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13 Cards in this Set
- Front
- Back
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What occurs 2-3 days after surgery to cause urine output to come back up?
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Post-operative reabsorption of third-space fluids.
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What is the most common cause of decreased urine output in the surgery patient?
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Intravascular fluid deficit
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What are some common causes of intravascular fluid deficit in the surgical patient?
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Fluid deficit due to illness itself:
-nausea/vomiting, diarrhea, hemorrhage Fluid deficit due to surgery: -intra-operative hemorrhage and fluid loss Fluid loss occurring during post-operative recovery: -third-spacing -post-operative hemorrhage |
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How do you divide causes of decreased urine output in the surgical patient:
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1) Pre-renal causes
-intravascular fluid deficit 2) Renal causes -hepatotoxic agents (i.e. CT contrast), hypotension 3) Post-renal causes -autonomic disturbance due to anesthesia, loss of bladder tone due to over-extention. 4) Problems with the regulatory system in charge -syndrome of inappropriate ADH |
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What findings in urinalysis suggest the problem lies with the kidney itself?
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Abnormalities in the renal sediment (i.e. not just the amount that's the problem, but the contents)
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The nursing flowsheets report low urine output. What must you rule out before working the patient up for decreased urine output.
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Is the catheter placed correctly? Is it kinked?
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What laboratory investigations are employed in decreased urine output?
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Electrolytes, BUN/creatinine, lactic acid, blood gas
Urinalysis with microscopy |
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If you suspect intravascular fluid deficit to be the cause of decreased urine output, what is the first step in management?
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Fluid resuscitation:
IV bolus of isotonic solution, 1000mL |
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Name 2 post-renal causes of decreased urine output in the surgical patient.
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1) Anesthetic interference with autonomic bladder regulation
2) Loss of bladder tone because of overdistention (did they have a foley in?? |
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What is adequate urine output for an adult?
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0.5-1 mL/kg/hour
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What is the definition of oliguria in adults?
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<500 mL per day
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What is the definition of anuria in adults?
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<50 mL per day
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What is the average total fluid intake in a day for an adult?
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2500-3000 mL
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