Assessment of the Renal/Urinary System Flashcards
Decreased GFR
Nocturia
Decreased bladder capacity
Weakened urinary sphincter muscles and shortened urethra in women
Tendency to retain urine
Changes in the renal sys related to aging
Higher risk for dehydration = adequate intake
Careful with certain meds that are nephrotoxic
Decreased GFR
Assess need to void - get up to void
Avoid having lot fluid before bed
Nocturia
Safety issues
Not sit around and wait
Decreased bladder capacity
Help to bathroom
Weakened urinary sphincter muscles and shortened urethra in women
UTI - decrease estrogen as well: higher in women
Prostate
Anticholinergic drugs
Tendency to retain urine
Nutrition
Diet or recent changes in diet
Daily fluid intake (2 L per day unless fluid restriction)
History
History
Medications
Family history and genetic risk
Current health problems
Assessment methods
Prescription drugs
Antibiotics
Dye as well
OTC drugs
Medications
high-dose or long-term use of NSAID’s or acetaminophen can seriously reduce kidney function
OTC drugs
Document current health problems
Assess changes in appearance of urine, pattern of urination, ability to initiate or control voiding, other unusual symptoms; not voiding at all
Current health problems
General appearance
Skin assessment
Edema
Lung sounds
Weight, BP (risk factor for kidney damage but need BP to perfuse kidneys)
Level of consciousness and alertness
Abdominal assessment
Physical assessment
check for bladder distension
Abdominal assessment
Serum creatinine
Abnormalities in electrolytes
Serum blood urea nitrogen (BUN) –
Glomerular filtration rate (GFR)
Laboratory assessment
0.5-1.2
Increased: kidney impairment
Decreased: decreased muscle mass
Produced when muscle and other proteins are broken down
Excreted by the kidneys
No common pathologic condition other than kidney diseases increases the serum creatinine level
Does not increase until at least 50% of the kidney function is lost
Serum creatinine
Measures the effectiveness of kidney excretion of urea nitrogen, a by-product of protein breakdown in the liver
Kidneys filter urea nitrogen from the blood and excrete the waste in urine
Other factors influence the BUN level
An elevation does not always mean kidney disease is present
10-20
Increased: liver/kidney disease, dehydration/decreased kidney perfusion, high-protein diet, infection, stress, steroid use, GI bleeding, other situations in which blood in body tissues
Decreased: malnutrition, fluid volume excess, severe hepatic damage
Serum blood urea nitrogen (BUN) –
Decreased levels indicative of kidney failure
Glomerular filtration rate (GFR)
Urinalysis - screening; color, concentration, odor, clear/cloudy, specific gravity: high = dehydration, pH - 6, glucose, ketones, proteins, RBC
Urine culture and sensitivity
Composite urine collections (24 hour)
Creatinine clearance
Laboratory assessment
all urine in the designated time frame must be collected
How well urine clearing things
Collect all urine in 24-hour
Composite urine collections (24 hour)
Measure of glomerular filtration rate and kidney function
Creatinine clearance
Used to screen for post-void residual volumes
Non invasive method to determine the need for intermittent catheterization
Bladder scanners
KUB - plain x-ray of the kidneys, ureters, and bladders; stones, strictures, obstructions
CT of abdomen
MRI - metal screening, NPO
Ultrasonography
Renal Scan
Imaging assessment
Oral and IV dye usually given
When dye used ensure increased fluid intake to dilute and excrete the dye
May use diuretics immediately after the dye is injected to enhance dye excretion in patients who are well hydrated
NPO and only drink PO dye
Cysts, masts and obstructions - lot fluids
Hold Metformin (Glucophage) 24 hours prior and 48 hours after procedure or until adequate kidney function has been determined
CT of abdomen
Common: Requires a full bladder
To identify the size of the kidneys or obstruction in the kidneys or the lower urinary tract
Ultrasonography
Radioisotope injected IV to examine the perfusion, function, and structure of the kidneys
Renal Scan
Endoscopic procedure performed for diagnosis or treatment
Operative procedure and informed consent required
General or under local anesthesia with sedation
Preparation: light evening meal, NPO after midnight, bowel preparation
Postoperative care
Cystoscopy or cystourethroscopy
Observe for changes in VS and urine output,
Monitor for active bleeding and infection
Oral or IV fluids to increase urine output
May have a catheter postoperatively
ABCs postop
Postoperative care - Cystoscopy or cystourethroscopy
X-rays using contrast dye/medium instilled directly into bladder
Enhances visibility of the lower urinary tract
Dye is not nephrotoxic because it does not enter the bloodstream and does not reach the kidney
Voiding cystourethrogram: x-rays taken during voiding
Monitor for infection, urine output to ensure no damage
Encourage fluid intake
Cystography and cystourethrography
Retrograde
Pyelogram
Cystogram
Urethrogram
Instill dye into lower urinary tract using a cystoscope, anesthesia, NPO
Prep: light evening meal, NPO after midnight, bowel preparation
Post: Monitor for infection
Retrograde Procedures
Going against the normal flow of urine
X-rays are taken after dye instilled in urinary tract
Retrograde
Retrograde examination of the ureters and the pelvis of both kidneys
Pyelogram
Retrograde examination of the bladder
Cystogram
Retrograde examination of urethra
Urethrogram
Examines the process of voiding and include:
Tests of bladder capacity, pressure and tone
Studies of urethral pressure and urine flow
Tests of perineal voluntary muscle function
Urodynamic Studies
Most are performed percutaneously (through the skin and other tissues)
Guided by ultrasound or CT - IR to avoid comps
Informed consent required
NPO for 4-6 hours before procedure
Coagulation studies completed prior because of the huge risk for bleeding
Local anesthesia with conscious sedation
Nursing interventions post biopsy
Kidney biopsy
For 24 hours monitor dressing site, VS, urine output, H/H: Major risk for bleeding
Monitor for internal bleeding: large hematomas: suspected with flank pain, decreased BP, decreasing urine output
Strict bed rest in a supine position with a back roll for 2-6 hours post biopsy to mitigate issues bleeding
Monitor for hematuria - some will have little after; keep close eye: most common complication
If bleeding occurs, IV fluids and PRBC’s may be required
If bleeding is extensive, surgery or a nephrectomy may be required if cannot control bleeding
Nursing interventions post biopsy - Kidney biopsy
