GENITO-URINARY SYSTEM
tubule (PCT).
ANATOMY AND PHYSIOLOGY
A. KIDNEY ANATOMY
1. Each person has two kidneys, which are
located behind the peritoneum; they are
attached at the level of the last thoracic
and first three lumbar vertebrae, on the
right and left sides.
2. The kidneys are enclosed in the renal
capsule.
3. The renal cortex is the outer layer of the
renal capsule, which contains blood-
filtering mechanisms (glomeruli).
4. The renal medulla is the inner region,
which contains the renal pyramids and
renal tubules.
5. Together, the renal cortex, pyramids,
and medulla constitute the
parenchyma.
B. NEPHRONS
a. Located within the parenchyma
b. Composed of glomerulus and
tubules
c. Selectively secretes and
reabsorbs ions and filtrates,
including fluid, wastes,
electrolytes, acids, and bases
 The nephrons are the functional units of
the kidney.
C. GLOMERULUS
a. Each nephron contains tufts of
capillaries, which filter large plasma
proteins and blood cells.
b. Blood flows into the glomerular
capillaries from the afferent arteriole and
flows out of the glomerular capillaries
into the efferent arteriole.
D. BOWMAN’S CAPSULE
1. Thin double-walled capsule that
surrounds the glomerulus
a. Fluid and particles from the blood such
as electrolytes, glucose, amino acids,
and metabolic waste (glomerular filtrate)
are filtered through the glomerular
membrane into a fluid-filled space in
Bowman’s capsule (Bowman’s space)
and then enter the proximal convoluted
E. TUBULES
a. The tubules include the PCT, the loop of
Henle, and the distal convoluted tubule
(DCT).
b. The PCT receives filtrate from the
glomerular capsule and reabsorbs water
and electrolytes through active and
passive transport.
c. The descending loop of Henle passively
reabsorbs water from the filtrate.
d. The ascending loop of Henle passively
reabsorbs sodium and chloride from the
filtrate and helps maintain osmolality.
e. The DCT actively and passively
removes sodium and water.
f. The filtered fluid is converted to urine in
the tubules; then the urine moves to the
pelvis of the kidney.
g. The urine flows from the pelvis of the
kidneys through the ureters and empties
into the bladder.
FUNCTIONS OF KIDNEYS
1. Maintain acid–base balance
2. Excrete end products of body
metabolism
3. Control fluid and electrolyte balance
4. Excrete bacterial toxins, water-soluble
medications, and medication
metabolites
5. Secrete renin to regulate the blood
pressure (BP) and erythropoietin to
stimulate the bone marrow to produce
red blood cells
6. Synthesize vitamin D for calcium
absorption and regulation of the
parathyroid hormones
Urine Formation
Blood
↓
Renal Artery
↓
Small Arteries called Arterioles
↓
Nephrons (functional unit of kidney)
↓
Bowman’s capsule
↓
 Afferent Arteriole 2. Urinary urgency and frequency
↓ 3. Nocturia
Glomerulus 4. Inability to start (hesitancy) or continue a
↓ urinary stream
Efferent arteriole 5. Feelings of incomplete bladder emptying
↓ ↓ 6. Post-void dribbling from overflow
Filtered Blood Glomerular Filtrate incontinence (later sign)
↓ ↓ 7. Urinary retention and bladder distention
Renal Veins PCT 8. Hematuria
↓ ↓ 9. Urinary stasis and UTIs
Back to the Body Loop of Henle 10. Dysuria and bladder pain
↓
DCT Interventions
↓  Encourage fluid intake of up to 2000 to
Collecting Duct 3000 mL/day unless contraindicated.
↓  Prepare for urinary catheterization to
(Urine) Waste Products drain the bladder and prevent distention.
↓  Avoid administering medications that
Ureters cause urinary retention, such as
↓ anticholinergics, antihistamines,
Bladder decongestants, and antidepressants.
 Administer medications as prescribed to
Tubular absorption and secretion shrink the prostate gland and improve
PCT urine flow.
 absorbs H2O, Na, Glucose, Amino Acid,  Administer medications as prescribed to
Urea back to blood relax prostatic smooth muscle and
 Secretes wastes, drugs, improve urine flow.
