magnesium and phosphate may aggravate respiratory failure and other organ dysfunctions
• Serum creatine kinase and troponin I: to help exclude recent myocardial infarction. Elevated creatine kinase may also indicate myositis
• Thyroid function test: hypothyroidism may cause chronic hypercapnic respiratory failure
• Spirometry: to evaluate lung capacity
• Echocardiography: if a cardiac cause of acute respiratory failure is suspected
• Pulmonary function tests are useful in the evaluation of chronic respiratory failure
• ECG: to evaluate a cardiovascular cause, it may also detect dysrhythmias resulting from severe hypoxemia or acidosis.
• Right heart catheterization: should be considered if there is uncertainty about cardiac function, adequacy of volume replacement, and systemic oxygen delivery
• Pulmonary capillary wedge pressure may be helpful in distinguishing cardiogenic from noncardiogenic edema

MANAGEMENT

Management of acute respiratory failure is dependent upon the cause and its severity. The principle of management of acute respiratory failure is the following:

• Treat the cause
• Maintain a patient airway
• Provide adequate ventilation
• Provide optimum oxygen
• Carry out chest physiotherapy

The main goal of treating of respiratory failure is to get oxygen to lungs and organs and remove the carbon dioxide from the body

The promoting effective airway clearance effective gas exchange

Preventive complication of immobility

Monitoring and documenting indication of altered tissue perfusion

Promoting comfort

Correction of hypoxemia

Correction of hypercapnia

Airway an another goal is to treat the underlying cause of the condition

Administration of Oxygen

Nasal prongs, nasal catheters, or face masks are commonly used to administer oxygen to the spontaneously breathing patient

The actual fraction of inspired oxygen depends upon:

• Flow rate of oxygen
• Degree of mouth breathing
• Patency of nasal passage
• Inspection of insertion of nasal catheter

Positive End Expiratory Pressure (PEEP)

• Used with mechanical ventilation
• Increases interthoracic pressure
• Keeps the alveoli open
• Decreases shunting
• Improves gas exchange

Management of Upper Airway Obstruction

As soon as upper airway obstruction is diagnosed, measures must be taken to correct it.

• The mouth is opened to see if tongue has fallen back or if there are secretions, blood clot or any particles obstructing the airway
• Extension of the head is the simplest way of relieving upper airway obstruction by the tongue falling back
• If simple extension of the head is not adequate to clear the airway, the mandible should be forced forward
• Maneuver is designed to put further tension on the musculature that supports the tongue. It is best executed by standing behind the patient
• If maneuver is not adequate and partial airway obstruction still exists, then oral airway may have to be inserted or end tracheal intubation be done
• If assisted ventilation is required, a resuscitator bag and mask are used initially prior to intubation and mechanical ventilation

Medical Management

Medical management includes:

• Antibiotics for pneumonia infection
• Bronchodilators: reduce bronchospasm, COPD
• Diuretics for pulmonary edema
• Chest physical therapy and the hydration to mobilize secretions
• Maintain fluid and electrolytes and avoid fluid overload
• Intubation and mechanical ventilation

COMPLICATIONS

• Oxygen toxicity if prolonged high FIO₂ required
• Barotrauma may occur from excessive intra-alveolar pressure
• Ventilator-associated pneumonia
• Infection to the lower respiratory tract due to intubation
• Dental or vocal cord trauma
• Gastric complications: distension from air entering the GI tract, stress ulcers from hyperacidity and inadequate nutrition
• Other complications include deep venous thromboembolism, skin breakdown, malnutrition, stress and anxiety

NURSING MANAGEMENT

Nursing Assessment

• Note the changes suggesting increased work of breathing or pulmonary edema
• Assess breathing sound
• Assess sign of hypoxemia and hypercapnea
• Analyze the ABG and compare the previous values
• Determine hemodynamic status and compare it with previous value

Nursing Diagnosis

• Impaired gas exchange related to inadequate respiratory center activity or chest wall movement, airway obstruction, or fluid in lung
• Ineffective airway clearance related to increased or tenacious secretion
• Acute pain related to inflammatory process and dyspnea
• Anxiety related to pain, dyspnea and serious conditions

Nursing Intervention

• Improve gas exchange:

Administer oxygen to maintain PaO₂ of 60 mm Hg, using devices that provide increased oxygen concentration

Monitor fluid balance by intake and output measurement, urine-specific gravity, daily weight measurement

