 Chapter 65

Assessment of Renal and Urinary Function

 OBJECTIVES
 Describe anatomy & physiology of the renal/urinary system, including elimination, fluid
& electrolyte balance, and acid-base balance
 Identify age-related changes in the urinary system
 Use standard precautions when handling urinary samples and examining genitalia
 Determine risk for allergic reactions related to use of dyes.
 Verify that informed consent has been obtained and that the patient has a clear
understanding of potential risks associated with invasive procedures or testing.
 Encourage patients & families to express concerns about changes in urinary elimination.
 Interpret assessment findings for the patient with a urinary or renal system health
problem
 Teach the patient and caregivers about diagnostic procedures associated with
assessment of kidney and urinary health problems
 Renal System
 Links:
 https://youtu.be/H2VkW9L5QSU
 https://www.youtube.com/watch?v=hiNEShg6JTI
 Nephron
 PHYSIOLOGY OVERVIEW
Kidneys maintain homeostasis:
 Urine formation
 Regulatory function
 Hormonal function
 URINE FORMATION
 REGULATORY FUNCTION
 HORMONAL FUNCTION
 AGE-RELATED CHANGES
 GFR
 Nocturia
 Bladder capacity
 Urinary sphincters
 Urinary retention
 ASSESSMENT
 History collection
o Demographics and personal data
 Gender, age, race, socioeconomic status, occupational history, and
dietary and personal habits
 Socioeconomic status
 Smoking history
o Personal and family health history
  Alterations in the functioning of the renal and urinary systems can
produce systemic effects
o ASSESSMENT
 Renal and urinary assessment
o Anuria, oliguria, and polyuria
 Physical examination
o Inspection
o Auscultation
o Palpation
o Percussion
o DIAGNOSTIC STUDIES
 Laboratory studies
o Blood tests
o Urine tests
 http://www.youtube.com/watch?v=S49nUD-iA4A&feature=related
 Imaging studies
 Care of Patients with Urinary Problems
 Chapter 66
 OBJECTIVES
 Describe different types of incontinence
 Describe clinical manifestations of urinary tract infections, pyelonephritis, cystitis,
urolithiasis, and bladder cancer
 Teach the patient about common drugs and treatments used for urinary problems
 Bladder
o Muscle trouser
o Micturition: urinating
 INCONTINENCE
 Major health problem
 Common types of incontinence:
o Stress
o Urge
o Mixed
o Overflow
o Functional
o MANAGEMENT
 Urinary Tract Infections
 URINARY TRACT INFECTIONS
o Epidemiology
 Over 60% of females will have at least one UTI in their lifetime
 Pathophysiology
o Occurs when bacteria enters the sterile bladder causing inflammation
 Clinical manifestations
 Management
o Diagnostics
 o Medications
o Surgical management
o UROLITHIASIS
 Epidemiology
o Renal stones are the most prevalent
o Incidence higher in males- in the SE United States
 Pathophysiology
o The majority of stones are calcium
o Microscopic crystals aggregate to form stone
 Types of Calculi
 Calcium Oxalate
 Struvite
 Uric Acid
 Cystine
 Staghorn
 UROLITHIASIS
 UROLITHIASIS (cont’d)
 Clinical manifestations
 Management
o Diagnostics
o Surgical procedures
 UROLITHIASIS (cont’d)
 BLADDER CANCER
 BLADDER CANCER…cont’d
 Reservoir
 Ureterostomy/Conduit
 Chapter 67
 Care of Patients with Renal Disorders
 OBJECTIVES
 Describe clinical manifestations and management of pyelonephritis
 Describe clinical manifestations and management of polycystic kidney disease
 Describe clinical manifestations and management of acute/chronic glomerulonephritis
 Describe clinical manifestations and management of renal cancer
 Describe clinical manifestations and management of renal trauma
 Describe clinical manifestations and management of nephrotic syndrome
 PYELONEPHRITIS
 Glomerulonephritis
 Polycystic Kidney Disease (PKD)
 RENAL CANCER
 RENAL TRAUMA
 Nephrotic Syndrome