UNIT 5 URINARY PNUR138

understand normal and abnormal assessment findings related to the urinary system.

GFR greater than 60mL/minute

describe the normal function of the urinary system.

decreased oxygen levels stimulate the kidneys to produce erythropoietin

list the effects of aging on the urinary system.

nocturia and frequency caused by weaker bladder muscles and decreased bladder capacity

higher risk for nephrotoxicity from medications

decreased tubular function

decreased renal flow by 50%

smaller renal mass

delayed voiding reflex

nursing care for clients undergoing urine culture testing

obtain culture first thing in the morning due to high concentrations of different factors present in urine

nursing care for clients undergoing urinalysis testing

ensure sterile specimen container and sterilizing wipe are being used by client prior to voiding into cup

nursing care for a client undergoing a cystoscopy procedure

encourage fluids

note color/amount/pain during urination

educate on possible side effects like pink-tinged urine

educate on possible infection side effects

monitor for urinary retention after

nursing care for a client undergoing a pyelogram procedure

monitor bp, insertion site, color, and amount of urine excreted

encourage fluids

report any abdominal pain

may have an order for a bowel cleanse prior to procedure

nursing care for a client undergoing 24hr urine specimen collection testing

collect ALL voided urine in the 24hr period, do not miss a drop

start in the morning, discard first void at test start time

if pt starts at 8am, collect until 8am the next day

at exactly 24hrs later, have pt urinate and keep void as final sample for collection

kidney function lab test: serum creatinine

very good indicator of kidney function

measures how well kidneys are filtering waste from blood

serum creatinine normal value for adult

0.51-1.21 mg/dL

kidney function lab test: blood urea nitrogen

measures level of urea nitrogen present in blood

BUN normal value for adult

8-21 mg/dL

kidney function lab test: serum uric acid

measures level of uric acid present in blood

elevated serum uric acid levels

increases risk for kidney stones

kidney function lab test: glomerular filtration rate (GFR)

renal filtrate formed by kidneys in one minute

GFR normal value for adult

above 60 mL/min

average GFR for adult

100-125 mL/min

relationship between contrast medium and the kidneys

contrast dye is nephrotoxic

contrast dye is filtered by kidneys

pts with impaired kidney function have higher risk for contrast-induced nephropathy

always check BUN and creatinine before contrast procedure

encourage fluids after procedure to flush remaining contrast dye from pt's body

normal urinalysis findings: color

yellow or amber

normal urinalysis findings: appearance

clear

normal urinalysis findings: odor

light ammonia

normal urinalysis findings: pH

4.5-8.0

normal urinalysis findings: specific gravity

1.005-1.030

normal urinalysis findings: protein

less than 20mg/dL

normal urinalysis findings: glucose

neg

normal urinalysis findings: ketones

neg

normal urinalysis findings: bilirubin

neg

normal urinalysis findings: nitrite

neg

normal urinalysis findings: leukocyte esterase

neg

normal urinalysis findings: rbc

less than 5/hpf

normal urinalysis findings: wbc

less than 5/hpf

abnormal urinalysis findings: color

dark amber (dehydration)

brown/green (excessive bilirubin; liver function related)

red/pink (hemoglobin present; kidney function related)

abnormal urinalysis findings: appearance

cloudiness (microorganisms present; possible infection)

abnormal urinalysis findings: odor

foul smell (infection)

fruity smell (diabetes)

abnormal urinalysis findings: pH

low (CKD)

high (infection; renal disease)

abnormal urinalysis findings: specific gravity

low (diabetes insipidus; excessive fluid intake)

high (dehydration; shock)

VERY high (rbc; kidney disease)

abnormal urinalysis findings: protein

more than 20mg/dL (kidney impairment)

abnormal urinalysis findings: glucose

pos (diabetes mellitus; excessive glucose intake)

abnormal urinalysis findings: ketones

pos (diabetes mellitus)

abnormal urinalysis findings: bilirubin

pos (liver disorder)

abnormal urinalysis findings: nitrite

pos (infection)

abnormal urinalysis findings: rbc

greater than 5/hpf (kidney stone; trauma)

abnormal urinalysis findings: wbc

greater than 5/hpf (infection; inflammation)

abnormal urinalysis findings: leukocyte esterase

pos (infection)

nursing care for stress incontinence

pelvic floor exercises (Kegels)

bladder training

PT intervention

nursing care for urge incontinence

bladder training

medications (anticholinergics)

nursing care for functional (disability) incontinence

improve environment for pt to reach bathroom/urinal/commode easier

ensure proper lighting

frequent checks on pt

nursing care for overflow incontinence

scheduled toileting

nursing care for total incontinence

brief use for pt

frequent, thorough perineal care

check skin integrity frequently (keep area dry)

change briefs often

nursing care to decrease risk of infection in urinary catheterized pts

maintain sterile technique when catheterizing pt

keep catheter in for as short of a period of time as possible

predisposing causes of urinary tract infections (UTIs)

