urinary renal

8/8/2019 Urinary Renal

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Urinary & Renal DeviationsEdited by:

Cynthia Bartlau, MSN, RN, PHN


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URINARY SYSTEM DISORDERS

Age related changes

Common diagnostic tests

Incontinence - types

Nursing mgt/patient teaching forincontinence

Types of indwelling catheters Urinary tract disorders


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URINARY SYSTEM DISORDERS,

CONTINUED

UTI- risk factors/S&S

Urethritis, cystitis, pyelonephritis

Common urinary obstructions

Renal calculi

Hydronephrosis, nephrostomy

Ureteral stents, nephrostomy tubes,supra-pubic catheters


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URINARY TRACT DISORDERS,

CONTINUED

Tumors of the renal system

Bladder/kidney cancer

Nursing diagnosis for patients withurinary tract disorders


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Anatomy of renal/urinary system


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Urinary System Anatomy

2 kidneys Nephron

Blood vessels

Formation of urine Glomerular filtration (*dependent on BP &

perfusion)

Tubular reabsorption

Tubular secretion

2 ureters Urinary bladder

Urethra


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Urinary System Function

Removal of toxic waste products

Regulation of blood volume

Regulation of electrolyte balance Regulation of acid-base balance

Regulation of fluids/electrolytes in

tissue fluid Production of erythropoietin*


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Age related changes

Urinary bladder Decreased bladder size & tone of detrusor

muscle

Kidneys Decreased ability to concentrate urine GFR decreases Nephrons decrease

Males

Enlarged prostate Females

Pelvic floor muscle weakness Prone to bladder infections, urinary

incontinence, & urethral irritation


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Urinalysis

Routine

Clean-catch midstream From catheter

Straight catheterization (in & out)

24-hour urine collection


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Renal function tests See book

Diagnostic procedures

See book Radiological studies

May be contrast allergies??? May be nephrotoxic Glucophage not to be given w/in 48 hours

Endoscopic procedures Renal ultrasound Renal biopsy


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Urinary Incontinence

Difficulty/inability to control urine

Weak bladder muscle

Stress incontinence Women following childbirth

Men prostatectomy/radiation


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Incontinence, cont.

FUNCTIONAL- Inability to reachthe toilet, due to environmentalbarriers Loss of memory

Disorientation

Dependent on others

TOTAL- continuous /unpredictableloss of urine

Neurologically impaired


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Incontinence, cont.

Stress incontinence

Urge incontinence

Overflow incontinence


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Management/Patient teaching

17 million adults incontinent

Under diagnosed - due to

embarrassment Keep a voiding diary

Referred to urologist/determinecause

Kegel exercises- increase perinealmuscle tone


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Group Work

Incontinence management

Concept map, drawing, diagram, be

creative!!!


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Indwelling Catheters

Foley catheter- avoided if possible

High risk of UTI

44% of patients develop infection inurinary tract

Bacteria enters bladder throughurine draining back intobladder/around up the urethra

*Foley insertion & removal procedures


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Urinary Retention


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Urinary Catheterization


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Urinary Tract Infection (UTI)

Most common- nosocomial

UTIs can affect any portion ofurinary tract ex. lower urinary tract infections =

urethritis, prostatitis, cystitis

Most common upper urinary tractinfection =pyelonephritis

(inflammation of kidney and renalpelvis) Urinary tract is normally sterile above the urethra

Bacteria from intestines (E-coli) = UTI


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Continued : UTI

Risk factors for UTI:

Catheterizations or indwelling Foley caths***

Obstructions, strictures

Incomplete bladder emptying Diabetes

Tissue trauma

Contamination during sexual intercourse

Voluntary urinary retention (keep holding it)

Enlarged prostate

Diaphragm for birth control

**Poor personal Hygiene practices, and notwiping from front-back


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Continued: UTI

Cystitis: inflamm of bladder

Most common UTI

Inflamm process causes classic

manifestations (s/s) Dysuria, urgency, nocturia, pyuria=pus

and cloudy urine, with odor,hematuria=bld.

