WEBVTT 00:00:06.059 --> 00:00:09.800 Welcome to the bed. We'll go ahead and give you 00:00:09.800 --> 00:00:12.580 the story. This is all going to happen super 00:00:12.580 --> 00:00:47.489 fast. Welcome to the emergency room. Welcome 00:00:47.489 --> 00:00:49.770 to the deep dive. So if you're getting ready 00:00:49.770 --> 00:00:52.509 for a big medsurg exam, you are probably looking 00:00:52.509 --> 00:00:55.490 at a literal mountain of notes, right? Textbooks, 00:00:55.670 --> 00:00:57.950 articles. and you're feeling that pressure to 00:00:57.950 --> 00:01:00.829 just memorize all of it, we get it. We really 00:01:00.829 --> 00:01:03.810 do. So, okay, let's unpack this. Our whole mission 00:01:03.810 --> 00:01:05.969 today is to apply that Pareto principle, you 00:01:05.969 --> 00:01:09.069 know, the 80 -20 rule, to renal and urologic 00:01:09.069 --> 00:01:11.870 problems. We're going to find that core 20 % 00:01:11.870 --> 00:01:14.629 of concepts that will give you like 80 % of what 00:01:14.629 --> 00:01:16.469 you need for your exams and for your confidence 00:01:16.469 --> 00:01:18.269 on the floor. And we're going to be focusing 00:01:18.269 --> 00:01:20.510 strictly on nursing implications, what you need 00:01:20.510 --> 00:01:23.319 to assess, how to intervene. all of it. And that's 00:01:23.319 --> 00:01:25.400 such a critical approach for these systems. What's 00:01:25.400 --> 00:01:27.680 fascinating here is that the kidneys, they regulate 00:01:27.680 --> 00:01:30.140 almost everything. We're talking fluid, electrolytes, 00:01:30.280 --> 00:01:32.819 acid -base balance. It means that a small sort 00:01:32.819 --> 00:01:34.659 of minor seeming change in a patient's urine 00:01:34.659 --> 00:01:37.280 output or their vitals can be the first and sometimes 00:01:37.280 --> 00:01:39.700 the only warning sign of a huge crisis. So we're 00:01:39.700 --> 00:01:41.480 really going to isolate those three big nursing 00:01:41.480 --> 00:01:44.260 concerns. Infection and sepsis, immunological 00:01:44.260 --> 00:01:46.620 fluid imbalances, and of course the crisis of 00:01:46.620 --> 00:01:48.099 pain and obstruction. All right, let's start 00:01:48.099 --> 00:01:49.879 with the most common one, the one everyone sees. 00:01:50.299 --> 00:01:54.140 the urinary tract infection. For any learner, 00:01:54.420 --> 00:01:56.340 I think the absolute core distinction you have 00:01:56.340 --> 00:01:59.319 to master is the difference between a simple 00:01:59.319 --> 00:02:04.489 lower UTI cystitis, and that severe upper tract 00:02:04.489 --> 00:02:08.110 infection, acute pylonephritis. It's a huge distinction. 00:02:08.469 --> 00:02:11.370 I mean, pathologically, cystitis is pretty much 00:02:11.370 --> 00:02:13.150 confined to the bladder lining. It's just local 00:02:13.150 --> 00:02:15.469 inflammation. Pylonephritis, though, that's a 00:02:15.469 --> 00:02:18.289 whole different ballgame. Now you have inflammation 00:02:18.289 --> 00:02:20.349 of the actual kidney tissue, the parenchyma, 00:02:20.449 --> 00:02:23.199 the... pelvis. The infection has literally climbed 00:02:23.199 --> 00:02:25.259 up into the kidney. And when the kidney itself 00:02:25.259 --> 00:02:27.620 is involved, what's the looming danger? What 00:02:27.620 --> 00:02:29.819 are we really worried about? The immediate danger 00:02:29.819 --> 00:02:32.620 is systemic invasion. Pylonephritis puts a patient 00:02:32.620 --> 00:02:34.960 at a very, very high risk for urus sepsis. A 00:02:34.960 --> 00:02:37.699 systemic infection. Exactly. It can lead to septic 00:02:37.699 --> 00:02:40.219 shock, multi -organ failure, and it can happen 00:02:40.219 --> 00:02:43.080 fast. Being able to spot that transition from 00:02:43.080 --> 00:02:46.099 a bladder ache to a full -blown systemic emergency 00:02:46.099 --> 00:02:47.860 is probably one of the most important skills. 