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NUR2226 > Week 6: Renal disorders > Flashcards

Week 6: Renal disorders Flashcards

1
Q

What 3 components classify a UTI?

A
  • Location
  • Complexity
  • Presence or absence of associated symptoms
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2
Q

Name the two locations, the involved body parts and the specific symptoms to each

A

Upper;

  • Kidneys and ureter
  • Fever, chills, Flank pain

Lower;

  • bladder and urethra
  • may be asymptomatic
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3
Q

Complexity refers to what two types of UTI’s? Explain what constitutes each.

A

Uncomplicated= non-instrumental cause
- non pregnant
no structural abnormalities
- no neurological abnormalities

Complicated
- anatomical abnormalities
functional abnormalities
- Risk of serious complications

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4
Q

List symptoms of a UTI

A
  • increased frequency of urination
  • dysuria (tingling, burning, pain on urination)
  • loin pain
  • significant growth of organisms on urine culture
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5
Q

Risk factors for a UTI

A
  • female
  • Pregnancy
  • Obstruction e.g. tumor, calculi
  • Urinary stasis e.g. retention, structural, renal impairment
  • Urinary reflux
  • Sexual Trauma
  • Instrumental e.g. IDC
  • Sexual trauma
  • Immunosuppression
  • anatomical factors e.g. obesity
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6
Q

List some clinical manifestation of a lower UTI

A
  • Dysuria (burning, tingling and pain on urination)
  • increased urinary frequency (think swollen bladder)
  • urinary hesitation
  • Heamaturia, proteinuria
  • Nocturia (wake up in middle of night to urinate)
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7
Q

List some clinical manifestations of an upper UTI

A
  • Pain; flank, lower abdominal, loin, superpubic, lower back

Systemic symptom; lethargy, fever, chills, rigours, headache, vomiting, myalgia(muscle aches and pain)

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8
Q

Explain the pathophysiology of a lower UTI

A
  • A pathogen colonised in periurethral area
  • retrograde movement of the pathogen up the urethra and into bladder
    pathogen attached to bladder epithelium and continues to replicate
    infection initiated the inflammatory response
    Oedema of the bladder wall stimulated fullness sensation which leads to urgency and frequency and passing of small amounts of urine.
  • It is the bacteria that contaminated the sterile urine.
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9
Q

What does polyuria mean?

A

An increased total urine output

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10
Q

Explain the pathophysiology of a upper UTI

A
  • pathogen ascends further up the urinary tract into the ureter and kidneys.
  • it does this by ongoing attachment to epithelial lining and
  • infection causes renal inflammation and odema with rurulen urine (pyelonephritis)
  • inflammation cascade continues. This can result in tubular construction and AKI
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11
Q

What is pyelonephritis?

A

Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels to one or both of your kidneys

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12
Q

List 2 functional and 2 bacterial factors that prevent a UTI

A

Function

  1. micturition (washes out bacteria)
  2. closure of ureterovesical junction during bladder contraction preventing reflux of urine back into the bladder

Bactericidal

  1. low pH (acidic) and high osmolality (high chemical contents) of urea
  2. secretions from epithelial lining of the urethra

An example of a combinations of functional and bactericidal factors= long urethra and prostatic secretions for men

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13
Q

List some causative agents/bacterias for a UTI

A

E. coli
Candida albicans
Pseudomonas
Staphylococcus

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14
Q

What factors are combined to diagnose a UTI?

A
  • clinical history
  • Subjective and objective information
  • results of diagnostics (e.g. presence of pathogen)
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15
Q

When assessing a patient for a UTI, what questions should be asked?

A
  • what is the colour of your urine? (haematuria, cloudy)
  • Does out urine smell? (foul- smelling)
    New onset of pain? (where is it? flank, lower back, dysuria)
  • this ay help differentiate between upper and lower UTI
  • Associated symptoms (fever, chills, nausea, vomiting, headaches)
  • this ay help differentiate between upper and lower UTI (fever- more common in upper)
  • No symptoms may indicate an asymptomatic lower UTI
  • changes to frequency or urgency
  • experiencing any changes in frequency or urgency?
  • new/chronic incontinence
  • changes sin urine volume
  • urinary retention?
  • new onset of confusion in elderly?
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16
Q

Run through a physical assessment for a suspected UTI

A

Primary= DRSABCD

Secondary=

  • General: do they look well? pale? in pain?
  • Vital signs: look for pyrexia, changes in BP and HR= infection indicators
  • Hydration assessment: oral mucosa (more hydration allows for pathogen colonisation as low urination)

Focused assessment=
Inspection, auscultation, palpation and percussion
- tender lower abdomen?
- pain on bladder palpation?
- may have distension
- ask about pain and voiding habits to help understand what type of UTI it is

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17
Q

Define pyrexia

A

Raised body temp

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18
Q

What might some pharmacological management be for a UTI?

