Urinary and Renal Disorders: Urinary Tract Infection, Acute Pyelonephritis, Obstructive Uropathies, Ureteral Strictures, Urinary Incontinence, Urinary Retention, Acute Poststreptococcal Glomerulonephritis, Chronic Glomerulonephritis, Polycystic Kidney Disease, Renal Failure, Hyperkalemia, Hyperphosphatemia, and Hypernatremia

What is pyelonephritis?

it is an upper urinary tract infection involving the kidneys and ureters

What is cystitis?

it is a lower urinary tract infection involving the bladder

What is urethritis?

it is a lower urinary tract infection involving the urethra

What are some signs or symptoms of Urinary Tract Infection?

• hematuria

• cloudy urine

• foul urine odor

Emptying:

• hesitancy

• intermittency

• post-void dribbling

• urinary retention

• incomplete emptying of bladder

• dysuria

Storage

• urinary frequency

• urinary urgency

• incontinence

• nocturia

• nocturnal enuresis

What is a complication of a Urinary Tract Infection?

Pyelonephritis is a complication

What are some labs and diagnostic tests for Urinary Tract Infection?

• urinalysis (+nitrates, WBCs, leukocytes)

• urine culture and sensitivity 

• ultrasound

• CT scan

• cystoscopy (camera & scope to look inside the bladder by a urologist)

What are some nursing actions and intervention for Urinary Tract Infection?

• administer phenazopyridine (AZO) for symptom relief

• administer prophylactic antibiotics for 3 days

What are some teachings for Urinary Tract Infection and Acute Pyelonephritis?

• tell pt. to drink lots of water

• tell pt. to avoid irritating foods such as dairy, caffeine, alcohol, spicy foods, smoking, sodas, and sugar

• tell pt. that orange urine is normal when taking medications

• tell pt. to apply heat for comfort

What are some risk factors for Acute Pyelonephritis?

• pregnancy

• female

What are some signs and symptoms of Acute Pyelonephritis?

• fever

• flank pain

• costovertebral tenderness

• chills

• fatigue

• anorexia

What are some complications of Acute Pyelonephritis?

• chronic pyelonephritis

• kidney disease

• kidney death

What are some labs and diagnostic tests for Acute Pyelonephritis?

• urinalysis (pyuria, bacteriuria, hematuria, WBC casts)

• urine culture and sensitivity

• blood cultures

• basic metabolic panel 

• ultrasound

• CT scan

• possible voiding cystourethrogram to check for backflow of urine

• cystoscopy

What are some nursing actions and interventions for patients with Acute Pyelonephritis?

• give pt. fluids

• administer NSAIDs

• collect followup urinary cultures and sensitivity

• administer oral antibiotics for 7-10 days

• administer IV antibiotics for 14-21 days

• watch for relapses or recurrence

• monitor for urosepsis

What are some common causes of Obstructive Uropathies?

• urinary tract calculi (kidney stones)

• strictures

• enlarged prostate

What are some signs and symptoms of Obstructive Uropathies?

• acute sharp, severe pain in flank area

• acute sharp severe pain in back or lower abdomen

• nausea and vomiting 

• fever

• chills

• urinary tract infection

What are some complications of Obstructive Uropathies?

• hydronephrosis

• acute kidney injury 

• chronic kidney disease

What are some surgical interventions for Obstructive Uropathies?

• lithotripsy (uses sound waves to break up stones) 

• ureteral stent placement

What are some labs and diagnostic tests for Obstructive Uropathies?

• non contrast abdominal/pelvic CT scan

• ultrasound

• abdominal x-ray

• urinalysis

• 24hr urine collection

• stone analysis

What are some nursing actions and interventions for Obstructive Uropathies?

• administer analgesics and NSAIDs when ordered

• administer alpha-adrenergic blockers (tamsulosin) to help relax bladder muscles

What are Ureteral Strictures?

they are narrowing of the ureter

What are some signs and symptoms of Ureteral Strictures?

• moderate to mild renal colic

• flank pain

• costovertebral angle tenderness 

What are some surgical interventions for Ureteral Strictures?

• surgical bypass with stent

• nephrostomy tube replacement 

• ureteroureterostomy

• endarterectomy

• ureteroneocystostomy

What are the types of Urinary Incontinence?

• functional-limited mobility/cognitive issues

• overflow-obstruction, neurogenic

• reflex-spinal cord injury

• stress-cough, sneeze, laugh, bearing down

• urge-overactive bladder

What are some labs and diagnostic tests for Urinary Incontinence?

• urinalysis

• bladder scan for post void residual 

• cystoscopy 

• urodynamics

What is Acute Urinary Retention?

it is a medical emergency due to refluxing urine, hydronephrosis

What can cause Chronic Urinary Retention?