00:02:48.199 --> 00:02:50.139 And your source material is very clear on this. 00:02:50.319 --> 00:02:53.080 The main culprit is usually E. coli. We're talking, 00:02:53.139 --> 00:02:56.939 what, up to 75 % of cases? That's right, especially 00:02:56.939 --> 00:02:59.280 in patients who don't have other structural problems. 00:02:59.740 --> 00:03:02.659 It's really just a GI bacteria migration issue, 00:03:03.020 --> 00:03:05.159 which, as you said, points directly to a key 00:03:05.159 --> 00:03:07.379 piece of education we have to give later. Okay, 00:03:07.379 --> 00:03:09.400 so let's talk about how we fight it. What are 00:03:09.400 --> 00:03:12.840 the go -to medications? Well, for a simple, uncomplicated 00:03:12.840 --> 00:03:15.939 UTI, we start with first -line empirical therapies. 00:03:16.360 --> 00:03:19.500 Things like trimethoprim sulfamethoxazole or 00:03:19.500 --> 00:03:22.699 TMP SMX and nitrofuranthine are really common. 00:03:23.099 --> 00:03:26.000 But once we're talking about acute, severe pylonephritis, 00:03:26.319 --> 00:03:28.919 the stakes are way higher. That patient is often 00:03:28.919 --> 00:03:31.259 in the hospital on broad -spectrum IV antibiotics. 00:03:31.300 --> 00:03:33.689 So much more aggressive. Much more. We're talking 00:03:33.689 --> 00:03:36.270 about fluoroquinolones like ciprofloxacin or 00:03:36.270 --> 00:03:38.830 maybe extended spectrum cephalosporins. You have 00:03:38.830 --> 00:03:41.389 to hit it hard and fast with IV meds to stop 00:03:41.389 --> 00:03:43.930 that systemic spread in its tracks. Now, this 00:03:43.930 --> 00:03:46.110 is where we get into those critical high -yield 00:03:46.110 --> 00:03:48.810 nursing details. Let's talk about nitrofrantamine. 00:03:49.310 --> 00:03:51.930 What is the one non -negotiable assessment you 00:03:51.930 --> 00:03:54.509 have to make for a patient on that drug? You 00:03:54.509 --> 00:03:56.509 absolutely have to know their kidney function. 00:03:57.139 --> 00:03:59.539 Specifically, you have to monitor their creatinine 00:03:59.539 --> 00:04:02.620 clearance. Nitroferantoin is contraindicated 00:04:02.620 --> 00:04:06.419 if that CRCL drops below 30 milliliters per minute. 00:04:06.620 --> 00:04:09.060 And why is that? Because if their kidney function 00:04:09.060 --> 00:04:12.120 is too low, they can't clear the drug effectively, 00:04:12.439 --> 00:04:15.060 it builds up, and the risk for toxicity just 00:04:15.060 --> 00:04:18.199 skyrockets. That threshold, less than 30, that 00:04:18.199 --> 00:04:21.839 is... pure high yield testable knowledge. And 00:04:21.839 --> 00:04:24.660 what about that other drug, finazopyridine or 00:04:24.660 --> 00:04:26.720 pyridium, the one for symptom relief? What's 00:04:26.720 --> 00:04:29.180 the key teaching point there that's going to 00:04:29.180 --> 00:04:31.420 prevent a panic phone call? Oh, absolutely. You 00:04:31.420 --> 00:04:33.800 have to tell them it's a dye. It's a local anesthetic, 00:04:34.040 --> 00:04:36.160 not an antibiotic, and it will turn their urine 00:04:36.160 --> 00:04:38.579 a very, very bright orange or red. So they don't 00:04:38.579 --> 00:04:40.519 think they're bleeding. Exactly. If you don't 00:04:40.519 --> 00:04:42.379 warn them, they will think something terrible 00:04:42.379 --> 00:04:44.060 is happening. Yeah. You just need to be clear. 