NUR 2502 Multidimensional Care 3 Exam 1 Blueprint

NUR 2502 Multidimensional Care 3 Exam 1 BlueprintMDC 3 – EXAM 1 BLUEPRINT Breast Cancer Patho: - Impaired cellular regulation in the breast tissue. One single cell that grows and multiplies in epithelial cells in one or more of the mammary ducts or lobules Risk Factors: - Increased age - family history - early menarche - nulliparity - late menopause - lack of breastfeeding - postmenopausal obesity - smoking/alcohol consumption - positive BRCA 1 or 2 Assessment: - Lump in the breast, changes in the size, shape or appearance of a breast, changes to the skin over the breast such as dimpling, a newly inverted nipple, peeling, scaling, crusting, or flaking of areola or breast skin, peau d’ orange, tender, firm, enlarged or itchy breast. Diagnosis: - Mammogram, tomosynthesis, ultrasound, MRI, chest x-ray, CT scan, liver enzymes, serum calcium, alkaline phosphate Treatment: - Non-surgical: vitamins, diets, and herbal therapy - Surgical: lumpectomy, mastectomy (partial, total, or radical) - Adjuvant: radiation, chemo or combo, drug therapy, stem cell transplant therapy Self-screening and mammogram recommendations: - Self-breast exam MONTHLY for all women 7-10 days after menstruation starts - 45-54 mammograms every year - Screening should continue as long as a woman is in good health - Those with risk factors start screening earlier Fibrocystic Breast Disorder Patho: - Non-cancerous, lumpy breast texture Risk Factors: - Hormone replacement therapy - 20-50 years old Assessment: - breast pain/tenderness/lumps Diagnosis: - Clinical breast exam - Mammogram - Ultrasound - Fine-needle aspiration - Breast biopsy Treatment: - Analgesics - Limit salt intake before menses - Wear supportive bra at all times - Ice or heat may help - Reduce or eliminate caffeine, dairy product - Needle aspiration may be necessary - Oral contraceptives or selective estrogen receptor modulators may be prescribed to help with hormonal imbalance Endometrial Cancer Patho: - Most common reproductive cancer of the inner uterine lining. Adenocarcinoma is the most common tumor type. It arises from the glandular part of the endometrium and usually follows endometrial hyperplasia (overgrowth) - Stages of Endometrial Cancer: Stage 1: endometrium only Stage 2: endometrium, cervix Stage 3: endometrium, cervix, vagina, lymph nodes Stage 4: endometrium, cervix, vagina, lymph nodes, bowel and bladder Risk Factors: - women in reproductive years - family history - diabetes mellitus - hypertension - obesity - uterine polyps - late menopause - nulliparity - smoking Assessment: - The main symptom of endometrial cancer is postmenopausal bleeding. Ask the patient how many tampons or pads they use each day. - Other symptoms include low pelvic pain, watery and bloody vaginal discharge, low back/abdominal pain. Ask the patient to describe where the pain is and perform a pelvic examination. Diagnosis: - CBC’s because of blood loss and serum tumor markers CA-125 - -transvaginal ultrasound and endometrial biopsy **GOLD STANDARD** - Chest x-ray, abdominal US, CT of pelvis, MRI of the abdomen and pelvis. Treatment: - Surgical: total hysterectomy and bilateral salpingo-oophorectomy - Nonsurgical: radiation, chemotherapy, drug therapy. Cervical Cancer Patho: - The uterine cervix is covered with squamous cells on the outer cervix and columnar (glandular) cells that line the endocervical canal. Most cervical cancers arise from the squamous cells on the outside of the cervix. The other cancers arise from the mucus-secreting glandular cells (adenocarcinoma) in the endocervical canal. Risk Factors: - HPV or STI - smoking - having multiple full-term pregnancies - age (late-teens-early 30’s most at risk) - no access for screening - oral contraceptives Assessment: - (hematuria) painless vaginal bleeding, unexplained weight loss, dysuria (painful urination), pelvic pain, chest pain, rectal bleeding. - Pap smear will be performed to visualize the tumor if it is visible. Diagnosis: - Pap smear - colposcopy-visualizing the characteristics of cells by using a light. - endocervical curettage (scraping of the uterine lining-may cause bleeding) Treatment: - LEEP (loop electrosurgical excision procedure)- a thin loop wire electrode that