Professional Documents
Culture Documents
Outline of review
Recall the anatomy and physiology of the
Renal System Renal Assessment Renal Laboratory Procedure Common Conditions:
UTI Kidney Stones ARF and CRF
Outline of review
BPH Prostatic cancer
Urological Assessment
Nursing History
Reason for seeking care Current illness Previous illness Family History Social History Sexual history
Urological Assessment
Key Signs and Symptoms of Urological Problems EDEMA associated with fluid retention Renal dysfunctions usually produce ANASARCA
Urological Assessment
Key Signs and Symptoms of Urological Problems PAIN Suprapubic pain= bladder Colicky pain on the flank= kidney
Urological Assessment
Key Signs and Symptoms of Urological Problems HEMATURIA Painless hematuria may indicate
URINARY CANCER! Early-stream hematuria= urethral lesion Late-stream hematuria= bladder lesion
Urological Assessment
Key Signs and Symptoms of Urological Problems DYSURIA Pain with urination= lower UTI
Urological Assessment
Key Signs and Symptoms of Urological Problems POLYURIA More than 2 Liters urine per day OLIGURIA Less than 400 mL per day ANURIA Less than 50 mL per day
Urological Assessment
Key Signs and Symptoms of Urological Problems Urinary Urgency Urinary retention
Urinary frequency
Urological Assessment
PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation
Urological Assessment
Laboratory examination 1. Urinalysis 2. BUN and Creatinine levels of the serum 3. Serum electrolytes
Urological Assessment
Laboratory examination Radiographic IVP KUB x-ray KUB ultrasound CT and MRI Cystography
2. Quinolones
Not given to less than 18 because they can cause cartilage degradation
Nephrolithiasis/Urolithiasis
Presence of stones
anywhere in the urinary tract
Calcium oxalate and uric acid
Nephrolithiasis/Urolithiasis
Pathophysiology Predisposing factors a. Diet: large amounts of calcium and oxalate b. Increased uric acid levels c. Sedentary life-style, immobility d. Family history of gout or calculi e. Hyperparathyroidism
Nephrolithiasis/Urolithiasis
Pathophysiology Supersaturation of crystals due to stasis Stone formation May pass through the urinary tract OBSTRUCTION, INFECTION and HYDRONEPHROSIS
Nephrolithiasis/Urolithiasis
Assessment findings 1. Abdominal or flank pain 2. Renal colic radiating to the groin 3. Hematuria 4. Cool, moist skin 5. Nausea and vomiting
Nephrolithiasis/Urolithiasis
Diagnostic tests 1. KUB Ultrasound and X-ray: pinpoints location, number, and size of stones 2. IVP: identifies site of obstruction and presence of non-radiopaque stones 3. Urinalysis: indicates presence of bacteria, increased protein, increased WBC and RBC (hematuria)
Nephrolithiasis/Urolithiasis
Medical management 1. Surgery a. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi. b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus.
Nephrolithiasis/Urolithiasis
Medical management 2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization 3. Pain management : Morphine or Meperidine 4. Diet modification
Nephrolithiasis/Urolithiasis
Nursing interventions 1. Strain all urine through gauze to detect stones and crush all clots. 2. Force fluids (30004000 cc/day). 3. Encourage ambulation to prevent stasis.
Nephrolithiasis/Urolithiasis
Nursing interventions 4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area. 5. Monitor intake and output
Nephrolithiasis/Urolithiasis
Nursing interventions 6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones
Nephrolithiasis/Urolithiasis
Nursing interventions Calcium stones limit milk/dairy products provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and whole grains)
Nephrolithiasis/Urolithiasis
Nursing interventions Oxalate stones avoid excess intake of foods/ fluids high in oxalate (tea, chocolate, rhubarb, spinach) maintain alkaline-ash diet to alkalinize urine (milk; vegetables; fruits except prunes, cranberries, and plums)
Nephrolithiasis/Urolithiasis
Nursing interventions Uric acid stones reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes) maintain alkaline urine
Nephrolithiasis/Urolithiasis
Nursing interventions 7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production
Allopurinol Rashes Nasal congestion
Nephrolithiasis/Urolithiasis
8. Provide
client teaching and discharge planning concerning Prevention of Urinary stasis by maintaining increased fluid intake especially in hot weather and during illness; mobility; voiding whenever the urge is felt and at least twice during the night
Nephrolithiasis/Urolithiasis
8. Provide
client teaching and discharge planning concerning: Adherence to prescribed diet Need for routine urinalysis (at least every 34 months) Need to recognize and report signs/ symptoms of recurrence (hematuria, flank pain).