A
  • antibiotics

- analgesia

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19
Q

What might some non-pharmacological management be for a UTI?

A
  • heat/cold packs
  • changing positioning
  • increased fluid consumption (begin fluid balance chart to indicate urinary retention)
  • treat the structural cause if applicable e.g. remove tumor instruct
  • begin IV to increased hydration
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20
Q

What are some diagnostic tests to assess UTI and its severity/impacts?

A

Bladder scan
- feeling of fullness with urine volume under 200mls post void= UTI

Fluid balance chart
- may indicate urinary retention

Urinalysis (FWT)= should be midstream, clean catch

  • the presence of nitrates, haematuria, leukocytes (WBC), protein (albumin, h), high pH (alkaline), decreased specific gravity (SG= concentration of dissolved solutes)
  • smell= fruity, ammonia, fecal, fishy
  • colour= blood or cloudy

MCS (micro/culture/sensitivity)= urine specimen that is tested for presence of bacteria.

Blood test= can pic up bacteria from infections in upper tract or complicated UTIs that can be hard to diagnose.

Imaging=
CTKUB (CT of kidney, ureters and bladder): detects abnormalities e.g. obstruction, inflammation.
US (ultrasound): determine structural abnormalities

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21
Q

What is the term used to describe normal smelling urine?

A

Urinoid

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22
Q

How can nurses help prevent a UTI?

A
  • encourage fluid intake
  • correct aseptic technique when interventions such as IDC are being placed or drained
  • maintaining aseptic when gaining a urine sample.
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23
Q

List 6 points of education that should be provided to someone with a UTI.

A
  • importance if increased hydration
  • discuss how to prevent e.g. wiping front to back, hygiene, urinate regularly, completely empty bladder, hydration
  • discuss potential bladder irritants e.g. caffine, citrus juice, spicy foods
  • explain all diagnostics
  • provide psychological support to ensure anxiety is reduced/prevented
  • educate about prescribed medications
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24
Q

Who are some allied health care professionals that we can collaborate with for UTI treatment.

A
  • Doctor- for medication and some diagnosis
  • Occupational therapist - incontinence support, home help aides
  • Physiotherapist - exercises to support pelvic floor
  • Dietician - nutritional needs, electrolyte balance, hydration
  • Social worker - anxiety support, family support, home support
  • Pharmacist - discuss medications
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25
Q

Define Acute cystitis.
List its;
- cause
- common clinical manifestations
- which gender is it more common in and why?
- which populations are at an increased risk of infection?

A 
An acute (fast) inflammation of the bladder (Lower UTI)
- most common site for UTI

Cause= most commonly caused by E.coli followed by Staphylococcus saprophyticus

Clinical manifestations= urgency, frequency, dysuria, suprapublic/lower back main

More common in females due to shortened urethra and closeness to anus (increased contamination for bowel bacteria)

Youth (poor hygiene) and elderly (often experience delirium)

26
Q 
Define Pyelonephritis 
List its;
- cause
- complications 
- common clinical manifestations 
- what are the symptoms?
- What are common miss diagnoses?
A

Pyelonephritis= acute infection of the kidney
‘pyelo’ means pelvis and ‘neph’ refers to renal
- can effect both kidneys

Cause: ascending bacterial infection, urinary reflux and obstructions such as kidney stones and pregnancy

Complications= can lead to tubular necrosis and AKI (one or both kidneys can be involved)

Clinical manifestations= flank pain on side of infection, loin pain, fever, rigours, chills, nausea and vomiting, lethargy, malaise, symptoms of cystitis

Symptoms= this triad is a clear indicator: vomiting, flank pain, fever.

