Disorders Of Urinary System Urinary Calculi

Disorders of Urinary System Urinary Calculi Etiology 1. formation of stones in the urinary tract 2. causes obstruction, infection, and hydronephrosis Findings Subjective 1. pain in kidney area – radiates to the flank and pubic area 2. frequency, urgency to void 3. nausea and Hx of prior associated health problems Objective 1. diaphoresis 2. vomiting 3. grimacing 4. hematuria, dysuria, pyuria 5. fever Interventions 1. analgesics as ordered 2. antispasmodics to reduce renal colic 3. allopurinol and allopurinol Na 4. antibiotics to reduce infection 5. fluids – 3000 ml/day 6. diet according to type of renal calculi (kidney stone) 7. strain all urine Types of Calculi / Stone 1. Calcium Stone Diet - low Ca and P diet - eliminate dairy products - acid ash diet - encourage cranberry juice, vegetables, fruits, Vit C 2. Oxalate Stone Diet

- avoid oxalate rich foods 3. Uric Acid Stone Diet - avoid purine rich foods - alkaline ash diet 4. Cystine Stone Diet - limit protein rich foods - alkaline ash diet Surgical Intervention 1. Nephrolithotomy, Ureterolithotomy, Cystolithotomy 2. Percutaneous Ultrasonic Lithotripsy (PUL) 3. Laser lithotripsy 4. ESWL Extracorporeal shockwave lithotripsy (non-invasisve) Nursing Care 1. monitor VS 2. fluid intake 3000-4000 ml daily 3. encourage client to monitor diet as ordered 4. encourage weight bearing exercise if not contraindicated 5. change dressings frequently during 1st 24 hours after nephrolithotomy 6. maintain patency of urethral catheter to prevent hydronephrosis Prevention 1. increase fluid intake 2. diet Acute Renal Failure Etiology 1. d/t trauma to kidneys or overwhelming physiologic stress 2. sudden loss of renal function 3. may cause death Findings Subjective

- irritability - headache - anorexia - tingling of extremities - lethargy or drowsiness Objective - uriniferous breath and perspiration odor - uremic frost - anemia - hypocalcemia - destruction of RBC, WBC, Platelets Stages of Acute Renal Failure (ARF) Olliguric Phase - decreased urine output - increased BUN, creatinine - edema, HPN - hyperkalemia - hyponatremia - metabolic acidosis - lasts 1 to 3 weeks Diuretic Phase - increased urine output - initially BUN, creatinine, BP are elevated (normalize later on) - hypokalemia - lasts 1 week Recovery Phase - takes 3 to 12 months - avoid nephrotoxic drugs Intervention 1. fluid control 2. electrolyte control 3. AB to prevent infection 4. complete bed rest (CBR) 5. peritoneal dialysis and hemodialysis Nursing Care

1. monitor VS and I/O of fluids 2. promote rest 3. provide skin care Chronic Renal Failure Etiology 1. occurs as a result of chronic kidney infection, abnormalities, vascular d/o, and destruction of kidney tubules 2. continuous deterioration in renal function results in uremia Findings Subjective 1. lethargy, drowsiness 2. headache, nausea, pruritus Objective 1. oliguria or anuria 2. anemia 3. HPN and Anasarca 4. uremic frost 5. hypocalcemia 6. metabolic acidosis 7. hyperkalemia 8. renal osteodystrophy 9. kussmaul’s respiration Stages of Chronic Renal Failure Normal adult GFR is 100-120 ml/min (1.67 to 2.0 ml/sec) Renal Impairement (Char by GFR 40-50%) Renal Insufficiency (GFR 20-40%) Renal Failure (GFR 10-20%) End Stage Renal Disease (ESRD) (GFR <10%) Benign Prostatic Hypertrophy Etiology 1. slow enlargement of the prostate 2. constricts urethra and interferes w/ urination 3. may be d/t hormonal imbalances

Findings 1. frequency, urgency 2. difficulty initiating stream 3. feeling of incomplete emptying of bladder 4. nocturia and hematuria 5. decreased force of stream 6. urinary retention Interventions 1. relief of obstruction by insertion of indwelling catheter 2. admin Finasteride (PROCAR) 3. Terazosin (Hytrin) Alpha 1 adrenergic receptor blocker Surgical Procedures Transurethral Resection of the Prostate (TURP) - no incision - resectoscope is inserted through the urethra - no incontinence, impotence postop