NU155
What is the normal urine output?
-30ml/hr
-this let us know if the kidneys are perfusing correctly
What are the function of the kidneys?
-The kidneys eliminate metabolic wastes by filtration
-The kidneys regulate fluid volume by filtration, reabsorption, and excretion
Name the different structures involving urinary system?
(from my drawing)
The kidneys, ureters, urinary bladder, and urethra are the structures of the urinary system
As you age (the elderly), what are some things that can occur with your kidneys?
•Kidney function decreases
•The prostate gland can block the flow of urine in men
•Hormones secreted by the kidneys decrease
•Bladder tone decreases
•Bladder capacity decreases
•Nocturia becomes more common
•become more common to infection and incontinence
Normal ranges for K, Ca, Na, Mg, Phosphate
3.5-5.0
9-10.5
135-145
mg 1.5-2.5
phosphate 2-4.5
-What does nephrotoxic mean?
-List some examples of substances that are potentially nephrotoxic.
- Drugs that are toxic to the kidneys
-ANTI-INFECTIVES
• ACE INHIBITORS (CAPTOPRIL)
• ANTINEOPLASTIC AGENTS (CISPLATIN)
• IMMUNOSUPPRESSANTS (CYCLOSPORINE)
• NSAIDS (SALICYLATES, IBUPROFEN, INDOMETHACIN)
• (ACETAMINOPHEN, FUROSEMIDE,
PHENAZOPYRIDINE HCL)
• CONTRAST MEDIA DYE (GASTROGRAFIN)
• ANESTHETICS (HALOTHANE)
• HEAVY METALS (LITHIUM, GOLD SALTS, LEAD)
• INDUSTRIAL (CARBON TETRACHLORIDE FOR CLEANING)
• ENVIRONMENTAL (PESTICIDES, SNAKE VENOM)
You are assessing a patient who is having difficulty urinating. What might you check?
-NOTE THE CHARACTER OF URINE (I.E., COLOR, ODOR, CLARITY)
-NOTICE CHANGES IN THE PATTERN OF VOIDING
-ASSESS PAIN AND DISCOMFORT
-MEASURE INTAKE AND OUTPUT
-EVALUATE ABNORMAL FLOW OF URINE
After reviewing Sarah urine labs, you note the following are in her urine.
Note the abnormal labs that may indicate sarah has an
•Glucose
•Ketones
•Blood
Sarah is dx with Cystitis. What would you include in your teachings to Sarah to avoid this from occurring again?
•Use cotton underwear, no nylon
•Clean the perineum from front to back
•Urinate before and after intercourse
•Void every 4 hours and as needed
•Advise to take medications
•Drink plenty of water
pg811
-Ashley is c/o flank pain, hematuria and bladder distention. The nurse tells Ashley to continue straining her urine.
-What are some interventions?
-Renal calculi
-ambulation to help facilitate the stone and increase fluids
if surgery is needed lithotripsy, stent can be placed by MD
-Fever, Nausea & Vomiting, and Flank pain, chills, Fatigue, dysuria all are s/s associated with?
-Based of the s/s how would you treat this patient?
- Acute Pyelonephritis
-fever: antipyretics
n/v: antiemetics
Flank pain: Nsaids
antibiotics (bacterial)
fluid restriction,
meds to control symptoms,
watch sodium intake (nutritional considerations – what foods should they avoid?)
-Name the 3 out of 5 different kinds of renal stones one can have?
-What teachings would you anticipate the nurse to include in the care for this patient?
-Calcium phosphate, calcium oxalate, uric acid
-Tx –pain management ketorolac (Toradol), strain urine, thiazide diuretic/allopurinol, ambulation, I&O, increase fluid intake
IF needed: Lithotripsy, stent
Whenever giving your patient a new IV medications what are somethings the nurse should educate the patient on?
s/s of the medication
overload
itching
Stacy is experiencing incontinence what are some nursing teachings for your patient?
-kegel exercise, bladder training, bladder diary. if immobile turning patient every 2-4 hours.
What are some tests that the doctor may order to check the kidneys? (diagnostic test and or procedures)
-List 3 diagnostic test
•Urinalysis and culture and sensitivity
•Complete blood count
•Blood urea nitrogen
•Serum creatinine and creatinine clearance
•BUN: creatinine ratio
•X-ray: KUB
•Angioplasty
•Urodynamic testing
Stacy c/o fever often 103° F [39° C] or higher, chills, headache, malaise, nausea and vomiting, and pain in the flank and radiating to the thigh and genitalia
-Stacy s/s correlates with?
-What diagnostic tests would you anticipate the doctor to order?
-acute pyelonephritis
-physical assessment, and urine culture and sensitivity, radiograph of the kidneys, ureters, and bladder (KUB), an intravenous pyelogram (IVP), or a renal computed tomography (CT) or magnetic resonance imaging (MRI)
-This commonly occurs about 2 to 3 weeks after a group A beta-hemolytic streptococcal infection, such as “strep throat”
-What clinical signs are indicative of this disorder?
-Acute Glomerulonephritis
- Hematuria,
•Edema, shortness of breath (SOB)
•Hypertension and tachycardia
•Increased BUN, creatinine, hyperkalemia
•Hypoalbuminemia, proteinuria
•Flank pain, headache, & malaise
•Elderly may experience circulatory overload - edema
-List the four stages of AKI
- interventions for each stage
onset, oliguric, diuretic and recovery phases
Oliguric: Monitor electrolytes, FVE they will have increased phosphate (so calcium will be low), hyperkalemia, hypervolemia tx:dialysis
diuretic/polyuric phase: Monitor I&O, Electrolytes
Recovery: GFR returns to normal . Bun &creatinie , electrolyte everything is maintain. Complete recovery may take 3-12 months
List some diagnostic you anticipate the doctor will order to look at the structures of the kidneys?
-IVP (intravenous pyelogram), Angioplasty
-CT, MRI
-KUB
- ultrasounds, bladder scans
-kidney biopsy
Decreasing the work of the kidney is a primary goal in treating this disorder?
-acute glomerulonephritis