Islamic University of Gaza faculty of Nursing

1. Islamic University of Gazafaculty of Nursing Chapter (11) Assessment of Urinary System

2. Objectives

3. Anatomy and Physiology • 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.

7. 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.

10. Blood flow Doppler

11. Subjective data • Pain • Fever • Burning sensation • Unurea • Disurea • Family history • Stone • Past history • Hematurea • Urgency • Frequency • Oligurea • DM • HTN

12. Objective Data • Normal voiding pattern • Appearance of the urine • Tumor • Culture

13. Preparation for Urinary System Assessment • Equipment • stethoscope • Sphygmomanometer • Drapes • Specimen cup to collect urine sample

14. Physical Assessment of Urinary System Techniques Inspection – Auscultation- Percussion- Palpation • 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

15. 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

18. 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

20. 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

21. Palpation of bladder • Normally feel firm and smooth. • In adult bladdre may not be palpable Inspection of the urethral meatus • Look for • Swelling • Discharge • And inflammation

22. 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

23. Assessment of Urine • Measure volume of urine • Inspect colour, clarity, and volume • Test the specific gravity, glucose, ketone bodies • Blood and pH

24. 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)

25. 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.

26. 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.

27. Diagnostic Tests to determine urinary tract disease or disorders of other body systems influencing the production of urine • Urinalysis • Urine culture • Radiographic examinations ; kidney, Ureter and Bladder (KUB) AND Intravenous Pyelogram (IVP). • Cystoscopy • Blood tests

28. Diagnostic Studies of the Urinary System • Urine Studies • Urinalysis • Creatinine clearance • Urine culture (clean catch midstream) • Concentration test • Residual urine • Protein determination • Urine cytology

29. Diagnostic Studies of the Urinary System • Blood Chemistries • BUN • Creatinine • Uric acid • Sodium • Potassium • Calcium • Phosphorus • bicarbonate

30. Diagnostic Studies of the Urinary System • Radiologic Procedures • Kidneys, ureters, bladder (KUB) • IVP or excretory urogram • Nephrotomogram • Retrograde pyelogram

31. Diagnostic Studies of the Urinary System • Radiologic Procedures • Cystogram • Renal arteriogram (angiogram) • Ultrasound • CT scan • MRI

32. 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

33. Questions