Sudden interruption of
kidney function to regulate fluid and electrolyte balance and remove toxic products from the body
Most important
manifestation: OLIGURIA
Kidney function
The Nephron produces urine to eliminate waste Secretes Erythropoietin to increase RBC Metabolism of Vitamin D Produces bicarbonate and secretes acids Excretes excess POTASSIUM
Impaired urine production and azotemia
1. Oliguric phase
2. Diuretic phase
3. Convalescence or recovery phase
1. Oliguric phase Urine output less than 400 cc/24 hours duration 12 weeks Manifested by dilutional hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesemia, and metabolic acidosis Diagnostic tests: BUN and creatinine elevated
Gradual, Progressive
irreversible destruction of the kidneys causing severe renal dysfunction. The result is azotemia to UREMIA
CVS
Pulmo Hema Musculoskeletal
DIALYSIS
Important Drugs
Aluminum hydroxide (Amphogel) Kayexalate Binds with PHOSPHATE to decrease phosphorus Binds with POTASSIUM to manage hyperkalemia To decrease edema To increase RBC To manage Hypertension
DIALYSIS
a procedure that is used to remove
fluid and uremic wastes from the body when the kidneys cannot function
DIALYSIS
Two methods 1. Hemodialysis 2. Peritoneal dialysis
DIALYSIS
Diffusion Osmosis Ultrafiltration
DIALYSIS
Nursing management 1. Meet the patient's psychosocial needs 2. Remember to avoid any procedure on the arm with the fistula (HEMO)
Monitor WEIGHT, blood pressure and fistula site for bleeding
DIALYSIS
Nursing management 3. Monitor symptoms of uremia 4. Detect complications like infection, bleeding (Hepatitis B/C and HIV infection in Hemodialysis) Peritonitis in peritoneal dialysis 5. Warm the solution to increase diffusion of waste products (PERITONEAL) 6. Manage discomfort and pain
DIALYSIS
Nursing management 7. To determine effectiveness, check serum creatinine, BUN and electrolytes
BPH
NURSING INTERVENTION 1. Encourage fluids up to 2 liters per day 2. Insert catheter for urinary drainage 3. Administer medications alpha adrenergic blockers and finasteride 4. Avoid anticholinergics 5. Prepare for surgery or TURP 6. Teach the patient perineal muscle exercises. Avoid valsalva until healing
BPH
NURSING INTERVENTION: TURP Maintain the three way bladder irrigation to prevent hemorrhage Only initially the drainage is pinktinged and never reddish Administer anti-spasmodic to prevent bladder spasms
Prostate Cancer
a slow growing malignancy of the
prostate gland Usually an adenocarcinoma This usualy spread via blood stream to the vertebrae
Prostate Cancer
Predisposing factor
Age
Prostate Cancer
Assessment Findings 1. DRE: hard, pea-sized nodules on the
anterior rectum 2. Hematuria 3. Urinary obstruction 4. Pain on the perineum radiating to the leg
Prostate Cancer
Diagnostic tests 1. Prostatic specific antigen (PSA) 2. Elevated SERUM ACID
PHOSPHATASE indicates SPREAD or Metastasis
Prostate Cancer
Medical and surgical management 1. Prostatectomy 2. TURP 3. Chemotherapy: hormonal therapy to slow the rate of tumor growth 4. Radiation therapy
Prostate Cancer
Nursing Interventions 1. Prepare patient for chemotherapy 2. Prepare for surgery
Prostate Cancer
Nursing Interventions: Postprostatectomy 1. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours 2. Monitor urine for the presence of blood clots and hemorrhage 3. Ambulate the patient as soon as urine begins to clear in color