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

2. Objectives

3. Anatomy and Physiology Urinary system consist of the two kidneysUrinary system consist of the two kidneys Two ureters draining the kidneysTwo ureters draining the kidneys The urinary bladder and the urethraThe urinary bladder and the urethra Mid pole of kidneys level with L1/L2.Mid pole of kidneys level with L1/L2. 10-12cm long, 5-7cm wide, 2.5cm thick.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.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.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)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.Ureters enter the bladder obliquely in the trigone, which creates a natural seal when the bladder fills. Rugae in the bladder allow expansion.Rugae in the bladder allow expansion. Average volume 700 – 800ml.Average volume 700 – 800ml. Reduced in prostatic enlargement.Reduced in prostatic enlargement. Urethra: 4cm in females and 15 to 20 cm in males.Urethra: 4cm in females and 15 to 20 cm in males.

10. Blood flow Doppler

11. Subjective data PainPain FeverFever Burning sensationBurning sensation UnureaUnurea DisureaDisurea Family historyFamily history StoneStone Past historyPast history HematureaHematurea UrgencyUrgency FrequencyFrequency OligureaOligurea DMDM HTNHTN

12. Objective Data Normal voiding patternNormal voiding pattern Appearance of the urineAppearance of the urine TumorTumor CultureCulture

13. Preparation for Urinary System Assessment EquipmentEquipment stethoscopestethoscope SphygmomanometerSphygmomanometer DrapesDrapes Specimen cup to collect urine sampleSpecimen cup to collect urine sample

14. Physical Assessment of Urinary System Techniques Inspection – Auscultation- Percussion- Palpation Inspection including examination of abdomen and urethral meatus.Inspection including examination of abdomen and urethral meatus. Auscultation including renal arteriesAuscultation including renal arteries Percussion includes the kidneys to detect tendernessPercussion includes the kidneys to detect tenderness Palpation to detect any mass, lumps, tendernessPalpation 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.Contour, size, tenderness, and lump. In adult normal the kidneys not be palpable because of their location deep with abnormal.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 palpateElderly 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.Percuss the area over the bladder (5cm) above the symphysis pubis. To detect difference in sound, percuss toward the base of the bladder.To detect difference in sound, percuss toward the base of the bladder. Percussion normally produces a tympanic soundPercussion normally produces a tympanic sound

21. Palpation of bladder Normally feel firm and smooth.Normally feel firm and smooth. In adult bladdre may not be palpableIn adult bladdre may not be palpable Inspection of the urethral meatus Look forLook for SwellingSwelling DischargeDischarge And inflammationAnd inflammation

22. Urine 95% Water, 5% solutes95% Water, 5% solutes Urea from breakdown of amino acids (protein) to give ammonia + C02 giving ureaUrea from breakdown of amino acids (protein) to give ammonia + C02 giving urea Creatinine from breakdown of creatine phosphate in muscleCreatinine from breakdown of creatine phosphate in muscle Depends how much muscle you have!Depends how much muscle you have! Girl normal 60mm/litreGirl normal 60mm/litre Man 120 mm/litreMan 120 mm/litre Used as a test of functionUsed as a test of function Coloured by pigment from breakdown of bileColoured by pigment from breakdown of bile Sterile fluidSterile fluid

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

24. Assessment of Urine The other consist of solutes (chemicals that are dissolved in the water)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.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 drugsOther 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) 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.)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.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.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 solutionAcidity :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.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.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 1.Urinalysis 2.Urine culture 3.Radiographic examinations ; kidney, Ureter and Bladder (KUB) AND Intravenous Pyelogram (IVP). 4.Cystoscopy 5.Blood tests

28. Diagnostic Studies of the Urinary System Urine StudiesUrine 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 ChemistriesBlood Chemistries –BUN –Creatinine –Uric acid –Sodium –Potassium –Calcium –Phosphorus –bicarbonate

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

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

32. Consider the Developmental Stages Pediatric:Pediatric: (difficulties, crying, change in urinary in childhood). (difficulties, crying, change in urinary in childhood). Pregnant:Pregnant: Pain during urination, normal increase urine in volume and frequency and decrease urine specific gravity Elderly: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