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Chapter 53
Assessment of Kidney and
Urinary Function
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Kidney and Urinary Systems
• Regulates fluid and electrolytes, removing wastes and
providing hormones involved in red blood cell production,
bone metabolism, and control of blood pressure
• Structures
– Kidneys
– Ureters
– Bladder
– Urethra
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Kidneys, Ureters, and Bladder
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Gerontologic Considerations
• Older adults may intentionally limit fluids to decrease
frequency or incontinence
• Diminished thirst, need reminding to drink, increased
dehydration
• Incomplete emptying of bladder, urinary stasis,
decreased nerve innervations
• Decreased GFR and renal reserve
• Decreased drug clearance = increased drug–drug
interactions
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Diagnostic Studies
• Urinalysis and urine
culture
• Renal function tests:
refer to Table 53-5
• Biopsies
• IV urography
• Retrograde pyelography
• Ultrasonography
• Cystography
• CT and MRI
• Renal angiography
• Nuclear scans
• Refer to Chart 53-4
• Endoscopic procedures
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Cystoscopic Examination
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Question
Is the following statement true or false?
Urea is an abnormal constituent of urine.
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Answer
False
Urea is not an abnormal constituent of urine. Glucose is an
abnormal constituent of urine.
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Nursing Process: The Care of the Patient
Undergoing Testing of the Renal–Urologic
System—Assessment
• Patient knowledge
• Psychosocial and emotional factors; fear, anxiety
• Urologic function, include voiding habits/pattern
• Fluid intake
• Hygiene
• Presence of pain or discomfort
• Allergies
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Question
What is the normal adult bladder capacity?
A. 50 to 100 mL
B. 100 to 200 mL
C. 300 to 500 mL
D. 600 to 800 mL
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Answer
C. 300 to 500 mL
The normal adult bladder capacity is 300 to 500 mL of
urine.
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Nursing Process: The Care of the Patient
Undergoing Testing of the Renal–Urologic
System—Diagnosis
• Knowledge deficient
• Pain
• Fear
• Refer to Chart 53-4
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Nursing Process: The Care of the Patient
Undergoing Testing of the Renal–Urologic
System—Planning
• Patient goals may include understanding of procedures,
tests, and expected behaviors; decreased pain or
absence of discomfort; and decreased apprehension and
fear
• Patient education: provide a description of the tests and
procedures in language the patient can understand.
• Use appropriate and correct terminology.
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Nursing Process: The Care of the Patient
Undergoing Testing of the Renal–Urologic
System—Interventions
• Encourage fluid intake unless contraindicated
• Instruct in methods to reduce discomfort; sitz baths,
relaxation techniques
• Administer analgesics and antispasmodics as prescribed
• Assess voiding and provide instruction related to voiding
practices and hygiene
• Provide privacy and respect
• Refer to Chart 53-4
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Question
A 24-hour urine collection is scheduled to start at 0100.
When should the nurse start the procedure?
A. At 0100, with or without a specimen
B. At the first specimen that was voided at 0400
C. 2 hours after the urine was discarded
D. After discarding the 0100 specimen
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Answer
D. After discarding the 0100 specimen
A 24-hour urine collection that starts at 0100 begins after
discarding the 0100 specimen.
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