Download ASSESSMENT OF THE RESPIRATORY PATIENT

Islamic University of Gaza
faculty of Nursing
Chapter (11)
Assessment of Urinary System
Objectives
Anatomy and Physiology
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Urinary system consist of the two kidneys
Two ureters draining the kidneys
The urinary bladder and the urethra
Mid pole of kidneys level with L1/L2.
10-12cm long, 5-7cm wide, 2.5cm thick.
Lie between T11/T12 and L3. The right kidney
some 1 or 2cm lower than the left.
• Surrounded by fat which helps protect the
kidneys from trauma and anchor them in place.
Bladder
• Bladder sits behind the pelvis (15o
caudal angle needed to x-ray it)
• Ureters enter the bladder obliquely in the
trigone, which creates a natural seal
when the bladder fills.
• Rugae in the bladder allow expansion.
• Average volume 700 – 800ml.
• Reduced in prostatic enlargement.
• Urethra: 4cm in females and 15 to 20 cm
in males.
Blood flow Doppler
Subjective data
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Pain
Fever
Burning sensation
Unurea
Disurea
Family history
Stone
Past history
Hematurea
Urgency
Frequency
Oligurea
DM
HTN
Objective Data
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Normal voiding pattern
Appearance of the urine
Tumor
Culture
Preparation for Urinary System
Assessment
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Equipment
stethoscope
Sphygmomanometer
Drapes
Specimen cup to collect urine sample
Physical Assessment of Urinary System
Techniques
Inspection – Auscultation- PercussionPalpation
• Inspection including examination of abdomen
and urethral meatus.
• Auscultation including renal arteries
• Percussion includes the kidneys to detect
tenderness
• Palpation to detect any mass, lumps,
tenderness
Physical Assessment of Urinary System
Percussion of the kidney
To detect areas of tenderness by
costovertebral test, normally will feel a
thudding sensation or pressure but not
tenderness
Palpation
• Contour, size, tenderness, and lump.
• In adult normal the kidneys not be palpable
because of their location deep with abnormal.
• Elderly the right kidney is slightly lower than the
left, it may be easier to palpate
Percussion and palpation of the bladder
• Percuss the area over the bladder (5cm) above the
symphysis pubis.
• To detect difference in sound, percuss toward the
base of the bladder.
• Percussion normally produces a tympanic sound
Palpation of bladder
• Normally feel firm and smooth.
• In adult bladdre may not be palpable
Inspection of the urethral meatus
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Look for
Swelling
Discharge
And inflammation
Urine
• 95% Water, 5% solutes
• Urea from breakdown of amino acids
(protein) to give ammonia + C02 giving urea
• Creatinine from breakdown of creatine
phosphate in muscle
• Depends how much muscle you have!
• Girl normal 60mm/litre
• Man 120 mm/litre
• Used as a test of function
• Coloured by pigment from breakdown of bile
• Sterile fluid
Assessment of Urine
•Measure volume of
urine
•Inspect colour,
clarity, and volume
•Test the specific
gravity, glucose,
ketone bodies
•Blood and pH
Assessment of Urine
• The other consist of solutes (chemicals
that are dissolved in the water)
• These solutes are the result of normal
biochemical activity within the cells of
the body such as urea, creatinine,
phosphates, sulfates and uric acid.
• Other solutes may be due to chemicals
that originated outside of the body, such
as pharmaceutical drugs
• normal urine volume 1-2 litter per 24
hours (normal adult)
Assessment of Urine
• Color: typically yellow-straw but varies according to
recent diet and concentration of the urine. Drinking
more water generally tends to reduce the
concentration of the urine and therefore cause it to
have a lighter color. (The converse is also true.)
• Smell: Generally fresh urine has a mild smell but
aged urine has a stronger odor, similar to that of
ammonia.
• The smell urine may provide health information.
For example, urine of diabetics may have a sweet or
fruity odor due to the presence of ketones.
• Acidity :PH is a measure of the acidity ( or
alkalinity0 of a solution. PH is a measure of the
activity of hydrogen ions (H+) in a solution.
The PH of normal urine is generally in the
range 4.5-8
• A typical average being around 6.0 Much of
the variation is due to diet. For example,
high protein diets result in more acidic
urine, but vegetarian diets generally result in
more alkaline urine.
• Density ; Density is also known as “
specific gravity”. This is the ratio of the
weight of a volume of a substance compared
with the weight of the same volume of
distilled water. Density of normal urine is in
the range 1.005- 1.020.
Diagnostic Tests
to determine urinary tract disease or disorders of
other body systems influencing the production
of urine
1. Urinalysis
2. Urine culture
3. Radiographic examinations ; kidney, Ureter and
Bladder (KUB) AND Intravenous Pyelogram
(IVP).
4. Cystoscopy
5. Blood tests
Diagnostic Studies of the Urinary
System
• Urine Studies
– Urinalysis
– Creatinine clearance
– Urine culture (clean catch midstream)
– Concentration test
– Residual urine
– Protein determination
– Urine cytology
Diagnostic Studies of the Urinary
System
• Blood Chemistries
– BUN
– Creatinine
– Uric acid
– Sodium
– Potassium
– Calcium
– Phosphorus
– bicarbonate
Diagnostic Studies of the Urinary
System
• Radiologic Procedures
– Kidneys, ureters, bladder (KUB)
– IVP or excretory urogram
– Nephrotomogram
– Retrograde pyelogram
Diagnostic Studies of the Urinary
System
• Radiologic Procedures
– Cystogram
– Renal arteriogram (angiogram)
– Ultrasound
– CT scan
– MRI
Consider the Developmental Stages
• Pediatric:
(difficulties, crying, change in urinary in
childhood).
• Pregnant:
Pain during urination, normal increase urine in
volume and frequency and decrease urine
specific gravity
• Elderly:
How much and how type of liquid do you drink
in the evening? do you ever lose of control of
your bladder
Questions