This video will cover general renal assessment which includes health status, history and physical exam.
Before we start, be sure to download the free PDF study guide with this video to enhance your learning. Link is listed below!
Importance of the Assessment
A good assessment allows us to gather important information that serve as clues as to what is going on with the patient. Once we have enough information, treatments can begin. Assessments also allow us to re-evaluate current treatment or past treatment to determine whether the treatment is helping the patient or not.
Current Health Status
It's important to document the reason the patient is seeing the doctor and their complaints. Common complaints for renal disorders are pain, change in frequency and urgency and difficulty urinating.
Previous Health Status
Ask about the patient's previous major illnesses, recurrent illnesses, accidents or injuries. You should also ask about surgical procedures and allergies as these could also be clues to possible causes. Sometimes the patient may not remember or understand how to explain certain issues so it's also good to ask specific questions like, “Do you have pain or burning on urination? Is initiating urination difficult? What color is your urine?”
Family History
It is important to ask if there is a family history of cardiovascular disorders, cancer or other chronic diseases. Physical Examination
The first step begins with obtaining vital signs and weighing the patient. During this time, you may also collect a urine specimen as well. In the previous video, we learned that the renal system affects many body functions so a head to toe assessment would be done.
Inspection
When focusing on the renal system, inspection includes the abdomen and urethral meatus.
While inspecting the abdomen, you look for abnormalities which include enlargements or fullness while comparing both sides. A normal abdomen is symmetrical. Ask about scars, legions or bruises if they are seen
Auscultation
During auscultation, you will listen to the renal arteries for any abnormalities such as systolic bruits which have a whoosh sounds.
Percussion
Here you will gently tap on the kidneys to note any tenderness or pain which is an abnormality. Also percuss the bladder to note the position of the bladder.
Palpation
During this examination, the kidney and the bladder would be palpated. Here you would be able to notice any lumps, masses or tenderness. Encourage the patient to relax as much as possible by taking deep breaths through the mouth.
Fluid and Electrolyte Imbalances
Patients with kidney disorders will commonly experience fluid and electrolyte imbalance. Knowing this will be very helpful in your exams because signs and symptoms will indicate certain electrolyte imbalances.
Fluid Imbalance
Fluid is a very big indicator when it comes to renal disorders. There will be fluid overload which means the patient has too many fluids for the kidney to handle and fluid volume deficit which means the patient doesn't have enough fluid in the body.
Now, what's very important to remember is that fluid and blood pressure have a strong relationship so careful monitoring of fluid is crucial. The most accurate indicator of fluid loss/gain is weight gain.
The three most important imbalances we are going to go over is Fluid Volume, Sodium and Potassium
Fluid Volume Deficit
These manifestations include decreased skin turgor, dry mucous membranes, oliguria or anuria.
Fluid Volume Excess
These manifestations include edema, crackles, shortness of breath
Sodium deficit
These manifestations include nausea, tiredness, lethargy, headache
Sodium excess
This would include the patient complaining of thirst, rough dry tongue and fever
Potassium Deficit
These manifestations include abdominal distention, paralytic ileus and ECG changes
Potassium Excess
Manifestations include diarrhea, nausea, irritability
Interventions
When manifestations are present, there are nursing interventions we take to help improve the patient's condition which we will talk about later when discussing treatments.
Well that concludes this post, join us in the next post as we cover Diagnostic Tests Part One of the Renal system. Thanks for reading!