 Instruct the client to decrease intake of
RAS caffeine and artificial sweeteners and
Descending LOH – Absorbs water limit spicy or acidic foods.
Ascending LOH – Absorbs Sodium  Instruct the client to follow a timed
DCT – Secretes K, H voiding schedule.
Collecting Duct – reabsorbs H2O  Prepare the client for surgery or invasive
procedures as prescribed (see Chapter
45, Figs. 45.6)

BENIGN PROSTATIC HYPERTROPHY

(HYPERPLASIA)
 Benign prostatic hypertrophy (benign
prostatic hyperplasia; BPH) is a slow
enlargement of the prostate gland, with
hypertrophy and hyperplasia of normal
tissue.
 Enlargement compresses the urethra,
resulting in partial or complete
obstruction.
 Usually occurs in those older than 50
years
BLADDER CANCER
 Bladder cancer is a papillomatous growth in
the bladder urothelium that undergoes
malignant changes and that may infiltrate
the bladder wall.
Predisposing factors
1. Cigarette smoking
2. Exposure to industrial chemicals, and
exposure to radiation

SIGNS AND SYMPTOMS Common sites of metastasis

1. Diminished size and force of urinary 2. Liver
stream (early sign of BPH)
 3. Bones
4. Lung
 As the tumor progresses, it can extend into
the rectum, vagina, other pelvic soft tissues,
and retroperitoneal structures.
ASSESSMENT
1. Gross or microscopic, painless
hematuria (most common sign)
2. Frequency, urgency, dysuria
3. Clot-induced obstruction
4. Bladder wash specimens and biopsy
confirm diagnosis.
DIAGNOSIS:
● Cystoscopy: A procedure to examine the
inside of the bladder using a thin tube
with a camera.
● Biopsy: Removal of a small tissue
sample for laboratory examination.
● Imaging Studies:
○ CT Scan: To assess the extent
of the cancer and identify
potential spread.
○ MRI: Magnetic resonance
imaging may provide detailed
images of the bladder.
○ Urine Cytology: Examination of
urine for cancer cells.
○ Intravenous Pyelogram (IVP):
An X-ray of the urinary tract
after injection of a contrast dye.
TREATMENTS:
● Surgery:
○ Transurethral Resection of
Bladder Tumor (TURBT):
Removal of small tumors
through the urethra.
● Partial or Radical Cystectomy: Partial or
complete removal of the bladder.
● Chemotherapy: Systemic or intravesical
(directly into the bladder) administration
of drugs to kill cancer cells.
● Immunotherapy: Stimulating the immune
system to target and destroy cancer
cells.
● Radiation Therapy: Using high-energy
rays to target and kill cancer cells.
● Targeted Therapy: Medications targeting
specific molecules involved in cancer
growth.
MEDICATIONS:
● Chemotherapy Drugs:
● Cisplatin, Gemcitabine, Methotrexate:
Commonly used in bladder cancer
treatment.
● Immunotherapy:
● Bacillus Calmette-Guérin (BCG): Intravesical
immunotherapy to stimulate an immune
response against cancer cells.
● Pembrolizumab, Atezolizumab: Checkpoint
inhibitors targeting the immune system.
NURSING INTERVENTIONS:
● Preoperative and Postoperative Care:
○ Education: Provide information on
procedures, potential complications,
and postoperative care.
○ Psychosocial Support: Address
concerns, fears, and emotional well-
being.
● Symptom Management:
○ Pain Control: Administer pain
medications as prescribed.
○ Fatigue Management: Encourage
rest and provide support for fatigue.
● Side Effect Management:
○ Nausea and Vomiting: Administer
antiemetic medications as needed.
○ Monitoring for Complications: Watch
for potential side effects of
treatments and report promptly.
● Cystectomy Care:
○ Stoma Care: For patients with an
ostomy after cystectomy.
■ Wound Care: Monitor and
care for incisions or surgical
wounds.
