*PAIN won’t always be present.
KIDNEY: (dull constant ache) Not always present if pt has renal disease (don’t have w/ proteinuria or hematuria) Have CVA tenderness (hit hand over kidney), lower abdominal pain, intermittent pain(indicates renal stones), flank pain (side) N/V, diaphoresis, s/sx of shock. Cause: Acute obstruction like stone, clot BLADDER- lower ABD pain (usually seen w/ distention) dull, continuous pain may be intense after voiding S/Sx: Urgency, pain after voiding (from spasms) Causes: Infection, cystitis, over distended bladder
*Patients should urinate 5-6 times daily with a urinary output of 1500-2000 mL/day! *”How many times do you urinate a day??”
* Pt’s may have increased frequency, urgency, burning/ hesitancy (indicative of enlarged prostate), nocturia, polyuria(diabetes), or oliguria(100-400mL/day!)
*Creatinine (protein)- Normal 0.6-1.2- best indicator of renal function (looks @ effectiveness) It is the end product of skeletal muscle metabolism
*Urea Nitrogen (BUN) Normal 10-20 Index of renal function. Can be affected by muscle/tissue damage, fluid volume (decrease volume increases BUN b/c it is more concentrated), & protein intake *BUN to Creatinine ratio- 10:1 Evaluates hydration status. Elevated ratio seen in hypovolemia. Normal ration w/ elevated BUN & creatinine is seen w/ intrinsic renal failure *Specific Gravity- 1.003-1.030- Evaluates ability of kidney to concentrate urine. (If kidney can’t concentrate may not be functioning properly) *Urine Osmolarity- Normal 300-900. Concentrating ability is lost early in kidney disease. SG & Osmolarity may be used to determine early renal failure *Renin assists in blood pressure control
*Erythropoetin is needed for production of RBC’s in the bone marrow.
*The best time to obtain a specimen is EARLY MORNING!
*Instruct pt to call immediately after specimen is obtained b/c it collects bacteria (if longer than 1 hr no good!) *Clean catch- wipe front to back, clean 3 times wiping the labia’s first then the urethra. first part of stream goes into the toilet, catch midstream for specimen *In and out cath
*Indwelling cath- clamp tubing for appx 30 mins, and then obtain from port (never from bag)- Sterile!
*24 hr Creatinine clearance- VERY sensitive test to indicate renal disease/or progression of disease. Lab comes around 6 am & draws blood to compare serum and urine levels. Directions: Discard 1st specimen & then 24 hr measure begins. Men- don’t urinate into container b/c of chemicals (can burn them) Good measure of GRF. Volume of urine x urine creatinine/ (divided by) serum creatinine.
*Blood Tests- Creatinine is MOST SENSITIVE to renal function!
*Urinanalysis- should NEVER see protein, bacteria, or glucose. pH may be affected by ingestion of fruits, vegetables, and protein.
ABNORMAL SUBSTANCES IN URINE:
*Glucose- seen from diabetes when spilling over
*Protein- indicates damage to glomeruli (some benign causes are fever & strenuous exercises) *Bacteria- infection (UTI)
*Ketones- breakdown of fat (byproduct) Seen with DM type 1 (DKA)
*IVP- intervenous pyelography- Inject radiographic dye to show kidneys, bladder, urethra. Pre op- ASSESS allergies to shellfish, dye, iodine Contrast agents should be used carefully in elderly, pt’s with diabetes, vol depletion, & renal insufficiency b/c can’t excrete. May give laxative to prevent interference of visualization. Encourage pt to increase fluid intake unless on fluid restrictions.
*Renal biopsy- To diagnose cancer. Insert needle through skin.
*Because of the risk for bleeding after the biopsy, coagulation studies such as platelet count, Pt and aPTT may be performed prior to surgery.
*PreOp- Need consent!! Pt must be NPO 4-6hrs before procedure.
*PostOp: Pt must be supine for 4-6 hrs post procedure., 24 hr bedrest, watch for hematuria (if there is blood in urine...