Urinary and Renal Disorders Flashcards
Nephrolithiasis (kidney stones)
Diagnostics = Noncontrast CT scan, Blood chemistries (calcium, uric acid, creatinine, Na, pH, total volume), renal colic (back pain), hematuria, pyuria (high white blood cells).
Medical Management = Determine stone type, eradicate stones, prevent nephron destruction, Extracorporeal Shock Wave Lithotripsy (ESWL), Endourologic methods, surgical removal of affected area.
Nursing Management:
- pain management
- strain all urine to collect stones for analysis
- monitor urine output and patterns of voiding
- encourage ambulation
- educate on causes and prevention, high fluid intake 3-4L/day to excrete >2L, avoid high protein foods.
Acute Kidney Injury (AKI)
Prerenal = hypoperfusion to kidneys leads to lowered GFR, high BUN, low creatinine
Intrarenal = intrinsic damage to kidney. Acute Tubular Necrosis (ATN) most common and is caused by neprotoxic agents (contrast agents, aminoglycosides, ACE inhibitors, NSAIDs). High BUN and creatinine, with low GFR
Postrenal = obstruction from renal calculi, BPH, or strictutres, causing increased pressure. Leads to low GFR and increased BUN/creatinine.
Diagnostics = Noncontrast CT scan or ultrasonography (contour of kidney); evaluation of changes in urine; increased BUN/creatinine, decreased GFR, hyperkalemia; urine sodium and sediment anaylsis help differentiate categories.
Medical Management = optimize renal perfusion (prerenal); supportive therapy and removal of causative agents (intrarenal);relieve obstructive (postrenal); Dialysis to prevent hyperkalemia, metabolic acidosis, pericarditis, and pulmonary edema
Nursing Management:
- monitor I&O and assess for hypo or hypervolemia (daily weights)
- assess for infection and monitor cardiac and resp status
- prevent exposure to nephrotoxic agents
Chronic Kidney Disease (CKD/ESKD)
Staging:
stage 1 = GFR > 90 with damage
stage 2 = GFR 60-89 (mild decrease)
stage 3 = GFR 30-59 (moderate)
stage 4 = GFR 15-29 (severe)
stage 5 = GFR < 15 or need for RRT (ESKD)
Diagnostics = Decreased GFR, decreased creatinine clearance, increased serum creatinine, increased BUN, hyperkalemia, hypocalcemia, hyperphosphatemia, anemia, metabolic acidosis
Medical Management = Maintain kidney function with dialysis, treat reversible factors, administer medications
Nursing Management:
- assess I&O, edema, JVD, BP, pulse
- monitor and manage hypo and hypervolemia
Hemodialysis
Nursing Management:
- monitor patient, dialyzer, and dialysate for complications (clotting, air embolism, inadequate/excessive fluid removal, hypotension, cramping, vomiting, blood leaks, contamination access complications).
- support and assess patient during treatment, care for the vascular access device
- educate on kidney disease
Peritoneal Dialysis
Continuous Ambulatory (CAPD) = manual exchange
Continuous Cyclic (CCPD) = automatic exchange
Nursing Management:
- prepare patient by explaining procedure and assisting with consent
- obtain baseline vitals, weight, and electrolytes
- Assess abdomen for catheter placement
- educate on emptying bladder/bowel before insertion
- maintain aseptic technique during connections to prevent peritonitis
Urinary Diversion (Ileal Conduit)
Nursing Management:
- monitor hourly urine volume (<0.5 mL/kg/hr may indicate dehydration or obstruction)
- closely monitor for complications and report/intervene promptly
- Assess urine drainage from conduit and ureteral stents
- irrigation of stents with sterile saline (5-10 mL) using aseptic technique
- hematuria may be present for 48 hours
Benign Prostatic Hyperplasia (BPH)
- noncancerous enlargement of prostate
- causes obstruction to urine flow leading to UTI
- can cause renla colic and postrenal CKD
Continuous Bladder Irrigation (CBI)
Nursing Management:
- Monitor the rate of irrigation fluid to ensure clear urine output without clots
- Assess for bladder distension and pain, which may indicate obstruction
- Monitor intake and output of irrigation fluid to calculate true urine output
- observe signs of transurethral resection syndrome (TURP syndrome) if hyponatremia or fluid overload is suspected
Pyelonephritis
Diagnostics = Urine culture and ultrasound or CT scan to locate obstruct, IV pyelogram if functional/structural abnormalities suspected, radionuclide imaging may identify infection sites not seen on CT/ultrasound
Medical Management = Antibiotic therapy based on culture and sensitivity, relief of obstruction if present, hospitalization may be needed for severe illness, dehydration, or complications
Nursing Management:
- Administer antibiotics as prescribed
- Monitor vital signs for sepsis (urosepsis)
- Encourage liberal fluid intake (H2O, cranberry juice)
- Monitor urine output and characteristics
- Manage pain with analgesics and heat to the flank/abdomen
- encourage frequent voiding.
Cystisis
Diagnostics = Assess voiding pattern, urine assessment, urine culture and sensitivity
Medical Management = Antimicrobial therapy, antiplasmodic agents may help relieve bladder irritability and pain, analgesic for pain relief
Nursing Management:
- Relieve pain (analgesics and heat to perneum)
- Encourage liberal fluid intake (water, cranberry juice) to fluch bacteria
- advise avoiding urinary tract irritants.
- Encourage frequent voiding (q2-3 hours) to empty bladder completely
Urethral Colic
Nursing Management:
- Immediate pain relief is priority
- Assist patient to assume a position of comfort
- Monitor pain level closely and report any increase in severity
- Encourage increased fluid intake to help pass the stone
- Strain all urine to collect any passed stones for analysis
- Monitor for signs of complications such as infection or obstruction
Urinary Retention
Diagnostics = Post-void Residual (PVR) measurement via catheterization or bladder scan (ultrasound) can determine the amount of urine remaining in the bladder after voiding
Nursing Management:
- promote normal voiding patterns
- apply warmth to relax sphincter (sitz baths; warm compresses)
- offer hot caffeine-free beverages
- use trigger techniques
- Ensure prescribed analgesics are given after surgery/childbirth to facilitate voiding
- catheterization
- bladder retraining program
- have patient report feelings of fullness
Infection Control: Peritoneal Dialysis Complications
Prevention:
- Strict aseptic technique during all PD exchanges
- Proper catheter and exit site care
- Use of closed system dialysate bags and tubing
- Thorough hand hygiene before and after any contact with the dialysis system
- Ensure proper training of patients performing home PD
- Recognize and treart with antibiotics immediately
Infection Control: Antibiotics for UTI
Nursing Management:
- Administer antibiotics as prescribed, ensuring correct dose, route, and frequency.
- Educate patient on the importance of taking the full course of antibiotics even if symptoms improve
- Obtain urine culture and sensitivity prior to initiating antibiotics, if possible, to guide selection
- Monitor for antibiotic side effects and allergic reactions
