Assessment of the Renal/Urinary System Class Flashcards
What renal change associated with aging does the nurse expect an older adult client to report?
A.Concentrated urine
B.Hematuria
C.Dysuria
D.Decreased GFR (glomerular filtration rate)
Answer: D
Tendency decrease age; also decrease with renal failure - less renal func - give older adults lower dose becuase decrease GFR
Dilute urine
The nurse is talking to a group of older women about changes in the urinary system related to aging. What symptom is likely to be the common concern for this group?
A.Incontinence
B.Retention
C.Dysuria
D.Olyguria
Answer: A
Decreased strength urinary sphincter
Retention - men more likely have; prostate
Decreased glomerular filtration rate (GFR)
Decreased bladder capacity
Weakened urinary sphincter muscles
Tendency to retain urine
More dilute urine changes in ADH secretion
Changes in the renal sys r/t aging
Lower numbers - more damage to kidneys and aging
Ability to filter and excrete is decreased
Ability to regulate fluid decreases
Decreased glomerular filtration rate (GFR)
Could lead to overflow incontinence
Decreased bladder capacity
Could lead to incontinence and nocturia
Weakened urinary sphincter muscles
More common in men (enlarged prostate)
Tendency to retain urine
The nurse is assessing a client newly admitted to the nephrology unit. Which of the following questions should the nurse ask? (SATA)
A.Have you noticed any changes with urination lately?
B.What is your average fasting blood glucose?
C.How much fluid do you drink in 24 hrs period?
D.What medications are you taking?
E.Have you noticed any changes with your bowel elimination?
Answer: A, B, C, D
Diabetes and HTN number 1 causes of renal failure; may want get A1C - long-term issues with blood glucose
I&O
Lot meds can be nephrotoxic - prescription and OTC
What is the average urine output of a healthy adult for a 24-hour period?
A.500 mL to 1000 mL per day
B.1500 mL to 2000 mL per day
C.3000 mL to 5000 mL per day
D.5000 mL to 7000 mL per day
Answer: B
At least 700 min - perfusing and getting blood supply
The client describes over the counter medications that she is taking. Which medication would alert the nurse to further explore for potential impact on kidney function?
A.Mouthwash with alcohol
B.Metamucil
C.Vitamin C
D.Ibuprofen
Answer: D
Nutrition
Medications
Family history and genetic risk
Current health problems
Client’s history
Diet, recent changes in diet - protein
Daily fluid intake (2 L per day unless fluid restriction)
Nutrition
Prescription drugs
OTC drugs
Medications
Antibiotics (BIG), some antihypertension and antivirals, diuretics, contrast dye - tough on kidneys to excrete
Prescription drugs
High-dose or long-term use of NSAID (ibuprofen diff on kidneys or naproxen) or aspirin can be nephrotoxic; steroids
Antihistamines can have a side effect of urinary retention
OTC drugs
Any issues; painful, diff, fully emptying
Document current health problems
Assess changes in appearance of urine, pattern of urination, ability to initiate or control voiding, other unusual symptoms
Current health problems
The nursing student is measuring urine output and observing for urine characteristics in a client. Which finding is the most urgent and must be reported to the nurse?
A.Output has decreased
B.Specific gravity is decreased
C.pH is decreased
D.Color is dark amber
Answer: A
Get further assessment
Specific gravity decreased - dilute; higher: concentrated
More acidic; see if big change
Output direct info on circ; amount r/t damage to kidneys and retaining
Dark amber - concentrated - dehydration
General appearance
Level of consciousness
Skin assessment
Edema
Lung sounds
Weight, BP
Flank pain
Abdominal assessment
Phys assessment
Dry skin (dehydrated - affect urinary/kidney func), presence of uremic frost (specific for severe renal failure)
Skin assessment
Could be facial, periorbital, or generalized - renal failure - not excrete fluids
Edema
Could have crackles if fluid overload
Lung sounds
Increase weight indicates fluid retention
Fluid balance: #1 way check: daily weight
Weight, BP
Could indicate kidney infection or stone; UTI - not traveling to kidneys
Flank pain
Check for bladder distension - dull if percuss
See if have tenderness around suprapubic area
Abdominal assessment
The nurse is determining whether a client has risk factors for potential kidney disease. Which question is best to elicit this information?
A.Have you been under increased stress?
B.Have you had your cholesterol checked?
C.When was the last time you had your BP checked?
D.Have you ever been told that your BP was high?
Answer: D
Need direct info on BP if have HTN and that puts at high risk for renal disease
Which of the following laboratory serum findings indicates impaired kidney function?
