NLE Renal & Urinary Nursing — Renal & Urinary Assessment & DiagnosticsConcept Map

Concept

Renal Structure & Function

Sub Concepts

• Nephron anatomy & filtration
• Excretion of metabolic waste (urea, creatinine)
• Fluid & electrolyte balance
• Blood pressure control via RAAS
• Erythropoietin production
• Vitamin D activation
• Normal urine output parameters (1–2 mL/kg/hr)

Relationship To Central

Foundation for understanding normal kidney physiology and pathophysiology

Concept

Nursing Assessment (History & Physical)

Sub Concepts

• Voiding pattern changes (frequency, urgency, dysuria, nocturia, retention)
• Urine appearance (color, odor, blood)
• Fluid intake & output
• Weight changes & edema
• Flank/suprapubic pain
• Drug history (nephrotoxic agents)
• Daily weight (1 kg ≈ 1 L fluid)
• Skin assessment (pallor, dryness, uremic frost)
• CVA tenderness examination
• Bladder palpation/percussion

Relationship To Central

Primary data collection method for renal/urinary evaluation

Concept

Laboratory Tests — Blood Studies

Sub Concepts

• BUN: 10–20 mg/dL (non-specific marker)
• Serum creatinine: 0.6–1.2 mg/dL (MOST specific/reliable)
• BUN:creatinine ratio interpretation
• Prerenal vs. intrinsic renal causes
• Serum electrolytes (K+, Na+, Ca2+, PO4)
• Hyperkalemia as critical complication
• Bicarbonate & pH (metabolic acidosis)
• Glomerular Filtration Rate (eGFR) stages 1–5

Relationship To Central

Essential objective data for renal function assessment

Concept

Glomerular Filtration Rate (GFR)

Sub Concepts

• Normal GFR: 90–120 mL/min/1.73 m²
• Stage 1: ≥90 (with kidney damage)
• Stage 2: 60–89
• Stage 3: 30–59
• Stage 4: 15–29
• Stage 5 (ESRD): <15 (dialysis required)
• Creatinine clearance from 24-hour urine collection
• Age/sex body size factors in eGFR calculation

Relationship To Central

Best overall measure of kidney function; defines CKD staging

Concept

Urinalysis

Sub Concepts

• Color (pale yellow to amber; cola/tea = hematuria)
• pH: 4.5–8.0
• Specific gravity: 1.005–1.030
• Proteinuria (glomerular damage indicator)
• Glucose/ketones presence
• Blood/RBCs (stones, infection, glomerulonephritis)
• WBCs/leukocyte esterase/nitrites (UTI)
• Casts (RBC, WBC, other types)
• Culture & sensitivity
• Specimen collection (clean-catch midstream, first morning)

Relationship To Central

Single most useful, low-cost renal diagnostic test

Concept

Diagnostic Procedures

Sub Concepts

• KUB (kidney–ureter–bladder) X-ray
• Renal ultrasound (no radiation, good for structure)
• CT imaging
• MRI imaging
• IVP/Urography (contrast-based visualization)
• Contrast allergy assessment (iodine, shellfish)
• Pre-contrast: renal function check, hydration, hold metformin
• Cystoscopy (direct bladder/urethra visualization)
• Post-cystoscopy monitoring (pink urine, dysuria, bleeding)
• Renal biopsy (definitive diagnosis)
• Post-biopsy: bed rest, bleeding precautions, vascular kidney concern

Relationship To Central

Advanced imaging & invasive tests for structural/functional evaluation

Concept

Urinary Catheterization

Sub Concepts

• Strict sterile/aseptic technique
• CAUTI (catheter-associated UTI) prevention
• Bag placement BELOW bladder level always
• Closed drainage system maintenance
• Secure tubing; avoid dependent loops
• Routine perineal/catheter care
• Adequate fluid intake
• Early catheter removal (duration = biggest CAUTI risk)
• Gradual bladder decompression after removal
• Never force catheter against resistance
• Recognition of difficulty (stricture, BPH)

Relationship To Central

Nursing procedure for relief of retention, accurate output measurement, incontinence management

Concept

Principles of Dialysis

Sub Concepts

• Diffusion: solutes move from high (blood) to low (dialysate) concentration
• Osmosis/ultrafiltration: excess water removal via pressure or osmotic gradient
• Dialysate: balanced electrolyte solution, warmed to body temperature
• Dialysate composition: NO urea/creatinine, low/no potassium
• Hemodialysis mechanism
• Peritoneal dialysis mechanism
• Dialysis does NOT replace hormonal kidney functions
• Post-dialysis support: EPO, active vitamin D, phosphate control

