Objectives Chapter 88 Urinary Disorder

Front 1

Identify the components of a normal urinalysis

Back 1

The major structures of the urinary system are:
•Two kidneys extract wastes from the blood, balance body
fluids, and form urine.
•Two ureters conduct urine from the kidneys to the urinarybladder.
•The urinary bladder serves as a reservoir for urine.
•The urethra conducts urine from the bladder to the outside of the body for elimination.

The urinary system is able to adapt to wide variations indietary and fluid intake. It also adjusts and maintains the com-position of blood, tissues, and interstitial
fluids. The volume of circulating
fluids in the bloodstream affects blood pressure. The urinary system helps control blood volume by excreting or con-serving water.

Front 2

Discuss the rationale for using the following tests for renal function: BUN, serum creatinine, creatinine clearance and uric acid

Back 2

BUN: The blood urea nitrogen (BUN) is a normal product of the breakdown of proteins, both in the diet and in the body. Normal kidneys excrete urea efficiently, so the BUN level rarely exceeds 20 in patients without kidney disease. The BUN level will rise above the normal range when the ability of the kidneys to excrete urea is impaired or in situations where protein breakdown is increased (such as a high-protein diet or damage to cells). A decrease in BUN during dialysis is the most commonly used test to measure dialysis adequacy.
SERUM CREATININE: Serum creatinine is the most commonly used test of kidney function and is more accurate than the BUN since its level is not affected by dietary protein intake. Serum refers to the liquid part of the blood, and the tests described below using the term “serum” just mean that they are blood tests. Creatinine is a normal product of muscle breakdown, and is produced at approximately the same rate every day in each person. Creatinine is normally excreted by the

Front 3

Discuss the rationale for using the following tests for renal function: BUN, serum creatinine, creatinine clearance and uric acid

Back 3

CREATININE CLEARANCE:
The creatinine clearance test
uses a collected urine speci-men to indicate glomerular filtration rate and renal insufficiency. Commonly, a creatinine clearance test is ordered in addition to a morning serum creatinine. Serum creatinine
isfound at a basically constant level. Serum and urine creati-nine levels are compared, and a creatinine clearance ratio ascalculated. Creatinine clearance is one of the most valuable tests to identify early kidney disease and is useful in monitoring the renal function of clients with known kidney disease. To obtain a creatinine clearance test, a 12- or 24-hour urine collection is made, noting the exact time the collection started and ended.
RATIONALE: Exactness is vital to obtain the full 24-hour specimen.
Uric acid studies may be obtained from urine or serum. The main diagnostic purpose of obtaining a uric acid level is to evaluate the client for gouty arthritis or kidney disease. A urineuric acid study is generally performed with a 24-hour coll

Front 4

Describe the role imaging studies play in diagnosis of urinary disorders.

Back 4

The kidney-ureter-bladder x-ray examination, commonlyreferred to as a “KUB flat plate of the abdomen,” is a goodscreening test for kidney or bladder stones. Ultrasound may be used to view the kidneys and other urinary structures. CT scanswill reveal any kidney abnormalities, such as cysts, tumors, or calculi (stones). Spiral CT is used to image the kidneys to evaluate tumors and stones. In addition, MRI may be used to distinguish normal from abnormal tissue.

Front 5

Identify at least four nursing considerations related to pre- and post-procedure cystoscopy care.

Back 5

•A cystoscopy is a procedure to look inside your urinary bladder using a cystoscope. A cystoscope is a long metal tube with a lens and light on its end. The scope may be attached to a camera or monitor, and pictures may be taken. NURSE CONSIDERATION PRE: Nursing considerations will include reporting a blood-tingedurine for more than 24 hours or darkening urine. Encourage the client to drink
fluids to prevent urinary stasis and flush any remaining dye from the body. Help the client with sitzbaths to ease voiding and to soothe the affected area. Remindthe client to report signs or symptoms of a urinary tract infec-tion or increasing blood in the urine.

Front 6

Describe the role of urodynamic tests in diagnosising urinary disorders.

Back 6

Urodynamic testing is a series of tests that best determines the actual function of the detrusor muscle of the bladder (which pushes the urine out), the external sphincter muscle, and the pelvic pubococcygeal) muscles. Urodynamic tests also evaluate the ability of these muscles to work in sequence.
A urodynamic evaluation is usually done in two phases —phase one is the filling phase of the study; phase two is the emptying phase of the study. The
filling phase tests sensationof the bladder, capacity, the muscle activity, and the stretch ofthe bladder wall (accommodation
or compliance) as well as the ability of the bladder and pelvic muscles to hold the urine in without leaking. The emptying phase (voiding or micturition
studies) tests how well the bladder empties and what strategies the client uses to empty completely.

Front 7

Discuss medical and surgical approaches to treat incontinence

Back 7

MEDICAL: Conservative (medical) treatment is effective in milder cases of incontinence, especially for young people, inclients who are poor surgical risks, or in clients who do not wish to undergo surgery. Conservative treatment includes useof a bladder-retraining program, Kegel exercises, electrical stimulation, pessaries, medication therapy (eg, tricyclic anti-depressants), Credé’s maneuver, and a catheter to empty the bladder completely (in cases of incontinence caused by neurogenic bladder). Treatment for over flow incontinence caused by obstruction is relief of the obstruction; surgical intervention may be necessary.
MEDICATIONS: Medications available to treat urge incontinence include anticholinergics (eg, oxybutynin) and tricyclic antidepressants (eg, imipramine);both of these drug classes work to inhibit bladder spasms. Tricyclic antidepressants also are used to treat stress incontinence because another effect of these drugs is increased bladder neck resistance. Other drugs used to treat stress

Front 8

Discuss client teaching necessary for the client with recurrent cystitis

Back 8

x

Front 9

define and discuss hydronephrosis and calculi

Back 9

x

Front 10

identify at least six nursing considerations for the client with calculi

Back 10

x

Front 11

prepare a nursing care plan for a client who has been recently diagnosied with a metastaic kidney tumor

Back 11

Metastatic sites is a secondary cancer site. The cancer originates in the original site: liver, brain, stomach. ASSESSMENT: The patient may complain of hematuria and often a dull, aching flank pain. He may also report weight loss, although this is uncommon. Rarely, his temperature may be elevated. Palpation may reveal a smooth, firm, nontender abdominal mass.
Nursing Diagnosis: Acute pain, fear, Risk for imbalance fluid volume. Nursing Care Plan: identify stratergies to help relieve anxiety; report increased comfort after adjusting pillow/bed. Express fears/concerns relating to condition. Nursing Interventions: Assist pt with leg exercises and turn every 2 hrs after surgery. Assure pt he can live with kidney. Provide fluid and monitor I&O.

Front 12

State at least four nursing considerations for a client with a urinary diversion.l

Back 12

x

Front 13

Define and differentiate between actue renal failure and ERSD

Back 13

x

Front 14

Identify nursing considerations for a client receiving dialysis

Back 14

x

Front 15

Identify dietary modifications for the client with urinary disorders

Back 15

x

Front 16

Identify common medications for the client with urinary disorders

Back 16

x

Front 17

Discuss general client and family teaching for clients with a urinary disorder, include ages across the life span

Back 17

x