Nursing Care of Client Experiencing Kidney and Bladder Disorders

1. Nursing Care of Client Experiencing Kidney and Bladder Disorders

2. Objectives for Class: • Describe the anatomy and physiology of the upper and lower urinary tract (self review) • Describe diagnostic studies used to determine upper and lower urinary tract function and client education • Discuss the functions of the kidney • Discuss urinary retention & urinary incontinence • Discuss the causes, pathophysiologic changes, clinical manifestations, management & nursing care for clients with UTIs, glomerulonephritis, pyelonephritis, nephrotic syndrome, renal calculi (kidney stones) • Describe nursing management of the client with dialysis • Discuss care of clients undergoing renal surgery • Develop a teaching plan for clients with acute/chronic renal failure, UTIs, renal calculi (kidney stones)

3. Topics to be Considered • Common bladder & renal problems: • calculi • infections • neoplasms • diverticuli • pyleonephritis (review pediatric content) • neurogenic • incontinence • kidney failure /dialysis (presentation) • transplant

4. This is material you are required to know - some is from 3rd year It is testable in N405 & RNs • Review changes in the urinary tract due to aging • Review common laboratory findings: • Creatinine • BUN • ratio • Urinalysis lab profile • Preparing clients for tests involving contrast media • Follow up care after Renal Biopsy • Preventing UTIs READ!!

5. Readings: • In your text Chapters 43, 44, 45 • Recommended readings • Websites • Kidney foundation • Canadian Society of Nephrology • College of Family Physicians of Canada

6. Elimination System http://www.youtube.com/watch?v=zEpUQkQ-uKM&feature=related • The structures of this system precisely maintain the internal chemical environment of the body (Smeltzer & Bare, 2007, pg. 1255) • Comprised of: • Upper urinary tract • Kidneys: “balance the urinary excretion of substances against the accumulation within the body through ingestion or production”.(Balck Hawkes & Keene, 2001, p.732) • Ureters: connect the kidney from the renal pelvis to the bladder. • Lower urinary tract • Bladder: hollow elastic organ that holds urine • Urethra: extends from base of bladder to the surface of the body.

9. Anatomy Renal Pyramid of the Kidneyhttp://www.youtube.com/watch?v=Pz5DHAv_Mw4

11. Nephron and Associated Vascular Structureshttp://www.youtube.com/watch?v=glu0dzK4dbU&feature=related B Menu F

12. http://ca.video.search.yahoo.com/video/play;_ylt=A2KLqItOez5Q2XwASQYWFQx.;_ylu=X3oDMTBrc3VyamVwBHNlYwNzcgRzbGsDdmlkBHZ0aWQD?p=filtration+of+the+nephrons&vid=8C04D06CD00E0B5CE5C28C04D06CD00E0B5CE5C2&l=&turl=http%3A%2F%2Fts1.mm.bing.net%2Fvideos%2Fthumbnail.aspx%3Fq%3D4971292194701408%26id%3Db5842e6e0e73c9880a8c5f4faf14440c%26bid%3DwuVcCw7QbNAEjA%26bn%3DLargeThumb%26url%3Dhttp%253a%252f%252fwww.youtube.com%252fwatch%253fv%253dAfjUru7nTsk&rurl=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DAfjUru7nTsk&tit=Urinary+part+2&c=11&sigr=11agcl1d3&http://ca.video.search.yahoo.com/video/play;_ylt=A2KLqItOez5Q2XwASQYWFQx.;_ylu=X3oDMTBrc3VyamVwBHNlYwNzcgRzbGsDdmlkBHZ0aWQD?p=filtration+of+the+nephrons&vid=8C04D06CD00E0B5CE5C28C04D06CD00E0B5CE5C2&l=&turl=http%3A%2F%2Fts1.mm.bing.net%2Fvideos%2Fthumbnail.aspx%3Fq%3D4971292194701408%26id%3Db5842e6e0e73c9880a8c5f4faf14440c%26bid%3DwuVcCw7QbNAEjA%26bn%3DLargeThumb%26url%3Dhttp%253a%252f%252fwww.youtube.com%252fwatch%253fv%253dAfjUru7nTsk&rurl=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DAfjUru7nTsk&tit=Urinary+part+2&c=11&sigr=11agcl1d3&

13. Major Functions: Kidneys • Urine formation • Excretion of waste products • Electrolyte regulation • Water balance • Acid Base Balance • Blood Pressure regulation • Renal clearance • Blood component production (RBC’s) • Vitamin D synthesis • Prostaglandinsecretion

16. Why do problems occur with the bladder? Why do problems occur with the kidney?

17. Changes related to Aging: • Nocturia • Decreased Bladder Capacity • Weakened sphincter & shortened urethra in women • Tendency to retain urine • Decreased glomerular filtration rate • Hydration • ensure adequate hydration • administer nephrotoxic drugs with care

18. Assessment • Health history • Risk factors • Unexplained anemia - why • Pain • Changes in voiding • GI symptoms ? • Physical Exam

19. Risk Factors

20. Risk Factors

22. Bladder Palpation

23. Genitourinary Pain

24. Changes in Voiding

25. Changes in Voiding

26. Urine Color

27. Diagnostic Evaluation (See Plan of Nursing Care Pg. 1424) • Urinalysis and Urine Culture • Renal Function Tests (P. 1419 table 43-4) • X-ray and other imaging modalities • Urological Endoscopic Procedures • Biopsy • Urodynamic Tests

28. Goal of Clean Catch Urine(Mid Stream) To minimize contamination of the specimen by organisms on the skin Do you remember how to collect a midstream sample ??? A 12 or 24 hr specimen??