● Psychosocial Support:
■ Counseling: Provide
emotional support and
resources for coping.
■ Communication:
Maintain open
communication with the
patient and family.
 10. Pulmonary Edema
11. Anorexia
12. Cardiovascular Problems
CHRONIC KIDNEY DISEASE (CKD)
 CKD is a slow, progressive, irreversible loss ASSESSMENT
in kidney function, with a GFR less than or 1. Assess body systems for the
equal to 60 mL per minute for 3 months or manifestations of CKD
longer. 2. Assess psychological changes, which
 It occurs in stages (with loss of 75% of could include emotional lability,
functioning nephrons, the client becomes withdrawal, depression, anxiety, denial,
symptomatic) and eventually results in dependence–independence conflict,
uremia or end-stage kidney disease (with changes in body image, and suicidal
loss of 90% to 95% of functioning behavior.
nephrons).
 Hypervolemia can occur because of the DIAGNOSIS:
kidneys’ inability to excrete sodium and ● Blood Tests:
water; hypovolemia can occur because of ○ Creatinine and Blood Urea
the kidneys’ inability to conserve sodium Nitrogen (BUN): Elevated levels
and water. indicate impaired kidney
 CKD affects all major body systems and function.
may require dialysis or kidney ○ Glomerular Filtration Rate
transplantation to maintain life. (GFR): A measure of kidney
function.
○ Electrolyte Levels: Assessing
imbalances such as high
potassium.
○ Urinalysis: Examination of urine
for abnormalities.
● Imaging Studies:
○ Ultrasound: To visualize the
kidneys and identify structural
PRIMARY CAUSES
abnormalities.
11. May follow AKI
○ CT Scan or MRI: Detailed
12. Diabetes mellitus and other metabolic
disorders imaging for assessing kidney
13. Hypertension structure.
14. Chronic urinary obstruction ○ Kidney Biopsy: In some cases,
15. Recurrent infections a sample of kidney tissue is
16. Renal artery occlusion taken for examination.
17. Autoimmune disorders
NURSING INTERVENTIONS
SIGNS AND SYMPTOMS 1. Monitor vital signs, especially for signs
1. Proteinuria of hypertension, tachycardia, tachypnea,
2. Polyuria, nocturia (Early Signs) and an irregular heart rate.
3. Oliguria, Anuria (Late Signs) 3. Monitor urine and intake and output
4. Diluted, straw colored urine hourly and urine color and
5. Hematuria characteristics and check laboratory
6. Anemia results.
7. Muscle Weakness and Cramps 4. Monitor daily weight (same scale, same
8. Poor skin turgor clothes, same time of day), noting that
9. Pruritus
 an increase of 0.5 to 1 lb/day (0.25 to
0.5 kg/day) indicates fluid retention.
5. Monitor for altered level
consciousness caused by uremia
6. Monitor the lungs for fine crackles,
wheezes, and rhonchi, and monitor for
edema, which can indicate uid
overload.
7. Administer the prescribed diet, which is
usually a low- to moderate-protein (to
decrease the workload on the kidneys)
and high-carbohydrate diet; ill clients
may require nutritional support with
supplements, enteral feedings, or
parenteral nutrition.
8. Restrict potassium and sodium intake as
prescribed based on the electrolyte
level.
9. Administer medications as prescribed;
be alert to the mechanism for
metabolism and excretion of all
prescribed medications.
10. Be alert to nephrotoxic medications,
which may be prescribed.
11. Be alert to the PHCP’s adjustment of
medication dosages for kidney injury.
12. Prepare the client for dialysis if
prescribed; continuous renal
replacement therapy may be used in
AKI to treat fluid volume overload or
rapidly developing azotemia
metabolic acidosis.
KIDNEY TUMORS
 Kidney tumors may be benign or
malignant, bilateral or unilateral.
 Common sites of metastasis of
malignant tumors include bone, lungs,
liver, spleen, and the other kidney.
 The exact cause of renal carcinoma is
unknown.
