o Infections blockage No filter problem Not in Renal Failure Can Take Fluids o Diseases like Infections Kidney filter NOT working decreased GFR o Problem with filter decreased output NO output Renal Failure Fluid Jenna Cohen Exam 5 Study Guide Renal and Urological Conditions Renal Disease Kidney filter working Pyelonephritis Cystitis Blockage Renal Calculi Prostate Hypertrophy Restrictions o Diseases like Acute and chronic Renal Failure Glomerulonephritis Nephrotic Syndrome Elimination focused on urinary o Control incontinence problem Urinary Bowel Urinary Incontinence Enuresis Bedwetting Fecal Incontinence Diarrhea o Retention Blockage Urinary Benign prostatic hypertrophy prostate enlarges and blocks off Renal calculi renal stones Bowel Bowel obstructions o Infection Urinary Lower Urinary Tract o Cystitis Urethritis Prostatitis Upper Urinary o Pyelonephritis Bowel Infections of small or large bowel System Specific Assessment Lab Concept Elimination Urinalysis UA Suggestive of UTI WBC s 10 000 mm3 Nitrites Bloody cloudy urine Urine Culture toilet trained male Done if repeated infections poor response to antibiotics repeated infection in 24 hour Urine will have it on ice looking over time how well the clearance renal function is Creatinine BUN Na Ca catecholamine protein or for Creatinine clearance Blood Cultures if infections are not resolving or if UTI didn t get treated and gets Renal Function BUN Creatinine could indicate renal damage systemic C reactive protein Erythrocyte Sedimentation Rate ESR During acute or chronic inflammation Prostate specific antigen PSA Measures amount of protein produced by prostate gland in blood in level 4 to 10ng ml may indicate cancer System Specific Assessment Diagnostic Tests Procedures Concept Elimination Cystoscopy for complicated UTIs with Voiding cystourethrography VCUG look at for bladder injury and looking at ureters dye is not nephrotoxic so don t have to worry about clients who have renal problesm not being able to clear die Detects urethral or bladder injury VCUG detects if urine refluxes into ureters taken while voiding Dye is not nephrotoxic absorbed into blood stream Electromyography EMG Determines strength of pelvic muscles Electrical Pelvic Stimulation Ultrasound X Ray KUB kidney ureters bladder Urodynamic Testing Different tests visualization of the bladder Pressure inside bladder Rate and degree of bladder emptying and bladder pressure with certain activities MRI Gallium scan Intravenous Pyelogram IVP does use contrast dye check for shellfish and iodine allergies worried about it getting through kidneys so make sure kidney function is good before you do pyelogram alert for geriatrics heart failure renal failure diabetes have to drink lots of fluids System Specific Assessment Diagnostic Tests Procedures Concept Elimination Renal Calculi hopefully the stone passes on their own Extracorporeal Shock Wave Lithotripsy ESWL Retrograde Ureteroscopy Stenting Percutaneous ureterolithotomy nephrolithotomy Open surgery Ureterolithotomy Into the Ureter Pyelolithotomy Into the Renal Pelvis Nepholithotomy Into the Kidney Concepts for Elimination POTTY S when you have issues with elimination self conscious so issues with coping embarrassing P Pain particularly with renal calculi kidney stone pyelonephritis O Observe Fluid Electrolyte Balance are they holding onto fluid are they peeing too much T Treat Infection T Try Nutrition issue when looking at infections need protein calories vitamin C also important with skin breakdown renal calculi specific diets based off of type of stone Y You need SAFETY Prevention of Injury S Skin Tissue Integrity Physiology Control Elimination Urinary Incontinence Physiology Urinary Incontinence Urinary Incontinence to urinate strength of the muscles o Loss of bladder control with range of severity o Can be caused by urinary tract infections irritate bladder causing strong urges o Physiological issues of contractility of muscles urinary sphincter resistance Types of Incontinence don t need to know which is which sometimes it s just about the o Stress incontinence laughing crying too hard o Urge incontinence can t stop flow of getting there o Overflow incontinence cognitive problems like alzheimer s o Reflex o Functional o Total incontinence either very serious neurological issue no control of bowel bladder Physiology Etiology and Risk Factors Urinary Incontinence Risk Factors o Risk Factors o Female more common Multiple pregnancies Vaginal Births o Aging o Renal Disease o Urinary Bladder Spasms o Chronic Urinary Retention o Chronic Bladder Infections Cystitis Other Risk Factors o Neurological Disorders o Medication Therapy o Obesity o Confusion o Dementia o Immobility bc start to lose muscle strength o Depression Concepts Urinary Incontinence Altered Elimination Psychosocial o Coping Impaired Skin Integrity Urinary Incontinence Altered Elimination Bladder Training Important to keep clients dry very important get on regular schedule need to know what clients norm is kegal exercises tighten up all muscles squeeze vagina and they practice over and over at least 1x hr Sometimes incontinence can be due to an infection Nutrition needed for healing Use barrier ointments to keep skin dry and prevent from breaking down Teaching Moment Which of these statements alerts the nurse that further teaching is needed for an elderly client who has recently successfully completed a bladder retraining program I should continue to follow my established elimination schedule a b I can have coffee and red wine in moderation be careful of fluids at night time they c are stimulants so avoid I should not drink fluids at night and should empty my bladder on schedule before bedtime d I should continue my bladder strengthening exercises as this is a lifestyle change Which of these is an appropriate intervention for a client with a right side hemiplegia as a result of a CVA a Check the patient for urinary incontinence every 2 hours to maintain skin integrity Wouldn t be often enough b Assist the patient to the toilet on a scheduled basis to help ensure bladder emptying They just had a CVA so that may not be good to do yet c Use intermittent catheterization on a regular schedule to avoid the risk of infection d Ask the patient about the usual urinary pattern and measures used for bladder control What would be a priority in establishing a bladder retraining program a Provide a flexible schedule for the client to decrease anxiety b Schedule