A.Potassium 6.3
B.Blood Urea Nitrogen (BUN) 34
C.Creatinine 7
D.Phosphorus 6.5
Answer: C
Creatinine: 0.5-1.2
Elevated K with critically high in renal failure but could be other things - not getting rid of K
BUN high without creatinine not renal failure - could mean dehydration; both elevated means renal failure
Phosphorus (high 4.5) - high levels: cannot get rid of it from food so take meds to manage it
Only lab low with renal pats is calcium
0.5-1.2 mg/dL
Produced when muscle and other proteins are broken down
Excreted by the kidneys - kidneys not working see increase
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
Increased level: kidney impairment
Decreased level: decreased muscle mass
Serum Creatinine
10-20 mg/dL
Measures the effectiveness of kidney excretion of urea nitrogen
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, and an elevation does not always mean kidney disease is present
Increased level: liver or kidney disease, dehydration or decreased kidney perfusion, high-protein diet, infection, stress, steroid use, GI bleeding, or other situations in which blood is in body tissues; bleeding
Decreased level: malnutrition, fluid volume excess, severe hepatic damage
Serum blood urea nitrogen (BUN)
Decreases indicate impaired kidney function
As renal func decreases this decreases - filtration rate decreases
GFR (glomerular filtration rate)
Infection; UTI
WBC
Bleeding; hematuria; bleeding in UT
CBC, H/H
Infection in blood; #1 comps in UTI is this and septicemia - older people get septic quickly; catch and treat soon but also closely monitor
Bacteremia
Inflammation - markers; anything cause inflammation increases
C-reactive protein, erythrocyte sed rate
Kidney impairment
K, Mg, Phosphorus will be increased, and Ca will be decreased
Sometimes use dialysis/meds to lower K
Abnormal electrolytes
test for bacteria, WBCs, ketones and glucose: diabetes/DKA, pH (acidic), proteins (renal failure/disease), specific gravity (concentrated/dilute), blood, color, clarity; great screening
Urinalysis
issues with UTI
Urine culture and sensitivity
misses one start over - lot off this: creatinine clearance; on ice for odor
All urine in the designated time frame must be collected
Composite urine collections (full 24 hour)
Serum Creatinine
Serum blood urea nitrogen (BUN)
GFR (glomerular filtration rate)
Other serum labs:
Urinalysis
Urine culture and sensitivity
Composite urine collections (full 24 hour)
Creatinine clearance
Bladder scanners
Laboratory assessment
Used to screen for post-void residual volumes and to determine the need for intermittent catheterization
See how much urine in bladder - look for s/s
Bladder scanners
Which of the following microorganisms is the most common cause of urinary tract infections?
A.Streptococcus
B.Staphylococcus
C.Escherichia coli
D.Enterococcus
Answer: C
Contamination from rectal area and found in stool
The client is scheduled to have a kidney, ureter, and bladder (KUB) X-ray. What preparation instructions should the nurse include?
A. No special preparation is required
B. Client will be NPO for 6 hours
C.A sedative will be given
D. An enema will be given
Answer: A
Few scans abdominal area where not have be NPO; most time with MRIs/CTs have be NPO - GI and renal; not invasive
A client is scheduled for an abdominal CT with contrast. Which medication should be discontinued 24 hours before the procedure and for at least 48 hours?
A.Furosemide (Lasix)
B.Acetylcysteine (Musomyst)
C.Acetaminophen (Tylenol)
D.Glucophage (Metformin)
Answer: D
Hold until kidney func returned
Can cause lactic acidosis in kidneys
Muscle pain, fast shallow breathing, weakness, diarrhea, abdominal pain
Imaging assessment
MRI of abdomen
Ultrasonography
Renal Scan
Cystography and cystourethrography
Cystoscopy or cystourethroscopy
Urodynamic Studies
Diagnostic imaging
KUB - x-ray of the kidneys, ureters, and bladders
CT of abdomen
Imaging assessment
Oral and IV dye usually given
When dye used increase fluid intake to dilute and excrete the dye
Screen for renal failure and dye allergy; creatine too high cannot do it - dye bad on kidneys
May use diuretics immediately after the dye is injected to enhance dye excretion in patients who are well hydrated
Hold Metformin (Glucophage) 24 hours prior and 48 hours after procedure or until adequate kidney function has been determined
CT of abdomen
Requires a full bladder
To identify the size of the kidneys or obstruction in the kidneys or the lower urinary tract - temp urinary cathether where inject them with air to get bladder inflated
Ultrasonography
Radioisotope injected IV to examine the perfusion, function, and structure of the kidneys; inject radioactive dye
Renal Scan
Cystography: bladder
Cystourethrography: bladder and urethra
X-rays using contrast dye instilled directly into bladder via urinary catheter; issues with renal failure; not affect kidneys as much; just going into bladder
Pre procedure:
Post Care:
Cystography and cystourethrography
Urinary catheter will be placed
Pre procedure: - Cystography and cystourethrography
Monitor for infection, urine output
Encourage fluid intake
Peeing ok
Instilled dye via cathether
Post Care: - Cystography and cystourethrography
Endoscopic procedure performed for diagnosis or treatment
Scope into bladder and urethra
Can do interventions - look in UT with scope
Operative procedure and informed consent required
General or under local anesthesia with sedation
Preparation: light evening meal, NPO after midnight (invasive and anesthesia), bowel preparation
Postoperative care
Cystoscopy or cystourethroscopy
Observe for changes in VS and urine output,
Monitor for bleeding and infection
Oral or IV fluids to increase urine output
Monitor for rupture
May have a catheter postoperatively
Postoperative care - Cystoscopy or cystourethroscopy
Examines the process of voiding and studies it
Urodynamic Studies
A client has undergone a kidney biopsy. What does the nurse monitor for in this client related to this procedure?
A.Nausea and vomiting
B.Amount and color of urine
C.Urinary retention and pain
D.Urgency and dysuria
Answer: B
Sample of kidney - check for bleeding; very vascular so risk for bleeding very high so monitor for bleeding frequently after
Flank pain and bleeding
Dramatic drops in BP - bleeding into body - retroperitoneal bleeding so keep close eye
Most are performed percutaneously (through the skin and other tissues) using ultrasound or CT guidance so comps less common
Informed consent required
NPO for 4-6 hours before procedure
See changes act quickly
Coagulation studies completed prior because of the risk for bleeding - bleed quickly
Local anesthesia with 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: 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 - put pressure roll and good if lean on it to keep pressure on it
Monitor for hematuria: most common complication
If bleeding occurs, IV fluids and mass PRBC’s may be required
If bleeding is extensive, surgery or a nephrectomy may be required - take kidney if extensive enough
Nursing interventions post biopsy - Kidney biopsy
