Assessment of Kidney and Urinary System.pptx

assessment of kidney and renal system

1. Assessment of Kidney and Urinary System By. Srivani

2. Introduction The renal assessment helps in identifying the normal functioning and impairment of the urinary system. Clinical clues of advanced diseases can be inferred with physical examination. It is important to infer the normal variations in assessment findings for the older adults.

3. Definition Renal examination is the general review to identify the functioning, diseases, or pathologies related to the renal system.

4. Purposes To identify the presence of renal dysfunctions at the early stage To compare the variations of current to the previous data for determining the need for change in the interventions To obtain a database for formulating nursing care plan

5. Indications Routine protocol as a part of physical examination/ screening before progressing to detailed investigation Comprehensive examination for patients with renal complaints to understand the extent of disease progression

6. Conti…. History collection(e.g. chief complaints, past medical, surgical history, personal and family history) Physical examination(head to toe) Review patient record. Assess vital signs (temperature, pulse, and respiration (TPR), and BP]. Assess the level of consciousness. Assess for any alert on latex hypersensitivity. Assess the level of pain.

7. TERMINOLOGY Micturition—Urination Frequency—Frequent voiding >every 3hours Urgency—Strong desire to void Hesitancy—Delay or difficulty in initiating voiding Nocturia—Excessive urination at night Oliguria—Output <400mL/day Anuria—Output <50mL/day Polyuria—Increased volume of urine voided Hematuria—RBCs in urine Dysuria—Painful or difficult voiding Enuresis—Involuntary voiding during sleep Incontinence—Involuntary loss of urine

8. Renal/Urinary System Changes Associated with Aging Reduced renal blood flow causing kidney loss of cortical tissue by 80 years of age Thickened glomerular and tubular basement membranes, reducing filtrating ability Decreased tubule length Nocturnal polyuria and risk for dehydration Decreased glomerular filtration rate

9. Diagnostic Tests Blood Tests Serum Creatinine (0.5 – 1.2 mg/dl) Blood Urea Nitrogen (10-20 mg/dl) BUN/Creatinine Ratio (12:1 to 20:1 mass) Urine Tests Urinalysis Urine for C&S Composite (e.g., 24hr) urine collections Creatinine Clearance Test Urine Electrolytes Osmolality (plasma; urine)

10. Conti…. Bedside sonography; Bladder scanners Radiographic Examinations Kidneys, Ureter, and Bladder X-ray Intravenous Urography Computed Tomography Cystography and Cystourethrography Other Renal Diagnostic Tests Renal Arteriography (Angiography) Renal Biopsy Renography (Kidney Scan) Ultrasonography

11. Nursing Implications Anticipate anxiety, discomfort and embarrassment Promote relaxation, comfort and privacy as able Provide teaching

12. ASSESSMENT TECHNIQUES Family history and genetic risk assessment Demographic data and personal history Diet history Socioeconomic status Current health problems

13. PHYSICA ASSESSMENT Inspection Auscultation Palpation Percussion Assessment of the urethra

14. URINE ANALYSIS Color, odor, and turbidity Specific gravity pH Glucose Ketone bodies Protein Leukoesterase Cells, casts, crystals, and bacteria Urine for culture and sensitivity Composite urine collections Creatinine clearance—best indication of overall kidney function Urine electrolytes Osmolarity, blood/plasma osmolarity, urine osmolarity

15. Cystography and Cystourethrography Instilling dye into bladder via urethral catheter Voiding cystourethrogram Monitoring for infection Encouraging fluid intake Monitoring for changes in urine output and for development of infection from catheter placement

16. Renal Arteriography (Angiography) Possible bowel preparation Light meal evening before, then nothing by mouth Injection of radiopaque dye into renal arteries Assessment for bleeding Monitoring of vital signs Absolute bed rest for 4 to 6 hours Serum creatinine measured for several days to assess effects of test

17. Renal Biopsy Percutaneous kidney biopsy Clotting studies Preprocedure care Follow-up care Assessment for bleeding for 24 hours Strict bedrest Monitoring for hematuria Comfort measures

18. Stress Incontinence Interventions: Nonsurgical Drug therapy Behavioral interventions (diet and exercise) Vaginal Cone therapy Other: behavior modification, psychotherapy Surgical Vaginal, abdominal or retropubic procedures

19. Urge Urinary Incontinence Interventions: Drug Therapy (Chart 73-9, p. 1691) Diet Therapy Behavioral Interventions Bladder training Habit training Exercise therapy Electrical stimulation

20. Reflex Urinary Incontinence Interventions: Drug Therapy Behavioral Interventions Bladder Compression ( Cred é , Valsalva) Intermittent Self- Cathererization (Clean tech .)

21. Thankyou