Organs of the Renal/Urinary

System
 Kidney Functions
Identify 6 Nursing interventions for each failed function

1. FILTERS BLOOD (1200mL/MIN)->URINE

FORMATION-> EXCRETE WASTE: UREA,
CREATININE URIC ACID
2.FLUID & ELECTROLYTE; ACID - BASE BALANCE
3. CONTROL BLOOD PRESSURE: RENIN-
ANGIOTENSINALDOSTERONE
4. ERYTHROPOETIN-> STIMULATES PRODUCTION
OF RBCs IN THE BONE MARROW
5. VITAMIN D ACTIVATED via gi tract for calcium
absorption

Collaborative management?
 Kidney/Urinary System Changes
Associated with Aging
Reduced blood flow to kidneys
Thickened glomerular and tubular
basement membranes
Decreased tubule length
Decreased glomerular filtration rate
Nocturnal polyuria
Risk for dehydration
 Laboratory Assessment
Serum creatinine
BUN
BUN to serum creatinine ratio
Blood osmolarity
Urine C & S
Creatinine clearance
Urine osmolarity
GFR
Lytes
Calcium, Phosphorous, Magnesium
 Urinalysis
Color, odor, turbidity
Specific gravity
pH
Glucose
Ketone bodies
Protein
Leukoesterase, nitrites
Cells, casts, crystals, bacteria
No crystals, microalbuminuria parasites,
nitrites, leukoesterase, sediment
 Acute Glomerulonephritis
Patient assessment
Connection with sore throat?
Proteinuria
Physical assessment
Clinical manifestations
Laboratory assessment
Other diagnostic tests
 Nephrotic Syndrome
Condition of increased glomerular
permeability; allows larger molecules to
pass through the membrane into urine
and be excreted
Severe loss of protein into urine, edema
formation, and decreased plasma
albumin levels
 Pediatric Genital-Urinary
Focus on teaching

Cryptorchidism
At risk for ________ & _______
TSE
Epispadias/Hypospadias
Why no circumcision?
Bladder exstrophy-care
Wilms tumor
 DIAGNOSTIC TESTS
"How will you prepare/ teach the Client?"
KUB
IVP
CYSTOSCOPY
ULTRA SOUND
CT
MRI
RENAL BIOPSY
RENAL SCAN
Bladder Sonography
 Pyelonephritis
Bacterial infection in kidney and renal
pelvis (upper urinary tract)
Acute symptoms:
Fever, chills, tachycardia, tachypnea
Flank, back, or loin pain
Abdominal discomfort
Turning, nausea and vomiting, urgency,
frequency, nocturia
General malaise or fatigue
 NCLEX REVIEW
Review Sterile catheter insertion
Contact precautions with drainage
Calculate I/O, irrigation with CBI
CAUTI
Discuss case studies: incontinence
Health promotion- 2L water/day
IVs & Drug therapies
NSG: Assessing, PSYCHOSOCIAL
TEACHING & EVALUATION
 UROLITHIASIS/NEPHROLITHIASIS

RISK: age ____;dietary;____ lifestyle____

metabolic/genetics____________
Cultural__________
Types Of Stones: ____;____; ______; _____
Renal colic: pain; obstruction of urinary flow
DX: _________
TX: Drug therapies; Nutrition
ENDOUROLOGIC, LITHOTRIPSY, SURGERY,Stent
 Lithotripsy
Uses sound, laser, or dry shock wave
energy to break stones into small
fragments
Patient undergoes conscious sedation
Topical anesthetic cream applied to skin
site
Continuous monitoring by ECG
 BLADDER CANCER
RISK: 50-70yo, SMOKER, CARCINOGEN
EXPOSURE
S/S: PAINLESS HEMATURIA
DX: CYSTO-Bx-> STAGING, IVP, CT, MRI, U/S
TX: TUR-FULGURATION, CYSTECTOMY,
RADIATION, CHEMO
URINARY DIVERSION
NSG: pre-op, teaching priority Post-op nursing
priority
Urostomy care:
Teaching
Care of Patients with Acute Kidney Injury and
Chronic Kidney Disease
 Acute Kidney Injury (AKI)
Pathophysiology
Types:
Prerenal
Intrarenal
Postrenal
Prerenal azotemia
Causes:
Hypovolemic shock
Heart failure
 Chronic Kidney Disease
Concept Map in Iggy
History
Expected Outcomes
Patient Problems
Interventions
Fluid management
Pulmonary edema
Drug therapy
BP
Vitamins/supplements
Potassium restrictions
Diet
Sodium, Potassium

Drugs: Why are they used?

Avoid NSAIDs , No magnesium antacids
 Collaborative Care CKD
Preventing infection
Preventing injury
Minimizing fatigue
Reducing anxiety
Drugs: How do they work? Kayexalate,
Calcium channel blockers, Venofer
vasodilators, Calcium, (Renagel),NaHCO3
Procrit/Epogen/Aranesp diuretics(which
are contraindicated?), Zemplar, PTH
 Dialysis
Hemo: palpate thrill; auscultate bruit.
Monitor for steal syndrome
hypotension, bleeding and infection.
Peritoneal: inflow, dwell, drain, I/O,
teaching, trouble shooting, prevent
peritonitis,
What are the s/s of peritonitis?
What is the nurses ppe for PD?
 Donor Transplant
pre-op: immunosuppressants- Immuran,
Cyclosporine, Tacrolimus-
purpose/adverse effects?

Post-op: urinary output, list signs of graft

rejection, infection control measures
(where is the new kidney placed?)
Transplanted Kidney
Care of Patients with Breast Disorders

BSE
BSE
 Risk Factors Signs/Symptoms

1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. Options for Breast
Cancer
 Nursing Management
Prioritize post op discharge home
care

1.
2.
3.
4.
5.
Care of Patients with Gynecologic
Problems
 Gynecological Problems
(Leiomyomas) Fibroids
Endometriosis
Dysfunctional uterine bleeding
Toxic shock syndrome
Pelvic organ prolapse
Cervical cancer
Uterine cancer
Ovarian cancer
Focus on: risk & prevention of complications
 HIV-AIDS
Review immune system-CD4+Tcell
Opportunistic Infections-list
Health promotion and Maintenance
Reduce exposure
Safer sex practices
IDUs
Perinatal transmission
Transmission and Health Care Workers
 Medical Management
Testing
Drug therapy-HAART

Nursing Focus
Enhance oxygenation
Manage pain
Enhance nutrition
Community/Home management/Self care
 Testicular Cancer
Does this affect young or old men?
Risk factors
S/S
Prevention
Treatment
Nursing focus
 Benign Prostatatic Hyertrophy
Risk
S/S
Tx
Rx:
Alpha adrenergic blockers zosin
Finestride
Advodart
Side effects
 Prostatecomy
Types

Post op
CBI-purpose; calculation
Teaching
 Prostate Cancer
Dx
Treatment
Nursing Focus
 Teaching
Female condom
Birth control types

Genital Herpes Genital warts

 STIs
GC Syphilis