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Functions of the Kidney
Urine Formation 30 mL Urine hourly Fluid and Electrolyte Control Acid-base balance Maintain Blood pH 7.35 – 7.45 Excretion of Waste Products
Functions of the Kidney (cont)
Blood Pressure Regulation Controls the Circulating volume Red Blood Cell Production Erythropoietin made by kidneys stimulates bone marrow to produce RBCs Regulation of Ca-Phos Metabolism
Phases of Urine Formation
Filtration Water and blood products Reabsorption Water and Glucose Necessary ions Secretion Ions, Nitrogenous Wastes Reverse of Reabsorption
Urine Composition and Characteristics
95% Water Nitrogenous Wastes Salts Yellow pH 4.6 – 8.0 Sterile
Urine Abnormalities
Albumin Glucose Erythrocytes Ketone Bodies DM, Starvation, Fats Rapidly Metabolized Leukocytes UTI
Normal Aging of Urinary System
Decreased blood Supply Loss of Nephrons Stress Incontinence Prostate Enlarges Constricts Urethra Urinary Retention
Nursing Considerations for a Patient with a Foley
Aseptic Technique Intake and Output Catheter Care BID Check for Leaks Do not place drainage bag higher than level of bladder Avoid Kinks in tubing After removing pt must Void within 8 hours
Alterations in Voiding Patterns
Urinary Retention Urinary Incontinence Neurogenic Bladder Urinary Tract Infection Pyelonephritis
Urinary Retention
Etiology Inability to void even with the urge Acute or Chronic Urinary Stasis = Infection Clinical Manifestations Pt states an inability to void
Urinary Retention (cont)
Assessment Bladder Distention Bladder Scan Medical Management Catheterization Nursing Considerations Bladder Training Warm Baths Environment for Voiding
spastic
spastic = loss of sensation, loss of motor control, atrophy, decreased bladder capacity, reflex urine released.
flaccid
urine in bladder pools and distense the bladder pt losses feeling of fullness.
Urinary Incontinence
Etiology Inability to void even with the urge Total or Dribbling Obesity, Lung Disease, Smoking, Surgery Clinical Manifestation. Medical Management Depends on Cause Self Catheterization Nursing Interventions Bladder Training Incontinence Pads Limiting Caffeine Emotional Support
Neurogenic Bladder
Etiology Loss of voluntary voiding control, resulting in Urinary Retention or Incontinence Lesion on the Voiding Reflex Spastic or Flaccid Clinical Manifestation Urinary retention
Neurogenic Bladder (cont)
Assessment Nausea, Diaphoresis, Flushing Infrequent voiding Medical Management ABX therapy Self-Catheterization Sacral nerve modulation Nursing Interventions Bladder Training
Urinary Tract Infection
Etiology Pathogens entering Urinary Tract DM, MS, Spinal Cord Injuries, HTN Changes in Urinary Tract Homeostasis Clinical Manifestation Urgency, Frequency, Burning, Hematuria, Nocturia, LOC Changes
Urinary Tract Infection cont
Diagnostic Test Urine Culture Inspection of Urine Medical Management ABX therapy Nursing Interventions Hydration of Pt Urinary Analgesics (Pyridium)
Pyelonephritis
Etiology Inflammation of structures of the Kidney E. coli Clinical Manifestation Unilateral or Bilateral Chills, Fever, Flank pain Chronic = Kidney atrophy Azotemia Assessment Acute Illness, Nausea CVA Tenderness
Pyelonephritis cont
Diagnostic Tests Urine Culture with Bacteria, Pus, Leukocytes present BUN, Creatinine Medical Management ABX Therapy Hydration, Pyridium Nursing Interventions Signs/Symptoms of Infection Follow up Care with PC
azotemia
= nitrogenous wastes build-up in blood
Obstructive Disorders of the Urinary Tract -Urolithiasis
Etiology Formation of Renal Calculi Clinical Manifestations Intense pain Nausea, Vomiting Diagnostic Tests KUB Ultrasound Cystoscopy Urinalysis
Urolithiasis (cont)
Medical Management ABX Pain Meds Ultraviolet Shock Waves Nursing Interventions Strain urine Increase fluid intake Increase Ambulation
Benign Prostatic Hypertrophy
Etiology Prostate Enlarges Prevents complete emptying of bladder Clinical Manifestation UTI Symptoms –hematuria, nocturia, frequency, oliguria Diagnostic Tests Rectal Exam
Benign Prostatic Hypertrophy
Medical Management Meds to decrease size of the prostate Prostatectomy- TURP Nursing Interventions Patency of Foley Irrigation CBI
Urethral Stricture
Etiology Narrowing of Urethra Congenital or Acquired Clinical Manifestation Dysuria, weak stream, “fork”, nocturia Diagnostic Test Voiding Cystourethrogram Medical Management Dilate Urethra Surgical release Nursing Interventions Increase hydration
Urinary Tract Trauma
Etiology Any damage occurring after trauma of any kind Nursing Interventions Monitor Urine output, color, presence of blood Diagnostic Tests KUB, Urinalysis,
Nephrotic Syndrome
Etiology Immunological disorder triggered by an URI or allergic reaction Clinical Manifestations Generalized edema, anorexia, Fatigue Proteinuria, hypoalbuminemia Diagnostic Tests Blood Chemestries
Nephrotic Syndrome cont
Medical Management Corticosteroids Immunosuppressants Loop Diuretics Nursing interventions Weight, I&O, monitor edema Protein Replacement and Na Restrict diet Prognosis Progresses to Renal Failure
Renal Failure
Etiology Anything that limits blood flow to the Kidneys Acute Oliguric Phase Diuretic Phase Recovery Phase If recovery not successful illness will lead to Chronic Renal Failure
Renal Failure cont
Chronic Anuria Dialysis Peritoneal Hemodialysis Diet Fluid Intake Limited Protein, Na, K Medical Management Blood pressure meds Antidysrhythmics Epogen
Care for Patient on Dialysis
Hemodialysis AV Fistula Bleeding Patency Thrill/Bruit No BP, Sticks on AV Fistula Arm Monitor I &O Circulation
Care for Peritoneal Dialysis Patient
Peritoneal Monitor I &O Monitor Dialysis site for Infection Measure and weigh Fluid after Dialysis
Nephrostomy
Incision to drain the pelvis of the kidney Nursing Interventions Prevent obstruction to the drain Irrigate per MD order Never Clamp Use Surgical Sepsis when working with Nephrostomy
Kidney Transplant
Pre-operative teaching to lesson Pts fears Post-operatively Daily weights, I&O Immunosuppresant therapy Increased risk for infection Increased risk for steroid bleeding Keep close contact with medical team
Urinary Diversion
Diverts the flow of urine from bladder to outside Ileal Conduit Keep skin clean
Nephrectomy
Surgical removal of the Kidney Nursing Care Monitor Hemorrhage Vital signs, I&O Pain Patient Teaching Prognosis
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