Provide measures to prevent atelectasis and promote chest extension and secretion clearance as per advice, spirometer

Elevated head level to 30 degrees

Monitor adequacy of alveolar ventilation by frequent measurement of respiratory system

Administer antibiotic, cardiac medication and diuretics as prescribed by doctor

• Maintain airway clearance:

Administer medication to increase alveolar function

Perform chest physiotherapy to remove mucus

Administer IV fluids

Suction patient as needed to assist with removal of secretions

• Relieving pain:

Watch patient for sign of discomfort and pain

Position the head elevated

Give prescribed morphine and monitor for pain-relieving sign

• Reducing anxiety:

Correct dyspnea and relieve from physical discomfort

Speak calm and slowly

Explain diagnostic procedure

REHABILITATION OF DISASTER VICTIMS – Challenges of Rehabilitation, Kinds of Reactions and Psychosocial Interventions

In the post-disaster period, along with relief, rehabilitation and the care of physical health and injuries, mental health issues need to be given importance. Apart from material and logistic help, the suffering human beings will require human interventions.

CHALLENGES OF REHABILITATION

• Ensuring that people living in the relief camps have access to regular food supplies, additional set of clothes, sanitation drinking water, public health intervention immunization, preventive health care, heat and rain proof shelters, child care and education facilities and support.
• Ensuring access to basic entitlements in terms of their compensation, government schemes and credit institutions so that they can rebuild their homes and livelihood back to the same levels as before the disaster.
• Ensuring livelihood reintegration
• Ensuring legal right and social justice to the disaster victims including filing of FIRs, investigation and contesting cases in the court
• Providing psychosocial counseling and support for dealing with loss, betrayal and anger.
• Community based rehabilitation for widows orphans, elderly, children and physically disabled
• Actively rebuilding a culture of communal harmony and trust

KINDS OF REACTIONS SHOWN BY DISASTER VICTIMS

• Physical impact: stomach aches, diarrhea, headaches, and body aches, physical impairments (limbs, sight, voice, hearing), injuries, fever, cough, cold, miscarriage etc.
• Emotional reactions: anger, betrayal, irritability, revenge-seeking, fear, anxiety, depression, withdrawal, grief, addiction to pan masala, cigarette, beedi, drug abuse (flask back, numbness, depression)
• Socioeconomic impact: loss of trust between communities, lack of privacy, single parent families, widows, orphan state with loss of both parents, discontinuity in educational plans (e.g. loss of employment, homelessness migration, disorganization of life routines, material loss).

PSYCHOSOCIAL INTERVENTIONS

Principles

• Ventilation
• Empathy
• Active listening
• Social support
• Externalization of interest
• Lifestyle choice
• Relaxation and recreation
• Spirituality
• Health care
• Work with individuals (willing to talk immediately unwilling to talk)

For people who are willing to talk immediately

Listen attentively

Do not interrupt

Acknowledge that you understand the pain and distress by learning forward

Look into the eyes

Console them by patting on the shoulders or touching or holding their hand as they cry

Respect the silence during interaction; do not try to fill it in by talking

Keep reminding them I am with you. It is good you are trying to release your distress by crying. It will make you feel better

Do not ask them to stop crying

For those unwilling to talk (angry, or remain mute and silent)

Do not get anxious or feel rejected, remain calm

Maintain regular contact and greet them

Maintain interaction

Acknowledge that you understand they are not to blame

Tell them you will return the next day or in a couple of days

Tell them you are not upset or angry because he or she did not talk

Once the person starts talking, maintain a conversation using the following queries like how you are and how are your other family members, what can individuals do to recover?

Work with Families

• Share their experience of loss as a family
• Contact relatives to mobilize support and facilitate recovery
• Participate in rituals like prayers, keeping the dead persons photographs
• Make time for recreation
• Resume normal activities of the pre-disaster days with the family
• Try and do things together as a writ and support one another
• Be together as a family member. Do not send women and children and the aged too far off places for the sake of safety
• Restart activities that are special to your family like having meals together, praying, playing games, etc
• Keep touching and comforting your parents, children, spouse and the aged in your family
• Keep in constant touch with the family member who is hospitalized

Work with the Community

• Group mourning
• Group meetings
• Supporting group initiatives
• Cultural aspects
• Rally
• Group participation for rebuilding efforts
• Sensitization process

