Islamic University of GazaIslamic University of Gazafaculty of Nursingfaculty of Nursing

Chapter (11)Chapter (11)Assessment of Urinary SystemAssessment of Urinary System

ObjectivesObjectives

Anatomy and PhysiologyAnatomy 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 Lie between T11/T12 and L3. The right kidney

some 1 or 2cm lower than the left.some 1 or 2cm lower than the left.• Surrounded by fat which helps protect the Surrounded by fat which helps protect the

kidneys from trauma and anchor them in place. kidneys from trauma and anchor them in place.

BladderBladder• Bladder sits behind the pelvis (15o Bladder sits behind the pelvis (15o

caudal angle needed to x-ray it)caudal angle needed to x-ray it)• Ureters enter the bladder obliquely in the Ureters enter the bladder obliquely in the

trigone, which creates a natural seal trigone, which creates a natural seal when the bladder fills.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 Urethra: 4cm in females and 15 to 20 cm

in males. in males.

Blood flow Doppler

Subjective dataSubjective data• Pain Pain • FeverFever• Burning sensationBurning sensation• UnureaUnurea• DisureaDisurea• Family historyFamily history• StoneStone• Past historyPast history• HematureaHematurea• UrgencyUrgency• FrequencyFrequency• OligureaOligurea• DMDM• HTNHTN

Objective DataObjective Data

• Normal voiding patternNormal voiding pattern

• Appearance of the urineAppearance of the urine

• TumorTumor

• CultureCulture

Preparation for Urinary System Preparation for Urinary System AssessmentAssessment

• EquipmentEquipment

• stethoscope stethoscope

• Sphygmomanometer Sphygmomanometer

• DrapesDrapes

• Specimen cup to collect urine sampleSpecimen cup to collect urine sample

Physical Assessment of Urinary SystemPhysical Assessment of Urinary System

TechniquesTechniquesInspection – Auscultation- Percussion- Inspection – Auscultation- Percussion-

PalpationPalpation• Inspection including examination of abdomen Inspection including examination of abdomen

and urethral meatus.and urethral meatus.• Auscultation including renal arteriesAuscultation including renal arteries• Percussion includes the kidneys to detect Percussion includes the kidneys to detect

tendernesstenderness• Palpation to detect any mass, lumps, Palpation to detect any mass, lumps,

tendernesstenderness

Physical Assessment of Urinary SystemPhysical Assessment of Urinary System

Percussion of the kidneyPercussion of the kidney

To detect areas of tenderness by To detect areas of tenderness by costovertebral test, normally will feel a costovertebral test, normally will feel a thudding sensation or pressure but not thudding sensation or pressure but not tendernesstenderness

PalpationPalpation

• Contour, size, tenderness, and lump.Contour, size, tenderness, and lump.

• In adult normal the kidneys not be palpable In adult normal the kidneys not be palpable because of their location deep with abnormal.because of their location deep with abnormal.

• Elderly the right kidney is slightly lower than the Elderly the right kidney is slightly lower than the left, it may be easier to palpate left, it may be easier to palpate

Percussion and palpation of the bladderPercussion and palpation of the bladder

• Percuss the area over the bladder (5cm) above the Percuss the area over the bladder (5cm) above the symphysis pubis.symphysis pubis.

• To detect difference in sound, percuss toward the To detect difference in sound, percuss toward the base of the bladder.base of the bladder.

• Percussion normally produces a tympanic soundPercussion normally produces a tympanic sound

Palpation of bladderPalpation 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 meatusInspection of the urethral meatus• Look for Look for

• SwellingSwelling

• DischargeDischarge

• And inflammation And inflammation

UrineUrine• 95% Water, 5% solutes95% Water, 5% solutes• Urea from breakdown of amino acids Urea from breakdown of amino acids

(protein) to give ammonia + C02 giving urea(protein) to give ammonia + C02 giving urea• Creatinine from breakdown of creatine Creatinine from breakdown of creatine

phosphate in musclephosphate 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

Assessment of UrineAssessment of Urine

•Measure volume of Measure volume of urineurine•Inspect colour, Inspect colour, clarity, and volumeclarity, and volume•Test the specific Test the specific gravity, glucose, gravity, glucose, ketone bodiesketone bodies•Blood and pH Blood and pH

Assessment of UrineAssessment of Urine• The other consist of solutes (chemicals The other consist of solutes (chemicals

that are dissolved in the water)that are dissolved in the water)• These solutes are the result of normal These solutes are the result of normal

biochemical activity within the cells of biochemical activity within the cells of the body such as urea, creatinine, the body such as urea, creatinine, phosphates, sulfates and uric acid.phosphates, sulfates and uric acid.

