Nursing study guide
Renal + urinary nursing
Trend filtration, fluid, electrolytes, urine, access, medications, and the patient response.
Nursing filter
Assess the patient first, recognize time-sensitive change, prevent harm, and trend the response.
Connect systems
Symptoms, laboratory patterns, medications, nutrition, function, and psychosocial needs interact.
Safety boundary
Use current orders, facility policy, clinical supervision, and emergency pathways.
Assessment
Urine output is one clue, not the whole kidney
Compare baseline creatinine, trend, volume status, medications, obstruction risk, and urine findings.
| Assess | Look for | Why it matters |
|---|---|---|
| Perfusion + volume | Blood pressure, orthostasis, edema, lung sounds, weight, intake/output | Too little or too much effective circulating volume can worsen kidney function. |
| Urine | Amount, timing, color, clarity, blood, foam, odor, pain, retention | Connect output and symptoms with urinalysis, culture, obstruction, and baseline. |
| Chemistry | Creatinine/eGFR, BUN, potassium, bicarbonate, sodium, calcium, phosphate | Patterns guide urgency and medication/fluid decisions. |
AKI
Find the cause before injury progresses
AKI can reflect reduced perfusion, intrinsic kidney injury, or urinary obstruction.
Prerenal
Volume loss, hypotension, sepsis, or reduced effective circulation may lower perfusion.
Intrinsic
Ischemic/toxic tubular injury, glomerular, interstitial, or vascular disease damages kidney tissue.
Postrenal
Obstruction impairs urine flow; bladder scan, catheter patency, imaging, or urologic evaluation may be needed.
Nursing priorities
Trend output and labs, avoid nephrotoxins when possible, adjust medicines per orders, manage volume, treat the cause, and escalate potassium, acidosis, overload, or uremia.
CKD
Protect remaining function and anticipate systemic effects
CKD affects fluid, electrolytes, blood, bone-mineral balance, nutrition, cardiovascular risk, and medication clearance.
Monitor
Blood pressure, edema, weight, urine, kidney trend, potassium, bicarbonate, hemoglobin, calcium/phosphate, nutrition, skin, cognition, and symptoms.
Medication safety
Review renal dosing, contrast risk, NSAIDs and other nephrotoxins, supplements, and interactions with the pharmacist/prescriber.
Teach
Individualized blood pressure, glucose, diet/fluid, medication, follow-up, access-preservation, and symptom plan.
Dialysis
Protect the access and monitor the shift
Hemodialysis and peritoneal dialysis remove wastes and fluid differently.
| Modality | Assessment | Urgent concerns |
|---|---|---|
| Hemodialysis | Pre/post weight and vitals, access thrill/bruit, bleeding, symptoms, medication timing | Absent thrill/bruit, access infection/bleeding, hypotension, chest pain, dyspnea, neurologic change. |
| Peritoneal dialysis | Aseptic connections, inflow/outflow, dwell, effluent, abdomen, glucose and fluid balance | Cloudy effluent, abdominal pain, fever, poor outflow, respiratory compromise, or leak. |
UTI + obstruction
Lower and upper urinary symptoms carry different risk
Older adults and patients with devices may present atypically, but nonspecific confusion alone does not diagnose UTI.
Lower UTI
Dysuria, frequency, urgency, suprapubic discomfort, and hematuria may occur.
Pyelonephritis
Fever, flank pain, systemic illness, nausea/vomiting, or sepsis concern requires prompt evaluation.
Retention / obstruction
Bladder fullness, low output, overflow, pain, hydronephrosis, or abrupt kidney change requires patency and obstruction assessment.
Catheter safety
Use only for an accepted indication, maintain a closed unobstructed system, provide hygiene, collect specimens correctly, and remove promptly.
Electrolyte interplay
The kidney and electrolyte guides belong together
Potassium, acid-base, magnesium, calcium, phosphate, and sodium can become the immediate threat.
Hyperkalemia
Verify the sample, assess ECG and symptoms, stop potassium sources as directed, and activate urgent treatment for severe elevation or ECG change.
Acidosis + overload
Worsening acidosis, pulmonary edema, refractory electrolyte change, or uremic complications can require urgent renal replacement evaluation.
Cross-reference
Review detailed fluid, electrolyte, laboratory, and urine-testing patterns in the related Nurse Arcade guides.
Teaching + delegation
Make the trend visible
Routine collection can be delegated; interpretation and unstable care remain RN work.
Delegate
Stable weights, intake/output, vital signs, hygiene, and specimen collection may be assigned with exact technique and report parameters.
RN retains
Volume and access assessment, interpretation, unstable dialysis care, teaching, medication evaluation, and plan changes.
Teach
Access care, infection prevention, medicine safety, diet/fluid plan, daily observations, and emergency symptoms.
Sources
Reference notes
Current nephrology, dialysis, urology, and facility policies control care.