Question

2. You are a urologic nurse whose patient has voiced concern over his kidneys losing their function within the past few weeks. He has maintained a log of the past week, recording his urination and fluid intake. He has a history of diabetes mellitus and hypertension, which are treated with medication. (Learning Objectives #3 & #4) a. In your patient interview, how would you define renal failure for your patient? b. Which diseases could be included as possible etiologies for renal failure? c. What data should be included in a complete urinary system assessment? d. How might an accurate urinary output measurement be obtained? e. What is important to remember when collecting a 24-hour urine specimen?

Answer 1

2 a) Failure of the kidneys means the body cannot excrete certain waste products, excess water, and salts or control the body's acidity. There are two types of renal failure- Acute and chronic.
Acute Renal failure is the sudden and often temporary loss of kidney function.
Chronic renal failure is the Irreversable renal damage developing slowly over many years.

2 b) These diseases, conditions may damage the kidneys and lead to kidney failure:

• Blood clots in the veins and arteries in and around the kidneys
• Cholesterol deposits that block blood flow in the kidneys
• Glomerulonephritis, inflammation of the tiny filters in the kidneys (glomeruli)
• Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
• Infection
• Lupus, an immune system disorder causing glomerulonephritis
• Urine blockage in the kidneys
• Diabetes
• High blood pressure
• Heart failure
• Kidney diseases
• Liver diseases.

2 c) The following data's should be included in a complete urinary system assessment -

Personal and family history:

• The family history of the client with a suspected kidney or urologic problem is significant because some disorders have a familial inheritance pattern.
• The client is asked about any previous renal or urologic disorders, including tumors, infections, stones, or urologic surgery. A history of any chronic health problems, such as diabetes mellitus or hypertension, may contribute to the development of renal disease.
• The patient is asked whether painful urination, frequency or burning on urination, dribbling, a decreased urinary stream, nocturia, stress incontinence, headache, back pain, or increased thirst has occurred.
• The color, odor, and amount of urine voided are determined.
• The patient's vital signs; any bladder distension; skin condition; neurological changes; the location, duration, and character of pain; and the presence of bladder spasms are recorded. -It is determined whether the patient has hypertension, diabetes, a venereal disease, urethral drainage or discharge, or a history that includes cystitis, pyelonephritis, kidney stones, prostatectomy, renal surgery, a kidney transplant, or a venereal infection.
• The nurse identifies all of the client's prescription medica­tions. The client is asked about their duration of use and whether any recent changes in medications have been pre­scribed. Drugs prescribed for diabetes mellitus, hypertension, cardiac disorders, hormonal disorders, cancer, arthritis, and psychiatric disorders are potential causes of renal dysfunc­tion. Antibiotics taken for infections, such as gentamicin may also produce sudden renal dysfunction.
• The use of over-the-counter (OTC) drugs or agents, in­cluding vitamin and mineral supplements and replacements, laxatives, analgesics, and nonsteroidal anti-inflammatory drugs (NS AIDs) is explored. Many of these drugs affect renal function.
• Additional information is obtained about the following: Chemical or environmental toxin exposure in occupa­tional or other settings, Recent travel to geographic regions that pose infectious disease risks, Recent physical injuries, Trauma, A history of altered patterns of urinary elimination.

Diet History:

• The client with known or suspected renal or urologic disor­ders is asked about his or her usual diet and any recent changes in the diet. The excessive intake or omission of cer­tain categories of foods is noted.
• Information about food and fluid intake is obtained. If the client has followed a diet for weight reduction, the details of the diet plan are pertinent. A high-protein intake can result in temporary renal problems. Clients susceptible to calculi (stone) formation who ingest large amounts of calcium-containing products or have an in­sufficient fluid intake may form new stones.
• Changes in appetite, alterations in taste acuity, and an inabil­ity to discriminate tastes are important.

Socioeconomic staus:

• The socioeconomic status of the client may influence health care practices. People with limited income or no health insur­ance often ignore physical ailments or delay seeking health care because they lack the funds to pay for diagnostic tests or treatment. They may also have difficulty following medical advice, having prescriptions filled, and keeping follow-up appointments.
• The information that a client has about the disease and its symptoms may relate to educational level.
• The client's health beliefs affect the approach to health and illness.

Current Health Problems:

• The effects of renal failure result in changes in all body systems. Therefore all of the client's current health problems are docu­mented. The client is encouraged to describe all health concerns, because some renal and urologic disorders are associated with symptoms that are related to other body systems or that occur as generalized problems. Recent upper respiratory problems, gen­eralized musculoskeletal discomfort, or gastrointestinal (GI) problems may be related to problems of kidney function.

Physical examination:

• Assessment of the kidneys, ureters, and bladder is performed in conjunction with an abdominal assessment. Auscultation is performed before percussion and palpation because these ac­tivities can enhance bowel sounds and obscure abdominal vascular sounds.

Psychosocial Assessment

• Concerns about the urologic system may evoke fear, anger, embarrassment, anxiety, guilt, or sadness in the client. The client may ig­nore symptoms or delay seeking health care because of emo­tional responses or cultural taboos about the urogenital area.

Diagnostic Assessment:

• Laboratory tests such as blood test, urine test, radiographic examinations, KUB Xray etc.,may be assessed.

2 d) The measurement of urinary output is a procedure which requires handling of the urinary collection system, visual assessment and manual data recording.The method includes patient voiding into a container, pouring urine from container into a calibrated measuring device, reading measurement while device is on a level surface, reading the amount at eye level and recording amount voided.

2 e) A 24-hour urine collection is a simple lab test that measures what's in your urine. The test is used to check kidney function. A 24-hour urine collection is done by collecting your urine in a special container(s) over a full 24-hour period. The  important factor to be remembered when collecting a 24-hour urine specimen is :

• The container(s) must be kept cool until the urine is returned to the lab.
• Post a sign on the patient’s door to communicate collection to all caregivers, including date and beginning/ending time of specimen collection.
• Forward specimen to lab immediately after last void is collected.