1. Assessment of Urinary System

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

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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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.

14. 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

15. 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

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

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

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

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

20. 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