NURS 120L Exam 4 Review- West Coast University

2/15/202




1 Elimination
* Renal Problems
* Fluid and Electrolyte Imbalance


2 Week 4 Objectives
Elimination
Summarize the nursing process in care of the patient with alterations in elimination.
Classify priorities in the care of patients with alterations in elimination using the following
applicable concepts: oxygenation, nutrition, perfusion, fluid/electrolyte regulation,
infection/inflammation, tissue integrity, pain, metabolism, elimination, safety, and intracranial
regulation.
Identify interprofessional collaboration/team management for needs of the patient with
alterations in elimination.
Examine the pharmacologic, nutritional, developmental, and teaching needs of the patient with
alterations in elimination.

3 Topics Covered
Lewis Ch. 16: Fluid, Electrolyte, and Acid-Base Imbalances
Lewis Ch. 44: Assessment: Urinary System
Lewis Ch. 45: Renal and Urologic Problems
ATI Ch. 43: Fluid Imbalances
ATI Ch. 44: Electrolyte Imbalances
ATI Ch. 45: Acid-Base Imbalances
ATI Ch. 56: Renal Diagnostic Procedures
ATI Ch. 60: Infections of the Renal and Urinary System
ATI Ch. 61: Renal Calculi
4 Functions of the Kidneys
Regulate volume and composition of ECF
Excrete waste products
Control BP
Produce erythropoietin
Stimulates RBC production in the bone marrow
Activate Vitamin D
Regulate acid-base balance
5 Assessment of the Urinary System
Subjective Data
Past Health History
Any specific urinary problems?
Cancer, Infections, Calculi, BPH (benign prostatic hyperplasia)
Medications
Many are nephrotoxic
Can alter the quality of character of urine output
Diuretics

, 2/15/202



Phenazopyridine (Pyridium) (turns urine orange)
Nitrofurantoin (Macrodantin) (turns urine dark yellow/brown)
Anticoagulants (hematuria)
Surgery or Previous Hospitalizations
6 Nephrotoxic Medications
NSAIDs
Diuretics
Contrast Dye
ACE Inhibitors
lisinopril, enalapril, ramipril
Aminoglycoside Antibiotics
Neomycin, gentamycin, tobramycin
HIV meds
Zometa
Treats osteoporosis and bone cancer metastasis
Jardiance
Treats diabetes
Vancomycin
7 Assessment of the Urinary System
Subjective Data
General Health
Symptoms of abnormal kidney function: changes in weight/appetite, excessive thirst, fluid
retention, headache, puritis, blurred vision, malaise
Smoking History
Major risk factor for bladder and kidney cancer
Daily Fluid Intake
Dehydration: can contribute to UTI, calculi formation, kidney failure
Bowel Elimination
Constipation: can partially obstruct the urethra causing inadequate emptying, overflow
incontinence, infection
8 Assessment of the Urinary System
Subjective Data
Nocturia
Can lead to sleep deprivation, daytime sleepiness, fatigue
Can be caused by incontinence, retention, interstitial cystitis
Can be secondary to kidney disease, poorly controlled diabetes, alcoholism, excessive fluid
intake, liver disease, heart failure, obstructive sleep apnea
Normal
1 episode per night for younger person
2 episodes per night for those over 65
9 Assessment of the Urinary System
Objective Data
Landmark: Costovertebral Angle (CVA)

, 2/15/202



Formed by rib cage and vertebral column
Kidneys are NOT normally palpable
Enlargement is usually neoplasm or other serious renal pathological conditions
Bladder is only palpable if distended
Sensitive to palpation
Kidney Punch
Percussion
Tenderness in flank area
Could be a kidney infection or polycystic kidney disease
10 Terms to Know
Anuria: No urination
Dysuria: Painful or difficult urination
Enuresis: Involuntary nocturnal urination
Hematuria: Blood in the urine
Nocturia: Frequency of urination at night
Oliguria: Diminished amount of urine
(100 – 400mL/24 hours)
Polyuria: Large volume of urine at a given time
Retention: Inability to urinate even though bladder full
Stress Incontinence: Involuntary urination with increased pressure
11 Diagnostic Studies
Urinalysis
First void is best
Should be examined within one hour
Creatinine Clearance
Waste product of muscle breakdown
Almost all is excreted by kidneys, so a good indicator of renal function
Need 24 hour urine specimen
Urine Culture
Confirms UTI and identifies causative agent
Clean catch, mid-stream
Residual Urine
Amount left in bladder after voiding
12 Blood Studies
BUN (Blood Urea Nitrogen) (Normal: 7-20 mg/dL)
Excreted by the kidneys
Creatinine (Normal: 0.5-1.2 mg/dL)
More reliable than BUN to determine renal function
Sodium (Normal: 135-145 mEq/L)
Value stays normal until late stages of renal failure
Potassium (Normal: 3.5-5 mEq/L)
Kidneys excrete most of body’s potassium
One of the first electrolytes to become abnormal with kidney disease