• Other solutes may be due to chemicals Other solutes may be due to chemicals that originated outside of the body, such that originated outside of the body, such as pharmaceutical drugsas pharmaceutical drugs

• normal urine volume 1-2 litter per 24 normal urine volume 1-2 litter per 24 hours (normal adult)hours (normal adult)

Assessment of UrineAssessment of Urine• Color: typically yellow-straw but varies according to Color: typically yellow-straw but varies according to

recent diet and concentration of the urine. Drinking recent diet and concentration of the urine. Drinking more water generally tends to reduce the more water generally tends to reduce the concentration of the urine and therefore cause it to concentration of the urine and therefore cause it to have a lighter color. (The converse is also true.)have a lighter color. (The converse is also true.)

• Smell: Generally fresh urine has a mild smell but Smell: Generally fresh urine has a mild smell but aged urine has a stronger odor, similar to that of aged urine has a stronger odor, similar to that of ammonia.ammonia.

• The smell urine may provide health information. The smell urine may provide health information. For example, urine of diabetics may have a sweet or For example, urine of diabetics may have a sweet or fruity odor due to the presence of ketones. fruity odor due to the presence of ketones.

• Acidity :PH is a measure of the acidity ( or Acidity :PH is a measure of the acidity ( or alkalinity0 of a solution. PH is a measure of the alkalinity0 of a solution. PH is a measure of the activity of hydrogen ions (H+) in a solutionactivity 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 A typical average being around 6.0 Much of the variation is due to diet. For example, the variation is due to diet. For example, high protein diets result in more acidic high protein diets result in more acidic urine, but vegetarian diets generally result in urine, but vegetarian diets generally result in more alkaline urine.more alkaline urine.

• Density ; Density is also known as “ specific Density ; Density is also known as “ specific gravity”. This is the ratio of the weight of a gravity”. This is the ratio of the weight of a volume of a substance compared with the volume of a substance compared with the weight of the same volume of distilled weight of the same volume of distilled water. Density of normal urine is in the water. Density of normal urine is in the range 1.005- 1.020.range 1.005- 1.020.

Diagnostic TestsDiagnostic Tests

to determine urinary tract disease or disorders of to determine urinary tract disease or disorders of other body systems influencing the production other body systems influencing the production of urineof urine

1.1. UrinalysisUrinalysis2.2. Urine cultureUrine culture3.3. Radiographic examinations ; kidney, Ureter and Radiographic examinations ; kidney, Ureter and

Bladder (KUB) AND Intravenous Pyelogram Bladder (KUB) AND Intravenous Pyelogram (IVP).(IVP).

4.4. CystoscopyCystoscopy5.5. Blood testsBlood tests

Diagnostic Studies of the Urinary Diagnostic Studies of the Urinary SystemSystem

• Urine StudiesUrine Studies– UrinalysisUrinalysis– Creatinine clearanceCreatinine clearance– Urine culture (clean catch midstream)Urine culture (clean catch midstream)– Concentration testConcentration test– Residual urineResidual urine– Protein determinationProtein determination– Urine cytologyUrine cytology

Diagnostic Studies of the Urinary Diagnostic Studies of the Urinary SystemSystem

• Blood ChemistriesBlood Chemistries– BUNBUN– CreatinineCreatinine– Uric acidUric acid– SodiumSodium– PotassiumPotassium– CalciumCalcium– Phosphorus Phosphorus – bicarbonatebicarbonate

Diagnostic Studies of the Urinary Diagnostic Studies of the Urinary SystemSystem

• Radiologic ProceduresRadiologic Procedures

– Kidneys, ureters, bladder (KUB)Kidneys, ureters, bladder (KUB)

– IVP or excretory urogramIVP or excretory urogram

– NephrotomogramNephrotomogram

– Retrograde pyelogramRetrograde pyelogram

Diagnostic Studies of the Urinary Diagnostic Studies of the Urinary SystemSystem

• Radiologic ProceduresRadiologic Procedures

– CystogramCystogram

– Renal arteriogram (angiogram)Renal arteriogram (angiogram)

– UltrasoundUltrasound

– CT scanCT scan

– MRIMRI

Consider the Developmental StagesConsider the Developmental Stages

• Pediatric:Pediatric: (difficulties, crying, change in urinary in (difficulties, crying, change in urinary in

childhood).childhood).• Pregnant:Pregnant:Pain during urination, normal increase urine in Pain during urination, normal increase urine in

volume and frequency and decrease urine volume and frequency and decrease urine specific gravityspecific gravity

• Elderly:Elderly:How much and how type of liquid do you drink How much and how type of liquid do you drink

in the evening? do you ever lose of control of in the evening? do you ever lose of control of your bladder your bladder

QuestionsQuestions