Evaluating Renal Function (Nursing)

00:01 Hi! Welcome to our video on renal assessment.

00:04 Now this one we're going to talk about what to do to evaluate renal function of their patients.

00:09 Primary job of the kidneys is filter and remove filter and remove that's what we're looking for.

00:15 That's what healthy kidneys do.

00:17 They filter the blood that enters through that renal artery.

00:20 It'll also dumped off a small percentage of waste and water to make urine.

00:25 Dumps down that ureter into the bladder and out of the body.

00:29 So we looked at an overview of what healthy kidneys do.

00:33 Now I want to give you three categories of things that you can be looking for as a nurse, caring for a patient in assessing the renal problems.

00:41 So, the first group are pretty obvious signs, if you saw a patient who had gross hematuria, that means a lot of blood, Hematuria, in their urine.

00:51 You're going to know right away things are not right.

00:54 Also, if they're complaining of really bad flank pain, those are going to be some acute symptoms that let you know, there's a definite problem.

01:02 So we'll call those the obvious category.

01:06 The second category are ones that require a little more assessment to figure out if the kidneys are involved or how they're involved.

01:13 Take a Edema for example, Edema is fluid in inappropriate spaces.

01:20 Have you taken care of a patient whose legs are swollen? That means too much fluid has leaked out into their tissues.

01:27 Now, I know if you push down on their shin bone with your thumb and your move your thumb and there's still a divot left in their leg that's called pitting edema because it leaves a little pit the exact shape of my thumb so that could be a renal problem because they're not able to get rid of enough fluid or to filter enough or well, it could be a cardiac problem.

01:47 it could be a fluid overload problem.

01:49 They need to do some more assessment to figure out what is the cause and for really sick patients, It may be all of the above.

01:57 Now also we look at things like hypertension and for signs of symptoms of uremia, that would cause us to do some further digging.

02:05 Now this third category are silent ones.

02:09 They're asymptomatic meaning without symptoms "A" means without symptoms.

02:15 So these are the things where the patient may not even know they have a problem.

02:19 We look at lab work.

02:21 They might have an elevated serum creatinine concentration or they have some abnormal things on their urine analysis not only take urine and really do some close observation maybe even under a microscope as needed.

02:34 so the main point of this slide is some things are obvious, Some things are hidden, Some things are going to need further assessment.

02:42 And that's our role as part of the health care team that we understand how all these categories fit together because our job is to keep patients safe.

02:52 We're the ones who are right at the bedside and the earlier you catch these things these types of assessments can help save your patients life and absolutely improve their quality and shorten their length of stay.

03:06 Because the nurses are accountable to understand when there's an increased risk for acute kidney injury.

03:12 Now you see on the slide there, We have Acute Kidney Injury (AKI) / acute renal failure.

03:19 Accute renal failure is in older term for lack of better words.

03:24 Acute kidney injury is what you'll see mostly in the literature now, but that means acute.

03:30 It is happening now and it's your job to recognize when patients are at risk for acute kidney injury.

03:37 Maybe the patient's blood pressure has dropped their hypotensive kidneys are not being perfused that can put them at risk for acute kidney injury.

03:46 Maybe they're just severely severely dehydrated another reason why those kidneys are not getting perfused well.

03:53 That can put them at risk for acute kidney injury.

03:56 Now at the other end of the time spectrum is chronic renal disease this isn't an acute event.

04:03 This is kidney damage and deterioration that has happened over a period of time.

04:08 But our jobs as nurses is to understand when they're at increased risk for acute kidney injury and to watch our patients ultra close who have chronic renal disease.

04:19 Okay, because early identification equals increased safety for your patience, I can't stress enough how important that is when you take the time to learn about the kidneys and renal function and assessments, you're going to be an excellent nurse who can advocate for their patients.

04:37 Because the healthcare provider is going to look at the BUN and the creatinine the look at an estimate of the GFR, they look at a urinalysis probably even with some microscopic examination of the sediment, but we play a part of that team in making sure the lab work is done correctly and you too can look at those results and learn a lot about your patients kidney function, because monitoring and screening of a patient's kidney function can help us identify problems earlier.

05:03 There's no reason to wait because you can learn enough to know when your patient is in trouble because then we can intervene and hopefully slow the progression of kidney disease and definitely try to intervene with acute kidney injury.

05:17 Now when the disease or the damage is figured out we identify we know that it's going on.

05:22 We're probably gonna have to do some additional testing to kind of figure out what the degree of the damage is and what the progression of the disease is.