Know why you are giving diuretics
Empty the foley bag before the diuretic is administered so you can track the output closely.
Can have pre, intra, and post renal injuries
- Post renal is an obstruction
- Intrarenal is Structural damage to the kidney can be caused by radiocontrast dye
- Prerenal is a reduction in blood flow
- Structural damage to the kidney
Things that increase the chance for infection in urinary system
- Urinary stasis
- High levels of glucose in the urine
Pyelonephritis – infection of the kidneys,
- Give lots of fluids
- Treat pain, infection, and nausea
- Look for blood in the urine
- Proteinuria, high BUN, periorbital edema, and hematuria
Renal calculi –
- rf – high protein, dehydration, warm climates
- Flank and abdominal pain
- Use a NON radio contrast CT scan
- Manage pain!
BPH – benign prostatic hyperplasia
- Digital rectal exams are the prefered method
- Increase chance of renal stones due to urine retention.
- May need a catheter placed to urinate properly.
- Can give Alfa blockers to relax smooth muscle
- A side effect of these is orthostatic hypotension
- Three way foley is use to continuously irrigate the bladder and catheter to prevent clots from stopping up urine flow.
Prostate cancer –
- Mimics BPH symptoms
- Screen with DRE and PSA
Chronic kidney disease – long term decrease in kidney function
- Can have chronically high BUN and Cre levels
- polyuria in the beginning, it will progress to oliguria
- Often need dialysis
- On HTN meds, Na and fluid restrictions, calcium based phosphate binders
- Indications for dialysis – we wait as long as possible because being dialyzed is not optimum for the patient.
- Types – hemo, and peritoneal
- Peritoneal has a high chance for infection, but the person can do it at home and does not need to be hooked up to the dialysis machine for 12 hours a week. 4x day for about 30 mins each time.
- Hemodialysis – 12 hours a week at the center
- Have an Arteriovenous fistula for better access commonly in the forearm