00:04:44.439 --> 00:04:46.939 It's only for the pain, the dysuria, and the 00:04:46.939 --> 00:04:49.519 color change is normal and expected. So when 00:04:49.519 --> 00:04:51.500 we're managing pylonephritis in the hospital, 00:04:51.620 --> 00:04:54.060 it's a real team effort. The medical team is 00:04:54.060 --> 00:04:56.339 ordering IV fluids, especially if the patient 00:04:56.339 --> 00:04:59.180 is nauseous and managing the pain. Right. And 00:04:59.180 --> 00:05:01.339 they'll often use a combination of NSAIDs like 00:05:01.339 --> 00:05:04.759 Ketrolac and opioids. But the nurse is the one 00:05:04.759 --> 00:05:06.540 at the center of it all. We're the ones making 00:05:06.540 --> 00:05:08.939 sure those IV antibiotics are given right on 00:05:08.939 --> 00:05:11.540 time, every time. We're monitoring their response, 00:05:11.720 --> 00:05:13.420 watching the vital signs. And really looking 00:05:13.420 --> 00:05:15.399 for those subtle signs that the patient is getting 00:05:15.399 --> 00:05:17.680 worse, that they might be tipping over into shock. 00:05:17.870 --> 00:05:19.889 Okay, so let's put ourselves in the room. You 00:05:19.889 --> 00:05:22.730 walk in, you suspect pilonephritis. What are 00:05:22.730 --> 00:05:25.550 the clinical signs that scream life -threatening 00:05:25.550 --> 00:05:28.709 priority to you? It's a classic triad. Fever, 00:05:28.970 --> 00:05:32.029 chills, and that very specific flank pain called 00:05:32.029 --> 00:05:35.430 CVA tenderness, costo -vertebral angle tenderness. 00:05:35.550 --> 00:05:38.629 And if you see that with, what, a high heart 00:05:38.629 --> 00:05:40.930 rate? A high heart rate, tachycardia, and a dropping 00:05:40.930 --> 00:05:43.009 blood pressure, hypotension. If you see that 00:05:43.009 --> 00:05:46.120 combination, you just... You assume your osepsis 00:05:46.120 --> 00:05:48.060 until it's proven otherwise. That's an emergency. 00:05:48.220 --> 00:05:50.600 And that's so different from the lower UTI symptoms, 00:05:50.680 --> 00:05:52.439 which are all about elimination, right? Yeah. 00:05:52.519 --> 00:05:56.079 Frequency, urgency, pain with urination. Exactly. 00:05:56.680 --> 00:05:59.959 Much more localized. OK, so for nursing management 00:05:59.959 --> 00:06:02.379 of that pilo patient with the fever and pain. 00:06:02.980 --> 00:06:06.199 What are go -to interventions besides the meds? 00:06:06.519 --> 00:06:08.699 Well, continuous monitoring of vitals is a given. 00:06:08.800 --> 00:06:11.360 You're watching for any sign of shock. And for 00:06:11.360 --> 00:06:13.699 comfort, something as simple as a heating pad 00:06:13.699 --> 00:06:16.680 on their flank or their suprapubic area can make 00:06:16.680 --> 00:06:19.160 a huge difference with the muscle spasms. And 00:06:19.160 --> 00:06:21.300 fluids, fluids, fluids. We are pushing fluid 00:06:21.300 --> 00:06:23.680 intake, right? We need at least eight glasses 00:06:23.680 --> 00:06:26.459 a day minimum to help flush everything out. And 00:06:26.459 --> 00:06:29.060 then to prevent it from happening again, we shift 00:06:29.060 --> 00:06:31.990 into education mode. Totally. You assess their 00:06:31.990 --> 00:06:33.930 habits, their risk factors, and then you teach. 