  • often misdiagnosed as appendicitis or acute abdomen
27
Q

Define and describe a Catheter acquired urinary tract infection (CAUTI)
Describe the;
- risk factors
most common causative

A

Hospital-acquired infections are typically nosocomial (originate in hospital) infections that aren’t present at the time of admission.
Risk factors= IDC’s (in for longer durations and poor quality care further increase risk)

Causatuve= E. coli

Associated complications= cystitis, pyelonephritis, prostatitis, bacteria, orchitis and epididymitis

The most preventable HAI

28
Q

List key nursing managements for prevention CAUTI.

A
  • perform hand hygiene immediately before inserting IDC
  • use strict a septic techniques (replace IDC when if aseptic technique is broken)
  • obtain urine samples via clean access port
  • if taking sample from urinary bag, keep bag lower then body, maintain aseptic status.
  • to maintain unobstructed flow od IDC bag; empty regularly, never allow the bag to get over ¾ full, use closed irrigation if obstruction is anticipated
  • for short term IDCs; avoid routinely changing the IDC or drainage bag. Only change if clinically indicated e.g. obstructed, break in closed circuit, infection
    only use an IDC for appropriate indications, not for routine use e.g. post-op, avoid use to manage incontinence
    minimise duration - only keep inserted for as long as clinically needed - this may vary and can be discussed with the patient’s medical team
    secure IDC to prevent movement and trauma to the urethra
    use the smallest bore necessary that will ensure good drainage whilst eliminating as much trauma as possible
    consider alternatives e.g. use a bladder scanner to assess urine volume instead of inserting catheter
    always clearly document all care of IDC including date, time, need for catheterisation, insertion, gauge of IDC, amount of water used to inflate balloon, reviews, observations, drainage type, total output
    adopt quality-improvement strategies e.g. education, review of practices, audits
29
Q

Define urinary retention.

  • List the clinical manifestations/presentations.

- List some complications

A
  • inability to void voluntary
  • complete lack of voiding, incomplete bladder emptying and overflow incontinence.
  • renal failure and infection

Causes =
Diabetes
Constipation
Prostatic enlargement
Urethral pathology (infection, calculi, tumour) (most common infection is acute prostatitis)
Trauma/injuries
Surgery - for example anorectal surgery, hernia repair, orthopaedic surgery
Anaesthesia - post operative - known as postoperative urinary retention (POUR)
Neurological disorders
Medications
Frailty and immobility

30
Q

Define acute urinary retention and chronic urinary retention

A

Acute urinary retention= the sudden and often painful inability to void despite having a full bladder.

Chronic urinary retention= painless retention associated with an increased volume of residual urine.

31
Q

List some nursing interventions for urinary retention.

A
  • escalate to nurse in charge and medical team
  • PHHx questions= last time voided, void volume, recent illness or symptoms
  • Pain assessment
  • Physical assessment= (Focused assessment on abdomen and renal system)
  • perform bladder scan to determine volume of bladder and PVR- post void residual(nurse initiated)

Most patients will require prompt management with immediate urinary catheterisation - you do not require a medical order to insert an IDC EXCEPT if the patient has significant urinary comorbidities e.g. benign prostatic hyperplasia

32
Q

Describe a bladder scan, who can initiae it and why it is carried out.

A

A bladder scan is a simple, non-invasive procedure that is nurse-initiated to assess the volume of urine in a patient’s bladder

This procedure is often performed prior to the insertion of a catheter or when you suspect your patient has urinary retention

33
Q 
Describe glomerulonephritis (GN)
Describe the cause.
A

a kidney disorder that involved damage/inflammation to the glomeruli (the filtration units if the kidney responsible for removing waste and toxins from blood to make urine)

Cause= unknown by may be streptococcal infection of the throat/skin an immune disease, hypertension, vasculitis or viruses such as HIV or hepatitis

  • affects both kidneys equally
  • higher risk of developing GN if of Aboriginal Torres Strait Islander descent.
34
Q

Explain the difference between Chronic GN, Primary GN and Secondary GF.

A

Chronic= develops gradually over time, progressive (usually results in irreversible kidney failure)

Primary= if GF occurs on its own

Secondary= if GN occurs in association with an immunological disorder such as diabetes or lupus

35
Q

List some risk factors from glomerulonephritis

A
  • kidney disease
  • infections e.g. post-sttreptococcal glomerulonephritis (APSGN) (most common cause, especially for children and young adults), infective endocarditis, viral infections such as tonsillitis
  • Systemic diseases (immunological disorders) e.g. systemic lupus erythematosus (SLE), scleroderma, Goodpasture’s syndrome, IgA nephropathy
  • Vasculitis = polyarteritis nodosa
  • Conditions that cause scarring of the glomeruli = hypertension, diabetic nephropathy
  • Illicit drug use
  • Cancer
36
Q

List some clinical manifestations for GN and link them to the pathophysiology.