CAUSES:
● The specific causes of kidney cancer
are not always clear, but several risk
factors are associated with its
development:
○ Smoking: Smokers have a
higher risk of kidney cancer.
○ Age: The risk increases with
age, and it is more common in
of people over 40.
○ Gender: Men are more likely
than women to develop kidney
cancer.
○ Obesity: Overweight individuals
have an increased risk.
○ High Blood Pressure:
Hypertension is a risk factor for
kidney cancer.
○ Genetic Factors: Hereditary
conditions, such as von Hippel-
Lindau (VHL) disease.
○ Family History: A family history
of kidney cancer may increase
the risk.
○ Occupational Exposure: Certain
workplace exposures to
chemicals like asbestos or
cadmium.
ASSESSMENT
 Dull flank pain
 Palpable renal mass
 Painless gross hematuria
 Weight Loss
 Hematuria
and
DIAGNOSIS:
● Blood Tests:
○ Creatinine and Blood Urea
Nitrogen (BUN): Elevated levels
indicate impaired kidney
function.
○ Glomerular Filtration Rate
(GFR): A measure of kidney
function.
○ Electrolyte Levels: Assessing
imbalances such as high
potassium.
○ Urinalysis: Examination of urine
for abnormalities.
● Imaging Studies:
○ Ultrasound: To visualize the
kidneys and identify structural
abnormalities.
 ○ CT Scan or MRI: Detailed
imaging for assessing kidney
structure.
● Kidney Biopsy: In some cases, a
sample of kidney tissue is taken for
examination.
MEDICATIONS:
● Tyrosine Kinase Inhibitors (TKIs):
○ Sunitinib (Sutent)
○ Pazopanib (Votrient)
○ Cabozantinib (Cabometyx)
● mTOR Inhibitors:
○ Everolimus (Afinitor)
○ Temsirolimus (Torisel)
● Checkpoint Inhibitors:
○ Nivolumab (Opdivo)
○ Ipilimumab (Yervoy)
○ Pembrolizumab (Keytruda
RADICAL NEPHRECTOMY
a. Surgical removal of the entire kidney,
adjacent adrenal gland, and renal artery
and vein
b. Radiation therapy and possibly
chemotherapy may follow radical
nephrectomy.
c. Before surgery, radiation may be used
to embolize (occlude) the arteries
supplying the kidney to reduce bleeding
during nephrectomy.
Postoperative interventions
a. Monitor vital signs for signs of bleeding
(hypotension and tachycardia).
b. Monitor for abdominal distention,
decreases in urinary output, and
alterations in level of consciousness as
signs of bleeding; check the bed linens
under the client for bleeding.
c. Monitor for signs of adrenal
insufficiency, which include a large
urinary output followed by hypotension
and subsequent oliguria.
d. Administer fluids and packed red blood
cells intravenously as prescribed.
e. Monitor intake and output and daily
weight.
f. Monitor for a urinary output of 30 to 50
mL/hr to ensure adequate renal function.
g. Maintain the client in a semi-Fowler’s
position.
h. If a nephrostomy tube is in place, do not
irrigate (unless specifically prescribed)
or manipulate the tube.
KIDNEY STONES / NEPHROLITIASIS
 Calculi are stones that can form
anywhere in the urinary tract; however,
the most frequent site is the kidneys.
 Problems resulting from calculi are
severe intermittent pain, obstruction,
tissue trauma, secondary hemorrhage,
and infection.
 The stone can be located through
radiography of the kidneys, ureters, and
bladder; IV pyelography; computed
tomography (CT) scanning; and renal
ultrasonography.
 A stone analysis is done after passage
to determine the type of stone and assist
in determining treatment.
 Urolithiasis refers to the formation of
urinary calculi; these form in the ureters.
 Nephrolithiasis refers to the formation
of kidney calculi; these form in the renal
parenchyma.
 When a calculus occludes the ureter
and blocks the flow of urine, the ureter
dilates, producing hydro-ureter (see Fig.
55.5).
 If the obstruction is not removed, urinary
stasis results in infection, impairment of
renal function on the side of the
blockage, hydronephrosis (see Fig.