Rehabilitation of Special Groups

1. Aged people can be helped by

• Keeping them with their near and dear ones
• Visiting them regularly and spending time with them
• Touching them and allowing them to cry
• Re-establishing their daily routines
• Making them feel responsible by giving them some work to carry out which is not too difficult
• Getting them involved in relief work by requesting for their suggestion and advice, etc.
• Keeping them informed of positive news
• Attending to their medical ailments
• Organizing small group prayer meetings

Disabled People

• Removing them to places of safety
• Keeping them informed what is happening
• Getting them involved in activities
• Integrate them in group discussions
• Attend to their specific needs (wheel chairs, hearing aids)
• Helping them overcome their feeling of insecurity
• Taking cognizance of the fact that mentally challenged people, especially the women and children are vulnerable to sexual abuse and help them

Women

• Help them to be with their families
• Keep informing them what is happening
• Involve them in activities
• Involving them in relief and rehabilitation activities
• Initiating self-help formation
• Involve them in recreation
• Making them to spend time with young widows or people who have lost their children and supporting them

Children

• Letting him/her to be close to adults who are loved and familiar
• Re-establishing some sort of a routine for them like eating, sleeping, going for programs
• Actions like touching, hugging, reassuring them verbally
• Allowing them to take about the event
• Encourage them to play
• Involve them in activities like painting and drawing, where then can express their emotions
• Organize story telling sessions, singing, songs and games
• Praising coping behavior
• Provide referral if required
• Spending time on their studies once they return to school

Policies Related to Emergency and Disaster Management

This policy aims at:

• Promoting a culture of prevention, preparedness and resilience at all levels through knowledge, innovation and education
• Encouraging mitigation measures based on technology, traditional wisdom and environmental sustainability
• Mainstreaming disaster management into the developmental planning process
• Establishing institutional and technological frameworks to create an enabling regulatory environment and a compliance regime
• Ensuring efficient mechanism for identification, assessment and monitoring of disaster risks
• Developing contemporary forecasting and early warning systems backed by responsive and fail-safe communication with information technology support
• Ensuring efficient response and relief with a caring approach towards the needs of the vulnerable sections of the society
• Undertaking reconstruction as an opportunity to build disaster resilient structures and habitat for ensuring safer living and
• Promoting a productive and protective partnership with the media for disaster management

Policy Statement

To develop and implement an integrated action plan that will create an effective disaster management system at local, national and international levels.

Focus Areas and Strategies for Intervention

• Making disaster risk reduction a development priority:

To incorporate disaster risk principles in the development agenda and other country programme

To enhance institutional capacity in disaster risk reduction

To develop national platforms for disaster risk reduction

• Improving early warning systems:

To monitor continuously the hazard and vulnerability threats

To develop standard risk and monitoring instruments

Do a risk and hazard mapping

To foster an understanding of disaster management mechanisms through dissemination of information and advocacy

• Addressing priority development concerns to reduce underlying risk factors:

To integrate disaster risk reduction in poverty reduction strategy paper

To address sources of vulnerability especially outbreak of diseases and pests (HIV/AIDS, Avian Flu, locusts, etc)

To sensitize both local and traditional authorities with a view to understanding disaster prevention as a development challenge

Mainstream gender and youth policies in the development agenda

• Effective disaster response through disaster preparedness:

To promote contingency planning in all government departments and all other sectors to ensure alignment of national, local and district disaster management plans

To review and periodically rehearse national preparedness and contingency plans for major hazards

To ensure that operational capacity exists within disaster management systems to enhance community resilience

Policy Implementation Agencies and Structures

The policy will adopt various approaches to ensure that risk reduction in particular and disaster management in general is a national and local priority with strong involvement of local actors, the victims of disaster and institutional basis for implementation

Agencies

• NGOs
• Civil Society Organizations
• Government Agencies
• UN Agencies
• Private Sector

Functions

• Identify, assess and monitor disaster risks and enhance early warning systems
• Use indigenous knowledge, innovation, practices and education to build a culture a safety and resilience at all levels
• Strengthen disaster preparedness for effective response at all levels
• Creation of Disaster Prevention Volunteer Corps at local and national levels to be fully trained and equipped to identify, assess and monitor disaster events

Operational Mechanism

This policy will be implemented through the following strategic actions:

• Sensitization programmes and advocacy on disaster prevention
• Mainstreaming disaster prevention and management in school curricula and development programmes
• Factor disaster scenarios into economic planning and programmes
• Capacity building and information sharing
• Monitoring and Evaluation