A

Symptoms usually occur 1-3 weeks after infection, can come on suddenly or be gradual, be silent, mild, moderate or severe:

Foamy urine - proteinuria

  • Pink urine - bleeding in the upper urinary tract (infection causing pain)
  • Hypertension (poor filtration leading to water retention)

Fluid retention - swollen hands, feet, abdomen, face (poor filtration leading to water retention)

Shortness of breath

Nocturia

37
Q

Explain the pathophysiology of GN

A

Disease occurs which triggers an immunological response

→ deposition of immune antigen-antibody complexes or antibodies specific for glomerular basement membrane

→ activation of biochemical mediators of inflammation e.g. complement, cytokines

→ cell lysis & attraction of neutrophils, monocytes & T cells (Bowman space)

→ release of oxidants and lysosomal enzymes increasing inflammatory response

→ damage to glomerular epithelial cells & basement membrane (increases permeability & decreases glomerular membrane surface area)

→ decreased glomerular blood flow and GFR, decreased hydrostatic pressure, hypoxic injury, platelet aggregation

→ glomerular sclerosis, interstitial fibrosis and glomerular thrombosis

→ proteinuria, haematuria

→ acute kidney injury and renal failure

38
Q

Explain the diagnosis of GN

A
  • accurate clinical history (progressive development of signs and symptoms)
  • urinalysis (elevated protein and erythrocytes)
  • Bloods= renal function= FBE, UEC, CRP
  • renal biopsy
39
Q

Name some nursing management interventions for GN

A
  • accurate assessment including clinical history= diagnose, guide are and ensure patient comfort
  • Interventions= urinalysis, vital signs, bloods, fluid balance chart, medications as per chart
  • Documentation (clear and accurate documentation e.g. fluid balance, vital signs, progress notes)
  • education and support
40
Q

Explain some medical management strategies for GN for both acute and chronic GN and

A

Acute

  • Mostly conservative management
  • Treat primary disease e.g. antibiotics to treat infection
  • Prevent & minimise immune response
  • Occasionally may need; antihypertensives to control blood pressure and corticosteroids to reduce inflammatory response

Chronic

  • No treatment
  • Diet changes = low salt, protein and potassium
  • Diuretics to manage fluid retention
  • Antihypertensives
41
Q

What is Acute kidney injury (AKI)

A

This is a clinical syndrome characterised by
- sudden decline in renal function with or without a decrease in urine output (oliguria)= this inhibits kidneys ability to regulate fluid, electrolytes and acid-base balance.

  • it incorporates all stages from slight deterioration in function to sever impairment that occurs during renal failure.
  • potentially reversible but only with early diagnosis and treatment
42
Q

Define oliguria

A

a decrease in urine output

43
Q

What are key characteristics of an AKI?

What is the effects of these characteristics?

A
  • rapid onset= within hours to days
  • Rapid loss of kidney function= 25% of normal or GFR 25-30ml/min

Effects include;

  • azotaemia (an elevation of blood urea nitrogen (BUN) and serum creatinine levels)
  • uraemia (build up of toxins in the body)- symptoms exhibited
  • fluid imbalances
  • electrolytes imbalances
  • acid-base imbalance
44
Q

List some risk factors of an AKI

A
  • Trauma e.g. burns, blunt force, shearing injuries, stabbing, crush injury
  • Surgery
  • Shock e.g. sepsis, anaphylaxis
  • Decreased cardiac output e.g. myocardial infarction
  • Dehydration
  • Hypovolaemia, hypoxaemia, hypotension
  • Nephrotoxic agents e.g. drugs (some antibiotics such as gentamicin), iodinated radiocontrast agents, heavy metals
  • Age >70
  • Comorbidities or illnesses e.g. chronic diseases of the heart, lungs and liver, diabetes mellitus, anaemia
  • Hospital admission - 1-5% of patient and 20-50% of all ICU patients
45
Q

What are the clinical manifestations of an AKI?