transmits a painless electrical current is used to cut away affected tissue. - Chemotherapy, radiation, cryotherapy, laser therapy, total hysterectomy, conization Cervical ablation- post op care: - No sexual intercourse - No tampons / douche - No baths (showers only) - No fragrant soaps on vagina - Avoid lifting heavy objects - report vaginal bleeding Uterine Leiomyoma/Fibroid Patho: - benign, slow-growing solid tumors of the uterine myometrium. Classified by the location. Intramural leiomyomas are contained in the uterine wall. Submucosal leiomyomas protrude into the cavity of the uterus and can cause bleeding and disrupt pregnancy. Subserosal leiomyomas protrude through the outer surface of the uterine wall and may extend to the broad ligament pressing other organs. Risk Factors: - Cause is unknown but they think leiomyomas develop from excessive local growth of smooth muscle cells. - May be a genetic error causing a lack of ability to halt growth. - The growth of leiomyomas may also be stimulated by estrogen, progesterone, and growth hormone. Assessment: - Acute pain, usually seek medical attention because of heavy vaginal bleeding, depending on the location she can have constipation, urinary frequency, or retention., abdominal pressure. Diagnosis: - Abdominal, vaginal, and rectal examinations usually reveal the presence of a uterine enlargement. - CBC, pregnancy test, transvaginal US, laparoscopy, hysteroscopy Treatment: - Nonsurgical: oral contraception, MRI - Surgical: MRI focused ultrasound- heat to tumor to kill it, Uterine artery embolization-starves tumor or circulation allowing it to shrink, myomectomy- laser removal of tumor, hysterectomy-removal of ovaries Hysterectomy- post op care: - monitor patient for fluid overload, embolism, hemorrhage, and to make sure the patient reports any sudden onset PAIN Vulvovaginitis Patho: - inflammation of the lower genital tract / imbalance of hormones. Think yeast, bacterial vaginosis, pH changes. Risk Factors: - Multiple sexual partners - Sexually transmitted diseases - Spermicides - Use of vaginal sprays or douching - Diabetes - Birth control use - Wet clothing - Antibiotics/Steroids Assessment: - Pruritus - Painful sex - abnormal vaginal discharge - vaginal itching/odor Diagnosis: - Pelvic exam - Vaginal discharge microscopy - pH testing Treatment: - Antifungals - Antibiotics Education: - Practice safe sex - wear cotton underwear/dry clothing - wipe front to back - cleanse vagina with water NO soap - Void after sex - Vulvar self-exams monthly Toxic Shock Syndrome (TSS) Patho: -Infection from STAPHYLOCOCCUS AUREUS & bacteria from menstruation and tampon usage which crosses into the bloodstream. Risk Factors: -Immunosuppression -use of highly absorbent tampons or contraceptive sponges -deep skin infection Assessment: -fever -rash -hypotension -GI upset -neuromuscular disturbances -increased liver enzymes -THINK SEPSIS Diagnosis: -blood cultures -assist provider with pelvic exam Treatment: - IV antibiotics - fluid replacement - Corticosteroids Education: - Teach about hand hygiene when changing pads/tampons - se pads at night, no longer that 4 hours without changing tampon - No intercourse during treatment Prostate Cancer Patho: - Slow growing cancer with predictable metastasis. The 2nd leading cancer in men after lung cancer, but is almost 100% curable. Risk Factors: - over 50 - African Americans AT HIGHER RISK - high fat diet - no exercise - consume alcohol or nicotine Assessment: - difficult starting urination/ dribbling after urination - polyuria - nocturia - urinary retention - Late symptoms: - blood in the urine or semen. (DIFFERENTIATES FROM BPH) Labs: - urinalysis, ultrasound, PSA, alkaline phosphate, biopsy Treatment: - Active surveillance (check up every 6 months) as long as there is no growth - Prostatectomy: removal of whole prostate. The patient will be catheterized. Education: - monitor urine output, control pain, watch for bleeding. Erectile dysfunction is common after total or radical prostatectomy Benign Prostatic Hyperplasia (BPH) Patho: - Non-cancerous enlargement of the prostate resulting in compression of the urethra and urinary retention Assessment: - polyuria, nocturia, trouble starting urination, feeling that the bladder is not