So let's take a look at elevated urea nitrogen
and renal function, what it tells us about that
because the serum level of
urea is measured by the BUN test.
So an elevated BUN, we've just
talked about three possible reasons.
See if you can stop and recall those reasons.
Cool, so an elevated BUN can be an
indicator that the kidneys are compromised
because we know that BUN gives us clues
about both the liver and the renal function.
Right now we're going to
focus on the renal function.
So what should you do when a patient
you're taking care of has a high BUN?
Well the goal is that that abnormal lab
work always requires follow up by you.
Okay, so whenever you see a lab work
that is outside of the range of normal,
that should be a red flag to you
that you need to do something else.
You need to know what additional assessment
you need to do, you will look at the patient's history,
look at their trends and events
and collaborate with other disciplines.
So this just doesn't apply to
BUN, it applies to all lab work.
Think of it as one tiny piece of the puzzle.
Your job is to pool all these other information
together, collaborate with other disciplines
and help keep your patient safe.
So let's walk through the priorities.
In case you've never cared for a patient with an
elevated BUN, I want you to know what to do when you do
because trust me, this is a very
common occurrence in the hospital setting.
So you're going to assess and
collaborate, that's our first step.
So first, you're going to take
a look at the patient's urine.
You're gonna look at the colour of it and the clarity.
That means if I held it up to
a light, what would it look like?
Now you're gonna see a series of
bladders appear across your screen.
I know, pretty amazing but we
spare no expense here at Lecturio.
So on one of the spectrum, it's gonna be
transparent, be kind of a pale straw-colored,
that means you're well hydrated.
For all of us that should be drinking water, you know
every time you use the restroom, you usually look at it.
This is what you're gunning for, this is what you want.
You want your urine to be transparent, kind of a
pale straw color, that means you're well hydrated.
As it begins to get darker, look at the
difference between those two bladders.
Now that it's getting darker, that's
because there is less water in there.
Either you're not taking as much
in or the body is hanging on to it,
but this looks like you probably
have a normal-ish kind of urine here
but you're definitely not as
well hydrated as the first bladder.
Now let's look at the number three.
Okay it's getting even darker, you may call it like an amber
or a honey color and you were on your way to dehydration.
Now let's take a look at bladder number
four, we seriously have a problem with this.
If you see urine that looks like this with your
patient, this requires an immediate intervention,
you need to follow up and figure out what is going on.
Now on the slide, we have there for you the the
cause is severe dehydration, that's absolutely a possibility
but you can also have some really significant renal problem,
so write yourself a note that says "possible renal problems"
Now just to bring you up to speed, if you're severely
dehydrated, your blood pressure is usually pretty low
meaning your organs are not being perfused, so it may
just be severe dehydration is causing the kidney problem
but keep in mind, if you see urine like
that, in bladder number four, that is urgent.
You need to follow up right away and find
out: is it severe dehydration? is it kidney function?
or even that third cause that
we've listed there as excess bilirubin.
That's another reason why
your urine can have a funny color.
Now we're not finished.
One night when I was in clinical, evening clinical with our
students, one of them came running out of a patient's room
with a urine sample and their eyes were this big
because the urine was craziest red-orange kind of color.
Now here we say, that could indicate a
problem with your liver or bile duct and that is true
but also a pretty common medication called pyridium
can also do some super funky things to your urine.
So before you jump to conclusion, if you
get this really weird red-orange colored urine,
make sure you assess the medications the patient's on and make sure they're not on
I got a great giggle out of it
just seeing that student's face
but they will never forget to go back and
ask what type of medications our patient is on.