Assessment of the Renal and Urinary Tract Function

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Assessment of the Renal and Urinary Tract
Function

• V. Alexander, DNP., ARNP

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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

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Renal and Urinary Systems

• Function
• Maintain the bodys 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

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Kidneys, Ureters, Bladder and Urethra
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Internal Structure of the Kidney
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Nephron
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Formation of Urine
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Renin Angiotensin System
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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

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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

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Nursing Care

• Family history
• UTIs
• Chronic diseases
• Genetics
• Psychosocial
• Cultural
• Review of systems

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Characteristics of Genitourinary Tract Pain

• Kidney
• Bladder
• Ureter
• Prostate
• Urethra

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Problems Associated with Voiding

• Frequency
• Urgency
• Dysuria
• Hesitancy
• Nocturia
• Polyuria
• Oliguria
• Anuria
• Hematuria
• Proteinuria
• Glycosuria
• Incontinence
• Enuresis

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Physical Assessment

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

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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

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Cystoscopic Examination
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Urinalysis

• 
  Reference Range Result
• 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

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Urine culture(Sample)

• Source, midstream Collection date
• Culture, Urine Date received
• Organism 1 Escherichia coli
• Colony count gt100,000 cfus/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 50,000cfus/ml
• Sensitivity to follow

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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 (lt 60 Kidney
  disease)
• GFR AA
• Calcium 8.4 - 10.2 mg/dl

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Biochemical Profile (BP-8)(Example)

• Chemistry Result Reference Range
• Glucose 216 60 - 110 mg/dl
• Bun 46 7 - 17
  mg/dl
• Sodium 137 137 - 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

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Abnormal findings

• Amino acids and glucose
• Filtered and reabsorbed at glomerulus
• Proteinuria
• Globulins
• Albumin
• Glycosuria
• Diabetes
• Pregnancy

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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

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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 2nd to urinary
  function and invasion of genitalia

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Planning

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

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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

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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

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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

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Question

• What is the normal adult bladder capacity?
• 50 100 mL
• 100 200 mL
• 300 500 mL
• 600 800 mL

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The End