empty Diagnosis: - transabdominal ultrasound or MRI - urinalysis and culture, CBC, BUN, PSA, Treatment: - Non-surgical - meds to stop hyperplasia (growth of prostate) - alpha blockers - 5alpha reductase inhibitors (Finasteride or Dutasteride) - Cialis - Surgical - prostatectomy (TURP) through the urethra Education: - TURP- post op care: monitor urine output, control pain, watch for bleeding Testicular Cancer Patho: - very rare - usually affects men 20-35 years of age (reproductive years) - Usually curable with early detection – self-examinations. - Germ cell tumors: arise from sperm-producing cells - Non germ cell tumors: arise from stromal, interstitial, or Leydig cells (more rare) Risk Factors: - genetics (brother) - CAUCASIAN MEN Assessment: - painless, hard swelling or enlargement of testicle. Lab tests: - AFP, hCH LDH, serum testosterone levels ELEVATED Diagnostic: - ultrasound - CT of abdomen - lymphangiography - MRI **DO NOT biopsy testicle. Can rupture and the cancer cells can spread throughout the body** Interventions: - store sperm if desired - orchiectomy (removal of testicle) scrotal support, maintain pain, no heavy lifting or stairs.e - chemo/radiation - emotional support** - reconstruction surgery is an option (implant that resembles a testicle) Erectile Dysfunction Patho: - inability to achieve or maintain erection for sexual intercourse - 90% organic (diabetes, high cholesterol, smoking, medications, etc.) - 10% functional (stress, anxiety, desire, etc.) Labs/Diagnostics: - history - serum hormone levels - doppler ultrasonography test Treatment: - Meds - PDE-5 (vasodilator) opens up blood flow - do not take with nitro - vacuum constriction device - injections with vasodilation drugs STI’s that recur and become chronic = sexually transmitted disease STD - Women more easily infected/asymptomatic - For patient education for each disease the focus is to educate the patient on the transmission, incubation, treatment, complications, and partner education. Herpes Patho: - Acute recurring incurable VIRAL disease w/ incubation of 2 to 20 days - PROBLEM= primary outbreak can be asymptomatic but still infectious; recurrences are not caused by re infection but rather viral SHEDDING - 2 strains: HSV-1 = oral cold sores. HSV-2 = genital lesions. Risk factors: - Multiple sex partners - Lack of protection Assessment: - Hx of sexual partners activity - Looking for lesions Diagnosis: - Blister/sore culture Treatment: - Antivirals to keep lesions under control BUT NO CURE - Self-management education about infection transmission recurrence etc. Syphilis Patho: - more serious BACTERIAL infections d/t systemic complications - Bacterial infection that grows into a chancre (ulcer) = FIRST sign of primary stage - Four stages: - Primary = HIGHLY INFECTIOUS, - Secondary = bacteria circulate through blood stream 6 weeks – 6 months - Latent = 1st year after infection, the bacterial infection can be hidden - Tertiary = 4-20 years after- hard to detect due to mimicking other diseases Risk factors: - Sexual contact - Blood exposure* Assessment: - hx of ulcers or rash - Sexual hx - Ulcer culture swab specimen Diagnosis: - VDRL and RPR tests Treatment: - Benzathine Penicillin G (VERY STRONG PENICILLIN SO WATCH FOR ALLERGIC REACTION) Education: - Follow up eval 6, 12, 24 months - Partner notification & treatment - Report to local health authority Genital Warts/HPV Patho: - One of the most common sexually transmitted diseases, affecting the moist tissues of the genital area. HPV can cause genital warts, or cervical cancer. Risk factors: - Unprotected sex with multiple partners - Sex with someone who’s hx you do not know - Sex at a young age - Hx of other STDs - Immunocompromised people (HIV, cancer, or organ transplant) Assessment: - Warts - Single small white or flesh colored papillary growth; cauliflower like masses Diagnosis: - Pap - HPV DNA testing - Wart Biopsy Treatment: - Gardasil = preventative - Cryotherapy, TCA, BCA, Podophyllin - Self-management and teaching about Chlamydia Patho: - Chlamydia trachomatis is an intracellular bacterium. It invades the epithelial tissues in the reproductive tract. Risk factors: - African American - Female - ages 15-24 - MSM (male on male sex) Assessment: - usually asymptomatic - may present with discharge or painful urination Diagnosis: - Genital culture - blood or urine test Treatment: - antibiotics - z-pack or doxycycline - Treat partner as well. **NO SEX UNTIL TREATMENT COMPLETED** Chronic Kidney Disease (CKD) - Dialysis types: - Hemodialysis (outside the body): Machine takes blood out, cleans it, and returns back to the patient. (Fluid in machine is call DIALYSATE) - Peritoneal (can be done at home and is done INSIDE the body): A catheter is placed into the abdominal cavity and dialysate is put in there and it is automatically pumped out in a continuous cycle. - Complications: - Pain, tunnel infections, leakage of medication - Always measure vital signs, weight, and lab tests - Watch for respiratory distress - What happens to lab values? - INCREASES Potassium, Phosphorus, & Calcium - DECREASES Sodium (kidneys cannot get rid of excess water so the blood becomes hypotonic) - Assessment: - Fluid overload, oliguria/anuria, dry skin, yellow/gray pallor - Late stages: HYPOtension - Risk factors: - Blood clots, manage VAD - Do NOT take BP on the arm that has the fistula and no IV’s - African American, Caribbean, Native Americans - Diagnosis: (based on GFR and Stages) - Stage 1: GFR 90, at risk but normal kidney function besides urine findings - Stage 2 (mild): GFR 60-89, reduced kidney function, lab values and other findings point to kidney disease - Stage 3 (moderate): GFR 30-59, implement strategies to slow progression - Stage 4 (severe): GFR 15-29, manage complication, discuss possible renal replacement therapy - Stage 5 (ESKD): GFR 15, implement renal replacement therapy or kidney transplant - Azotemia: buildup of nitrogen-based wastes in blood - Uremia: azotemia with symptoms- metallic taste, anorexia, N&V, muscle cramps, frost on skin, itchy, edema - Uremic Syndrome: systemic clinical and lab manifestations of ESKD - Treatment: - Manage fluid volume - Reduce anxiety - Prevent pulmonary edema - enhance nutrition - Give meds as prescribed Acute Kidney Injury (AKI) - Patho: rapid reduction in kidney function - Prerenal: before it gets to the kidney (could be blood/fluid loss, liver issues, burns, dehydration, or bleeding/clotting factors - Intrarenal: actual kidney damage (blood clot, infection, lupus, scleroderma) - Postrenal: urine flow obstruction, bladder cancer, colon cancer, kidney stones that block urethra, or an enlarged prostate Risk factors: - On NSAIDs or antibiotics - Coexisting conditions - Recent surgery/trauma Assessment: - N&V, diarrhea, fever, diaphoresis, decreased urine output, hypoxia, crackles in lungs, changes in urine characteristics - Assess for fluid overload - Evaluate VS for hypoperfusion and hypoxemia Diagnosis: - Creatinine, BUN, and GFR - Electrolytes (K+ is especially important) - US, CT, x rays, MAG3 Treatment: - always treat underlying condition - Oral fluid restrictions - Diuretics - Closely watch I/O - Education: discuss what foods have K+ in them to avoid (potatoes, bananas, dark leafy greens) - Kayexalate- binds with K+ and helps excrete through stool (loose bowel movements, which is a good thing) Nephrotic Syndrome - Patho: - Increased permeability of the glomerulus (filtering system of the kidneys) “leaky” - Massive loss of protein into urine - Risk Factors: - Diabetes - Lupus - Certain medications (NSAIDs and certain antibiotics) - HIV/Hepatitis B, Malaria, Hepatitis C - Assessment: - frothy urine - occurs because of high protein levels in the urine - severe edema - Fast onset - Diagnosis: - Urinalysis - Treatment: - Treat underlying condition (ACE inhibitors, heparin, diet, diuretics, sodium restriction) Glomerulonephritis: **Remember the glomerulus is responsible for the spilling of RBCs and protein from the kidney into the urine** Patho: - damage to the glomerulus which filters the blood - Primary: kidney itself - Secondary: involves another body system - Acute: sudden and results in a strep infection - Chronic: over a longer period of time, can lead to kidney failure (patients may not know it is happening) Risk Factors: - High BP - Progressive kidney damage (blood and protein) - CKD - Edema and anemia Assessment: - hematuria - blood in urine Diagnosis: - urinalysis Treatment: - monitor vitals - limit fluid and salt intake - monitor