55.5), and irreversible kidney damage.
Causes
1. Family history of stone formation
2. Diet high in calcium, vitamin D, protein,
oxalate, purines, or alkali
3. Obstruction and urinary stasis
4. Dehydration
5. Use of diuretics, which can cause
volume depletion
6. UTIs and prolonged urinary
catheterization
7. Immobilization
8. Hypercalcemia and hyperparathyroidism
9. Elevated uric acid level, such as in gout
 facilitate the passage of the stone and
SIGNS AND SYMPTOMS prevent infection; monitor for
1. Renal colic, which originates in the obstruction.
lumbar region and radiates around the 6. Administer fluids intravenously as
side and down to the testicles in men prescribed if unable to take fluids orally
and to the bladder in women or in adequate amounts to increase the
2. Ureteral colic, which radiates toward the flow of urine and facilitate passage of
genitalia and thighs the stone.
3. Sharp, severe pain of sudden onset 7. Provide warm baths and heat to the
4. Dull, aching pain in the kidney flank area (massage therapy should be
5. Nausea and vomiting, pallor, and avoided).
diaphoresis during acute pain 8. Administer analgesics at regularly
6. Urinary frequency, with alternating scheduled intervals as prescribed to
retention relieve pain.
7. Signs of a UTI 9. Assess the client’s response to pain
8. Low-grade fever medication.
9. High numbers of red blood cells, WBCs, 10. Assist the client in performing relaxation
and bacteria noted in the urinalysis techniques to assist in relieving pain.
report 11. Encourage client ambulation, if stable, to
10. Gross hematuria promote the passage of the stone.
12. Turn and reposition the immobilized
DIAGNOSIS: client to promote passage of the stone.
● Blood Tests: 13. Instruct the client in the diet restrictions
○ Creatinine and Blood Urea specific to the stone composition if
Nitrogen (BUN): Elevated levels prescribed (Box 55.13).
indicate impaired kidney 14. Prepare the client for surgical
function. procedures if prescribed.
○ Glomerular Filtration Rate
SURGICAL MANAGEMENT
(GFR): A measure of kidney
1. Cystoscopy
function.
2. Extracorporeal Shock Wave
○ Electrolyte Levels: Assessing
Lithotripsy (ESWL)
imbalances such as high a. noninvasive mechanical
potassium. procedure for breaking up
○ Urinalysis: Examination of urine stones located in the kidney or
for abnormalities. upper ureter so that they can
● Imaging Studies: pass spontaneously or be
○ Ultrasound: To visualize the removed by other methods
kidneys and identify structural b. A stent may be placed to
abnormalities. facilitate passing stone
CT Scan or MRI: Detailed imaging for assessing fragments.
kidney structure c. Fluoroscopy is used to visualize
the stone, and ultrasonic waves
Interventions are delivered to the area of the
1. Monitor vital signs, especially stone to disintegrate it.
temperature, for signs of infection. d. The stones are passed in the
2. Monitor intake and output. urine within a few days.
3. Assess for fever, chills, and infection. e. The client is taught to watch for
4. Monitor for nausea, vomiting, and signs of urinary obstruction,
diarrhea. bleeding, or hematoma
5. Encourage fluid intake up to 3000 formation.
mL/day, unless contraindicated, to
 f. Instruct the client to increase
fluid intake to flush out the stone
fragments.
3. Percutaneous lithotripsy
a. An invasive procedure in which
a guide is inserted under
fluoroscopy near the area of the
stone; an ultrasonic wave is
aimed at the stone to break it
into fragments.
b. Percutaneous lithotripsy may be
performed via cystoscopy or
nephroscopy (a small flank
incision is needed for
nephroscopy).
4. Partial or total nephrectomy
a. Performed for extensive kidney
damage, renal infection, severe
obstruction from stones or
tumors, and prevention of stone
recurrence
ACUTE KIDNEY INJURY (AKI)
Renal Failure
 Rapid loss of kidney function from renal cell
damage.
