Normal Urinary/Renal

Assessment

• No CVA tenderness
• No palpable kidney or bladder
• No palpable masses
• Urinary output 1500mL/day

painful/difficult urination

(UTI, cystitis)

involuntary nocturnal urinating

(lower UTI)

Delay in initiating urination

(partial urethral obstruction)

blood in urine

(cancer of GU tract, renal disease, UTI, stones, medications)

stinging pain in urethral area

(urethral irritation, UTI)

inability to urinate

(post-op, urethral stricture, neurogenic bladder)

large volume of urine

(diabetes, chronic renal failure, diuretics, excessive fluid intake)

<100mL/day

(acute renal failure, end-stage renal disease, bilateral urethral obstruction)

↓ urine; 100-400mL/day

(severe dehydration, shock, transfusion reaction, kidney disease, ESRD)

6-20 mg/dl

identifies presence of renal problems

70-135 mL/min

(24hr urine collection)

waste product of protein breakdown, clearance of creatinine approximates the GFR

135-145 mEq/L

usually stays WNL until late stages of renal disease

3.5-5.5 mEq/L

In renal disease K+ determinations are critical because K+ is one of the first electrolytes to become abnormal

2.4-4.4 mg/dl

inversely related to Ca+; In renal disease phosphorus levels are elevated b/c the kidney is the primary excretory organ

22-26 mEq/L

most pts in renal failure have metabolic acidosis and low serum bicarbonate levels

125mL/min

amt of blood filtered by the glomeruli; used to determine renal function

<1000 organisms/mL = no infection

(clean catch, midstream)

confirms/denies UTI and identifies organisms

≤50 mL

amount of urine left in bladder after urination

0.6-1.3 mg/dl

*may be normally higher in men

more reliable than BUN as determinant of renal function

-visualizes urinary tract after IV injection of contrast media. Presence, position, size and shape of kidneys, ureters, and bladder can be evaluated.

-Contrainindicated in decreased renal function because contrast medium can be nephrotoxic and worsen renal function

- Preprocedure: enema, assses patient for iodine sensitivity, tell pt they may feel warm, flushed, or have a salty taste during injection of contrast

- Postprocedure: force fluids to flush out contrast media

- inspects interior of bladder with a tubular lighted scope (cytoscope) 

- Can be used to insert urethral catheters, remove calculi, obtain biopsy specimens of bladder lesions, and treat bladder lesions

- Postprocedure: explain that burning on urination, pink-tinged urine, and urine frequency are expected effects; observe for bright red bleeding (not normal)

- Obtains renal tissue for examination to determine type of renal disease 

- Usually done as a skin biopsy through needle insertion into lower lobe of kidney

Preprocedure:  coagulation status

Postprocedure: pressure dressing; keep on affected side for 30-60 minutes;, bedrest for 24 hours; VS every 5-10 minutes for the first hour; assess for flank pain, hypotension, decreasing hematocrit, increased temp, urinary frequency, & dysuria