• untreated benign prostatic hyperplasia 

• diabetes

• chronic alcoholism

• neurogenic condition

What are some labs and diagnostic tests for Urinary Retention?

• urinalysis

• bladder scan for post void residual

• voiding diary

• cystoscopy

• urodynamics

What are some patient teachings for Urinary Retention?

• for pt with chronic urinary retention, teach them to self-catheterize 

• for pt, with chronic urinary retention, tell them they may have a long-term indwelling catheter

• tell pt. with chronic urinary retention, teach them to do timed voiding 

• tell pt. with acute urinary retention, they may have to have surgery

What is Acute Poststreptococcal Glomerulonephritis?

 it is inflammation of the glomeruli that affects both kidneys 

When does Acute Poststreptococcal Glomerulonephritis develop?

it develops 1 to 2 weeks after an infection of tonsils, pharynx, or skin by nephrotoxic strains of groups A beta-hemolytic streptococci

What are some signs and symptoms of Acute Poststreptococcal Glomerulonephritis?

• generalized edema

• hypertension

• oliguria

• vary degree of proteinuria

• fluid retention

• abdominal pain

• flank pain

What are some labs and diagnostic tests for Acute Poststreptococcal Glomerulonephritis?

• ASO titers blood tests

• Renal Biopsy

• urinalysis dipstick and urine sediment microscopy

• BUN and creatinine

What are some nursing actions and interventions for Acute Poststreptococcal Glomerulonephritis?

• restrict sodium and fluids

• administer diuretics to decrease edema

• administer antibiotics if streptococcal infection is still present 

What is Chronic Glomerulonephritis?

it is chronic syndrome of permanent and progressive renal fibrosis

What are some signs and symptoms of Chronic Glomerulonephritis?

• hematuria

• proteinuria

• urinary excretion of RBC, WBC, casts

• increases BUN

• increased creatinine

What is a complication of Chronic Glomerulonephritis?

end-stage renal disease

What are some labs and diagnostic tests for Chronic Glomerulonephritis?

• ultrasound

• CT scan

• renal biopsy

What is Polycystic Kidney Disease?

it is when the cortex and medulla within the kidney are filled with large cysts

What are some signs and symptoms of Polycystic Kidney Disease?

• hypertension

• hematuria

• flank pain

• flank heaviness

• urinary tract infection

• kidney stones

What are some complications of Polycystic Kidney Disease?

• liver cysts

• heart valve abnormalities

• aneurysms

• diverticulosis

• cerebral aneurysm

What are some patient teachings for Polycystic Kidney Disease?

• tell pt. they are most likely going to be put on dialysis

• tell pt. they may need a real transplant

What is Renal Failure?

it is partial or complete impairment of kidney function

What are some common causes of Renal Failure?

• diabetes

• hypertension

• glomerulonephritis 

• cystic disease

• urological diseases (UTI, urinary retention, kidney stones)

What is Acute Kidney Injury?

• rapid loss in renal function

• last less than 3 months

• may lead to chronic kidney disease

What is Chronic Kidney Disease?

• progressive, irreversible loss in renal function

• last longer than 3 months

• stages 1,2,3a,3b,4,5 (end-stage renal disease)

What are some labs and diagnostic tests for Renal Failure?

• urinalysis

• CBC

• GFR

• creatinine clearance

• lipid panel

• protein-to-creatinine ratio

• renal ultrasound

• CT scan

• renal biopsy

What are some nursing actions and interventions for Renal Failure?

• administer calcium supplements, phosphate binders or both when ordered

• administer antihypertensive medications when ordered

• administer ACE inhibitors or ARBs when ordered

• administer erythropoietin medications 

• administer lipid-lowering medications when ordered

• monitor for weight gain

What is Hyperkalemia?

it is a high potassium level

• life threatening if reaches 7 to 8 mEq/L

What are some nursing actions and interventions for patients with Hyperkalemia?

• try to keep potassium level below 5.5

• administer osmotic laxatives 

• monitor EKG changes

What is a patient teaching for Hyperkalemia?

tell pt. to avoid high potassium foods like potatoes, avocados, prunes, cooked spinach, bananas

What are some nursing actions and interventions for patients with Hyperphosphatemia?

• administer renvela, renagel, or phoslo when ordered

• administer stool softeners if constipation occurs

• try to keep phosphorus levels below 4.5

What are some patient teachings for Hyperphosphatemia?

• tell pt. to take phosphorus medication with food

• tell pt. medications can cause constipation

• tell pt. to avoid meat and dairy products

What are some complications of Hypernatremia?

• edema

• hypertension

• heart failure

What are some patient teachings for Hypernatremia?

• tell pt to limit sodium consumption to 2 g per day

• tell pt. to avoid high sodium foods like canned/frozen foods, cold cuts, pickled foods