1. Present by :Dr.Amira Yahia Assessment of Urinary System

3. Introduction Function of the Urinary System: The primary function of the urinary system is to maintain homeostasis Regulate fluids and electrolytes Eliminate waste products Maintain BP Involved with RBC production Involved with bone metabolism 3

4. The main function of urinary system is regulation of the fluid and electrolytes composition of the body fluids and removal of metabolic end products from the blood 4

5. KIDNEY FUNCTIONS Urine formation Excretion of waste products Regulation of electrolytes Regulation of acid-base balance Control of water balance Control BP Regulation of RBC production Synthesis of vitamin D to active form Secretion of prostaglandins Regulation of calcium and phosphorus balance

6. Nursing History: Normal voiding pattern and frequency (oliguria – urinary urgency – poyluria – anuria - dysuria –hematuria - enuresis) Appearance of the urine, urine culture and any recent changes (amount – color). Normal colure yellow-straw Family history of kidney problems (polycystic kidney and all types of hereditary nephritis are genetically transmitted, kidney and bladder calculi 6

7. The present illness such as pain or burning sensation, UTI, an ostomy. Past history and current problems with urination: (syphilis, gonorrhea, sexual transmitted disease STD) DM and HTN. Factors influencing the elimination pattern: Medications: Diuretics, Psychotropic agents, Anti- hypertensive. 7

8. Medical Terms related to urinary system Dysuria: painful or difficult voiding Hematuria: red blood cells in the urine Urgency: strong desired to urinate due to inflammation in bladder, prostate, urethra Polyuria: abnormal large volume of urine voided in given time = 2500ml Oliguria: small volume of urine between 100-500 ml Anuria: absence of urine in bladder less than 50 ml Enuresis: involuntary voiding during sleeping 8

9. Physical Assessment of Urinary System Inspection 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 Percussion of the kidney To detect areas of tenderness by costovertebral test, normally will feel a thudding sensation or pressure but not tenderness 9

10. Palpation of kidney 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. Percussion 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

11. Palpation of bladder Normally feel firm and smooth. In adult bladder may not be palpable Inspection of the urethral meatus Look for swelling, discharge and inflammation Assessment of Urine Urine assessment includes: Measure volume of urine Inspect color, clarity, and volume Test the specific gravity, glucose, ketone bodies and blood and pH Normal urine volume 1-2 litter per 24 hours (normal adult) 11

12. 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. 12

13. Acidity: PH is a measure of the acidity (or alkalinity of a solution). PH is a measure of the activity of hydrogen ions (H+) in a solution. 95% Water, 5% chemical solutes. Urea from breakdown of amino acids (protein) to give ammonia + C02 giving urea and creatinine from breakdown of creatine phosphate in muscle 13

14. Collection of urine samples All urine tests are ideally performed on fresh specimens: Urine container has been adequate protection agonist bacterial contamination and chemical deterioration Identification or labeled should be provided. The patient should then be gowned for the physical examination 14

15. Bring it into the dry room Urine specimens should collect from the patient means of the clean–catch midstream technique. All specimens should be refrigerated as soon as possible they are obtained to avoid shifting of the PH of urine to alkaline because contamination of urea- splitting bacteria from the environment. 15

16. 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? 16

17. Renal/Urinary System Changes Associated with Aging Reduced renal blood flow causing kidney loss of cortical tissue by 80 years of age Thickened glomerular and tubular basement membranes, reducing filtrating ability Decreased tubule length Nocturnal polyuria and risk for dehydration Decreased glomerular filtration rate

18. Diagnostic Tests Blood Tests Serum Creatinine (0.5 – 1.2 mg/dl) Blood Urea Nitrogen (10-20 mg/dl) BUN/Creatinine Ratio (12:1 to 20:1 mass) Urine Tests Urinalysis Urine for C&S Composite (e.g., 24hr) urine collections Creatinine Clearance Test Urine Electrolytes Osmolality (plasma; urine)

19. Diagnostic Tests (cont) Bedside sonography; Bladder scanners Radiographic Examinations Kidneys, Ureter, and Bladder X-ray Intravenous Urography Computed Tomography Cystography and Cystourethrography Other Renal Diagnostic Tests Renal Arteriography (Angiography) Renal Biopsy Renography (Kidney Scan) Ultrasonography

20. Nursing History: Normal voiding pattern and frequency (oliguria – urinary urgency – poyluria – anuria - dysuria –hematuria - enuresis) Appearance of the urine, urine culture and any recent changes (amount – color). Normal colure yellow-straw Family history of kidney problems (polycystic kidney and all types of hereditary nephritis are genetically transmitted, kidney and bladder calculi The present illness such as pain or burning sensation, UTI, an ostomy. Past history and current problems with urination: (syphilis, gonorrhea, sexual transmitted disease STD) DM and HTN. Factors influencing the elimination pattern: Medications: Diuretics, Psychotropic agents, Anti-hypertensive. 20

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