Editing Medical-Surgical Nursing (section)

== Renal and Genitourinary Disorders ==

=== Acute Kidney Injury ===

Acute kidney injury is a sudden decline in kidney function classified as prerenal (hypoperfusion from hypovolemia, heart failure, or shock), intrarenal (direct damage from nephrotoxins, contrast media, aminoglycosides, or acute tubular necrosis), or postrenal (obstruction from stones, tumors, or prostatic enlargement).

The classic course has an oliguric phase with rising blood urea nitrogen and creatinine, hyperkalemia, metabolic acidosis, and fluid overload, followed by a diuretic phase in which large volumes of dilute urine are produced and the risks shift to hypovolemia and hypokalemia, and finally a recovery phase.

Nursing application: hyperkalemia is the most immediately lethal complication. Monitor the electrocardiogram, restrict potassium, and anticipate calcium gluconate to stabilize the myocardium, insulin with dextrose or a beta agonist to shift potassium into cells, and a potassium binder or dialysis to remove it. Calcium gluconate protects the heart but does not lower the serum potassium level.

=== Chronic Kidney Disease ===

Progressive irreversible nephron loss produces uremia, fluid overload, hypertension, hyperkalemia, hyperphosphatemia with resulting hypocalcemia and bone disease, metabolic acidosis, and anemia from reduced erythropoietin production.

Nursing interventions: restrict sodium, potassium, phosphorus, and usually fluid; provide adequate calories with controlled high-quality protein as prescribed; give phosphate binders with meals so they bind dietary phosphorus; administer erythropoiesis-stimulating agents and iron for anemia; and avoid nephrotoxic drugs including nonsteroidal anti-inflammatory drugs and contrast media where possible.

=== Dialysis Access and Care ===

For an arteriovenous fistula or graft, palpate for a thrill and auscultate for a bruit every shift. Never take blood pressure, draw blood, or start an intravenous line in the access extremity, and avoid constrictive clothing or sleeping on that arm.

Hold dialyzable medications, including many antihypertensives, until after treatment unless otherwise ordered, and weigh the patient before and after dialysis. Disequilibrium syndrome, caused by rapid solute shifts, presents with headache, nausea, restlessness, and confusion and requires slowing or stopping the treatment.

In peritoneal dialysis, cloudy effluent with abdominal pain and fever indicates peritonitis and must be reported and cultured. Outflow that is less than inflow suggests catheter obstruction or constipation; reposition the patient and check for kinks.

=== Urinary Tract Infection and Pyelonephritis ===

Lower tract infection causes dysuria, frequency, urgency, and suprapubic discomfort. Upper tract infection adds flank pain, costovertebral angle tenderness, fever, and chills. In older adults, new confusion, incontinence, or falls may be the only presentation.

Nursing application: prevention centers on hydration, complete bladder emptying, front-to-back perineal hygiene, and avoiding unnecessary indwelling catheters. When a catheter is required, maintain a closed system, keep the bag below bladder level and off the floor, and remove it at the earliest opportunity.

=== Urolithiasis ===

Renal calculi cause severe colicky flank pain radiating to the groin, hematuria, nausea, vomiting, and restlessness. Nursing care includes aggressive pain control, increased fluid intake unless contraindicated, ambulation, and straining all urine to capture the stone for analysis, which determines the prevention plan.

=== Benign Prostatic Hyperplasia ===

Enlargement of the prostate obstructs urine flow, producing hesitancy, weak stream, straining, dribbling, nocturia, and incomplete emptying with retention. After transurethral resection of the prostate, expect continuous bladder irrigation; the drainage should progress from pink to clear. Bright red drainage with clots, or a distended painful bladder with decreased output, suggests bleeding or obstruction and is reported immediately. Subtract irrigation volume from total output to determine true urine output.