NCLEX Review: Renal and Urological Module

This week, lets take some time to go over some of the material that we cover in the Renal and Urological Module of “The Pearl for NCLEX Review”.

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The topics covered in this article are Urological Pharmacology, Acute Renal Failure, Evaluating Dialysis Candidates, and Catheters.

Urological Pharmacology

There are five classifications of pharmacology that are covered in this section.

1. Diuretics cause the kidneys to remove more sodium and water from the body, which helps to relax the blood vessel walls, thereby lowering blood pressure.
2. Cholinergic agents help the bladder to contract when the muscle has lost its tone such as in patients with flaccid neurogenic bladder or some types of incontinence. They usually work within one hour after oral administration.
3. Anticholinergic agents cause the bladder to relax and fill. They also help the patient to contract the external urethral sphincter on command and regain control of continence. Can be used for spastic bladder conditions. They usually work within one hour after oral administration.
4. Antispasmodics prevent bladder spasms which can be very painful and lead to incontinence.
5. Phosphate binders are used in renal failure to bind phosphate in the gastrointestinal tract so the body cannot absorb it.

Below is a flashcard showing which diuretics are potassium wasters, one of the sample questions that is covered during our NCLEX Review.

Acute Renal Failure

Acute renal failure (ARF) is a sudden and almost complete loss of the function of the kidneys over a short period of time. Various types and phases are discussed in this section.

Types of ARF:

Pre-renal

• Caused by decreased blood flow to the kidneys
• Urine output falls and the kidneys are unable to excrete waste products effectively
• BUN to creatinine ratio > 15:1
• Causes include severe dehydration, diuretic therapy, hypovolemia and shock

Intra-renal

• Damage to the kidneys
• Lose the ability to concentrate urine and excrete waste products
• BUN to creatinine ratio 10:1
• Caused by a disease process, ischemia, toxic chemicals or severe infection
• Iatrogenic causes include antibiotics and contrast dyes

Post-renal

• Obstruction to urine flow
• Leads to the inability to excrete waste products and hydronephrosis
• Causes include benign prostatic hypertrophy, renal calculi or tumors

Phases of acute renal failure:

Initiation phase

• Oliguric or non-oliguric depending on the cause

Maintenance phase

• Diuretic phase
• May put out up to 10 liters of urine a day

Recovery phase

• Renal function returns to normal
• Could take up to one year

 

Evaluating Dialysis Candidates

Peritoneal dialysis is less expensive and easier to train for home use than hemodialysis. It is better for patients with cardiovascular instability.

Insufficient outflow may occur during the procedure.

• Evaluate for catheter obstruction from clots or kinking
• Ask if a recent history of constipation
• Reposition patient and ambulate if able

Hemodialysis: Short term access is accomplished by the insertion of a catheter with two lumens which allows the blood to be withdrawn, cleansed and then returned.

AV fistula is a joining of an artery and a vein. Two needles are inserted during a treatment.  This is the preferred method of long term dialysis.

• You can “feel the thrill and hear the bruit” of the fistula
• Monitor for arterial steal syndrome where too much blood is diverted to the vein and perfusion is compromised
• Need to protect the site. Don’t use the arm for any other procedures such as BP or venipuncture
• Avoid any pressure to arm. Don’t sleep on the side of fistula or carry heavy objects
• No jewelry or constrictive clothing

Use the below flashcard and this YouTube Video to remember the considerations for dialysis candidates. When in doubt, stick with the vowels!

Catheters

Our founder Cindy Liette has over 35 years experience in nursing and provides you with expert tips and tricks that she has learned throughout her career.

The flashcard below is one of the hundreds of tips provided throughout the course!

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