00:06:34.350 --> 00:06:37.009 You're emphasizing avoiding irritants, like bubble 00:06:37.009 --> 00:06:39.550 baths or certain soaps, and most importantly, 00:06:39.730 --> 00:06:42.110 you teach proper perineal care. You have to explain 00:06:42.110 --> 00:06:44.129 that E. coli comes from the GI tract. You have 00:06:44.129 --> 00:06:46.850 to be direct. Wipe from front to back. It sounds 00:06:46.850 --> 00:06:49.470 simple, but it is the single most effective way 00:06:49.470 --> 00:06:52.060 to prevent recurrence. Okay. Quick review on 00:06:52.060 --> 00:06:55.740 infection. Pyelonephritis means fever, CVA tenderness, 00:06:56.199 --> 00:06:59.800 and a huge success risk. Priority is IV antibiotics 00:06:59.800 --> 00:07:03.000 and fluids now. For lower UTIs, relief should 00:07:03.000 --> 00:07:05.220 start in a day or two. And that key teaching 00:07:05.220 --> 00:07:09.860 point, front -to -back hygiene. All right. Here's 00:07:09.860 --> 00:07:11.730 where it gets really interesting. We're shifting 00:07:11.730 --> 00:07:14.350 gears now from a bacterial invasion to an immune 00:07:14.350 --> 00:07:16.730 system reaction that is literally attacking the 00:07:16.730 --> 00:07:19.850 kidneys' filters. We're diving into glomerulonephritis, 00:07:20.189 --> 00:07:23.370 specifically APSN, and its more severe cousin, 00:07:23.410 --> 00:07:26.269 Aphrodite syndrome. APSN is a classic type 3 00:07:26.269 --> 00:07:28.870 hypersensitivity reaction. Hello. And the key 00:07:28.870 --> 00:07:30.810 history point is that it almost always follows 00:07:30.810 --> 00:07:33.410 a streptococcal infection. Strep throat or skin 00:07:33.410 --> 00:07:35.629 infection. Exactly. About one to two weeks before 00:07:35.629 --> 00:07:37.709 the kidney symptoms start. What happens is the 00:07:37.709 --> 00:07:39.930 body creates these immune complexes, antigen 00:07:39.930 --> 00:07:42.509 and antibody. and they get stuck. They deposit 00:07:42.509 --> 00:07:44.529 in the glomeruli. And why is that deposit such 00:07:44.529 --> 00:07:46.649 a problem? It triggers a massive inflammatory 00:07:46.649 --> 00:07:48.930 response. The filtering membranes swell up, they 00:07:48.930 --> 00:07:51.629 get damaged, and that causes the glomerular filtration 00:07:51.629 --> 00:07:54.370 rate, the GFR, to just plummet. It's like clogging 00:07:54.370 --> 00:07:56.470 the main filter for the whole body. It's a perfect 00:07:56.470 --> 00:07:59.209 analogy. The kidneys can't filter, they can't 00:07:59.209 --> 00:08:01.430 excrete, so the body just holds onto all this 00:08:01.430 --> 00:08:04.029 fluid and waste. So clinically, what does that 00:08:04.029 --> 00:08:06.209 clogging look like? Yeah. What are the priority 00:08:06.209 --> 00:08:08.269 signs we need to assess for? Priority number 00:08:08.269 --> 00:08:11.870 one, is all about that fluid retention. You can 00:08:11.870 --> 00:08:14.910 see generalized edema, and it classically starts 00:08:14.910 --> 00:08:17.470 around the eyes. Periorbital edema. Why there 00:08:17.470 --> 00:08:19.569 first? Just because the tissue is so loose, it 00:08:19.569 --> 00:08:22.730 lets fluid accumulate really easily, and right 00:08:22.730 --> 00:08:26.110 behind the edema is severe hypertension because 00:08:26.110 --> 00:08:28.290 of all that extra fluid volume. And the urine 00:08:28.290 --> 00:08:31.300 itself... It changes completely, doesn't it? 00:08:31.319 --> 00:08:33.580 Oh, absolutely. That's priority number two. You'll 00:08:33.580 --> 00:08:36.600 see hematuria, which gives the urine a very distinct 00:08:36.600 --> 00:08:39.639 smoky, rusty kind of tea colored look. You'll 00:08:39.639 --> 00:08:42.340 also see protein in the urine and very often 00:08:42.340 --> 00:08:44.960 oliguria, which is a major drop in urine output. 00:08:45.320 --> 00:08:47.539 So since this is an immune process that sort 00:08:47.539 --> 00:08:50.470 of has to run its course. The treatment for APSN 00:08:50.470 --> 00:08:52.590 isn't really about fixing the kidney directly. 00:08:52.629 --> 00:08:54.590 It's more supportive. That's a great way to put 00:08:54.590 --> 00:08:56.929 it. It is largely supportive. We're using things 00:08:56.929 --> 00:08:59.830 like ACE inhibitors and diuretics to manage the 00:08:59.830 --> 00:09:03.049 hypertension and the fluid overload. And even 00:09:03.049 --> 00:09:05.769 if we give antibiotics like penicillin, that's 00:09:05.769 --> 00:09:08.149 only to treat any leftover strep bacteria. So 00:09:08.149 --> 00:09:10.629 the antibiotics aren't for the kidney inflammation 00:09:10.629 --> 00:09:13.669 itself. Correct. They do nothing for the glomerulonephritis. 00:09:13.830 --> 00:09:16.389 They just prevent the strep from spreading. The 00:09:16.389 --> 00:09:18.210 inflammation in the kidney just has to resolve 00:09:18.210 --> 00:09:20.669 on its own. Which means nursing's role in the 00:09:20.669 --> 00:09:23.070 non -drug management is huge. It's everything. 00:09:23.350 --> 00:09:26.149 We're managing strict fluid and sodium restrictions, 00:09:27.009 --> 00:09:29.509 and rest is absolutely critical during that acute 00:09:29.509 --> 00:09:32.370 phase to give the kidneys a chance to heal. Okay, 00:09:32.389 --> 00:09:34.230 let's connect this to nephrotic syndrome, which 00:09:34.230 --> 00:09:36.629 is even more severe. What's the core issue there? 00:09:36.809 --> 00:09:39.940 It's all about massive protein loss. The glomerular 00:09:39.940 --> 00:09:42.840 filters become hyperpermeable, just incredibly 00:09:42.840 --> 00:09:44.679 leaky. And the signs are pretty dramatic, right? 00:09:44.720 --> 00:09:47.340 They are unmistakable. You see massive proteinuria, 00:09:47.519 --> 00:09:50.259 which leads to hypoalbuminemia, low protein in 00:09:50.259 --> 00:09:53.299 the blood. That causes this profound generalized 00:09:53.299 --> 00:09:56.450 edema called Anisarca. the whole body is swollen. 00:09:56.610 --> 00:09:59.389 And there are other risks too. Yes, two very 00:09:59.389 --> 00:10:01.830 dangerous ones. The liver trying to compensate 00:10:01.830 --> 00:10:03.929 for the protein loss and goes into overdrive 00:10:03.929 --> 00:10:06.570 making livids. So you get hyperlipidemia and 00:10:06.570 --> 00:10:08.769 you also get hypercoagulability, which puts the 00:10:08.769 --> 00:10:12.029 patient at a huge risk for blood clots like DVTs 00:10:12.029 --> 00:10:15.570 and PEs. That's severe edema that Anisarca has 00:10:15.570 --> 00:10:18.529 got to be a major nursing challenge. What do 00:10:18.529 --> 00:10:21.029 we need to focus on? Skincare is non -negotiable. 