Question

You note that your client with chronic renal failure has a urine specific gravity (SG) of 1.035. You explain to the client that: a. this specific gravity is normal. b. this specific gravity indicates very concentrated urine and you recommend increased fluid intake. c. this specific gravity is high and indicates the presence of a urinary tract infection. d. this specific gravity indicates dilute urine due to the kidneys' lack of ability to concentrate urine.

Short answer

The correct answer is b. This specific gravity indicates very concentrated urine and it is recommended that the client increases fluid intake.

Step-by-step solution

Understand Specific Gravity

Specific gravity measures the concentration of the urine compared to water. A normal range is typically between 1.002 and 1.030.

Interpret the Specific Gravity Value

A specific gravity of 1.035 is higher than the normal range, indicating very concentrated urine.

Determine the Implication for the Client

Highly concentrated urine in a client with chronic renal failure may suggest inadequate fluid intake or potentially other underlying issues. Increased hydration is often recommended to reduce the risk of further kidney damage.

Choose the Correct Explanation

Since the specific gravity is high and denotes concentrated urine, the best advice would be to recommend increased fluid intake unless there's a medical restriction.

Key concepts

Urine Specific Gravity

Urine specific gravity (SG) is a valuable measurement used to assess the kidneys' ability to concentrate urine. It compares the density of urine to that of water, serving as an indicator of hydration status and kidney function. Normally, SG ranges from 1.002 to 1.030, implying that the kidneys can adjust urine concentration according to the body’s hydration needs.

When you encounter a specific gravity like 1.035, this is higher than usual, indicating very concentrated urine. It suggests that the body might be under-hydrated or that the kidneys are working extra hard to conserve water, potentially due to an underlying condition like chronic renal failure. For students and healthcare providers, understanding the implications of aberrant SG readings is essential for appropriate patient assessment and care.

Chronic Renal Failure Management

Chronic Renal Failure (CRF), also known as Chronic Kidney Disease (CKD), requires diligent management to slow progression and minimize complications. The primary goals in dealing with CRF include maintaining fluid balance, monitoring blood pressure, correcting electrolyte imbalances, and ensuring proper nutritional intake.

In managing hydration, someone with SG readings like 1.035 might need increased fluid intake to prevent further kidney strain. However, fluid management must be tailored individually since some patients may require fluid restrictions due to other complications like heart failure. Close monitoring of electrolytes, such as potassium and phosphate, is also crucial. Diet modifications often involve protein restriction and careful monitoring of calorie intake to avoid malnutrition. CRF management is a delicate balance and requires a comprehensive approach by the healthcare team.

Nursing Assessment and Interpretation

Nursing assessment and interpretation are critical components in the management of patients with health conditions such as chronic renal failure. Effective nursing assessment includes gathering a complete health history, understanding lab values—like urine specific gravity—and recognizing changes in the patient’s condition.

Interpreting urine SG is part of the required nursing competencies to make informed decisions about patient care. High SG may necessitate a nursing response such as advocating for increased fluid intake or assessing for other symptoms indicating a complication. Nurses must interpret SG in the context of the patient’s overall health status, not in isolation. This comprehensive interpretation helps form a baseline for effective patient education, intervention, and ongoing monitoring to ensure the best possible outcomes.