RN- elimination terms

The normal BUN level for healthy individuals

7-20 mg/dL in adults, 5-18 mg/dL in children. Patients on dialysis have higher BUN levels, usually 40-60 mg/dL. The nephrologist (kidney doctor) and dietitian will help determine whether the BUN is in the correct range.

Calcium level

8.5-10.5 mg/dL (2.2-2.6 mmol/L) 9.2 mg/dL (2.3 mmol/L)- WNL

End stage renal disease (ESRD) is receiving peritoneal dialysis The dialysate instilled into the client was 1500 mL and 1500 mL was removed. Explanation: The purpose of peritoneal dialysis is to remove excess water and electrolytes from the body. Output should be greater than input. Normal effluent is clear or straw colored and clear. Mild back pain is expected as large amounts of fluid are instilled into the abdomen. The client receiving peritoneal dialysis does not have a graft and there is no bruit to be assessed

A client diagnosed with end stage renal disease (ESRD) is receiving peritoneal dialysis. Which assessment data warrants immediate nursing intervention? Correct response: The dialysate instilled into the client was 1500 mL and 1500 mL was removed. Explanation: The purpose of peritoneal dialysis is to remove excess water and electrolytes from the body. Output should be greater than input. Normal effluent is clear or straw colored and clear. Mild back pain is expected as large amounts of fluid are instilled into the abdomen. The client receiving peritoneal dialysis does not have a graft and there is no bruit to be assessed

chronic hydronephrosis Client's blood urea nitrogen (BUN) is 32 mg/dL. Explanation: Clients with chronic hydronephrosis suffer kidney damage. The BUN is elevated. Calcium and potassium levels are within normal range. Urinary output is low but consistent with the diagnosis.

A client is admitted with a diagnosis of chronic hydronephrosis. Which of the following assessment findings require immediate action or will assist the nurse in planning care? Client's blood urea nitrogen (BUN) is 32 mg/dL. Explanation: Clients with chronic hydronephrosis suffer kidney damage. The BUN is elevated. Calcium and potassium levels are within normal range. Urinary output is low but consistent with the diagnosis.

UA VALUES

Color - Yellow (light/pale to dark/deep amber) Clarity/turbidity - Clear or cloudy pH - 4.5-8 Specific gravity - 1.005-1.025 Glucose - ≤130 mg/d Ketones - None Nitrites - Negative Leukocyte esterase - Negative Bilirubin - Negative Urobilirubin - Small amount (0.5-1 mg/dL) Blood - ≤3 RBCs Protein - ≤150 mg/d RBCs - ≤2 RBCs/hpf WBCs - ≤2-5 WBCs/hpf Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf Casts - 0-5 hyaline casts/lpf Crystals - Occasionally Bacteria - None Yeast - None

UA- TURBIDITY

Normal urine is transparent or clear; becomes cloudy upon standing. Cloudy urine may be evidence of phosphates, urates, mucus, bacteria, epithelial cells, or leukocytes.

ABNORMAL CONSTITUENT: ASSOCIATED CAUSES:

Protein (albumin) - Albumin is normally too large to pass through glomerulus. Indicates abnormal increased permeability of the glomerulus membrane. Non-pathological causes are: pregnancy, physical exertion, increased protein consumption. Pathological causes are: glomerulonephritis bacterial toxins, chemical poisons. Glucose - Glycosuria is the condition of glucose in urine. Normally the filtered glucose is reabsorbed by the renal tubules and returned to the blood by carrier molecules. If blood glucose levels exceed renal threshold levels, the untransported glucose will spill over into the urine. Main cause: diabetes mellitus Ketones - Ketone bodies such as acetoacetic acid, beta-hydroxybutyric acid, and acetone can appear in urine in small amounts. These intermediate by-products are associated with the breakdown of fat. Causes: diabetes mellitus, starvation, diarrhea Bilirubin - Bilirubin comes from the breakdown of hemoglobin in red blood cells. The globin portion of hemoglobin is split off and the heme groups of hemoglobin is converted into the pigment bilirubin. Bilirubin is secreted in blood and carried to the liver where it is conjugated with glucuronic acid. Some is secreted in blood and some is excreted in the bile as bile pigments into the small intestines. Causes: liver disorders, cirrhosis, hepatitis, obstruction of bile duct Urobilinogen - Bile pigment derived from breakdown of hemoglobin. The majority of this substance is excreted in the stool, but small amounts are reabsorbed into the blood from the intestines and then excreted into the urine. Causes: hemolytic anemias, liver diseases Hemoglobin - Hemoglobinuria is the presence of hemoglobin in the urine. Causes: hemolytic anemia, blood transfusion reactions, massive bums, renal disease Red blood cells - Hematuria is the presence of intact erythrocytes. Almost always pathological. Causes: kidney stones, tumors, glomerulonephritis, physical trauma White blood cells - The presence of leukocytes in urine is referred to as pyuria (pus in the urine). Causes: urinary tract infection Nitrite - Presence of bacteria. Causes: urinary tract infection

UA- pH

Ranges from 4.5 - 8.0. Average is 6.0, slightly acidic. High protein diets increase acidity. Vegetarian diets increase alkalinity. Bacterial infections also increase alkalinity.

UA- ODOR

Slightly aromatic, characteristic of freshly voided urine. Urine becomes more ammonia-like upon standing due to bacterial activity.

UA- COLOR

The color of normal urine is usually light yellow to amber. Generally the greater the solute volume the deeper the color. The yellow color of urine is due to the presence of a yellow pigment, urochrome. Deviations from normal color can be caused by certain drugs and various vegetables such as carrots, beets, and rhubarb.

UA- SPECIFIC GRAVITY

a measurement of the density of urine - the relative proportions of dissolved solids in relationship to the total volume of the specimen. It reflects how concentrated or dilute a sample may be. Water has a specific gravity of 1.000. Urine will always have a value greater than 1.000 depending upon the amount of dissolved substances (salts, minerals, etc.) that may be present. Very dilute urine has a low specific gravity value and very concentrated urine has a high value. Specific gravity measures the ability of the kidneys to concentrate or dilute urine depending on fluctuating conditions. Normal range 1.005 - 1.035, average range 1.010 - 1.025. Low specific gravity is associated with conditions like diabetes insipidus, excessive water intake, diuretic use or chronic renal failure. High specific gravity levels are associated with diabetes mellitus, adrenal abnormalities or excessive water loss due to vomiting, diarrhea or kidney inflammation. A specific gravity that never varies is indicative of severe renal failure. Specific gravity can be determined by either of two methods using a refractometer or a urinometer. a. Refractometer - measures the refractive index of urine which parallels the specific gravity. 1. Collect mid-stream sample of urine in collection cup. 2. Pipette 1-2 drops of urine into the plastic chamber located on the top of the refractometer. Be sure that the plastic is pressed firmly down in place on the refractometer. 3. Determine the specific gravity of the urine by looking through the refractometer and determining the value on the scale on the left hand side. The specific gravity value is where the light and dark intersect on the scale. 4. Clean the refractometer with kimwipes. b. Urinometer - Is a weighted, bulb shaped device that has a specific gravity scale on the stem end. 1. Fill the cylinder with enough urine so that the urinometer will float in the urine and not touch the bottom. 2. Be careful not to drop the urinometer in the cylinder! Gently release it in order not to break or burst the cylinder. It should NOT touch the sides or bottom of cylinder. 3. The specific gravity can be read on the scale on the stern of the urinometer at the meniscus. 4. The specific gravity of water is 1.000 with respect to temperature. The urinometer can be checked periodically against this standard to ensure quality control at that temperature.