V. Alexander, DNP., ARNP

ObjectivesReview 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

Renal and Urinary SystemsFunction

Maintain the body’s 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:KidneysUretersBladderUrethra

Kidneys, Ureters, Bladder and Urethra

Internal Structure of the Kidney

Nephron

Formation of Urine

Renin Angiotensin System

Risk FactorsChildhood diseases - strep throat, impetigo,

nephrotic syndromeAdvanced ageInstrumentationImmobilizationOccupational, recreational, or environmentalChronic diseases (DM, HTN, MS SLE, etc.)Radiation therapyPelvic surgeryPregnancyInjury – Obstetric or Spinal cord injuryTumors

Nursing Care……AssessmentSubjective and objective dataChief 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

Nursing CareFamily history

UTI’sChronic diseasesGenetics

PsychosocialCulturalReview of systems

Characteristics of Genitourinary Tract PainKidneyBladderUreterProstateUrethra

Problems Associated with VoidingFrequency Urgency DysuriaHesitancyNocturiaPolyuria OliguriaAnuriaHematuriaProteinuriaGlycosuriaIncontinenceEnuresis

Physical AssessmentObjective dataVital signs, weight, heightFull head to toe assessment

Techniques Detailed assessment of system involved

Documentation

Diagnostic StudiesUrinalysis, urine culture, Kidney, Ureter, and Bladder studiesRenal functionUltrasonographyCT and MRINuclear scansIntravenous urography, retrograde

pyelography, cystography, renal angiographyEndoscopic proceduresBiopsies

Cystoscopic Examination

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

Urine culture(Sample)Source, midstream Collection dateCulture, Urine Date receivedOrganism 1 Escherichia coli

Colony count: >100,000 cfu’s/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 – 50,000cfu’s/ml

• Sensitivity to follow

Biochemical Profile (BP – 8)(Example)Chemistry Reference RangeGlucose 60 - 110 mg/dlBun 7 - 17 mg/dlSodium 137 - 145 mmol/LPotassium 3.6 - 5.0 mmo/LChloride 98 - 107 mmol/LCo2 22 - 30 mmol/LAnion gap 10 - 20 mmol/LCreatinine 0.6 - 1.0 mg/dlGFR Non AA 90 – 120 ml/min (< 60 – Kidney

disease)GFR AACalcium 8.4 - 10.2 mg/dl

Biochemical Profile (BP-8)(Example)Chemistry Result Reference RangeGlucose 216 60 - 110 mg/dlBun 46 7 - 17 mg/dlSodium 137 137 - 145 mmol/LPotassium 5.6 3.6 - 5.0 mmo/LChloride 95 98 - 107 mmol/LCo2 30 22 - 30 mmol/LAnion gap 21 10 - 20 mmol/LCreatinine 9.11 0.6 - 1.0 mg/dlGFR Non AA 4GFR AA 5Calcium 8.9 8.4 - 10.2 mg/dl

Abnormal findingsAmino acids and glucose

Filtered and reabsorbed at glomerulusProteinuria

GlobulinsAlbumin

GlycosuriaDiabetesPregnancy

QuestionTrue 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

Nursing DiagnosesAcute pain related to infection within urinary

tractDeficient 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

PlanningPatient goals may include:

Understanding of procedures, tests and expected behaviors

Decreased pain or absence of discomfort Decreased apprehension and fear.

Interventions…….Assess knowledge of diagnosis and procedureProviding 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

InterventionsAssess voiding pattern and amountProvide instruction related to voiding

practices and hygieneProvide privacy and respectAssess level of fear and apprehensionInstruct on relaxation techniques

Goals/OutcomesStates rationale for planned diagnostic tests

and expected tasks and behaviorsComplies with urine collection, fluid

modifications and other proceduresReports decreasing pain levelAppears relaxed with low level of fear or

apprehension

QuestionWhat is the normal adult bladder capacity?A.50 – 100 mLB.100 – 200 mLC.300 – 500 mLD.600 – 800 mL

The End