ASSESSMENT

Nursing Care Management 103

Concept: Nursing Care of Patients with Problems in Fluid and Electrolytes Balance
 HEALTH HISTORY

1.as:
The nurse must query for disorders such
as ,
,
congenital disorders, and stroke
2.history of cancer with radiation or
chemotherapy.
3.history of any hospitalizations and surgical
history.
4.General health questions: current health
status, nutrition, and work history.
 HEALTH HISTORY

5.function:
Symptoms suggestive of decreased kidney
significantly reduced energy level,
,
anorexia, nausea, , decreased
ability to concentrate, decreased urine
output, and related weight gain from fluid
retention
6. ask the patient if he or she smokes, which
makes individuals more susceptible to
bladder cancer.
 ASSESSMENT OF URINARY
PATTERNS
QUESTIONS TO ASK
• Have you noticed a change in
?
• Do you have a history of incontinence,
urgency, or frequency of urination?
• Do you have difficulty with starting the
voiding process?
• Do you feel burning when you urinate?
 ASSESSMENT OF URINARY
PATTERNS
QUESTIONS TO ASK
• What is your urine?
• Has there ever been any indication of
(blood in the urine)?
• Do you feel full after you void?
• Is your urinary stream full, or are you able
to void only in ?
 MEDICATION HISTORY

• Renal system has a direct relationship

with the metabolism of many meds, and
the health of the renal system is vital to
the patient’s use of meds.
• Amount and duration of nonsteroidal
anti-inflammatory medication usage.
• Potential for damage increases in the
presence of HTN or exposure to other
nephrotoxic drugs
POTENTIALLY
AND OTHER AGENTS

1. Amikacin
2. Chemotherapeutic agents
3. Gentamicin
4. Contrast medium
5. Amphotericin B Ethylene
glycol
6. Gentamicin Gold and other
heavy metals
7. Sulfonamides
8. Nonsteroidal anti-
inflammatory drugs
PHYSICAL ASSESSMENT
 SKIN
• Note skin turgor - hydration status.
• Skin could be dry and lack turgor or
grossly edematous, depending on the
dysfunctions etiology within the urinary
system.
• Persistent scratching - phosphorus or
calcium imbalances of renal failure
• pallor or the yellow-gray cast - sometimes
seen in renal failure.
 MOUTH

• Check mucous membranes for signs of

irritation or dryness and note breath smell.
• The smell of ammonia is common with
uremia (accumulation of end-products of
protein metabolism in the blood)
 ABDOMEN

• Inspect and palpate for bladder distension,

masses, or enlarged kidneys - found with
renal cell cancer or polycystic renal
disease within an organ
 KIDNEYS

• Palpate the kidneys at the CVA (Normally,

the left kidney is not palpable)
• A normal right kidney may be palpable
during deep inhalation.
• Check for Tenderness - common finding
in kidney infection, pyelonephritis, and
polycystic kidneys.
 LUNGS

• A fluid-overloaded pulmonary capillary

bed easily infiltrates the lungs with fluid,
which is evidenced by crackles on
auscultation and wet lung fields on a chest
X-ray.
 BLADDER

palpate bladder for shape, size, and

consistency.
• An empty bladder is not usually palpable.
• A moderately full bladder is smooth and
round, and it is palpable above the
symphysis pubis.
• A full bladder is palpated above the
symphysis pubis, and it may be close to the
umbilicus.
BLADDER ABNORMALITIES
• A bladder that is nodular or asymmetrical to palpation.
A nodular bladder may indicate a malignancy. An
asymmetrical bladder may result from a tumor in the
bladder or an abdominal tumor that is compressing
the bladder.
• Men with
may be unable to completely empty their bladder
because of the pressure that the enlarged prostate
places on the bladder.
• Various types of urinary incontinence, due to altered
mental status, muscle function, medications, and other
causes can lead to incomplete bladder emptying.
DIAGNOSTIC STUDIES
 URINE STUDIES

• Urine culture- A bacterial count greater

than 100,000 indicates a treatable infection
• Timed urine collection - the most
common is the 24-hour creatinine
clearance to determine renal filtering
efficiency. Normal clearance range is
70–140 mL/minute.
 URINE STUDIES

Voiding Cystometrogram
• A graphic recording of bladder filling
pressure and abdominal pressure during
the filling and voiding cycle. A urinary
catheter is inserted into the urinary
bladder for filling and emptying during
the procedure.
 URINE STUDIES

Cystography
• Radiopaque dye is instilled via a catheter
directly into the bladder. As with the
voiding cystometrogram, pressure
recordings can be obtained.

Check for allergies to contrast media. Postprocedural hydration,

unless contraindicated, is important for nephrotoxic dye
excretion.
 RENAL FUNCTION
TESTS
• See table
 RADIOGRAPHIC
STUDIES
• See table
END