learning Objectives - Describe the management of clients with urinary and renal disorders. Demonstrate skill in giving care of client with urinary and renal disorders
Hours - 14
Teaching and Learning Activities - Lecture cum discussion Clinical teaching Visit to Dialysis unit Videos and Films
Assessment Methods - Short answer Objective type Essay type
Content of the chapter
a) Assessment of renal and urinary functions
– History
– Physical examination
– Diagnostic evaluation
b) Management of patients with renal and
urinary disorders
– Urinary retention and incontinence
– Urinary tract infection
– Acute and chronic glomerulonephritis
– Pyelonephritis
– Urolithiasis
– Renal calculi
– Trauma of kidney, bladder,urethra, ureters
– Urinary strictures
– TB of urinary tract
– Neurogenic bladder dysfunction
– Renal cyst and renal abscess
– Nephrotic syndrome
– Acute and chronic Renal failure
– Uremia
– Acute and chronic nephrosis
– Tumor – benign and malignant
– Care of patient on hemodialysis and
peritoneal dialysis
– Care of patient with renal transplant
c) Assessment of male Genitourinary function
– History
– Physical examination
– Diagnostic evaluation
d) Disorders of male genito urinary tract and its
management
– Hydrocele,
– Phimosis
– Benign and malignant prostatic
hypertrophy
– Orchitis
– Epididymoorchitis
– Cancer penis
e) Alternate therapies
f) Drugs used in treatment of renal and Urinary
disorders
Nursing Management of Renal and Urinary Disorders
Renal and urinary disorders affect fluid balance, waste elimination, electrolyte balance and blood pressure. Nursing management focuses on early assessment, maintaining renal function, preventing complications and patient education.
a) Assessment of Renal and Urinary Functions
1. History
- Urinary symptoms:
- Frequency, urgency, dysuria
- Hematuria
- Decreased or increased urine output
- Pain:
- Flank pain, suprapubic pain
- Edema, breathlessness
- History of:
- Hypertension, diabetes
- Renal stones, infections
- Drug history (NSAIDs, antibiotics)
- Family history of renal disease
2. Physical Examination
- General examination:
- Edema (face, ankles)
- Pallor
- Blood pressure
- Abdominal examination:
- Bladder distension
- Renal tenderness
- Inspection of urine:
- Color, clarity, odor
- Weight monitoring
3. Diagnostic Evaluation
- Urine examination (routine & culture)
- Blood tests:
- Serum creatinine
- Blood urea
- Electrolytes
- Ultrasound KUB
- CT scan
- IVP
- Renal biopsy (if indicated)
b) Management of Patients with Renal and Urinary Disorders
Urinary Retention & Incontinence
- Bladder training
- Timed voiding
- Catheterization if required
- Pelvic floor exercises
Urinary Tract Infection (UTI)
- Antibiotic therapy
- Encourage fluids
- Perineal hygiene
- Monitor urine output
Glomerulonephritis (Acute & Chronic)
- Bed rest
- Monitor BP and urine
- Low-sodium diet
- Steroids / immunosuppressants
Pyelonephritis
- Antibiotics
- IV fluids
- Monitor temperature and urine
Urolithiasis / Renal Calculi
- Pain management
- High fluid intake
- Strain urine
- Pre- and post-lithotripsy care
Trauma of Kidney, Bladder, Urethra, Ureters
- Monitor hematuria
- Maintain urinary drainage
- Observe for shock
- Post-surgical care
Urinary Strictures
- Dilatation care
- Catheter care
- Post-operative monitoring
TB of Urinary Tract
- Anti-TB therapy
- Nutrition support
- Monitor renal function
Neurogenic Bladder Dysfunction
- Intermittent catheterization
- Bladder training
- Prevent infection
Renal Cyst & Renal Abscess
- Antibiotics
- Drainage if required
- Monitor pain and fever
Nephrotic Syndrome
- Protein-rich diet
- Edema management
- Infection prevention
Acute & Chronic Renal Failure
- Strict intake and output charting
- Monitor electrolytes
- Dietary management
- Prepare for dialysis
Uremia
- Dialysis support
- Skin care
- Oral hygiene
- Nutritional management
Nephrosis (Acute & Chronic)
- Manage edema
- Monitor urine protein
- Steroid therapy as prescribed
Renal Tumors (Benign & Malignant)
- Pre- and post-nephrectomy care
- Pain management
- Psychological support
Care of Patient on Dialysis
Hemodialysis
- Check vascular access
- Monitor vitals during dialysis
- Prevent infection
- Weight monitoring
Peritoneal Dialysis
- Strict asepsis
- Monitor inflow and outflow
- Observe for peritonitis
Care of Patient with Renal Transplant
- Monitor graft function
- Administer immunosuppressants
- Infection prevention
- Patient education
c) Assessment of Male Genitourinary Function
1. History
- Urinary difficulties
- Sexual dysfunction
- Pain or swelling of scrotum
- Discharge
2. Physical Examination
- Inspection of penis and scrotum
- Palpation of testes
- Digital rectal examination (prostate)
3. Diagnostic Evaluation
- Urine analysis
- PSA levels
- Ultrasound
- Biopsy (if required)
d) Disorders of Male Genitourinary Tract and Management
Hydrocele
- Scrotal support
- Surgical care
Phimosis
- Local hygiene
- Circumcision if required
Benign & Malignant Prostatic Hypertrophy
- Catheter care
- Monitor urine retention
- Pre- and post-prostatectomy care
Orchitis / Epididymoorchitis
- Antibiotics
- Scrotal elevation
- Pain relief
Cancer of Penis
- Hygiene education
- Surgical and psychological care
e) Alternate Therapies
- Adequate hydration
- Yoga and relaxation
- Dietary modification
- Herbal remedies (with medical advice)
f) Drugs Used in Renal and Urinary Disorders
- Antibiotics: Nitrofurantoin, Ciprofloxacin
- Diuretics: Furosemide
- Antihypertensives: ACE inhibitors
- Steroids: Prednisolone
- Immunosuppressants: Cyclosporine
- Phosphate binders: Calcium carbonate
- Erythropoietin
- Alkalinizers: Sodium bicarbonate
Conclusion
Nursing management of renal and urinary disorders involves systematic assessment, maintenance of fluid and electrolyte balance, prevention of infection, dialysis care, and patient education. Skilled nursing care is vital for improving patient survival and quality of life.