A

Urinary

  • oliguria
  • proteinuria
  • ↓ specific gravity
  • haematuria

Cardiovascular

  • volume overload
  • congestive heart failure
  • hypotension (early)
  • hypertension (late)
  • arrhythmias
  • tachycardia

Respiratory

  • tachypnoea
  • dyspnoea

Integumentary

  • pruritus
  • dry skin

Haematological

  • anaemia (develops within 48 hours)
  • increased susceptibility to infection
  • defect in platelet functioning
Gastrointestinal
- nausea
- vomiting
metallic taste in mouth
- anorexia
- dry oral mucosa
Metabolic
↑ urea
↑ creatinine
↓ sodium
↑ potassium
↓ pH
↓ bicarbonate
↓ calcium
↑ phosphate

Neurological

  • lethargy
  • seizures
  • memory impairment
  • altered conscious state
46
Q

What are the 3 pathophysiological types of AKIs?

A

Prerenal AKI
Intrarenal AKI
Postrenal AKI

47
Q

Describe the pathophysiology and examples of Prerenal AKI

A
  • Caused by conditions that decrease renal blood flow and perfusion therefore injury occurs before the kidney
  • can lead to intrarenal disease if renal ischaemia is prolonged
  • most common cause = 55-60% of all cases of AKI
    PATHOPHYSIOLOGY

↓ systemic blood flow

→ ↓renal blood flow

→ ↓ perfusion to kidneys

→ ↓ glomerular perfusion and/or filtration pressure

→ ↓ GFR

→ oliguria, ↑ serum creatinine = AKI

EXAMPLES

Drugs that results in renal vasoconstriction (e.g. NSAIDs)
Hypoperfusion = hypotension, hypovolaemia, haemorrhage, poor cardiac output

48
Q

Describe the pathophysiology and examples of Intrarenal AKI

A

Occurs due to direct damage to renal parenchyma which causes impairment to nephron function therefore direct kidney injury
Most commonly caused by acute tubular necrosis (ATN) secondary to prerenal acute kidney injury (90% of intrarenal AKI cases)
2nd most common phase = 35-40% of all AKI cases
PATHOPHYSIOLOGY

Hypovolaemia

→ hypotension

→ ↓ renal blood flow

→ ↓ perfusion to kidneys

→ ischaemia

→ production oxygen-free radicals (toxins)

→ disruption of tubular epithelium

→ cell swelling, cell injury and cellular necrosis (ATN)

→ ↓ GFR, oliguria, ↑ serum creatinine = AKI

Nephrotoxins

→ necrosis of tubular epithelial cells

→ cells slough off

→ tubules occlude

→ cell injury and cellular necrosis (ATN)

→ ↓ GFR, oliguria, ↑ serum creatinine = AKI

EXAMPLES

Nephrotoxic agents (e.g. iodinated radiocontrast agents, some antibiotics such as gentamicin)
Acute glomerulonephritis, sepsis
Vascular disease = thrombotic disorders, prolonged renal ischaemia (up to 50% of post-op patients)
Trauma = crush injury
49
Q

Describe the pathophysiology and examples of postrenal AKI

A

Occurs due to a mechanical obstruction of urinary outflow resulting in reflux and impaired kidney function
Always treatable if identified before permanent damage occurs
Follows several hours of oliguria with lower urinary symptoms (frequency and hesitancy), with flank pain then polyuria.
Least common phase → <5% of all AKI cases
PATHOPHYSIOLOGY

Obstruction

→ urine reflux into renal pelvis

→ ↑intraluminal pressure upstream from obstruction

→ kidney dilation (hydronephrosis)

→ ↑ hydrostatic pressure

→ tubular blockage

→gradual ↓ GFR, oliguria, ↑ serum creatinine = AKI

EXAMPLES

All conditions that can cause obstruction of urine outflow e.g. prostatic hypertrophy, neurogenic bladder, bilateral ureteral obstruction or destruction from oedema, clots, stones, tumours.

50
Q

What are the four stages of an AKI and what are the characteristics of each?

A

Regardless of cause or type, AKI is progressive and follows a course characterised by 4 stages.