Relationship To Central

Substitution mechanism for kidney function when GFR <15

Concept

Common Nursing Diagnoses (NANDA-I)

Sub Concepts

• Fluid volume imbalance (excess or deficit)
• Electrolyte imbalance (especially hyperkalemia)
• Risk for infection (catheters, dialysis access, immunosuppression)
• Impaired skin integrity (edema, uremic pruritus, immobility)
• Knowledge deficit (diet, fluid limits, medication, access care)
• Maslow-based prioritization hierarchy
• Life-threatening vs. physiological vs. psychosocial

Relationship To Central

Framework for nursing care planning in renal patients

Concept

Renal Diet Principles

Sub Concepts

• Sodium restriction (control fluid retention & BP)
• Potassium restriction as GFR falls
• Phosphate restriction & binder use with meals
• Protein control (restrict before dialysis, increase after)
• Individualized fluid restriction
• Patient education on food selection
• Cultural dietary pattern assessment

Relationship To Central

Nutritional intervention supporting kidney function preservation

Concept

Special Populations & Considerations

Sub Concepts

• Older adults: age-related GFR decline
• Reduced renal concentrating ability in elderly
• Easy dehydration in older adults
• Medication renal dosing in older adults
• Herbal/traditional remedy nephrotoxicity
• Dietary pattern assessment (sodium, potassium, protein)
• Cultural health beliefs & practices
• RA 9173 (Philippine Nursing Practice Law) standards

Relationship To Central

Age & cultural adaptations for renal nursing care

To

Nursing Assessment

From

Renal Structure & Function

Strength

strong

Relationship

Understanding normal kidney physiology guides what to assess and what findings indicate dysfunction

To

Laboratory Tests — Blood Studies

From

Nursing Assessment

Strength

strong

Relationship

Clinical assessment findings direct which laboratory tests are most appropriate to order

To

Glomerular Filtration Rate (GFR)

From

Laboratory Tests — Blood Studies

Strength

strong

Relationship

GFR is calculated from serum creatinine and is the best overall measure of kidney function

To

Urinalysis

From

Glomerular Filtration Rate (GFR)

Strength

strong

Relationship

GFR staging combined with urinalysis findings helps differentiate types of kidney disease

To

Diagnostic Procedures

From

Urinalysis

Strength

moderate

Relationship

Abnormal urinalysis findings (hematuria, proteinuria, casts) may warrant advanced imaging or biopsy

To

Common Nursing Diagnoses (NANDA-I)

From

Diagnostic Procedures

Strength

strong

Relationship

Diagnostic findings confirm the underlying condition, guiding appropriate nursing diagnoses and interventions

To

Common Nursing Diagnoses (NANDA-I)

From

Urinary Catheterization

Strength

moderate

Relationship

Catheterization may be indicated based on nursing diagnoses like Urinary Retention or Impaired Urinary Elimination

To

Glomerular Filtration Rate (GFR)

From

Principles of Dialysis

Strength

strong

Relationship

Dialysis is initiated when GFR falls to Stage 5 (ESRD, <15 mL/min) and kidney function cannot be maintained

To

Renal Diet Principles

From

Common Nursing Diagnoses (NANDA-I)

Strength

moderate

Relationship

Nursing diagnoses like Fluid Volume Imbalance and Knowledge Deficit are managed partly through dietary intervention

To

Special Populations & Considerations

From

Renal Diet Principles

Strength

moderate

Relationship

Diet recommendations must be adapted for older adults and cultural dietary preferences

To

Nursing Assessment

From

Special Populations & Considerations

Strength

strong

Relationship

Age, medication metabolism, and cultural factors influence how the assessment is conducted and interpreted

To

Common Nursing Diagnoses (NANDA-I)

From

Laboratory Tests — Blood Studies

Strength

strong

Relationship

Abnormal electrolytes (e.g., hyperkalemia) directly inform nursing diagnoses like Electrolyte Imbalance

To

Urinalysis

From

Urinary Catheterization

Strength

moderate

Relationship

Urinalysis from catheterized specimens provides diagnostic data; proper catheter care is essential for accurate results

To

Urinalysis

From

Nursing Assessment

Strength

moderate

Relationship

Physical assessment findings (dysuria, hematuria, odor) guide urinalysis interpretation and culture ordering

To

Special Populations & Considerations

From

Diagnostic Procedures

Strength

moderate

Relationship

Older adults and those with pre-existing renal disease require modified protocols (e.g., contrast precautions, hydration)

To

Common Nursing Diagnoses (NANDA-I)

From

Principles of Dialysis

Strength

strong

Relationship

Dialysis patients require ongoing nursing diagnoses related to fluid balance, infection risk, and knowledge deficit about access care