Download Assessment of Urinary System

Chapter (14)
Assessment of Urinary System
Faculty of Nursing-IUG
 The main function of urinary system is regulation of the fluid and
electrolytes composition of the body fluids and removal of metabolic end
products from the blood
Nursing History:
 Normal voiding pattern and frequency (oliguria – urinary urgency –
poyluria – anuria - dysuria –hematuria - enuresis)
 Appearance of the urine, urine culture and any recent changes (amount –
color). Normal colure yellow-straw
 Family history of kidney problems (polycystic kidney and all types of
hereditary nephritis are genetically transmitted, kidney and bladder calculi
 The present illness such as pain or burning sensation, UTI, an ostomy.
 Past history and current problems with urination: (syphilis, gonorrhea,
sexual transmitted disease STD) DM and HTN .
 Factors influencing the elimination pattern:
 Medications: Diuretics, Psychotropic agents , Anti-hypertensive.
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Medical Terms related to urinary system
 Dysuria: painful or difficult voiding
 Hematuria: red blood cells in the urine
 Urgency: strong desired to urinate due to inflammation in bladder
, prostate , urethra
 Polyuria: abnormal large volume of urine voided in given time =
2500ml
 Oliguria: small volume of urine between 100-500 ml
 Anuria: absence of urine in bladder less than 50 ml
 Enuresis: involuntary voiding during sleeping
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Physical Assessment of Urinary System
 Inspection
 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
Percussion of the kidney
 To detect areas of tenderness by costovertebral test, normally will feel a
thudding sensation or pressure but not tenderness
Palpation of kidney
 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.
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Percussion 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 bladder may not be palpable
Inspection of the urethral meatus
 Look for swelling, discharge and inflammation
Assessment of Urine
 Urine assessment includes:
 Measure volume of urine
 Inspect color, clarity, and volume
 Test the specific gravity, glucose, ketone bodies and blood and pH
 Normal urine volume 1-2 litter per 24 hours (normal adult)
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 Color: typically yellow-straw but varies according to recent diet and
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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 alkalinity of a solution).
PH is a measure of the activity of hydrogen ions (H+) in a solution.
95% Water, 5% chemical solutes. Urea from breakdown of amino
acids (protein) to give ammonia + C02 giving urea and creatinine
from breakdown of creatine phosphate in muscle
Collection of urine samples
 All urine tests are ideally performed on fresh specimens:
 Urine container has been adequate protection agonist bacterial
contamination and chemical deterioration
 Identification or labeled should be provided.
 The patient should then be gowned for the physical examination
 Bring it into the dry room
 Urine specimens should collect from the patient means of the clean–catch
midstream technique.
 All specimens should be refrigerated as soon as possible they are obtained
to avoid shifting of the PH of urine to alkaline because contamination of
urea- splitting bacteria from the environment.
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?
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The End
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