00:10:21.159 --> 00:10:24.340 That swollen edematous tissue is incredibly fragile 00:10:24.340 --> 00:10:27.279 and prone to breakdown and infection. So we're 00:10:27.279 --> 00:10:30.360 doing meticulous skin assessments, frequent turning, 00:10:30.740 --> 00:10:33.600 daily weights, strict I's and O's. And with nephrotic 00:10:33.600 --> 00:10:35.919 syndrome, we're often using corticosteroids like 00:10:35.919 --> 00:10:37.940 prednisone. Right, which means now we have another 00:10:37.940 --> 00:10:41.259 priority, monitoring for infection. The patient 00:10:41.259 --> 00:10:43.419 is immunosuppressed from the steroids, so we 00:10:43.419 --> 00:10:45.639 have to be incredibly vigilant. And the diet 00:10:45.639 --> 00:10:48.600 for nephrotic syndrome is tricky. Very tricky. 00:10:49.000 --> 00:10:51.000 On one hand, you want to give them adequate protein 00:10:51.000 --> 00:10:53.340 to replace what they're losing. But on the other 00:10:53.340 --> 00:10:55.759 hand, if they start to show signs of uremia waste 00:10:55.759 --> 00:10:58.240 buildup, you might actually have to reduce their 00:10:58.240 --> 00:11:00.700 protein intake. It requires constant assessment 00:11:00.700 --> 00:11:03.179 and collaboration with the dietician. OK. Quick 00:11:03.179 --> 00:11:06.700 review on immunologic crisis. APSN follows strep. 00:11:06.879 --> 00:11:09.700 Look for edema, hypertension, and rusty urine. 00:11:10.519 --> 00:11:12.779 The main intervention is managing fluids and 00:11:12.779 --> 00:11:15.149 blood pressure. Nephrotic syndrome is all about 00:11:15.149 --> 00:11:18.049 massive proteinuria and severe edema. Your key 00:11:18.049 --> 00:11:20.529 nursing risks are skin breakdown and infection. 00:11:21.029 --> 00:11:22.769 You know, if we connect this to the bigger picture, 00:11:23.250 --> 00:11:25.789 urinary stones or calculi are just a perfect 00:11:25.789 --> 00:11:28.690 example of how metabolism, diet, and hydration 00:11:28.690 --> 00:11:31.570 directly impact kidney health. And for the learner, 00:11:32.289 --> 00:11:34.250 understanding stone management is so important 00:11:34.250 --> 00:11:37.139 because that pain... Renal colic is one of the 00:11:37.139 --> 00:11:39.440 most severe types of pain a person can experience. 00:11:39.620 --> 00:11:41.600 And it all starts with super saturation, right? 00:11:41.899 --> 00:11:44.120 Too much mineral, like calcium or uric acid in 00:11:44.120 --> 00:11:45.879 the urine. Exactly. Either too much mineral, 00:11:45.960 --> 00:11:48.480 not enough inhibitors, or most commonly just 00:11:48.480 --> 00:11:50.820 not enough urine volume, it allows crystals to 00:11:50.820 --> 00:11:52.759 form. And there's a key detail in the source 00:11:52.759 --> 00:11:55.179 material about struvite stones. What's the red 00:11:55.179 --> 00:11:57.639 flag there? Struvite stones are a huge red flag 00:11:57.639 --> 00:12:00.039 for infection. They're almost always associated 00:12:00.039 --> 00:12:02.820 with UTIs from specific urea -splitting bacteria 00:12:02.820 --> 00:12:05.600 like Proteus. The stone itself becomes a reservoir 00:12:05.600 --> 00:12:08.259 for the bacteria. But the real immediate danger 00:12:08.259 --> 00:12:11.340 isn't the stone itself, it's the blockage. Precisely. 00:12:11.639 --> 00:12:14.179 The obstruction blocks urine flow, which causes 00:12:14.179 --> 00:12:16.340 the kidney to swell up, that's hydronephrosis, 00:12:16.620 --> 00:12:18.980 and it massively increases the risk of infection 00:12:18.980 --> 00:12:21.299 and uracepsis behind that blockage. Let's talk 00:12:21.299 --> 00:12:24.039 about that pain. What makes renal colic such 00:12:24.039 --> 00:12:26.480 a priority? It's the severity and how it moves. 