Module 9 Altered Elimination - Renal and Urinary Elimination

Notes

• Bladder irrigation, turp, acute renal failure, nursing management ( WHEN TO CALL THE DOCTOR OR NOT)

• Only use powerpoint

  • ATI books and questions

Actual Powerpoint

• Functions of the kidney: Ecretion of waste from the blood, formation of urine, regulation of fluid and electrolytes, regulation of acid and base balance, secretion of erythropoietin, productions of urine, Vitamine D, production bradykinin prostagladin

• Anything less than

• 1,000 to 2,000 diaresing

  • Greater number is alarming

• Acute kidney injury. polycystic kidney disease, glomerulonephritis, benign protatic hypertrophy

• Stages of acute kidney injuery

  • Prereneal, intrinsic renal, prosternal

    • Intrinsic renal getting hit right away

    • Postrenal: there a blockage already

• 4 Phases of AKI:

  • Onset,

  • oliguric: Less than 40 mL

  • diuretic: when the healing process to occur if its able to, starts to excrete more than 2,000 ml. Keeps being leading to dehydration then goes to hypotension

    • Will need replacement therapy in this stage

  • recovery: Renal functions and tubular edema resolve and able to take PO to health

    • Monitor I/O and is there rentiional going on

• Antibitoics, NSAIDS are nephrotoxic so you have to titrate ( have it in lower dose)

  • CT contrast causes damage to the nephrons

• Treatment plan for AKI for difference stages ( FOCUS)

  • Prerenal

    • Correct hemodynamic rehab

  • Intrarenl

  • Postrenal

• Focus on loop diuretic, fluids to use, diuretics

• Insulin is given due to hyper or hypoglycemia action

• Electroyltes replacement when all the electrtroyles

  • Treatment of AKI: Monitor the electyoltes, checks BUN and creatinine level, vital signs but extra attention BP during diuresis phase, daily weight ( same clithign and same beddings), high calorie, low protein, low potassium, low sodium

• TURP is surgery to treat urinary bloacke due to enlarge prostate, remove excessive prostate tissue blocking the urine flow

• Bladder Catheter Irrigation: Prevent the formation of new organized clot

  • Irrigation of NS into a 3 way catheter. accurate I/O, Volume instilled into bladder, hourly output must be greater or equal to input

  • Blood should be light rosey pink, watch the bag closely so it deosn’t dry out,

• Education

  • Drink lot of water, everything has to be in moderation, not lifting anything heavy post surgical, erectile dysfunction, fresh blood is not normlaso reach out

Case Study

• Difficulty peeing with small amount and complains about abdominal fullness

• PMH: Benign prostatic hypertrophy and patient with diabetes usual have urinary disorder

  • Question to ask:

    • Is there blood in the urine and the characteristics

• BP 148/74, HR 106, RR 24, anxiety, tachypnea, racing in the chest, S1, S2 irregular, hypoactive sounds in lower quadrants, GU feeling of fullness

• Bladder scan, indwelling catheter

• Orders: CBC, CMP. UA, PIV insertion, bladder scan, strict I/O, indwelling catheter insertion, continuous cardiac monitoring

• We will now catherization and strict I/O

  • Need a coude catheterization, sterile technique, need a nephrologist insertion

    • When there is a prostate problem call the nephrogsit ( at night)

• Increase BUN (6-20) and creatinine (0.74 - 1.35) which is unable to exrete

  • BUN and creatine go hand in hand whihc is leading to kidney damage

    • This is the hallmarker for AKI

• Potassium cant be excreted causing cardiac arrhythmias leading to toxicity in the heart

  • With EKG will have shortening

• PVC are cause by increase in potassium

• 24 hours urine collection

• At risk for post type renal kidney injury

  • Has history of BPH, HTN, DM

• TURP is surgery to treat urinary bloacke due to enlarge prostate, remove excessive prostate tissue blocking the urine flow

• Post op: Continous bladder irrigation, strict I/O, repeat CBC, CMP, cardai monitoring, vital signs, NS, PRN narco

  • Check patient for vital signs with pain, check characteristics of blood in catheter, bladder spasm can happen after TURP

  • Elderly patient have a foley catheter in leading