Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 9 Genitourinary System^389



  • Weight loss due to chronic disease

  • Abdominal bruit with ischemic nephropathy

  • Peripheral edema with third spacing of fluids

  • Decreased urinary output

  • Uremic pruritis—see excoriations from scratching

  • Anemia in chronic disease—kidneys produce erythropoetin


INTERPRETING TEST RESULTS



  • BUN elevated.

  • Creatinine elevated.

  • BUN/creatinine ratio elevated.

  • Urinalysis may show casts (hyaline or granular in acute prerenal; RBC, WBC
    in renal), proteinuria.

  • Glomerular filtration rate decreases in chronic disease.

  • Creatinine clearance decreases.

  • Renal ultrasound shows decrease in renal size in chronic renal failure; dila-
    tion and fluid build up in post-renal failure.


TREATMENT


Treatment needs to address the underlying disease process. What will correct one
cause may make another cause worse.



  • Administer intravenous fluids to correct hypovolemia.

  • Administer inotropic agents for patients with CHF to enhance cardiac output.

  • Administer antibiotics for pyelonephritis.

  • Stent placement or catheter (urethral, suprapubic, nephrostomy) to allow for
    drainage of urine if blockage present.

  • Dialysis.

  • Administer erythropoetin to treat anemia.

  • Restrict potassium, phosphate, sodium, and protein in diet.

  • Administer phosphate binders to reduce phosphate levels.

  • Administer sodium polystyrene sulfonate to reduce potassium levels.

  • Monitor electrolyte levels.

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