 Occurs abruptly and can be reversible
 AKI leads to cell hypoperfusion, cell death,
and decompensation of renal function.
 The prognosis depends on the cause and
the condition of the client.
 Near-normal or normal kidney function may
resume gradually.
Causes
1. Pre-renal: Outside the kidney; caused by
intravascular volume depletion such as with:
a. Blood loss associated with trauma
or surgery
b. Dehydration
c. Decreased cardiac output (as with
cardiogenic shock)
d. Decreased peripheral vascular
resistance
e.
f. Decreased renovascular blood flow
g. Pre-renal infection or obstruction
2. Intra-renal: Within the parenchyma of the
kidney
a. Tubular necrosis
b. Prolonged prerenal ischemia
c. Intrarenal infection or obstruction
d. Nephrotoxicity (Box 55.3)
3. Post-renal: Between the kidney and urethral
meatus, such as:
a. Bladder neck obstruction
b. Bladder cancer
c. Renal calculi
d. Post-renal infection
Phases of AKI
 Onset: Begins with precipitating event
 Oliguric phase
o For some clients, oliguria does not
occur and the urine output is normal;
otherwise, the duration of oliguria is
8 to 15 days; the longer the
duration, the less chance of
recovery.
o Sudden decrease in urine output;
urine output is less than 400
mL/day.
o Signs of excess fluid volume:
Hypertension, edema, pleural and
pericardial effusions, dysrhythmias,
heart failure, and pulmonary edema
o Signs of uremia: Anorexia, nausea,
vomiting, and pruritus
o Signs of metabolic acidosis:
Kussmaul’s respirations
o Signs of neurological changes:
Tingling of extremities, drowsiness
progressing to disorientation, and
then coma
o Signs of pericarditis: Friction rub,
chest pain with inspiration, and low-
grade fever
 Diuretic phase
o Urine output rises slowly, followed
by diuresis (4 to 5 L/day).
o Excessive urine output indicates that
damaged nephrons are recovering
their ability to excrete wastes.
o Dehydration, hypovolemia,
hypotension, and tachycardia can
occur.
o Level of consciousness improves.
 Recovery phase (convalescent)
 o Recovery is a slow process;  Weigh Daily
complete recovery may take 1 to 2  High CHO
years.  Low CHON, Na, K
o Urine volume returns to normal.
o Memory improves. PHARMACOLOGIC
o Strength increases.  Kayaxelate
o The older adult is less likely than a o For hyperkalemia
younger adult to regain full kidney  Diuretics
function. o For hypernatremia

AKI Laboratory Findings Nursing Diagnosis

1. Onset 1. Activity Intolerance
2. Oliguric Phase 2. Excess/Deficient fluid volume
 Elevated blood urea nitrogen
(BUN) and serum creatinine
levels
 Decreased urine specific gravity
(prerenal causes) or normal
(intrarenal causes) DIALYSIS
 Decreased glomerular filtration  Anticoagulant is used
rate (GFR) and creatinine o Prepare antidote
clearance  No BP taking on affected arm or arm
 Hyperkalemia with fistula
 Normal or decreased serum  Auscultate bruit sound
sodium level  Palpate thrill
 Hypervolemia PERITONEAL DIALYSIS
 Hypocalcemia  Infuse
 Hyperphosphatemia  Dwell
 Outflow
3. Diuretic Phase  Warm dialysate before use
 Gradual decline in BUN and  First few bottles of drainage has normal
serum creatinine levels, but still pink-tinged
elevated  Cloudy Dialysate
 Continued low creatinine o Infection
clearance with improving GFR o Report to doctor
 Hypokalemia  If drainage stops
 Hyponatremia o Turn patient to side
 Hypovolemia
4. Recovery Phase (Convalescent) Nursing Interventions
 Increased GFR 1. Monitor vital signs, especially for signs
 Stabilization or continual decline of hypertension, tachycardia, tachypnea,
in BUN and serum creatinine and an irregular heart rate.
levels toward normal 2. Monitor urine and intake and output
 Complete recovery (may take 1 hourly and urine color and
to 2 years) characteristics and check laboratory
results.
