Chapter 60 Assessment of the Renal/Urinary System Concepts The priority concept in this chapter is Elimination The interrelated concepts in this chapter are Fluid and Electrolyte Balance Acid–Base Balance Organs of the Renal/Urinary System As noted in the figure above, the organs of the renal/urinary system include the inferior vena cava, adrenal gland, renal vein, iliac crest, uterus, kidneys, renal artery, abdominal aorta, ureter, sigmoid colon, urinary bladder, and urethra. Structures of the Kidney Structures of the kidney are identified in the figure above. Anatomy of the Nephron The nephron shown in the image above is a juxtamedullary nephron. Juxtaglomerular Complex The juxtaglomerular complex shown on the right includes the following: • Distal convoluted tubule • Efferent arteriole • Bowman’s capsule • Proximal convoluted tubule • Glomerulus • Renin-producing granular cells • Afferent arteriole • Macula densa Renal Tubules The image to the right shows the sodium and water reabsorption by the tubules of a cortical nephron. Kidney and Urinary Changes Associated with Aging Cortical tissue loss Smaller nephrons Blood flow to kidneys declines Decreased GFR Nocturia Decreased bladder capacity Weakened urinary sphincters and shortened urethra in women Tendency to retain urine Assessment: Recognize Cues (1 of 2) History Demographic information Socioeconomic status Nutrition history Medication history Family history and genetic risk Current health problems Assessment: Recognize Cues (2 of 2) Physical Assessment General appearance Skin Kidneys, ureters, and bladder Urethra Psychosocial Diagnostic Assessment (1 of 2) Laboratory assessment Blood tests Urine tests Imaging assessment KUB CT MRI Ultrasonography Renal scan Renal arteriography Diagnostic Assessment (2 of 2) Cystoscopy and cystourethroscopy Cystography and cystourethrography Retrograde procedures Urodynamic studies Kidney biopsy Chapter 60 Audience Response System Questions Question 1 Which client does the nurse identify as most likely to experience renal compromise assessed by decreased urine production? A. B. C. D. 12-year history of diabetes mellitus White blood cell count of 13,000/mm3 Recent history of myocardial infarction Blood pressure of 92/48 mm Hg for 12 hours Answer to Question 1 ANS: D The ability of the kidneys to self-regulate renal blood pressure and renal blood flow keeps the glomerular filtration rate (GFR) constant. A blood pressure of 92/48 mm Hg is a mean arterial pressure of 62 mm Hg. The kidney has a difficult time regulating GFR with a mean arterial blood pressure less than 65 mm Hg. Question 2 A client with kidney failure whose pulse oximeter reading is 96% reports dyspnea. The nurse assesses that the client is visibly distressed, with a respiration rate of 32 breaths/minute. What is the appropriate nursing intervention? A. Notify the respiratory therapist. B. Contact the health care provider. C. Administer oxygen by nasal cannula. D. Elevate the head of bed to 90 degrees. Answer to Question 2 ANS: C Clients with kidney failure are anemic because they cannot produce the hormone erythropoietin. A high oxygen saturation in an anemic client who is showing signs of respiratory distress may still be hypoxemic. Clients who have decreased hemoglobin could have a high percentage of the hemoglobin saturated with oxygen, but because they have a decreased hemoglobin level, not enough oxygen is provided. Administering oxygen is necessary. Question 3 A client with a history of kidney disease is admitted with acute shoulder pain. Which order will the nurse discuss with the prescribing health care provider? A. B. C. D. Digoxin 0.125 mg by mouth daily Metoprolol 50 mg by mouth twice daily Pan cultures for a temperature >38.5º C Ibuprofen 800 mg by mouth every 4 hours Answer to Question 3 ANS: D High-dose or long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) can seriously reduce kidney function, so the nurse will discuss this with the prescribing health care provider.
