Assessment of Urinary System

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

Objective Data Normal voiding pattern Appearance of the urine Tumor Culture

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

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

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

Inspection of the urethral meatus 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

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 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 Urinalysis Urine culture 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

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