Nursing the Urinary Patient

Question 1

What are the clinical signs of acute renal failure?

Answer 1

Sudden-onset anorexia, lethargy and depression.
Oliguria and anuria, followed by polyuria.
Vomiting and diarrhoea.
Polydipsia.
Dehydration.
Uraemic breath.
Abdominal pain.

Question 2

What are the clinical signs of chronic renal failure?

Answer 2

Polyuria/nocturia (as the kidney loses its ability to concentrate the urine).
Polydipsia.
Uraemia – anorexia, vomiting, lethargy and depression.
Weight loss.
Dehydration.
Oral ulceration and halitosis.
Non-regenerative anaemia (due to lack of erythropoietin production by the kidney).
Hypertension.
Rubber jaw (renal hyperparathyroidism)

Question 3

What are the clinical signs of cystitis?

Answer 3

Pollakiuria = Abnormally frequent urination
Urinary tenesmus.
Haematuria.
Stranguria.
Incontinence.
Dysuria.
Inappropriate urination.
Excessive grooming.

Question 4

What are the clinical signs of urinary incontinence?

Answer 4

Loss of control over urination.
Passing of urine when lying down or walking.
Urine around perineum which can cause urine scalding.

Question 5

What are the clinical signs of urolithiasis?

Answer 5

Pollakiuria.
Urinary tenesmus= feeling of incomplete emptying of bladder after urination
Haematuria.
Dysuria.
Distended bladder.

Question 6

What are the clinical signs of feline lower urinary tract disease?

Answer 6

Distress – vocalising and signs of abdominal pain.
Anuria.
Distended hard bladder.
Clinical signs of renal damage.
Anorexia and vomiting.
Lethargy and depression.
Dehydration.
Collapse and death if untreated.
Hyperkalaemia (high potassium levels).

Question 7

When presented with a urinary patient, what would be initially assessed?

Answer 7

Establish normal preferences from owner:
- What type of ground is preferred?
- Preferred posture?
- When in daily routine?
- What type of litter does cat prefer?
- Privacy?
- Cleanliness

Concurrent medications or conditions causing polyuria?

Concurrent procedures or condition of patient requires change to normal urination (e.g. orthopaedic surgery).

Baseline urine analysis, hydration status, vital signs.

Question 8

Which abilities are likely to be affected by a urinary condition?

Answer 8

Urinate normally
Defecate normally
Eating normally
Drinking normally
Mobilise adequately
Normal behaviour
Sleep/Rest
Grooming

Question 9

What nursing interventions would be used for a urinary patient?

Answer 9

Record abnormal output, appearance, dipstix/SG results, micturition posture and frequency

Express bladder/catheterise where indicated

Keep patient and kennel clean and dry, use kennel liners

Clip perineum and apply barrier cream where risk of scalding

Provide accurate medication - pain relief

• Encourage eating
• IVFT
• TLC
• environmental temp correct

Question 10

What equipment is used for catheterisation?

Answer 10

Analgesia
Sedate/GA
Gloves
Catheter
3 way tap
Closed urinary system
Sterile lubricant
Syringe
Kidney dish
Saline flush
Suture material & instrument

Question 11

What preparation is needed before a urinary catheter is placed?

Answer 11

Bloods
GA
Clean site - aseptic techniques

Question 12

What additional care can be given to a urinary patient?

Answer 12

Maintain fluid therapy, observe for fluid overload
Monitor fluid ins+outs
Assisted feeding
Palatable diets, warming food
Soft diets
Hand feeding
Pain management
Feeding tubes
Maintain body temperature
Stress reduction

Question 13

How would you evaluate a urinary patient?

Answer 13

Monitoring urine output (1-2ml/kg/hr)
- Washable litter
- Weighing newspaper/kennel liner
- Catheter attached to closed system - collection bag

Output, appearance, dipstix/SG results, micturition posture and frequency, signs of UTI infection

Monitor body weight, condition and muscle mass

Monitor hydration status

Monitor water intake

Pain levels and vital signs