Initiation (onset) stage

Begins with the onset of event that causes ATN → ↓ perfusion and toxicity → evolving kidney injury
May span several hours to 2 days
Patients can be asymptomatic
If AKI is recognised and interventions commenced at this stage, prevention of injury is possible and the prognosis is good
The initiation phase ends when renal damage occurs

Maintenance Stage
Begins within hours of initiating event and can last weeks to months
Renal damage well established
Characterised by persistent oliguria and elevated serum creatinine & blood urea nitrogen (BUN)
Necrotic cells are sloughed → tubular obstruction → ↓ GFR & urine output → inability to eliminate metabolic wastes, water, electrolytes and acids
Characterised by urinary changes, azotaemia, fluid retention, neurological disorders, metabolic acidosis and electrolyte imbalances = hyponatraemia, hyperkalaemia, hypocalcaemia, hyperphosphataemia

Diuretic Stage
Gradual rise in urine output
Nephrons not fully functioning
Excretes wastes but does not make urine concentrated
Risk of hypovolaemia and hypotension
Normalise fluid, electrolyte and acid-base balance

Recovery Stage
Begins when GFR and the renal tissues repair themselves and renal function is re-established
Phase may take 3 – 12 months but some patients may not have full renal function recovery
Progressive ↑ in urine output
Improvement in pathology results → ↓ serum creatinine & urea levels, ↑ creatinine clearance

51
Q

List some health history questions that should be asked to diagnose an AKI

A

Focus for health history questions:

new onset of dysuria
changes to frequency / urgency
new onset of incontinence
any nocturia
haematuria
any comorbidities e.g. diabetes, hypertension
exposure to nephrotoxins
Examples of health history questions

Do you have any symptoms such as frequency, urgency, pain on urination, incontinence, fevers, abdominal/lower back/flank pain?
Have you noticed any changes to your usual urinary function?
What colour is your urine?
Do you have difficulty passing urine? if so, how long has this been happening?
Do you feel like you have a problem with your kidney or bladder function?
How does your urine function impact your life?
What is your past medical/surgical history e.g hypertension, cardiac disease, diabetes etc.

52
Q

How do you assess a patient for an AKI?

A
  • Health history
  • physical assessment
  • Nursing management
  • medical management
53
Q

List some health history questions that should be asked to diagnose an AKI

A

Focus for health history questions:

new onset of dysuria
changes to frequency / urgency
new onset of incontinence
any nocturia
haematuria
any comorbidities e.g. diabetes, hypertension
exposure to nephrotoxins
Examples of health history questions

Do you have any symptoms such as frequency, urgency, pain on urination, incontinence, fevers, abdominal/lower back/flank pain?
Have you noticed any changes to your usual urinary function?
What colour is your urine?
Do you have difficulty passing urine? if so, how long has this been happening?
Do you feel like you have a problem with your kidney or bladder function?
How does your urine function impact your life?
What is your past medical/surgical history e.g hypertension, cardiac disease, diabetes etc.

54
Q

Explain some of the interprofessional care relationships that may exist and aid in the treatment of an AKI.

A 
Nursing team
accurate documentation e.g. progress notes
ISBAR handover
discuss concerns and progress
Liaise with treating

medical team (documentation and verbal discussion)
how often to perform venepuncture
dose adjustments of medications
results of diagnostics such as urinalysis and bladder scan
fluid replacement requirements
red flags with assessment such as changes to urine output, abnormal vital signs, met call criteria
Liaise with Allied health

Dietician
nutritional needs
electrolyte balances
hydration

Social worker
anxiety
family support
home support

OT
home aides / support

Physio
exercises,pelvic floor

Pharmacist
discuss medications

55
Q

What is the indication for a nephrostomy tube?

A

*When a ureter becomes completely obstructed, a nephrostomy tube can be inserted on a temporary basis to preserve renal function.

Causes of ureter obstruction include:

renal calculi
masses of crystals, protein or other substances
infection
anatomical abnormalities
trauma
56
Q

Explain some of the interprofessional care relationships that may exist and aid in the treatment of an AKI.

A 
Nursing team
accurate documentation e.g. progress notes
ISBAR handover
discuss concerns and progress
Liaise with treating medical team (documentation and verbal discussion)
how often to perform venepuncture
dose adjustments of medications
results of diagnostics such as urinalysis and bladder scan
fluid replacement requirements
red flags with assessment such as changes to urine output, abnormal vital signs, met call criteria
Liaise with Allied health
Dietician
nutritional needs
electrolyte balances
hydration
Social worker
anxiety
family support
home support
OT
home aides / support
Physio
exercises,pelvic floor
Pharmacist
discuss medications
57
Q

What is the indication for a nephrostomy tube?

