Nursing Assessment of client with Urinary System disorder

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STRUCTURES OF URINARY SYSTEM

The urinary system consists of :

– Two kidneys which filter waste products from the blood , such as water and salts .

– The kidneys produce urine which passes down the ureters in a wave-like motion .

– There is one ureter connected to each kidney and these carry urine down into the bladder where the urine is stored .

– There is one ureter connected to each kidney and these carry urine down into the bladder where the urine is stored .

– The urine then passes down the urethra to the outside .

Clinical Manifestation of urinary dysfunction

The following symptoms and signs are suggestive of urinary tract disease :

1 – Pain

2 – Change in micturation

3 – Gastrointestinal symptoms

1- Pain :

–  Kidney pain may be felt as a dull ache in the costovertebral angle (the area formed by the rib cage and vertebral column) and may be spread to the umbilicus .

–  Urethral pain produces pain in the back that radiates to the abdomen, upper thigh , testis , or labium .

– Flank pain ( the side between the ribs and ilium ) radiating to the lower abdomen or epigatrium and often associated with nausea , vomiting & paralytic ileus may indicate renal colic .

–  Bladder pain ( low abdominal pain or pain over suprapupic area ) can be due to an overdistended bladder or bladder infection .

– Tenesmus (painful straining ) .

– Terminal dysurea ( pain at the end of voiding ) .

–  Pain at the urethral meatus occurs with irritation of the bladder neck or urethra due to infection (urethritis), trauma or a foreingbody in the lower urinary tract .

– Sever pain in the scrotal region result from inflammation and edema of the epididymus or testicle or from torsion of the testicle .

– Perineal and rectal fullness and pain signal acute prostatitis or prostatic abscess .

– Back and leg pain may be due to metastasis of cancer or prostate to pelvic bone .

– Pain in the penile shaft may originate from urethral problems.

– Pain in the glans penis usually due to prostatitis .

2- Change in micuration ( voiding ) :
– Normal micturation is a painless function occurring 5 – 6 times/day and occasionally once at night .
– The average person void :  ( 1200-1500 ml of urine in 24 hours )

Urinary frequency:
– Is voiding that occurs more often than usual . It may result from ( infection , disease of urinary tract , metabolic disease , hypertension , and medication ( diuretic ) .

Urgency:
– Strong desire to void , may be due to inflammatory lesions in the bladder, prostate, or urethra, acute bacterial infection,chronic prostatitis in men , chronic posterior urethrotrigonitis (inflammation of urehra & trigone of bladder of the women).

Burning on micuration:
Seen in patients with urethral irritation or bladder infection.
Urethritis :
– Causes burning during act of voiding .
Cystitis :
– Produce burning both during and after urination .

Dysurae :
– Painful or difficult voiding .
Hesitancy :
– Undue delay & difficulty in initiating voiding . May indicate compression of urethra or neurogenic bladders or outlet obstruction .

Nocturia :
– Excessive urination at night .suggests decreased renal concentration ability, heart failure, diabetes mellitus, or poor bladder emptying .

Urinary incontinence:
– Involuntary loss of urine, may result from injury of the external urinary sphincter, or sever urgency from infection .

Stress incontinence:
– Intermittent leakage of urine due to sudden strain results from weakness of the sphincteric mechanism .
Enuresis :
– Involuntry voiding during sleep is physiologic to the age of 3 years .
After this it may be functional or symptomatic of obstructive disease, diuretics or excessive fluid intake .

Polyurea :
– A large volume of urine voided in a given time . May be due to diabetes mellitus, diabetes insipidus ,chronic renal disease, diuretic, or excessive
fluid intake .

Oligurea :
– A small volume of urine :
output between 100-500 ml/24 hours .
Anurea :
– Absence of urine in the bladder .
– output less than 50 ml/24 hours , indicate a serious renal dysfunction requiring immediate medical intervention

Complete absence of urine is usually indicative of complete obstruction of the urinary tract .

Hematurea :
– Red blood cells in the urine . It may indicate cancer of the genitourinary tract, acute glumerulonephritis , renal tuberculosis .
– The color of bloody urine is dependent upon pH of urine & amount of blood present :
– Acid urine a dark, smoky color
– Alkaline urine red

Proteinuria :
Albuminuria , abnormal amounts of protein in the urine is seen in all forms of acute & chronic renal disease .

Gastrointestinal symptoms:

– Gastrointestinal symptoms may occur with urologic conditions .
– The anatomical relation of the right kidney to the colon, duodenum, head of the pancrease, common bile duct , liver & galll bladder may cause Gastrointestinal disturbances .

– The proximity of the left kidney to the colon ( splenic flexure ), stomach, pancrease, spleen may also result in intestinal symptoms .

These may include:
– Nausea, vomiting, diarrhea, abdominal discomfort , parlytic ilues , GIT hemorrhage .
– Appendicitis also may be accompanied by urinary symptoms .

Some of the renal or urinary system focused questions

Ask patients include:

– Do you urinate more than usual ?  (frequency, urgency, nocturia)

– Any pain or burning upon urination?

– Any difficulty during or after urination ?

– Any blood in urine ?

– Any difficulty controlling your urine ?

PHYSICAL ASSESSMENT Of patients with Urinary System Disorder

– By direct palpation , determine the size and mobility of the kidney

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– With the patient in supine position, place one hand under the patient’t back so the fingers are clear of the lower ribs. The other hand ( palm down ) is located anterior to the kidney, with the fingers just above the level of umbilicus.

– Renal diseases may produce tenderness over the costovertebral angles (the 12th rib at the costovertebral angle on the person’s back ).

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– In a rectal examination in the male, the prostate gland may be palpated digitally as apart of the study of urinary difficulty
– The inguinal area is examined for enlargled nodes, an inguinal of femoral hernia and varicocele .

– In women the vulva, urethra and vagina are examined .

Inspection

– Client’s general appearance .

– The client’s hydration status and skin color provide data about the function of the urinary system.

– Assess skin turgor for dehydration, which may accompany diabetes or diuretic use.

– Inspect urine specimen for color and odor.

Urine – dipstick tests

– A dipstick test is a test when a special chemically treated stick is dipped into urine to check for levels of sugar, blood and keton .

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