Professional Documents
Culture Documents
SYSTEM
ANATOMY
THE URINARY SYTEM
The excretory (GUT)
system includes the
kidney, ureters,
urinary bladder,
urethra and the male
and female genitalia
Kidneys, Ureters, and
Bladder
Ma le Anatomy
Female Anatomy
The Kidney
• Two bean-shaped organs that lie in the
retroperitoneal space on either side of
the vertebral column at the level of T12
to L3
• Adrenal glands located on top of each
kidney surrounded by capsule and fats
• Right is lower than the left
• Each kidney is composed of:
- Renal parenchyma, Renal sinus and
pelvis and Nephrons
Kidney: Major Functions
Nursing History
Reason for seeking care
Current illness
Previous illness
Family History
Social History
Sexual history
GU T Asse ssm ent
Health History
• Presenting Problem: symptoms may
include
1. Pain in flank, groin; dysuria
2. Changes in urination patterns:
frequency, nocturia, hesitancy of
stream, urgency, dribbling,
incontinence, retention
GU T Asse ssm ent
Health History
• Presenting Problem: symptoms may
include
3. Changes in urinary output: polyuria,
oliguria, anuria
4. Changes in color/consistency of
urine: dilute, concentrated, malodorous;
hematuria, pyuria
GU T Asse ssm ent
Health History
Lifestyle:
- Occupation (type of employment,
exposure to chemicals such as carbon
tetrachloride, ethylene glycol)
- Level of activity
- Exercise
• Nutrition/Diet: water, calcium, dairy
product intake
GU T Asse ssm ent
Health History
Past Medical History
- Hypertension, diabetes mellitus, gout,
cystitis, kidney infections, connective
tissue diseases (SLE), infectious
diseases, drug use (prescribed/OTC);
previous catheterizations,
hospitalizations, or surgery for renal
problems
GU T Asse ssm ent
Health History
Family History
- Hypertension, diabetes mellitus, renal
disease, gout, connective tissue
disorders, urinary tract infections (UTIs),
renal calculi
GU T Asse ssm ent
Physical Examination
Inspect skin for color, turgor, and
mobility; purpuric lesions, integrity
Inspect mouth for color, moisture, odor,
ulcerations
Inspect abdomen, and palpate bladder
for distension; percuss bladder for
tympany or dullness (if full)
GU T Asse ssm ent
Physical Examination
Inspect face for edema, particularly
periorbital edema
Inspect extremities for edema
Determine rate, rhythm, and depth of
respirations
Inspect muscles for tremors, atrophy
GU T Asse ssm ent
Physical Examination
Palpate right and left kidneys for
tenderness, pain, enlargement; percuss
costovertebral angles for
tenderness/pain; first percuss kidneys
for tenderness/pain
Palpate flank area for pain
Auscultate aorta and renal arteries for
bruits
GUT Assessment
PHYSICAL EXAMINATION
Inspection
Auscultation
Percussion
Palpation
GUT Assessment
Key Signs and Symptoms of
Urological Problems
EDEMA
associated with fluid retention
renal dysfunctions usually
produce ANASARCA
check for weight daily ( weight
increase of 1 Kg = 1 Liter of fluid
retained)
GUT Assessment
Urinary Retention
Urinary Frequency
GUT Assessment
Irritation
Dysuria
Frequency
Urgency
Nocturia
Strangury
GUT Assessment
Obstruction
Weak Stream
Hesitancy
Terminal Dribbling
Incomplete emptying
GUT Assessment
Pain
Flank or lumbar
Inguinal or iliac
Initiation of voiding
End of voiding
GUT Assessment
Uri ne Changes
Pneumaturia
Proteinuria
Ketonuria
Glycosuria
Hematuria
GUT Assessment
Incontinence
Stress
Urge
Overflow
Total
Mixed
Enuresis
LAB OR ATO RY
DIA GNO STI CS
GUT: LABORATORY
DIAGNOSTICS
Urine Studies:
• Urinalysis: examination to assess the
nature of the urine produced
- evaluates color, pH and specific gravity
- determines presence of glucose
(glycosuria), protein (proteinuria), blood
(hematuria), ketones (ketonuria)
- analyzes sediment for cells (presence of
WBC called pyuria), casts, bacteria, crystals
Urine Specimen
GUT: LABORATORY
DIAGNOSTICS
Urine Studies:
1. Urinalysis: Interventions
- Wash perineal area & use a clean container
- Obtain 10 to 15 mL of the first morning
sample
- Specimen should be examined within 1 hour
of voiding. Note that refrigerated samples may
alter the specific gravity
- If the client is menstruating, indicate this on
Urine Specimen
Collection of Urine
Specimen
Clean catch (midstream) urine specimen
A. Cleanse perineal area
1. Females: spread labia and cleanse
meatus front to back using antiseptic sponges
2. Males: retract foreskin (if uncircumcised)
and cleanse glans with antiseptic sponges
B. Have client initiate urine stream then stop
C. Collect specimen in a sterile container
D. Have client complete urination but not in
specimen container
Collection of Urine
Specimen
24-hour urine specimen
- Preferred method for creatinine clearance test
INTERVENTIONS:
- Have client void and discard specimen; note
time
- Collect all subsequent urine specimens for 24
hours
- If specimen is accidentally discarded, the test
must be restarted
- Record exact start and finish collection; include
date and times
Collection of Urine
Specimen