Applied Renal System

Question 1

Alterations of the renal and urinary tract function

Answer 1

• renal and urinary function can be affected by a variety of disorders
• the most common is infection (UTI)
  1) obstruction can be caused by: stones, tumours, benign prostate dysplasia, associated inflammatory oedema, congenital abnormalities
  2) renal function may be impaired by: disorders of the kidney itself and many other systematic diseases
  Ultimately may result is acute or chronic kidney disease
• because the kidney filters the blood it is directly lined to every other organ system
• renal failure, whether acute or chronic is a life threatening condition

Question 2

Conditions

Answer 2

UTI
Obstruction
»> prostate urethral valve, prostate enlargement, stones, acute kidney injury
Pre-Renal
»> vascular damage, low blood flow, haemorrhage, shock, hypotension/hypertension

Question 3

Causes of a UTI

Answer 3

Stasis of urine
Obstruction
Constipation
Tumour
Pregnancy
Stones
Reflux
Poor bladder emptying
Inflammation - infection
Rough sex - abuse

Question 4

Signs and symptoms of a UTI in anyone >3 years of age

Answer 4

Painful urination
Frequent urination
Bed wetting
Reduced fluid intake
Foul smelling urine
Darker/cloudy urine
Blood in urine
Fever/shivering
Abdominal pain
Loin tenderness
Cap refill >3 seconds
History of UTI

Question 5

Nursing interventions&raquo_space;> safe sample collection

Answer 5

• gold standard is a clean catch
• where not possible, urine collection pads should be used - not cotton wool or gauze
• where neither is possible catheter samples or supra pubic aspirations under ultrasound guidance and aseptic conditions
• correct labelling and transportation - boric acid - follow manufacturers guidance for correct volumes to ensure no toxicity against microorganisms
• universal container where only small volume samples are available
• ensure the sample has the correct patient details written on the request form an bottle - completed at the bedside
• samples that cannot be sent to labs immediately must be refrigerated

Question 6

Nursing intervention&raquo_space;> care and evaluation

Answer 6

Managing body temperature
»> paracetamol as prescribed, light clothing, good fluid intake
Eating and drinking
»> fluids for the first 24 hours, light nutritious diet, low acid
Elimination
»> ensure bowels are opened, good fluid intake so urine is passed
Pain management
»> distraction and relaxation, pain relief as prescribed
Self actualisation and well being
»> listen, reassure, distract, occupy

Question 7

Obstruction

Answer 7

• an obstruction may be anatomic or functional
• it impedes urine flow&raquo_space;> increasing hydrostatic pressure&raquo_space;> increasing risk of infection&raquo_space;> compromising renal function
• anatomic changes in the urinary system caused by obstructions are referred to as obstructive uropathy

Question 8

What is the severity of an obstructive uropathy determined by?

Answer 8

• the location of the lesion
• the involvement of one or both of the upper urinary tracts (ureters and renal pelvis)
• the completeness of the obstruction
• the duration of the obstruction
• the nature of the obstructive lesion
  Obstructions may be relieved by correction of the obstruction. Permanent impairments occur if a complete or partial obstruction persists over weeks or longer

Question 9

What causes prostate enlargement?

Answer 9

Prostate enlargement can be caused by acute inflammation, benign prostatic hyperplasia or prostate cancer.
Each can cause encroachment on the urethra causing an obstruction to urine flow.

Question 10

What may result from a damaged bladder?

Answer 10

> > > distension
Trabeculation
vesicles-ureter reflux
high pressure
dilated kidneys
dilated ureters
leads to damage to the glomeruli and renal failure

Question 11

How do you manage or treat prostate enlargement?

Answer 11

Prostate enlargement can be treated by medication or surgery
- acute prostatitis is initially managed by broard-spectrum antibiotics until the results of a urine culture are obtained
- urinary retention may require transient placement of a supra pubic catheter

Question 12

Posterior urethral valves

Answer 12

• these are abnormal folds in the distal urethra that arise during foetal development and interfere with the normal outflow of urine
• most common cause of congenital urinary tract obstruction

Question 13

Acute kidney injury (AKI)

Answer 13

Most commonly caused by reduced blood flow to the kidneys
»> usually happens to someone who’s already unwell with another condition
This reduced blood flow could be caused by
»> low blood volume after bleeding, excessive D+V, severe dehydration

Question 14

NICE guidance for managing AKI

Answer 14

Refer patients to urologists when the following are more prevalent:
»> phyelonephritis, obstructive solitary kidney, bilateral upper UTI, AKI complications
Carry out a nephrostomy and stenting of people with AKI within 12 hours of diagnosis

Question 15

Treatment of AKI

Answer 15

Prompt identification
Correct fluid imbalance
Correct electrolyte imbalance
Maintain acid base balance
NEWS/PEWS
Present complications
Dialysis to remove toxins
Provide optimal nutrition
Medications to control blood potassium
Medications to control blood calcium

Question 16

Nursing care

Answer 16

Consider…..ALDs - breathing, circulation, safety, elimination, eating and drinking, rest and sleep, self actualisation, death and dying
…..NEWS/PEWS
…..Fluid balance