00:12:26.779 --> 00:12:29.240 The pain is sudden and excruciating, usually 00:12:29.240 --> 00:12:32.179 on the flank or back. But as the stone travels 00:12:32.179 --> 00:12:35.179 down the ureter, the pain radiates to the groin, 00:12:35.440 --> 00:12:38.080 the testes, the labia. It's a pain that makes 00:12:38.080 --> 00:12:40.799 people rive. They can't find a comfortable position. 00:12:41.100 --> 00:12:43.120 So in assessing a patient with a stone, what's 00:12:43.120 --> 00:12:45.960 one thing you absolutely cannot miss? A fever. 00:12:46.340 --> 00:12:48.500 If a patient with a known stone has flank pain 00:12:48.500 --> 00:12:51.220 plus a fever, that is not just a painful stone 00:12:51.220 --> 00:12:53.919 anymore. That is a urologic emergency. It means 00:12:53.919 --> 00:12:55.919 there's an infected obstruction. And you have 00:12:55.919 --> 00:12:57.879 to assume it's urocepsis until proven otherwise. 00:12:58.139 --> 00:13:00.000 So for the acute episode, the first thing we 00:13:00.000 --> 00:13:02.159 have to do is break that pain cycle. Absolutely. 00:13:02.320 --> 00:13:05.139 We use strong pain relief, opioid analgesics, 00:13:05.159 --> 00:13:07.899 and NSAIDs, especially IV Ketrolac or Toradol, 00:13:07.960 --> 00:13:09.960 which is fantastic for the inflammation and spasm. 00:13:10.179 --> 00:13:12.980 And then to actually help the stone pass, what 00:13:12.980 --> 00:13:16.240 medication do we use? We often use alpha adrenergic 00:13:16.240 --> 00:13:18.440 blockers. And the most common one is Tamsulosin. 00:13:18.570 --> 00:13:21.190 The teaching point is that it relaxes the smooth 00:13:21.190 --> 00:13:23.649 muscle in the ureter, which basically widens 00:13:23.649 --> 00:13:25.529 the pipe and makes it easier for the stone to 00:13:25.529 --> 00:13:27.669 pass. And for preventing future stones, the management 00:13:27.669 --> 00:13:29.889 gets very specific to the type of stone they 00:13:29.889 --> 00:13:31.950 have. Yes, and this is where the dietitian is 00:13:31.950 --> 00:13:35.690 key. A patient with uric acid stones might get 00:13:35.690 --> 00:13:38.250 allopurinol, but for the more common calcium 00:13:38.250 --> 00:13:41.769 oxalate stones, it's about dietary changes, reducing 00:13:41.769 --> 00:13:44.710 sodium and animal protein, and maybe taking a 00:13:44.710 --> 00:13:47.370 thiazide diuretic. Let's drill down on the nursing 00:13:47.370 --> 00:13:50.730 implications. We're assessing pain, monitoring 00:13:50.730 --> 00:13:53.970 INO, but what is arguably the single most critical 00:13:53.970 --> 00:13:56.210 testable nursing intervention for any patient 00:13:56.210 --> 00:13:59.389 with a kidney stone? You must, must strain all 00:13:59.389 --> 00:14:02.629 urine, every single drop. You have to retrieve 00:14:02.629 --> 00:14:05.490 that stone so it can be sent to the lab for analysis. 