NCLEX-RN Flashcards: Renal and Urinary Nursing, Catheter Care, Dialysis, UTI

Urinary tract infection, or UTI, presents with dysuria which is burning or pain during urination, urinary frequency and urgency, cloudy or foul-smelling urine, suprapubic discomfort, and possibly hematuria. If the infection ascends to the kidneys causing pyelonephritis, symptoms include flank pain, high fever, chills, nausea, and costovertebral angle tenderness. In elderly patients, UTI may present atypically with confusion or altered mental status as the primary symptom, without classic urinary complaints. Urinalysis shows nitrites, leukocyte esterase, white blood cells, and bacteria.

Catheter-associated urinary tract infections, or CAUTIs, are prevented by using indwelling catheters only when medically necessary and removing them as soon as possible. Insertion requires strict sterile technique. Maintain a closed drainage system and never disconnect the tubing. Keep the drainage bag below the level of the bladder at all times but off the floor. Perform perineal care daily. Secure the catheter to prevent traction and urethral trauma. Do not routinely irrigate the catheter. Empty the drainage bag regularly using a separate collection container for each patient.

Hemodialysis filters blood through an external machine with a semipermeable membrane, typically performed three times per week for three to four hours each session at a dialysis center. It requires vascular access through an arteriovenous fistula, graft, or central venous catheter. Peritoneal dialysis uses the patient's peritoneal membrane as the filter, with dialysate solution instilled into the abdominal cavity through a permanent catheter, allowed to dwell, then drained. It can be performed at home continuously or overnight.

An arteriovenous fistula, or AV fistula, is the preferred vascular access for hemodialysis, created by surgically connecting an artery to a vein in the forearm. The nurse must assess for a palpable thrill, which is a buzzing vibration felt over the fistula, and an audible bruit heard with a stethoscope, both confirming blood flow through the access. Never take blood pressure, draw blood, or start intravenous lines in the arm with the fistula. Report immediately if the thrill or bruit is absent, as this indicates clotting.

Patients with chronic kidney disease must limit sodium to reduce fluid retention and blood pressure, restrict potassium because damaged kidneys cannot excrete it, limit phosphorus because accumulation leaches calcium from bones, and moderate protein intake to reduce urea nitrogen waste while maintaining nutrition. Fluid restrictions apply based on urine output. High-potassium foods to avoid include bananas, oranges, potatoes, tomatoes, and avocados. High-phosphorus foods include dairy products, cola, chocolate, and processed meats. Renal dietitians help individualize meal plans.

Peritonitis is the most serious complication of peritoneal dialysis, presenting with cloudy dialysate effluent, which is the earliest and most reliable sign. Other signs include abdominal pain and tenderness, fever, nausea, and rebound tenderness. The effluent should be sent for culture and cell count, with white blood cell count above 100 per microliter with at least 50 percent neutrophils confirming the diagnosis. Treatment includes intraperitoneal antibiotics added to the dialysate.