V. Alexander, DNP., ARNP

Objectives Review major anatomical structures, physiology, and pathophysiology of the genitourinary and renal systems Select appropriate assessment parameters for clients with selected renal disorders Identify nursing implications for clients undergoing diagnostic testing with selected renal disorders Prioritize nursing interventions, based on the assessment of clients with selected renal disorders Examine current evidence-based guidelines for clients with selected renal disorders

Renal and Urinary Systems Function  Maintain the body’s state of homeostasis by regulating fluid and electrolytes, removing wastes, and providing hormones involved in red blood cell production, bone metabolism, control of blood pressure,. Structures:  Kidneys  Ureters  Bladder  Urethra

Kidneys, Ureters, Bladder and Urethra

Internal Structure of the Kidney

Nephron

Formation of Urine

Renin Angiotensin System

Risk Factors Childhood diseases - strep throat, impetigo, nephrotic syndrome Advanced age Instrumentation Immobilization Occupational, recreational, or environmental Chronic diseases (DM, HTN, MS SLE, etc.) Radiation therapy Pelvic surgery Pregnancy Injury – Obstetric or Spinal cord injury Tumors

Nursing Care…… Assessment Subjective and objective data Chief complaint  Onset  Effects Health history  Patient knowledge  Psychosocial and emotional factors; fear, anxiety  Urologic function, include voiding habits/pattern  Fluid intake  Hygiene  Presence of pain or discomfort  Allergies

Nursing Care Family history  UTI’s  Chronic diseases  Genetics Psychosocial Cultural Review of systems

Characteristics of Genitourinary Tract Pain Kidney Bladder Ureter Prostate Urethra

Problems Associated with Voiding Frequency Urgency Dysuria Hesitancy Nocturia Polyuria Oliguria Anuria Hematuria Proteinuria Glycosuria Incontinence Enuresis

Physical Assessment Objective data Vital signs, weight, height Full head to toe assessment  Techniques Detailed assessment of system involved Documentation

Diagnostic Studies Urinalysis, urine culture, Kidney, Ureter, and Bladder studies Renal function Ultrasonography CT and MRI Nuclear scans Intravenous urography, retrograde pyelography, cystography, renal angiography Endoscopic procedures Biopsies

Cystoscopic Examination

Urinalysis Reference RangeResult Color(yellow) Appearance(clear) Glucose(negative) Billirubin(negative) Ketones(negative) Specific gravity( ) Blood(negative) pH(5.0 – 8.0) Albumin(negative) Nitrite(negative) Leuk esterase(negative) WBC(0-3/ HPF) RBC(0-3 HPF0 Bacteria Mucus Casts Epithelial cells

Urine culture (Sample) Source, midstream Collection date Culture, Urine Date received Organism 1 Escherichia coli  Colony count: >100,000 cfu’s/ml  Note: this organism is an ESBL producer  Resistance due to probable acquired extended spectrum beta lactamase.  Decreased activity may occur with Pennicillins, Pennicillin/inhibitor combinations, Cephalosporins, and Monobactams Please refer to infection control policies for isolation guidelines. Oganism 2: Enterococcus Faecalis - Group D  Colony count 10,000 – 50,000cfu’s/ml Sensitivity to follow

Biochemical Profile (BP – 8) (Example) Chemistry Reference Range Glucose mg/dl Bun mg/dl Sodium mmol/L Potassium mmo/L Chloride mmol/L Co mmol/L Anion gap mmol/L Creatinine mg/dl GFR Non AA 90 – 120 ml/min (< 60 – Kidney disease) GFR AA Calcium mg/dl

Biochemical Profile (BP-8) (Example) Chemistry ResultReference Range Glucose mg/dl Bun mg/dl Sodium mmol/L Potassium mmo/L Chloride mmol/L Co mmol/L Anion gap mmol/L Creatinine mg/dl GFR Non AA 4 GFR AA 5 Calcium mg/dl

Abnormal findings Amino acids and glucose  Filtered and reabsorbed at glomerulus Proteinuria  Globulins  Albumin Glycosuria  Diabetes  Pregnancy

Question True or False? 1. Urea is an abnormal constituent of urine. 2.The angling of the ureterovesical junction is the primary prevention factor preventing backward movement of urine from the bladder toward the kidney

Nursing Diagnoses Acute pain related to infection within urinary tract Deficient knowledge about predisposing factors to infection, recurrence, detection and prevention of recurrence, and pharmacological therapy Fear related to potential alteration in renal function and embarrassment 2 nd to urinary function and invasion of genitalia

Planning Patient goals may include:  Understanding of procedures, tests and expected behaviors  Decreased pain or absence of discomfort  Decreased apprehension and fear.

Interventions……. Assess knowledge of diagnosis and procedure Providing description of the tests and procedures in language the patient can understand using appropriate and correct terminology. Encourage fluid intake unless contraindicated. Instruct in methods to reduce discomfort; sitz baths, relaxation techniques. Administer analgesics and antispasmodics

Interventions Assess voiding pattern and amount Provide instruction related to voiding practices and hygiene Provide privacy and respect Assess level of fear and apprehension Instruct on relaxation techniques

Goals/Outcomes States rationale for planned diagnostic tests and expected tasks and behaviors Complies with urine collection, fluid modifications and other procedures Reports decreasing pain level Appears relaxed with low level of fear or apprehension

Question What is the normal adult bladder capacity? A. 50 – 100 mL B. 100 – 200 mL C. 300 – 500 mL D. 600 – 800 mL

The End