Nursing Management of the Adult Patient with Urologic Alterations

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Nursing Management of the Adult Patient with
Urologic Alterations

• Donna Shepherd, MSN, RN, C
• Spring 2009

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Function of the Kidneys

• What are the functions of the kidneys?

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Urine Formation

• Glomerular filtration
• Tubular reabsorption
• Tubular secretion

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Assessment of the Renal System

• Physical Assessment
• Diagnostic Evaluation
• UA
• Renal function test
• Serum Creatinine
• BUN
• Creatinine Clearance

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Assessment of the Renal System

• Other Diagnostic Tests / Procedures
• KUB
• IVP
• Ultrasound
• CT MRI
• Renal angiogram
• Cystoscopy
• Renal biopsy

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Assessment of the Renal System

• Urodynamic testing

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Tests of Renal Function

• Creatinine 0.6 1.2 mg/dL
• BUN 7 18 mg/dL
• (gt 60 yrs) 8 20 mg/dL
• BUN to Creatinine Ratio 101
• Creatinine Clearance
• 24 hour urine
• Results by age, gender, ethnicity
• Specific Gravity 1.010 1.025

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Points to Ponder

• What are the normal substances found in urine?
• If found in urine, what substances warrant
  further investigation by the nurse?

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Nursing Interventions

• Administer urinary tract antiseptics
• Encourage medication compliance
• Administer systemic antibiotics
• Administer analgesics
• Increase fluid intake to 1,500 mL (if normal
  renal / cardiac function)
• Sitz bath for comfort

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Nursing Interventions

• Avoid irritants (coffee, tea, citrus fruits)
• Teach toileting hygiene
• Regular voiding
• Monitor IO
• Assess urine volume, color, cloudiness,
  specific gravity

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Surgery of the Kidney Preop. Care

• Focus
• Preparing patient
• Minimizing / Preventing complications
• Assessment
• Lab Values
• Reducing Anxiety
• Teaching
• Discharge Planning

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Surgery of the Kidney Postop Care

• Focus
• Prevention / early detection of complications
• Hemorrhage Shock
• Atelectasis Pneumonia
• Pneumothorax
• Fluid Electrolyte imbalances
• Abdominal distention Paralytic ileus
• Infection
• Thrombophlebitis
• Pain

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Post procedure Nursing Interventions

• Key Thorough assessment of each body system
• What measures should be implemented to prevent
  complications?
• What education should be provided to the patient?

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Post Surgery Nursing Plan of Care

• Alleviate pain
• Monitor urinary output
• Detect spontaneous passage of stone (strain
  urine)
• Ambulation
• Force fluids (if not restricted)
• Monitor IV fluids

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Post Surgery Nursing Plan of Care

• Monitor VS
• Assess for s/s infection, sepsis, urinary
  obstruction
• Education
• Self-care
• Continuing care
• Prevention of recurrent stones

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Nephrotic Syndrome

• Characterized by
• Proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia
• Due to lack of albumin (a plasma protein) in urine

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Nephrotic Syndrome

• Contributing Causes
• DM
• SLE
• Chronic glomerulitis
• Renal vein thrombosis
• Signs and Symptoms
• Edema
• Malaise Fatigue
• HA
• Irritability

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Nephrotic Syndrome

• Diagnostic Findings
• Albumin exceeds 3 to 3.5 gm/day
• ? WBC in urine
• Needle biopsy (to confirm diagnosis)

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Nephrotic Syndrome

• Medical Management
• Diuretics
• ACE Inhibitors
• Antineoplastic agents (Cytoxan)
• Dietary Management
• Low Na
• Liberal K
• Low fat
• Protein 0.8 gm/kg/day

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Nephrotic Syndrome

• Nursing Management
• As that of patient in chronic renal failure

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Acute Renal Failure

• Initiation Period
• Period of Oliguria
• Period of Diuresis
• Period of Recovery

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Chronic Renal Failure

• Stages
• Reduced renal reserve
• Renal insufficiency
• End Stage Renal Disease (ESRD)

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ESRD Dietary Management

• Goals
• Maintain body weight (age, height, build)
• Maintain serum lab values within safe limits
• Comply with dietary regimen

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Dialysis

• Hemodialysis
• Continuous Renal Replacement Therapy (CRRT)
• Peritoneal Dialysis
• Continuous Ambulatory (CAPD)
• Continuous Cycle (CCPD)

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Dialysis Nursing Management

• Protect vascular access
• Monitor
• Fluid balance
• Electrolyte balance
• Diet
• BP
• Assess for manifestations of
• Uremia
• Cardiac respiratory complications

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Dialysis Nursing Management

• Manage pain discomfort
• Prevent infection
• Knowledge deficiency regarding self care

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Peritoneal Dialysis - Complications

• Peritonitis
• Leakage
• Bleeding
• Long term complications

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Hemodialysis - Complications

• Hypotension
• Chest pain
• Air embolism
• Dialysis disequilibrium
• Dysrhythmias

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Hemodialysis - Complications

• Exosanguination
• CHF, CAD
• CVA
• Anemia
• Fluid electrolyte imbalance

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Hemodialysis - Complications

• Osteodystrophy
• Infection
• GI problems
• Diminished physical well-being
• Diminished emotional well-being

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Urinary Diversions

• Types
• Cutaneous (Ileal Loop)
• Continent (Indiana Pouch)
• Ureterosigmoidostomy
• Nursing Care
• Dependent upon type of diversion performed during
  surgery
• Common needs by patients

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Urinary Diversions

• Common Needs of Patients
• Teaching needs
• Anxiety reduction

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Urinary Diversions Nursing Diagnoses

• Preoperative
• Anxiety
• Altered nutrition
• Knowledge deficient
• Postoperative
• Risk for impaired skin integrity
• Pain
• Body image disturbance
• Altered pattern of urinary elimination

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Urinary Diversions Nursing Management

• Postoperative
• Monitor urinary function
• Assess skin prevent breakdown
• Monitor fluid electrolytes