1. V. Alexander, DNP., ARNP

2. 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

3. 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

4. Kidneys, Ureters, Bladder and Urethra

5. Internal Structure of the Kidney

6. Nephron

7. Formation of Urine

8. Renin Angiotensin System

9. 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

10. 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

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

12. Characteristics of Genitourinary Tract Pain Kidney Bladder Ureter Prostate Urethra

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

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

15. 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

16. Cystoscopic Examination

17. Urinalysis Reference RangeResult Color(yellow) Appearance(clear) Glucose(negative) Billirubin(negative) Ketones(negative) Specific gravity(1.005-1.030) 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

18. 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

19. Biochemical Profile (BP – 8) (Example) Chemistry Reference Range Glucose 60 - 110 mg/dl Bun 7 - 17 mg/dl Sodium 137 - 145 mmol/L Potassium 3.6 - 5.0 mmo/L Chloride 98 - 107 mmol/L Co2 22 - 30 mmol/L Anion gap 10 - 20 mmol/L Creatinine 0.6 - 1.0 mg/dl GFR Non AA 90 – 120 ml/min (< 60 – Kidney disease) GFR AA Calcium 8.4 - 10.2 mg/dl

20. Biochemical Profile (BP-8) (Example) Chemistry ResultReference Range Glucose 216 60 - 110 mg/dl Bun 46 7 - 17 mg/dl Sodium 137137 - 145 mmol/L Potassium 5.6 3.6 - 5.0 mmo/L Chloride 95 98 - 107 mmol/L Co2 30 22 - 30 mmol/L Anion gap 21 10 - 20 mmol/L Creatinine 9.11 0.6 - 1.0 mg/dl GFR Non AA 4 GFR AA 5 Calcium 8.9 8.4 - 10.2 mg/dl

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

22. 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

23. 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

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

25. 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

26. 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

27. 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

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

29. The End