Older adults may be asymptomatic Present with confusion, lethargy, behav.

changes, anorexia, just not feeling right.


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PYELONEPHRITIS

Pyelonephritis: *KIDNEY INFECTION Acute/chronic

Bacteria (E-coli-**) usually enters via lower

urinary tract Common in children/adults

S/S acute pyelonephritis rapid w/ chills, fever, malaise, vomiting,

flank pain/back pain *older adults = chgin behavior, incontinence, confusion,(may be no fever)

Chronic form= lead to fibrosis, scarring, renalfailure


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Diagnostics & Treatment of UTI

DX: urinalysis via mid-stream cleancatch or a straight-catheterization (inand out cath), CBC/WBC.

Uncomplicated UTI= antibiotics, drugs such as sulfa based drugs (if not

allergic), ex. Septra, Bactrim, DS, Gantrisin, Cipro

urinary analgesic=*Pyridium=turns the urine

*orange-reddish-use not more than 48 hrs.(stainclothes) yellow tinged skin or sclera=toxicity andcall the physician


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Diagnostics & Treatment of UTI

Tx Empty bladder frequently q 2-4 hrs/ force

fluid intake to 2-3L of fluid or water,

cranberry juice = maintain acidic urine (noorange juice,* vit C tabs ok),

Clean from front-back, men cleanse foreskin,void after sex, wear cotton briefs, avoidbubble baths/ feminine sprays,

Reduce intake of sugar, ETOH, and fat


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Urological obstructions

strictures & stones (calculi) Stricture: narrowing of the lumen of the

ureter caused by scar tissue, thus,decreased urinary stream and prone to

UTIs due to obstruction of urine flow. TX: urologist will perform dilation or surgical

repair (urethroplasty)

Often an indwelling catheter is used(Foley), therefore, risk for infection

Strictures: risk for UTIs as well: followpatient teaching on how to prevent UTIs


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Stones or Renal calculi

Nephrolithiasis: stones inside the kidney

Renal calculi: a kidney stone

Patho:

calcium, magnesium, uric acid, or cystinebased stones * calcium based is mostcommonly found

Etiology: usually a family history, chronicdehydration, infection, dietary related (Ca+),

immobility- calcium moves out of the bldstream & filtered via kidneys


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Renal calculi

S/S: Flank pain, renal colic; when stone is lodged in the

ureter

Hematuria, dysuria, frequency, urgency, enuresis,costovertebral tenderness, n/v

DX: Exam, KUB x-ray (kidney-ureter-bladder), IV

pyelogram

TX: **Flush the kidneys to pass the stone, strain the

urine, pain control, surgical removal if necessary, firsttry Lithotripsy: may see hematuria afterwards, OK

Nutritional info: avoid foods that cause the stones,limit dairy (ca+), avoid purines (PROTEIN) uricacid), etc.


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Lithotripsy


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HYDRONEPHROSIS/

NEPHROSTOMY

Hydronephrosis- condition resulting fromuntreated obstruction in the urinary tract

Usually treatable

Obstruction of urine can be from tumor,enlarged prostate, kidney stones

Stent placement- to hold open

Nephrostomy tube may be inserteddirectly into kidney pelvis to drain UA


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SUPRAPUBIC CATHETER

Following some surgeries

Long term situations

Suprapubic catheter indwellingcatheter directly inserted throughan incision into the lower abdomendirectly into the bladder

Nursing: Keep area clean & dry


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TUMORS OF RENAL SYSTEM

Cancer of bladder most commoncancer of urinary tract

Twice as common in men Common age between 50-70 yo

Correlation between cigarettesmoking/bladder cancer

Chemicals pass between viabloodstream to kidneys


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BLADDER CANCER

S/S

Painless hematuria

Bladder irritability Urinary retention (clots)

Pelvic pain

Pain in lower back Painful urination


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CANCER OF KIDNEY

Rare, but serious

Most patients between 50-70 yo

Risk factors: Smoking

Obesity

HTN

Years of hemodialysis

Radiation exposure

Asbestos

Industrial pollution


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3 CLASSIC SYMPTOMS OF KIDNEY

