Urinary Disorders Q 142 - Gyan Darpan : Learning Portal
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Monday, 4 April 2022

Urinary Disorders Q 142

A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and post obstructive diuresis is occurring. Which of the following interventions should be done?
    A. Take vital signs every 8 hours.
    B. Weigh the client every other day.
    C. Assess for urine output every shift.
    D. Monitor the client’s electrolyte levels.

Correct Answer: D. Monitor the client’s electrolyte levels.

Post-obstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life.

Option A: VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. A complete examination should be performed, focusing on the abdomen and genitalia. The presence of a distended bladder should direct the clinician to the possibility of urinary retention. A digital rectal examination may reveal prostatic enlargement or fecal impaction. An assessment of strength, sensation, reflexes, and muscle tone can be informative. A thorough history and physical examination will often point towards the underlying etiology.
Option B: The client’s weight should be taken daily to assess fluid status more closely. Electrolyte abnormalities should be corrected, as indicated. If renal function is significantly worse from baseline, or there are significant electrolyte abnormalities, hospital admission and urgent nephrology consultation may be warranted. Urinalysis is likely to be performed to rule out infection, and antibiotics should be prescribed as indicated. Urine samples are often also sent for culture.
Option C: Urine output needs to be assessed hourly. The treatment of obstructive uropathy is based on promptly addressing the obstructive process. Bladder volume measurements can help to guide further therapies from this point. A Foley catheter is likely to be attempted, particularly if the obstruction is due to the most frequent etiology, benign prostatic hypertrophy, or hyperplasia.

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