urinary assessment chap 45 Flashcards
which med taken by a renal pt is concerning to a nurse?
ibuprofen (NSAIDS) is processed by the kidneys.
if nurse cannot palpate kidney is that bad?
No- kidneys should not be felt upon palpation
what should nurse expect to see in a pt after cystoscopy?
blood tinged urine
Rifampin
phenazopyridine
turns urine bright red
turns urine dark orange
where is kidney located?
retro- perineal in the back. Right one should be felt in a very skinny person, but not the left one.
kidneys
run on a lot of hemodynamic control. about size of the person's fist located retro peritoneally adrenal gland on top of each cushioned by fat and connective tissue Hilus is on he medial side
nephron
functional unit of kidney
Loop of Henley
where Lasix (furosemide) takes effect
Blood supply of kidneys
Renal artery arises from aorta
-
GFR glomerular filtration rate (in adult)
Normal is 125mL/min
measured by 24 hour urine collection have pt void then start collecting all urine for 24 hours and store it on ice until 24 hours is up. to compare to creatinine clearance from labs
BUN
blood, urea, nitrogen= wastes that kidneys are filtering off helps us determine the function of the kidneys
elevated BUN= kidneys not doing a good job of condensing
other functions of kidney?
creation of erythropoietin
Ace inhibitors
work by preventing angiotensin 1 from changing to angiotensin 2
ureters
drain from kidneys to the bladder
bladder
reservoir for urine. can hold 600mL to 1 L at a time -
-detrusor muscle contracts bladder and stops and starts urination
Trigone muscle
controls ability of urine to pass through the bladder
aging and kidneys
between age 30 and 90- size and function decrease by 20-30%
by 7th decade loss of 30-50% of glomerular function,
atherosclerosis
accelerates the decrease of kidneys
aging changes of bladder?
prostate enlargements
loss of elasticity and muscle support
Assessment of Urinary system
subjective- past hx? Meds? surgery or other treatments? functional health patterns? nutritional/metabolic pattern? elimination pattern? exercise pattern? sleep/rest?
Assessment of US- physical exam
Inspection of skin, mouth , face, extremeties abdomen.
weight - general health
Palpation -
left kidney rarely palpable
right kidney
bladder (full bladder- not empty)
Percussion: kidney punch to see if pain aka costrovertebral
bladder (or use a bladder scanner which is easier!)
Auscultation- listen for bruit
anasarca
generalized edema?
US exams
Urinalysis-
first morning void
examine urine within 1 hr
Urinary System exams
Urinalysis-
first morning void
examine urine within 1 hr
creatinine clearance
collect 24 hour urine specimen
creatinine clearance closely approximates GFR
(should be close to equal to GFR)
urodynamics
not done often- place hoses into ureters or urethra
contrast test (IVP)
be sure kidneys are healthy enough to handle the dye- serum level should be 1.6 or lower and pt cannot be allergic to shellfish or iodine
cystogram
like and endoscope= can go in bladder and look for damage, tumors, foreign objects
cystoscopy = assessment finding requires IMMEDIATE
attention by the nurse
back pain =
UTI risk
Female diminished host defenses Urinary tract abnormality blockage of urinary tract urinary retention suppressed immune system catheterization and other procedures (over 48 hrs increases chance of UTI)
catheter can be used for
strict I and O required
palliative care for terminally ill
if has skin issue that would be affected by incontinence
upper UTI
pyelonephritis (fever, chills, flank pain) kidney infection can cross from urine into the blood = Urosepsis
lower UTI
cystitis
urethritis
urosepsis
pathogen has become blood borne can cause death in the elderly
HAI
hospital acquired infection - cause is usually due to use of antibiotics, instrumentation and catheterization
CAUTI
catheter associated UTI
bacteria biofilms develop on inner surface of catheter
UTI labs
CBC elevated WBC- neutrophils (basically signs of infection and inflammation)
Urinalysis - microscopic UA
tells urine specific gravity, pH, urine culture and sensitivity
drugs for UTI antispasmodic
oxybutynin, tolteridine (Detrol)
UTI analgesics
phenazopyridine == turns urine bright orange
Urised (methenamine/phenyl salicylate
bladder irritants
smoking (increases risk of bladder cancer)
