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Week 8

Week 8. Abdominal Assessment: Urinary Elimination. Learning Objectives 1. Describe and list factors that affect elimination. 2. Explain common physical assessment procedures used to evaluate elimination health of patients across the lifespan.

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Week 8

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  1. Week 8 Abdominal Assessment: Urinary Elimination

  2. Learning Objectives1. Describe and list factors that affect elimination. 2. Explain common physical assessment procedures used to evaluate elimination health of patients across the lifespan. 3. Identify priority elimination assessment findings. 4. Differentiate normal elimination assessment from abnormal findings. 5. Explain the process for assessment of the abdomen and bowel/bladder elimination.

  3. Elimination: The process of and ability to rid the body of waste.

  4. What are some factors that might have an effect on elimination?

  5. Assessment Interview *Voiding pattern *Description of urine and any changes (color, quantity, etc.) *Urinary elimination problems (such as pain, urgency, frequency, burning, etc.) * Factors influencing urinary elimination

  6. Pain with urination may not be directly related to urinary tract – it could be due to an STD or vaginal irritation

  7. Abdominal & Genitourinary Assessment First: Inspect

  8. Inspection - Distended Bladder

  9. Inguinal Hernia in Scrotum

  10. Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the underside of the penis.

  11. Congenital Urethral Fistulaabnormal passage that that occurs during the development in-utero between the urethra and the penile skin, somewhere beneath the normal urethral opening. During urination two streams of urine may be obvious — one coming from the urethral opening and the other from the site of the abnormal opening (fistula).

  12. Second: Auscultate abdomen for bowel sounds in all for quadrants

  13. Third: Percuss Percussion detects fluid, air, and any fluid-filled or solid masses.

  14. Pain that occurs with percussion over the flank could be kidney-related

  15. Fourth: Palpation

  16. Palpation: light, moderate, and deep

  17. Back pain, especially unilateral could be kidney pain

  18. Perfusion can be altered due to an obstruction or tear

  19. Our bodies should always be making urine. In the presence of an obstruction the urine cannot get out.

  20. Urine should be straw-colored to pale yellow, and clear, without odor. *Assess for color, clarity, and amount; note the presence of odor

  21. Note that increased frequency in older adults, along with nocturia = increased risk for falls

  22. Nocturia- the need to get up in the night to urinate

  23. Pregnancy creates pressure on the bladder due to the location and increasing size of the uterus

  24. Uterine Prolapse

  25. Prolapse- to fall out of place

  26. Prolapsed Bladder

  27. Prostate enlargement may obstruct (block) urine flow

  28. Developmental Considerationsof Urinary Elimination • Developmental Factors: • *Infants • Output • Frequency • Control • *Preschoolers • Independent toileting • Modeling, reminders • Instructions for wiping (front to back for • girls)

  29. Elizabeth Escalona, 23, admitted gluing her 2-year-old daughter to a wall and beating her over potty training. (CNN) MOBILE, Alabama - The North Texas mom who pled guilty to gluing her toddler daughter’s hands to a wall, kicking her in the stomach and beating her over “potty training” has been sentenced to 99 years in prison, according to CBS DFW. According to the report, State District Judge Larry Mitchell told Elizabeth Escalona that in spite of the ‘heartbreaking’ and ‘compelling’ evidence presented on both sides, “to me, it comes down to a single, salient fact: you savagely beat your child to the edge of death… for this you must be punished.” Pleading for leniency Escalona took to the stand Thursday where she admitted that she’d behaved “like a monster” but also said she deserved to be given “a second chance.”

  30. *School-age children Patterns Enuresis (involuntary voiding of urine) Nocturnal enuresis *Older adults Patterns Muscle weakness Nocturnal frequency Developmental Considerations (cont.)

  31. Developmental Considerations (cont.) • *Age-related changes • Renal function declines • Impaired excretion of drugs • Bladder more fibrous • Autonomic regulation decreases • Age-related weakening • Risk for hyponatremia

  32. Other Factors that Affect Urinary Elimination • Psychosocial factors • Fluid and food intake • Medications • Anticholinergics • Antidepressants • Antihistamines • Antihypertensives • Antiparkinsonism • Beta-adrenergics • Opioids

  33. Other Factors Affecting Urinary Elimination (cont.) • Muscle tone • Pathologic conditions • Surgical and diagnostic • Procedures • Trauma /spinal cord injuries

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