00:14:05.730 --> 00:14:07.450 Because without that analysis... Without the 00:14:07.450 --> 00:14:09.330 analysis, you don't know what it's made of and 00:14:09.330 --> 00:14:11.389 you can't create an effective long -term prevention 00:14:11.389 --> 00:14:13.850 plan. It's that simple. Straining the urine is 00:14:13.850 --> 00:14:16.409 not optional. And on the intervention side, we're 00:14:16.409 --> 00:14:18.730 pushing fluids like crazy. As long as there's 00:14:18.730 --> 00:14:20.809 no contraindication like heart failure, yes. 00:14:21.389 --> 00:14:23.570 We are aiming for a urine output of at least 00:14:23.570 --> 00:14:26.169 two and a half liters per day. That sheer volume 00:14:26.169 --> 00:14:28.669 is the number one way to prevent new stones from 00:14:28.669 --> 00:14:31.429 forming. The patient's urine should be clear. 00:14:31.830 --> 00:14:33.990 All right, quick review for stones. Priority 00:14:33.990 --> 00:14:36.470 one is aggressive pain management and you must 00:14:36.470 --> 00:14:39.659 strain all urine. Tamsulosan helps stones pass. 00:14:40.059 --> 00:14:42.519 Hydration is the absolute key for prevention. 00:14:42.919 --> 00:14:45.679 And remember, flank pain plus a fever in a stone 00:14:45.679 --> 00:14:48.379 patient equals a potential sepsis emergency. 00:14:48.940 --> 00:14:51.399 This high -yield deep dive really boils it all 00:14:51.399 --> 00:14:54.220 down to three critical areas, doesn't it? Managing 00:14:54.220 --> 00:14:56.960 that risk of infection and sepsis, stabilizing 00:14:56.960 --> 00:14:59.340 fluid balance in those immunologic crises, and 00:14:59.340 --> 00:15:01.100 aggressive management of pain and obstruction. 00:15:01.320 --> 00:15:03.299 Absolutely. And we've seen that all three really 00:15:03.299 --> 00:15:05.419 demand this constant vigilance over elimination. 00:15:05.860 --> 00:15:08.919 From the sepsis risk in... to the massive fluid 00:15:08.919 --> 00:15:11.059 shifts in skin breakdown risk and nephrotic syndrome, 00:15:11.460 --> 00:15:13.320 to the obstructive emergency of a kidney stone. 00:15:13.639 --> 00:15:15.860 It all comes back to monitoring intake and output 00:15:15.860 --> 00:15:18.419 and recognizing those tiny signs of decreased 00:15:18.419 --> 00:15:21.259 kidney perfusion. Right. Your ultimate priority 00:15:21.259 --> 00:15:24.080 is making sure that pathway is open and clean. 00:15:24.600 --> 00:15:26.700 Because if a patient isn't eliminating waste 00:15:26.700 --> 00:15:29.419 and fluid properly, every other system in the 00:15:29.419 --> 00:15:31.860 body is at risk. Which this raises an important 00:15:31.860 --> 00:15:33.639 question for you, the learner, to really think 00:15:33.639 --> 00:15:35.779 about. We've talked a lot about the big guns, 00:15:35.960 --> 00:15:37.740 you know, the pharmacological interventions, 00:15:37.980 --> 00:15:40.860 antibiotics, potent diuretics, strong pain meds. 00:15:40.879 --> 00:15:42.740 But think about the critical role of behavioral 00:15:42.740 --> 00:15:45.639 management in urology. Things like strict fluid 00:15:45.639 --> 00:15:48.539 schedules for stone prevention or timed voiding. 00:15:48.620 --> 00:15:51.679 incontinence. How do these non -drug interventions 00:15:51.679 --> 00:15:54.700 require even more intensive, more individualized 00:15:54.700 --> 00:15:57.519 teaching from the nurse than just giving a pill? 00:15:57.919 --> 00:16:00.379 Your ability to ensure a patient actually sticks 00:16:00.379 --> 00:16:02.779 with these changes long -term. That's off the 00:16:02.779 --> 00:16:04.399 difference between managing a chronic condition 00:16:04.399 --> 00:16:06.240 and preventing a life -threatening crisis. That's 00:16:06.240 --> 00:16:08.440 the real art of renal nursing, something to mull 00:16:08.440 --> 00:16:08.700 over.