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