Renal & Urologic Disorders

Care of the Adult with Renal & Urologic Disorders

Course Information

  • Course Title: Care of the Adult with Renal and Urologic Disorders

  • Course Code: NSG 331

  • Institution: Marian University

  • Program: Accelerated Nursing Programs

Structures and Functions of the Urinary System

  • Upper Urinary System:

    • Kidneys:

    • Form urine

    • Ureters:

    • Drain urine to the bladder

  • Lower Urinary System:

    • Urinary Bladder:

    • Stores urine

    • Urethra:

    • Passage for urine to leave the body

Gerontologic Considerations/Effects of Aging on the Urinary System

  • Physiologic Changes:

    • Kidney:

    • Decreased renal blood flow leads to decreased glomerular filtration rate (GFR)

    • Altered hormonal levels result in:

      • Decreased ability to concentrate urine

      • Altered excretion of water, sodium, potassium, and acid

    • Urethra and Bladder:

    • Female:

      • Decreased elasticity and muscle support lead to increased infections and incontinence

    • Male:

      • Enlarged prostate alters urinary patterns

Nursing Assessment of Renal System

  • Key Components of Assessment:

    • Health Information & History:

    • Previous kidney disease or urologic problems

    • Health issues affecting kidney function

    • Medications:

      • Include over-the-counter (OTC), prescription, and herbal substances

      • Assess for nephrotoxic drugs which may alter urine quantity and character

    • Surgery or Treatments:

      • Previous hospitalizations related to renal or urologic issues, radiation, or chemotherapy

    • Physical Exam:

    • Inspection and palpation are crucial components of the examination

Diagnostic Tests

  • Radiologic Studies:

    • Bowel preparation is required to enhance visualization

    • Note: Iodine-based contrast can potentially cause contrast-induced nephropathy (CIN) and allergic reactions

  • Cystoscopy:

    • Examination of the bladder

  • Urinalysis:

    • Collected using the first morning void; examine specimen within 1 hour of collection

    • Creatinine Clearance:

    • The most accurate indicator of renal function

    • Requires 24-hour urine collection and blood specimen

    • Closely approximates GFR

Manifestations of Urinary System Disorders

  • General Manifestations:

    • Fatigue, headache (HA), blurred vision

    • Elevated blood pressure (BP)

    • Anorexia, nausea/vomiting (N/V)

    • Chills, itching, excessive thirst

    • Change in body weight, cognitive changes

  • Edema Manifestations:

    • Periorbital, ankle, ascites, anasarca, sacral edema

  • Pain Symptoms:

    • Dysuria, flank or costovertebral angle pain, groin, suprapubic pain

  • Patterns of Urination:

    • Frequency, urgency, hesitancy or change in stream, retention, dysuria, nocturia, incontinence, stress incontinence, dribbling

  • Urine Output Characteristics:

    • Anuria, oliguria, polyuria

  • Urine Composition Details:

    • Concentrated, dilute, hematuria, pyuria, color variations (red, brown, yellowish green)

Urinary Tract Infections (UTIs)

  • Risk Factors:

    • Obstruction (such as stones)

    • Urinary retention

    • Renal impairment

    • Foreign bodies (like catheters)

    • Anatomic factors (like congenital anomalies)

    • Compromised immune response

    • Functional disorders

    • Other contributing factors

Acute Pyelonephritis

  • Definition:

    • Inflammation of renal parenchyma and collecting system

  • Pathophysiology:

    • Initial colonization of the lower urinary tract, usually from urethra

    • Preexisting factors include:

    • Vesicoureteral reflux (urine moves from lower to upper urinary tract)

    • Dysfunction of lower urinary tract, such as obstruction, stricture, or stones

    • Common in catheter-associated urinary tract infection (CAUTI) among long-term care residents

    • Pregnant women more susceptible due to physiological changes

  • Progression:

    • Starts in the renal medulla and progresses to the renal cortex

  • Clinical Manifestations:

    • Classic Symptoms:

    • Fever/chills, nausea/vomiting, malaise, flank pain

    • Other Symptoms:

    • Dysuria, urgency, frequency

    • Costovertebral angle (CVA) tenderness is a notable finding

Urethritis

  • Definition:

    • Inflammation of the urethra due to bacterial or viral infections

  • Pathogens:

    • Can be caused by Trichomonas, monilia, chlamydia, or gonorrhea

  • Sexual Transmission:

    • More common in males; characterized by discharge, dysuria, urgency, and frequency

    • For females, diagnosis is often challenging; may see lower urinary tract symptoms (LUTS)

  • Treatment:

    • Antimicrobials, sitz baths

  • Patient Teaching:

    • Recommendations include avoiding vaginal sprays, maintaining perineal hygiene, abstaining from sex for 7 days, and notifying partners

Urinary Tract Calculi (Kidney Stones)

  • Terminology:

    • Calculus: Refers specifically to the stone

    • Lithiasis: Refers to stone formation

  • Locations:

    • Can form in various locations throughout the urinary tract

  • Clinical Manifestations:

    • Sudden severe pain due to obstruction, often the first symptom of a kidney stone

    • Flank area, back, or lower abdomen; typically begins suddenly

    • Common sites of obstruction include the ureteropelvic junction (UPJ)

    • Renal Colic:

    • Characterized by sharp, severe pain resulting from the stretching, dilation, and spasm of the ureter in response to the obstructing stone

Nursing Implications for Calculi

  • Education:

    • Teach patients methods to prevent recurrence of urinary calculi

    • Emphasize lifestyle and dietary modifications

    • Ensure adequate fluid intake to produce approximately 2 liters of urine per day

    • Dietary restrictions may include limiting purines and sodium

Polycystic Kidney Disease (PKD)

  • Definition:

    • Most common life-threatening genetic disease affecting the kidneys

  • Pathophysiology:

    • Characterized by both kidneys being filled with large, thin-walled cysts

    • Cysts destroy surrounding tissue through compression

    • Cyst fluid may contain blood or pus

  • Common Complications:

    • Chronic pain, which can be constant and severe

    • Cerebral aneurysm: the most serious complication due to an increased risk of rupture

Kidney (Renal) Failure

  • Definition:

    • Partial or complete impairment of kidney function resulting in the inability to excrete metabolic waste products and water

  • Systemic Effects:

    • Affects all body systems due to accumulation of waste products

  • Challenges:

    • Treatments and necessary dietary changes present significant challenges for management