Assessment of Renal and
Urinary Tract Function
Renal and Urinary Systems
• Function to 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, and control of blood pressure.
• Structures:
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Kidneys
Ureters
Bladder
Urethra
Kidneys, Ureters, and Bladder
Internal Structure of the Kidney
Nephron
Formation of Urine
Renin Angiotensin System
Functions of the Kidneys:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Urine formation
Excretion of water products
Regulation of electrolytes
Regulation of acid-base balance
Regulation of water balance
Control of blood pressure
Renal clearance ( the ability of the kidneys to clear solutes from the plasma
Regulation of red blood cell production
Synthesis of vit.D to active form
Secretion of prostaglandins (PGE2) ( vasodilatation effect and maintaining
renal flow
Assessment:
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Health history
Patient chief concern
Pain ( characteristic, location, duration,…. Etc)
Dysuria, Hesitancy, urine incontinence, urinary
frequency, Hematuria, Nocturia, polyuria, oliguria (less
than 400/day), and anuria ( urine less than 50 ml/day)
• The present of renal calculi
• History of GI symptoms
• History of UTI
Cont…
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History of sexual transmitted disease
Habits: smoking, alcohol, drugs
Medication
History of any renal diagnostic test (
catheterization)
• Any risk factors ( DM, Hypertension, Sickle cell
anemia, Benign prostatic hypertrophy, spinal
cord injury, immobilization
Physical examination
Diagnostic Studies
• Urinalysis and urine culture
• Renal function tests
(See Table 43-5)
• Ultrasonography
• CT and MRI
• Nuclear scans
• Intravenous urography, retrograde pyelography, cystography, renal
angiography
(See Chart 43-2)
• Endoscopic procedures
• Biopsies
Diagnostic Evaluation:
1.
2.
3.
Urine analysis: urine color (light yellow), Urine clarity ( clear and
translucent), urine odor ( arometic), urine PH ( acidic: 6.0 or 4.6-8),
urine specific gravity, detect protein, glucose and ketone bodies in
the urine, microscopic examination of the urine sediments to
detect RBC’s, WBC’s, casts, crystals, pus (pyuria), and bacteria
Urine Culture and sensitivity
Renal function test (KFT): Renal concentrate test (Specific gravity,
and urine osmolarity) creatinine clearance test ( 24-hour urine
collection test), serum creatinine, BUN, and serum electrolyte level
Continue
• X-Ray film and other Imaging modalities:
1. KUB studies: to detect size, shape, location and position of the
kidneys, to reveal stone, hydronephrosis ( distention of the kidney
pelvis), Cysts, tumors, and any surrounding tissue abnormalities.
2. CT scan and MRI: cross section view of the kidney and urinary tract:
metal objects should be removed, sedative or certain contrasts may
given, contraindicated in patient has pacemaker, surgical clips, or any
metal objects
Cont…
3. General Ultrasonography: assess fluid accumulation, masses,
congenital malformation, changes in size, shape, or any
obstruction, fluid intake should be encouraged before the
procedure
4. Bladder Ultrasonography: to measure fluid volume in the
bladder, indicated for urinary frequency, inability to void
after removal of FC or postoperative, measuring residual
volume of urine after voiding
Cont….
5. Intravenous urography: intravenous pyelography
(IVP) or intravenous urogram (IVU). History of iodine or
any contrast allergy should be obtained before the
procedure. Patient should be instructed he may have
temporary feeling of wormth, flushing of the face and
unusual flavor (seafood) in the mouth. Monitor the
patient closely for any allergic reaction.
Cont.
6. Retrograde pyelography: catheter induced
7.
8.
through ureters to the kidney pelvis by means of
cystoscopy. Provide direct visualization of the kidney.
Cystography: direct visualization of the bladder
walls. Assessing vesicoureteral reflux ( back flow of
urine from the bladder to one or both of the ureters),
bladder injury
Renal Angiography: provide an image of the renal
arteries preparation done same as Cardiac
cathetarization
Cont……
9. Urologic Endoscopic Procedure ( Endourology):
through Cystoscope inserted via urethra or percataneously.
• Direct visualization of the system,
• removal of stone,
• obtaining urine specimen from the kidney.
• Sedation or anesthesia may performed, patient should be kept NPO.
• Post- procedure:
• moist heat to the lower abdomen and warm sitz bath are helpful in relieving
pain and relaxing the muscles,
• monitor the patient with prostatic hyperplasia for urine retention,
• intermittent catheterization may needed for few hours
• monitor for S/S of UTI, monitor for signs of retention
Cont…
10. Kidney biopsy:
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Indications:
1. Unexplained acute renal failure,
2. persistent proteinuria or hematuria,
3. transplant rejection,
4. and glomerulopathies.
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Contraindications:
1. Serious bleeding disorders,
2. excessive obesity, and sever hypertension.
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It is usually performed percataneously with a biopsy needle
Procedure for kidney biopsy include:
1.
2.
3.
4.
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1.
2.
3.
Place patient in prone position with a sandbag under the abdomin
The skin site of biopsy is infiltrated with local anesthesia
The needle biopsy is inserted just inside the renal capsule
The patient is instructed to breath in and hold the breath to immobile the
kidney during insertion of the needle
Nursing diagnosis for the patient undergoing assessment of urinary or
renal function include the following:
Knowledge deficit regarding the procedure and diagnostic test
Acute pain related to renal invasive diagnostic procedure
Fear related to possible procedure or serious illness
Cystoscopic Examination
Nursing Care of the Patient Undergoing
Diagnostic Testing of the Renal-Urologic
System—Assessment
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Patient knowledge
Psychosocial and emotional factors; fear, anxiety
Urologic function, include voiding habits/pattern
Fluid intake
Hygiene
Presence of pain or discomfort
Allergies
Nursing Care of the Patient Undergoing Diagnostic
Testing of the Renal-Urologic System—Diagnoses
• Knowledge deficient
• Pain
• Fear
Nursing Care of the Patient Undergoing Diagnostic
Testing of the Renal-Urologic System—Planning
• Patient goals may include understanding of
procedures, tests and expected behaviors;
decreased pain or absence of discomfort; and
decreased apprehension and fear.
Interventions
• Patient teaching: providing a description of the
tests and procedures in language the patient can
understand.
• Use appropriate, correct terminology.
• Encourage fluid intake unless contraindicated.
• Instruct in methods to reduce discomfort; sitz
baths, relaxation techniques.
• Administer analgesics and antispasmodics as
prescribed.
• Assess voiding and provide instruction related to
voiding practices and hygiene.
• Provide privacy and respect.