electrolytes Urinary Incontinence (this is NEVER normal) Patho: - Stress incontinence: increased abdominal pressure/decreased pelvic floor muscles - Urge incontinence: involuntary contraction of the bladder muscles - Overflow incontinence: blockage of the urethra (BPA) - no anticholinergics - Neurogenic incontinence: disturbed function of the nervous system Risk Factors: - multiple pregnancies - post-menopausal - surgery - spinal cord injury - brain disorders - disease treatment - drugs/caffeine - chronic conditions Assessment: - physical: intake/output, GU, history (more frequent, small amount) - Lab: urinalysis - Imaging: bladder scan - post void residual (more than 50 cc) Diagnosis: - Urinalysis - Bladder diary - Post-void residual measurement Treatment: - Nonsurgical: Kegel’s, nutrition therapy, drug therapy - Surgical: Bladder sling Cystitis/UTI Patho: - inflammatory condition of the bladder usually caused by bacteria or irritants. 90% are caused by E. Coli - UTI = anywhere in the urinary tract - Cystitis = in the bladder. UTI most common healthcare associated infection. Risk Factors: - long term catheter use - feminine products - poor toileting hygiene (wiping back to front) - not voiding after intercourse - taking baths Assessment: - frequency or urination - dysuria (painful urination) - urgency - cloudy urine or hematuria - foul-smelling urine - pelvic pain - low-grade fever - confusion (older adults) - Lab: clean catch urine specimen urinalysis nitrites, leukocytes, bacteria sign of UTI, WBC - Pelvic ultrasound, CT, voiding cystourethrography, cystoscopy Diagnosis: - Dipstick for nitrites, leukocytes, or bacteria Treatment: - Antimicrobials - increase fluid intake Urethritis Patho: - inflammation of the urethra Risk Factors: - Age 20-24 - STI’s Assessment: - urinalysis - pyuria - crusty pus like discharge Diagnosis: - urinalysis for STI Treatment: - estrogen cream - treat STI (antibiotic) Urolithiasis Patho: - presence of calculi (stones) in the urinary tract Risk Factors: - dehydration - high urine acidity or alkalinity - Caucasian - overweight Assessment: - excruciating pain (flank) - renal colic - nausea - vomiting - pallor - assess urine output, urinalysis, WBC, CT or KUB Diagnosis: - Urinalysis, WBC, CT, KUB Treatment: - pain medication - increase fluids to try and pass on own - lithotripsy (shock waves) Pyelonephritis (kidney infection) Patho: - Bacterial growth in the upper urinary tract caused by indwelling catheters and diabetic neuropathy - Acute - bacterial infection that moved into the kidneys - Chronic - repeated UTIs and more common in abnormal urinary system Risk Factors: - Women who are 20-30 years old Assessment: - Fever, N&V, fatigue, burning while urinating, nocturia - CVA tenderness, flank pain - Older adults will be CONFUSED Diagnosis: - UA/UC, may need catheter, CT and ultrasound - Labs: C reactive protein, EST, BUN, Creatinine, GFR - Kidney biopsy Treatment: - Antibiotics - Tylenol for pain (Aspirin is nephrotoxic) Polycystic Kidney Disease Patho: - Fluid-filled cysts that develop in the nephrons. Risk Factors: - family history - HTN - Pregnant women with HTN Assessment: - Increased size of abdomen - UTI or Kidney infections - May have dysuria and nocturia - Ask about back/side pain, constipation, urine changes, hypertension, headaches. Diagnosis: - High BP - Ultrasonography - MRI - Urinalysis Treatment: - manage blood pressure - manage pain and constipation - slow the progression of chronic kidney disease. - ***No medications are effective and there is no cure*** Renal Cell Carcinoma Patho: - The most common type of kidney cancer in adults. Typical metastasis to liver, bones, adrenal glands and other kidney. Risk Factors: - Older age - Smoking - Obesity - HTN - Kidney failure treatment - Family hx Assessment: - Blood in the urine (pink, red, or cola colored) - Pain in back or side that does not go away - Loss of appetite/unexplained weight loss - Tiredness - Fever Diagnosis: - Blood and urine tests - X-ray/CT/MRI - Biopsy Treatment procedures/options: - Nephrectomy (full or partial) - Cryoablation (freezing cancer cells) - Radiofrequency ablation (burning cancer cells) Bladder Cancer Patho: - Cancer within the bladder. Most bladder cancers are diagnosed at an early