CANCER

Hematuria

Flank pain dull

Mass in area Other symptoms:

Weight loss

Fever

Anemia Fatigue

Swelling in legs


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URINARY DIVERSION SURGERIES

Continent urinary diversionsurgeries

Kock pouch reservoir created fromsegment of ileum

Ileal conduit

Indiana pouch


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RENAL DISORDERS

Diabetic nephropathy

Nephrotic syndrome Nephrosclerosis


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Diabetic Nephropathy

Most common renal failure

Long term effects of diabetes

Damage to small vessels in kidneys Risk factors include: hypertension,genetic predisposition, smoking,chronic hyperglycemia

Progression to urine decrease, toxicwaste build up leading to kidneyfailure


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Nephrotic Syndrome

Protein in urine >3.5g/per day

May result from other disease processes

Large amts. of protein lost in UA

Serum albumin/total serum protein aredecreased

Fluids low/leaks into tissues, causingedema

Low sodium diet/low protein diet/diureticsmay be used/*daily wts/I & O


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Nephrosclerosis

Thickening and hardening of therenal blood vessels

Changes in kidney- result indecreased blood supply to thekidney-can eventually destroykidney

High pressure within kidney causedamage

Treatment is to reduce HTN


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Acute vs. ChronicRenal Failure

Acute (Reversible!) Sudden/complete loss kidney

function

Cause: failure of renalcirculation, tubular, orglomeruli dysfunction Pre-renal: hypo-perfusion of

kidney (shock,hemorrhage,etc.)

Intra-renal: damaged renaltissue (infection, transfusionrxs, burns, drugs, etc.)

Post-renal: an obstructionsomewhere distal to kidneys:renal flow (ex. calculi,stricture, tumor etc.)

Chronic: ESRD (Irreversible)

Progressive

uremia devps = affects allbody systems

funct. Glomeruli = GFR,

*urine creatinine clearance,but serum *creatinine o &*BUN o , Na+ H20 retention= edema, CHF, crackles, *K+o, *metabolic acidosis


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Acute vs. Chronic renal failure Acute S/S :

may include:*anuria (less50cc/day)

*oliguria (*lessthan 400cc/day or*30mL/hour)

* or a normal urineoutput!, however,the serum BUN andCreatinine will be

elevated for allabove! appear critically ill,

lethargic, n/v/d

Chronic (ESRD) Anemia (dec. *erythropoetin) Po4 & Ca+ imbalance S/S:

+ JVD, peri-orbital edema,dependent/pitting edema,crackles, SOB

Ammonia odor breath,anorexia, n/v

Skin=uremic frost, gray-bronze skin, dry flakey, itchy

skin, muscle cramps ? Bone fx Neuro = weakness, fatigue,

confusion, seizures (anuria = less than 50cc/day)

or *(oliguria=less 400cc/day)


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Acute vs. Chronic renal failure Acute skin & mucous

membranes dry fromdehydration, breathodor (uremic fetor),

h/a, muscle twitch, specific gravity urine,oBUN/creatinine, *24-hour urine creatinineclearance, *o K+*worry about cardiacdysrhythmias, tissue

edema, uremic frost,metabolic acidosis,anemia, PO4/Ca+/andF&E imbalance.**negative nitrogenbalance

Chronic or ESRD Management:

Dietary: renal diet, lowProtein, Na+, K+, fluidrestriction, higher fats &

CHO=calories, I&O Antacids: correct Po4/Ca+

imbalance, aluminum orca+ carbonate: give meals

Anti-hypertensives,

Erythropoietin (Epogen) = anemia,

to K+ levels = resin*Kayexelate = po or/enema =exchg Na+/K+ bowel = loosestool or *require dialysis tolower K+


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Acute vs. Chronic renal failure

Acute 4-phases of acute:

Initiation phase = startsw/insult and ends witholiguria

Oliguric Phase = periodwhere uremic s/s begin, urinary output

urinary renal

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