Assessment of the Renal/Urinary System

Question 1

Decreased GFR
Nocturia
Decreased bladder capacity
Weakened urinary sphincter muscles and shortened urethra in women
Tendency to retain urine

Answer 1

Changes in the renal sys related to aging

Question 2

Higher risk for dehydration = adequate intake
Careful with certain meds that are nephrotoxic

Answer 2

Decreased GFR

Question 3

Assess need to void - get up to void
Avoid having lot fluid before bed

Answer 3

Nocturia

Question 4

Safety issues
Not sit around and wait

Answer 4

Decreased bladder capacity

Question 5

Help to bathroom

Answer 5

Weakened urinary sphincter muscles and shortened urethra in women

Question 6

UTI - decrease estrogen as well: higher in women
Prostate
Anticholinergic drugs

Answer 6

Tendency to retain urine

Question 7

Nutrition
Diet or recent changes in diet
Daily fluid intake (2 L per day unless fluid restriction)

Answer 7

History

Question 8

History
Medications
Family history and genetic risk
Current health problems

Answer 8

Assessment methods

Question 9

Prescription drugs
Antibiotics
Dye as well
OTC drugs

Answer 9

Medications

Question 10

high-dose or long-term use of NSAID’s or acetaminophen can seriously reduce kidney function

Answer 10

OTC drugs

Question 11

Document current health problems
Assess changes in appearance of urine, pattern of urination, ability to initiate or control voiding, other unusual symptoms; not voiding at all

Answer 11

Current health problems

Question 12

General appearance
Skin assessment
Edema
Lung sounds
Weight, BP (risk factor for kidney damage but need BP to perfuse kidneys)
Level of consciousness and alertness
Abdominal assessment

Answer 12

Physical assessment

Question 13

check for bladder distension

Answer 13

Abdominal assessment

Question 14

Serum creatinine
Abnormalities in electrolytes
Serum blood urea nitrogen (BUN) –
Glomerular filtration rate (GFR)

Answer 14

Laboratory assessment

Question 15

0.5-1.2
Increased: kidney impairment
Decreased: decreased muscle mass
Produced when muscle and other proteins are broken down
Excreted by the kidneys
No common pathologic condition other than kidney diseases increases the serum creatinine level
Does not increase until at least 50% of the kidney function is lost

Answer 15

Serum creatinine

Question 16

Measures the effectiveness of kidney excretion of urea nitrogen, a by-product of protein breakdown in the liver
Kidneys filter urea nitrogen from the blood and excrete the waste in urine
Other factors influence the BUN level
An elevation does not always mean kidney disease is present
10-20
Increased: liver/kidney disease, dehydration/decreased kidney perfusion, high-protein diet, infection, stress, steroid use, GI bleeding, other situations in which blood in body tissues
Decreased: malnutrition, fluid volume excess, severe hepatic damage

Answer 16

Serum blood urea nitrogen (BUN) –

Question 17

Decreased levels indicative of kidney failure

Answer 17

Glomerular filtration rate (GFR)

Question 18

Urinalysis - screening; color, concentration, odor, clear/cloudy, specific gravity: high = dehydration, pH - 6, glucose, ketones, proteins, RBC
Urine culture and sensitivity
Composite urine collections (24 hour)
Creatinine clearance

Answer 18

Laboratory assessment

Question 19

all urine in the designated time frame must be collected
How well urine clearing things
Collect all urine in 24-hour

Answer 19

Composite urine collections (24 hour)

Question 20

Measure of glomerular filtration rate and kidney function

Answer 20

Creatinine clearance

Question 21

Used to screen for post-void residual volumes
Non invasive method to determine the need for intermittent catheterization

Answer 21

Bladder scanners

Question 22

KUB - plain x-ray of the kidneys, ureters, and bladders; stones, strictures, obstructions
CT of abdomen
MRI - metal screening, NPO
Ultrasonography
Renal Scan

Answer 22

Imaging assessment

Question 23

Oral and IV dye usually given
When dye used ensure increased fluid intake to dilute and excrete the dye
May use diuretics immediately after the dye is injected to enhance dye excretion in patients who are well hydrated
NPO and only drink PO dye
Cysts, masts and obstructions - lot fluids
Hold Metformin (Glucophage) 24 hours prior and 48 hours after procedure or until adequate kidney function has been determined

Answer 23

CT of abdomen

Question 24

Common: Requires a full bladder
To identify the size of the kidneys or obstruction in the kidneys or the lower urinary tract

Answer 24

Ultrasonography

Question 25

Radioisotope injected IV to examine the perfusion, function, and structure of the kidneys

Answer 25

Renal Scan

Question 26

Endoscopic procedure performed for diagnosis or treatment Operative procedure and informed consent required General or under local anesthesia with sedation Preparation: light evening meal, NPO after midnight, bowel preparation Postoperative care

Answer 26

Cystoscopy or cystourethroscopy

Question 27

Observe for changes in VS and urine output, Monitor for active bleeding and infection Oral or IV fluids to increase urine output May have a catheter postoperatively ABCs postop

Answer 27

Postoperative care - Cystoscopy or cystourethroscopy

Question 28

X-rays using contrast dye/medium instilled directly into bladder Enhances visibility of the lower urinary tract Dye is not nephrotoxic because it does not enter the bloodstream and does not reach the kidney Voiding cystourethrogram: x-rays taken during voiding Monitor for infection, urine output to ensure no damage Encourage fluid intake

Answer 28

Cystography and cystourethrography

Question 29

Retrograde Pyelogram Cystogram Urethrogram Instill dye into lower urinary tract using a cystoscope, anesthesia, NPO Prep: light evening meal, NPO after midnight, bowel preparation Post: Monitor for infection

Answer 29

Retrograde Procedures

Question 30

Going against the normal flow of urine X-rays are taken after dye instilled in urinary tract

Answer 30

Retrograde

Question 31

Retrograde examination of the ureters and the pelvis of both kidneys

Answer 31

Pyelogram

Question 32

Retrograde examination of the bladder

Answer 32

Cystogram

Question 33

Retrograde examination of urethra

Answer 33

Urethrogram

Question 34

Examines the process of voiding and include: Tests of bladder capacity, pressure and tone Studies of urethral pressure and urine flow Tests of perineal voluntary muscle function

Answer 34

Urodynamic Studies

Question 35

Most are performed percutaneously (through the skin and other tissues) Guided by ultrasound or CT - IR to avoid comps Informed consent required NPO for 4-6 hours before procedure Coagulation studies completed prior because of the huge risk for bleeding Local anesthesia with conscious sedation Nursing interventions post biopsy

Answer 35

Kidney biopsy

Question 36

For 24 hours monitor dressing site, VS, urine output, H/H: Major risk for bleeding Monitor for internal bleeding: large hematomas: suspected with flank pain, decreased BP, decreasing urine output Strict bed rest in a supine position with a back roll for 2-6 hours post biopsy to mitigate issues bleeding Monitor for hematuria - some will have little after; keep close eye: most common complication If bleeding occurs, IV fluids and PRBC’s may be required If bleeding is extensive, surgery or a nephrectomy may be required if cannot control bleeding

Answer 36

Nursing interventions post biopsy - Kidney biopsy