A

*When a ureter becomes completely obstructed, a nephrostomy tube can be inserted on a temporary basis to preserve renal function.

Causes of ureter obstruction include:

renal calculi
masses of crystals, protein or other substances
infection
anatomical abnormalities
trauma
58
Q

What are some post op nursing managements for nephrostomy tubes?

A
  • Regular vital signs = half hourly vital signs for 2 hours, hourly for 2 hours, then 4 hourly for 24 hours.
  • Pain management is essential and should be administered both prior to the procedure and regularly post-procedure.
  • Accurate fluid balance chart = urine measures hourly for the first 4 hours then every 4 hours for 24.
  • Drainage site assessment for bleeding = checked every hour for the first 4 hours, then every 4 hours for the next 24 hours
  • Ensure adequate hydration - the patient would have been nil by mouth for at least 6 hours prior to the procedure
  • Bed rest for 4 hours
  • Ensure drainage bag is placed below the level of the kidney at all times

Inform the doctor if:

  • urine output drops below 30mls over 1 hour, or
  • urine becomes heavily blood stained (some haematuria is normal and should decrease over the first 48 hours)
  • patient develops abnormal vital signs e.g. temperature above 38, hypotension, tachycardia
59
Q

List some on going nursing considerations for nephrostomy tubes

A
  • assess urine output / maintain strict fluid balance chart
  • monitor colour in drainage bag e.g. check for haematuria
  • monitor for signs of UTI e.g. vital signs
  • monitor for pain, inflammation, infection at drain site
  • wound management
  • assessment, dressing changes using aseptic technique
  • regular emptying of the drainage bag with appropriate
  • hand hygiene
  • irrigation of nephrostomy tube daily under aseptic technique
  • as instructed by the patient’s medical team
    and / or as per Organisational guidelines = 2-10mls of normal saline and no more than 20mls at a time
  • nephrostomy tube must be connected to a sterile closed drainage system
  • drainage bag should be below the level of the kidneys at all times
  • inspect tube to ensure it is secure with no obstruction and no leakage e.g. kinked tube, sediment, leaking from connection
  • communicate and document all treatment, progress and concerns i.e. tube not flushing, fevers, increased pain, urine output less than 30mls per hour
  • encourage fluid intake
  • maintain adequate analgesia
  • education and support
60
Q

What are some post op nursing managements for nephrostomy tubes?

A

Regular vital signs = half hourly vital signs for 2 hours, hourly for 2 hours, then 4 hourly for 24 hours.
Pain management is essential and should be administered both prior to the procedure and regularly post-procedure.
Accurate fluid balance chart = urine measures hourly for the first 4 hours then every 4 hours for 24.
Drainage site assessment for bleeding = checked every hour for the first 4 hours, then every 4 hours for the next 24 hours
Ensure adequate hydration - the patient would have been nil by mouth for at least 6 hours prior to the procedure
Bed rest for 4 hours
Ensure drainage bag is placed below the level of the kidney at all times
Inform the doctor if:
urine output drops below 30mls over 1 hour, or
urine becomes heavily blood stained (some haematuria is normal and should decrease over the first 48 hours), or
the patient develops abnormal vital signs e.g. temperature above 38, hypotension, tachycardia

61
Q

List some on going nursing considerations for nephrostomy tubes

A

assess urine output / maintain strict fluid balance chart
monitor colour in drainage bag e.g. check for haematuria
monitor for signs of UTI e.g. vital signs
monitor for pain, inflammation, infection at drain site
wound management
assessment, dressing changes using aseptic technique
regular emptying of the drainage bag with appropriate hand hygiene
irrigation of nephrostomy tube daily under aseptic technique
as instructed by the patient’s medical team
and / or as per Organisational guidelines = 2-10mls of normal saline and no more than 20mls at a time
nephrostomy tube must be connected to a sterile closed drainage system
drainage bag should be below the level of the kidneys at all times
inspect tube to ensure it is secure with no obstruction and no leakage e.g. kinked tube, sediment, leaking from connection
communicate and document all treatment, progress and concerns i.e. tube not flushing, fevers, increased pain, urine output less than 30mls per hour
encourage fluid intake
maintain adequate analgesia
education and support

NUR2226 (9 decks)

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