anatomical factors

obstruction

urinary stasis

instrumentation

immunosuppression

hygiene and lifestyle

predisposing causes of UTIs: anatomical factors

shorter urethra in females

congenital urinary tract abnormalities

predisposing causes of UTIs: obstruction

kidney stones

enlarged male prostates

strictures

predisposing causes of UTIs: urinary stasis

neurogenic bladder

vesicoureteral reflux (VUR)

predisposing causes of UTIs: instrumentation

catheterization

recent urinary tract procedures

predisposing causes of UTIs: immunosuppression

diabetes mellitus

HIV

chemotherapy

predisposing causes of UTIs: hygiene/lifestyle

poor perineal hygiene

frequent sexual activity

spermicide use

dehydration

UTI types

cystitis

urethritis

pyelonephritis

cystitis affects

bladder

urethritis affects

bladder and urethra

pyelonephritis affects

the kidneys

adult UTI sx

dysuria

hematuria

suprapubic or flank pain

urinary frequency and urgency

elderly UTI sx

altered mental status (confusion; delirium)

UTI lab value abnormality for UA

pos leukocyte esterase (pyuria)

pos nitrites

hematuria

bacteria present

UTI lab value abnormality for urine culture

confirms causative organism (bacteria)

> 100,000 CFU/mL is diagnostic

UTI lab value abnormality for cbc

elevated wbc in pylonephritis

UTI lab value abnormality for blood cultures

ordered if sepsis is suspected

UTI lab value abnormality for renal function tests

ordered if complicated UTI occurs

UTI nursing care

monitor VS and sx (check for fever, flank pain, and signs of sepsis)

encourage fluid intake for hydration

administer antibx as prescribed

administer analgesics to control pain and discomfort

education on hygiene and prevention

general UTI education

catheter care (If applicable)

UTI hygiene and prevention pt education

wipe front to back

avoid douching or irritating feminine products

urinate before and after sexual intercourse

general UTI pt education

recognize early signs of UTI - be familiar with s/s

complete full course of antibx (don't save antibx)

prevent recurrent infections with lifestyle modifications

renal calculi patho

hard, crystal deposits in the urinary tract from concentrated uric acid and calcium that begin to build up

renal calculi etio

dehydration

dietary factors

family hx of kidney stones

renal calculi sx

painful urination

hematuria

therapeutic interventions for renal calculi

pushing fluids; encouraging fluid intake

pain management

procedure to break up kidney stones

complications of renal calculi

infection (UTI; sepsis)

blockage of urinary tract

hydronephrosis

shock

preventative measures for renal calculi

hydration

diet change to limit intake of foods high in calcium and animal proteins

nursing care for renal calculi

assess and monitor pain

encourage fluid intake

monitor I&Os

monitor VS

strain all urine for expelled kidney stones

risk factors for bladder cancer

smoking

chemical exposure

chronic UTIs

age >60

bladder cancer early sx

painless hematuria

bladder cancer late sx

pelvic pain

dysuria

weight loss

urinary retention

nursing care for ideal conduit or continent reservoir pt

monitor urine output

monitor skin integrity

monitor stoma care

provide education on appliance use and signs of infection

body image support for pt

has to be catheterized regularly (can be done by pt or someone else who has been taught how)

diabetic nephropathy patho

long term complication of DM; atherosclerotic changes (plaque buildup) decrease blood to kidney

nephrosclerosis patho

HTN damages kidney by sclerotic changes (hardening of arteries and arterioles of the kidneys)

hydronephrosis patho

kidneys swell due to urine buildup that cannot be expelled due to blockage/obstruction

glomerulonephritis patho

antibodies form complexes that damage the basement membrane of the glomerulus, causing inflammation and impairing kidney filtration (function)

nursing care for glomerulonephritis

monitor VS

rest

sx support (control sx)

pt education for dietary changes and restrictions (fluid, sodium, protein restrictions)

diet for glomerulonephritis

low protein

low sodium

low phosphorus

low potassium

increase fiber intake

increase fluid intake

acute kidney injury (AKI) patho

sudden loss of kidney function due to injury or illness

AKI phases

oliguric

diuretic

recovery

AKI oliguric phase

less than 400 mL/day

AKI diuretic phase

high urine output, low specific gravity

AKI recovery phase

kidneys regain ability to concentrate urine

anuria

less than 50 mL/day

absence of urine output

oliguria

less than 400 mL/day

low urine output

AKI s/s

oliguria

fluid retention

electrolyte imbalances

nursing care for AKI pts

monitor I&Os

manage and maintain fluid and electrolyte levels

chronic kidney disease (CKD) dietary changes

high calorie

low protein (unless on dialysis)

low sodium

low potassium

low phosphorus

increased calcium intake

vitamins (D)

fluid restriction

CKD s/s

NV

anorexia

cardiac dysthymias

uremia (uremic frost)

electrolyte imbalances (hyperkalemia, hyponatremia, and hypocalcemia)

decreased rbc (anemia)

fluid retention (edema)

GFR less than 60

oliguria/anuria

HTN

therapeutic measures for CKD

dialysis

Kayexalate

diuretics

antihypertensives

vit d/calcium supplements