29. Renal Function Tests: Table 43-4

30. Adult: 7-18 mg/dl or 2.5-6.4 mmol/L Elderly 8-20 mg/dl or 2.9-7.5 mmol/L Child 5-18 mg/dl or 1.8-6.4 mmol/L BUN (Bld urea nitrogen)(table 43-4) Urea forms in the liver, along with CO2, constitutes the final product of protein metabolism. The amount of excreted urea varies directly with dietary protein intake. The test for BUN which measures the nitrogen portion of urea is used as an index of glomerular function in the production & excretion of urea. Thus, serves as an index of renal functioning. A marked increase in BUN = severe impaired renal function If confused, disoriented, or convulsions Chech BUN!

31. Urine Creatinine (table 43-4) • Amino acid waste product derived from muscle creatine (a product of protein metabolism) • All creatinine filtered by kidneys in a certain timeframe goes into the urine, creatinine levels thus are equal to the glomerular filtration rate. Disorders of kidney interfere with normal secretion of creatinine • Thus creatinine measures effectiveness of renal functioning (serum Creatinine) Keep in mind that rate normally decreases as we age • urine creatinine men 0.8 -1.8 g/24h • urine creatinine women 0.6 - 1.6 g/24h • blood creatinine: 0.4-1.5 mg/dl

32. Renal Function Tests: Table 43-4

33. Decreased Impaired kidney function Kidney Disease Shock & dehydration COPD CHF Increased State of high cardiac output Pregnancy Burns Carbon monoxide poisoning Creatinine Clearance Urine creatinine is of little value unless it is done as part of a creatinine clearance test!

34. What causes them? Who is at risk? What helps prevent UTIs? Urinary Tract Infections

35. Classifications of UTI Lower UTI Cystitis, prostatitis, urethritis Upper UTI Acute pyelonephritis, chronic pyelonephritis, renal abcess, interstitial nephritis, perirenal abcess

36. Classifications of UTI • Uncomplicated Lower or Upper UTI • Community acquired • Complicated Lower or Upper UTI • Often nosocomial related to catheterization, urologic abnormalities, pregnancy, immunosuppression, diabetes, obstructions

37. Risk Factors: UTI See Chart 45-2 Pg. 1483

38. Pathophysiology • Bacterial invasion: colony count 10^5 per ml/L urine • Reflux • Most common cause is gram negative organisms – E.coli, Klebsiella, Enterobacter & Proteus • Males & catheterized-psuedomonas & enterococcus • Routes of infection- urethra, bloodstream, fistula

39. Pathophysiology of E.Coli UTI

40. Clinical Manifestations Uncomplicated Lower UTI • Dysuria (burning pain on urination) • Frequency • Urgency • Voiding in small amts. or inability to void • Nocturia • Incontinence • Pain • Cloudy urine & hematuria • Gerontologic considerations-generalized fatigue, change in cognitive functioning

41. Medical/Nursing Interventions • Inhibit bacterial growth with antibacterials – often short course • Pain: urinary tract anesthetics – Pyridium • Modify diet – avoid foods that irritate such as caffeine, alcohol, tomatoes • Increase fluid intake (3-4 litres/day) • Education: • risk factors, early symptoms • Use of antibiotics (self-care) • Health promotion: p. 1488 table 45-4

42. Nursing Diagnoses • Acute pain • Altered health maintenance • PC: sepsis • PC: Renal failure Goal is to prevent renal damage

43. Catheterization • Indwelling devices and infections • Suprapubic catheterization • Bladder retraining • Intermittent self-catheterization

44. Suprapubic Catheterization • Catheter inserted through an incision or puncture made above the pubis • May be inserted: • When urethral route is impassable • After abdominal or gynecologic surgery • Pelvic fractures

45. Preventing Infection in the Catheterized Patient • Chart 45-9 Page 1500 KNOW!!

46. Condom Drainage and Leg Bag

47. Urethritis • Inflammation of the urethra • Commonly associated with STIs (gonorrhea, chlamydia), feminine hygiene products, scented toilet paper, spermicidal jellies • S & S include pain & pyuria • Management includes removing the cause, antibiotics (if bacterial) and drinking plenty of fluids, use of lubricants with intercourse, teaching re STI

48. Pyelonephritis • Is a bacterial infection causing inflammation of the renal pelvis, tubules, and interstitial tissue of one or both kidneys. • Common cause is E. coli • May also be caused by candidiasis. • May be acute • Usually enlarged kidney, maybe abscesses, & possibly destruction of glomeruli • May be chronic • Kidneys scarred, contracted, & nonfunctioning

50. Acute Pyelonephritis Clinical manifestations • Appears acutely ill • Fever, chills, flank pain, nausea, headache, muscle pain, dysuria, urgency, frequency • Urine cloudy, bloody, foul smelling, increased WBC & casts Diagnosis Ultrasound or CT to check for obstruction Urine C & S X-ray (KUB), MRI