Nursing Tips: Renal

The oliguric phase of acute kidney injury (AKI) is marked by urine output less than 400 mL/day. In the diuresis phase of AKI, urine output can reach 4 - 5 L/day.

Bethanechol, used to treat non-obstructive urinary retention, stimulates cholinergic receptors

Because spironolactone is a potassium-sparing diuretic, monitor the patient for signs of hyperkalemia. Educate patients to avoid salt substitutes, as most of these contain potassium.

Because oxybutynin is used to treat overactive bladder by inhibiting acetylcholine in the bladder, assess for anticholinergic symptoms. These include dry mouth, urinary retention, constipation, and blurred vision.

A patient undergoing hemodialysis may have an arteriovenous fistula in the arm. Educate patient that blood pressures, IVs, and blood draws must be done from the arm without the shunt. Also educate patients not to sleep on the arm with the fistula, and perform hand exercises to mature a new fistula.

A patient experiencing Acute Kidney Injury (AKI) will likely have hyperkalemia, hyponatremia, hypocalcemia, metabolic acidosis, anemia, and elevated creatinine and BUN.

A child demonstrating oliguria, cola-colored urine, and signs/symptoms of hypervolemia following a recent streptococcal infection (strep throat) should be evaluated for Acute Glomerulonephritis.

With a Urinary Tract Infection (UTI), the urinanalysis may be positive for leukocyte esterase and nitrites.

Key labs with Glomerulonephritis: Serum: Positive antistreptolysin-O titer. Urinanalysis: hematuria, proteinuria. Throat culture: Positive for group A beta-hemolytic streptococcus

Costovertebral tenderness is a key symptom with Pyelonephritis.

With peritoneal dialysis, bloody or cloudy outflow indicates possible infection!

For a patient with urolithiasis (kidney stone), a key nursing intervention is to strain the patient's urine. Send stone for lab analysis!

Phenazopyridine is a urinary tract analgesic. It is used to treat the symptoms of a UTI (burning, pain, frequency, urgency). It is not an antibiotic!

HINT: Pyro = Fire, and reminds you that this medication the "burning" feeling of a UTI.

Patients with Chronic Kidney Disease (CKD) should LIMIT intake of phosphorus, potassium, and sodium.

Sildenafil is used to treat erectile dysfunction. If you use sildenafil it will help you fill out "down there".

Terbutaline sulfate is a medication used to treat pre-term labor. HINT: Terbutaline looks like turbulence, and when flying, turbulence delays arrival time.