MANAGEMENT 3. Monitor daily weight (same scale, same
 Regular Insulin administration clothes, same time of day), noting that
 Dialysis an increase of 0.5 to 1 lb/day (0.25 to
 Water and Sodium Restriction 0.5 kg/day) indicates fluid retention.
 4. Monitor for altered level of Causes
consciousness caused by uremia 1. Allergens or irritants, such as soaps,
5. Monitor the lungs for fine crackles, sprays, bubble bath, perfumed sanitary
wheezes, and rhonchi, and monitor for napkins
edema, which can indicate fluid 2. Bladder distention
overload. 3. Calculus
6. Administer the prescribed diet, which is 4. Hormonal changes, influencing
usually a low- to moderate-protein (to alterations in vaginal flora
decrease the workload on the kidneys) 5. Indwelling urinary catheters
and high-carbohydrate diet; ill clients 6. Invasive urinary tract procedures
may require nutritional support with 7. Loss of bactericidal properties of
supplements, enteral feedings, or prostatic secretions
parenteral nutrition. 8. Microorganisms
7. Restrict potassium and sodium intake as 9. Poor-fitting vaginal diaphragms
prescribed based on the electrolyte 10. Sexual intercourse
level. 11. Synthetic underwear and pantyhose
8. Administer medications as prescribed; 12. Urinary stasis
be alert to the mechanism for 13. Wet bathing suits
metabolism and excretion of all
prescribed medications.
9. Be alert to nephrotoxic medications,
which may be prescribed. Assessment
10. Be alert to the PHCP’s adjustment of 1. Frequency and urgency
medication dosages for kidney injury. 2. Burning on urination
11. Prepare the client for dialysis if 3. Voiding in small amounts
prescribed; continuous renal 4. Incomplete emptying of the bladder
replacement therapy may be used in AKI 5. Lower abdominal discomfort or back
to treat fluid volume overload or rapidly discomfort, bladder spasms
developing azotemia and metabolic 6. Cloudy, dark, foul-smelling urine
acidosis. 7. Hematuria
8. Malaise, chills, fever
9. WBC count greater than 11,000 mm3
ACUTE CYSTITIS (URINARY TRACT (11.0 × 109/L) on urinalysis
INFECTION)
 Cystitis (urinary tract infection [UTI]) is an Interventions
inflammation of the bladder from an 1. Before administering prescribed
infection, obstruction of the urethra, or other antibiotics, obtain a urine specimen for
irritants culture and sensitivity, if prescribed, to
 The most common causative organisms are identify bacterial growth.
Escherichia coli and Enterobacter, 2. Encourage the client to increase fluids
Pseudomonas, and Serratia species. up to 3000 mL/day, especially if the
 Cystitis is more common in women, because client is taking a sulfonamide;
 women have a shorter urethra than men and sulfonamides can form crystals in
the urethra in the woman is located close to concentrated urine.
the rectum. 3. Administer prescribed medications,
 Sexually active and pregnant women are which may include analgesics,
most vulnerable to cystitis. antiseptics, antispasmodics, antibiotics,
 Acute cystitis should not be confused with and antimicrobials.
interstitial cystitis which is a chronic 4. Maintain an acid urine pH (5.5); instruct
condition of the bladder associated with pain the client about foods to consume to
and pressure of the bladder. maintain acidic urine.
5. Provide heat to the abdomen or sitz
baths for complaints of discomfort.
6. Note that if the client is prescribed an
aminoglycoside, sulfonamide, or
nitrofurantoin, the actions of these
medications are decreased by acidic
urine.
7. Use sterile technique when inserting a
urinary catheter.
8. Provide meticulous perineal care for the
client with an indwelling catheter.
9. Discourage caffeine products such as
coffee, tea, and cola.
10. Client education
a. Avoid alcohol.
b. Take medications as prescribed.
c. Take antibiotics on schedule
and complete the entire course
of medications as prescribed,
which may be 10 to 14 days.
d. Repeat the urine culture
following treatment.
e. Prevent recurrence of cystitis