stage when the cancer is highly treatable. most common in patients over 60. Quit smoking/do not start. High mortality rate*** Risk Factors: - Smoking - Male gender - Family hx - Increasing age - Previous cancer treatment - Chronic bladder inflammation/infections - Exposure to certain chemicals (heavy metals and asbestos) - Black people - HTN Assessment: - Blood in the urine (visible or occult blood seen on UA) - Frequent urination - Dysuria - Back pain Diagnosis: - Cystoscopy (scope examination of bladder) - Biopsy - CT/MRI/PET scan - Microscopic urine analysis Treatment: - Chemo/Radiation - Surgery: Transurethral resection of bladder tumor (TURBT), Cystectomy, Neobladder reconstruction, continent urinary reservoir, and ileal conduit. - Immunotherapy - STOP SMOKING - follow-up tests for years after treatment to look for bladder cancer that recurs. OTHER THINGS TO KNOW: - Screening recommendations for cancers: BREAST: self-breast exams monthly, mammograms, reporting anything new to your PCP CERVICAL: Pap smear with HPV testing TESTICULAR: self-exams monthly PROSTATE: DRE (digital rectal exam), check PSA blood level. - General Post-operative nursing care strategies o Watch for signs of infection o monitor vitals - Do not forget about ABC’s! Prioritization questions; look for relevant airway, breathing, & circulation issues! Medications: (Generic/common names, Therapeutic Effect, Side effects, Nursing Considerations) Drug Class: Phosphodiesterase inhibitor Therapeutic effects: Vasodilator, allows blood flow to help make an erection Side Effects: headache, flushing, congestion, runny nose. Nursing Considerations: Never give with Nitroglycerin because this could cause a severely low drop in blood pressure and could cause them to pass out. Drug Class: Alpha Blocker Therapeutic Effects: relax smooth muscles in the prostate gland creating less urinary resistance Side Effects: orthostatic hypotension, tachycardia, syncope (black out), dizziness Nursing Considerations: monitor LFTs, instruct patient to change positions slowly Drug Class: NSAIDS Therapeutic Effects: treats inflammation and relieve pain Side Effects: dizziness, stomach ulcers, drowsiness Nursing Considerations:history of allergic reaction, we need clotting times checked and have a liver evaluation done. Drug Class: Tetracycline Antibiotics Therapeutic Effects: Is an antibiotic that treats an infection like chlamydia. Side Effects: nausea, vomiting, diarrhea, loss of appetite Nursing Considerations: use with caution with liver impairment, monitor renal and liver labs and instruct patient to complete entire dose. Drug Class: Antivirals- Acyclovir Therapeutic Effects: helps treat genital herpes outbreaks by keeping vesicles/lesions at bay Side Effects: a feeling of pins and needles on the skin, diarrhea, drowsiness, agitation Nursing Considerations: History of allergic reactions to this med, pregnancy? Drug Class: Thiazide diuretics Therapeutic Effects: used to treat high blood pressure by getting rid of sodium into your urine. Side Effects: hypokalemia, dizziness, blurred vision, headache. Nursing Considerations: Give thiazide diuretics in the morning to prevent nocturia. Provide potassium-rich foods and potassium supplements to keep therapeutic levels of potassium. Laboratory Value Interpretation What do these lab values indicate/what disease processes would have these changes Elevated Serum Alkaline Phosphatase--------- Alpha-fetoprotein--------------------- Testicular cancer Testicular cancer, prostate Cancer or endometrial (uterine) cancer Electrolyte changes with KIDNEY FAILURE - sodium, potassium, phosphate, calcium Know normal values of: ● K (3.5-5) ● Na (135-145) ● Phosphorus (2.5-4.5) ● Calcium (8.5-10.9 ● Magnesium (1.5-2.5) ● Sodium (135-145) LOOK UP LEVELS OF ELECTROLYTES THAT WOULD INDICATE KIDNEY FAILURE Late kidney failure: HYPERnatremia HYPERkalmeia End stage renal disease Restrict the 3 P’s: Potassium, phosphorus, protein Decreased GFR = 60 (normal GFR is 90) UNDER 60 indication of Kidney DISEASE UNDER 15 indication of Kidney FAILURE Elevated Creatinine Glomerulonephritis 24-hour urine collection – indications and what it tells us Collect all urine for 24hrs. Shows us what is in their urine to prove possibly Glomerulonephritis.