1. Female urinary system
Nurs .230
Dr essmat gemaey
King Saud University

2. Objectives
Upon completion of this session ,the students will be able to:
Describe the anatomy and physiology of the urinary system.
Identify landmarks that guide assessment of the urinary system.
Perform assessment of the urinary system.
Differentiate normal from abnormal findings in physical assessment of the urinary system.

3. Overview of the urinary system
The urinary system is composed of
the kidneys, ureters, bladder, and urethra.
The glomeruli are the filtering units of the kidney and are responsible for removing wastes, toxins, and foreign matter from the blood.
The normal function of the kidneys are
prevents the accumulation of nitrogenous waste,
promotes fluid and electrolyte balance,
assists in maintenance of blood pressure, and contributes to erythropoiesis

6. Equipment Includes An examination gown
Clean nonsterile examination gloves
A stethoscope, and a specimen container.

7. Landmarks
The costovertebral angle is the area on the lower back formed by the vertebral column and downward curve of the last posterior rib.
The rectus abdominis muscles are longitudinal muscles extending from the pubis to the ribs on either side of the midline.
The symphysis pubis is the joint formed by the union of two pubic bones at the midline.

8. Gathering the data
The general questions in the focused interview concern voiding patterns, family history of renal disease, and information about diagnostic testing.
Questions in the focused interview include those related to illness, infection, symptoms, behaviors, and pain.
The subjective data will include hygiene practices, use of medications (especially analgesics), sexual practices, risk factors including smoking, and history of hypertension or diabetes

9. 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 starting or maintaining the stream of urine?
􀀹 Any blood in your urine?
􀀹 Any difficulty controlling your urine?

10. Inspection
client’s general appearance and assessment of mental status.
The client’s hydration status and skin color provide data about the function of the urinary system.
The renal arteries are auscultated for bruits.
The costovertebral angles and flanks are inspected for color, symmetry, and masses.

11. Assess skin turgor for
dehydration, which may
accompany diabetes or
diuretic use.
Palpate abdomen for
bladder distention.
Inspect urine specimen for
color and odor.

12. Posterior Exam
To assess the kidney, assess costovertebral angle tenderness. Using indirect percussion, place one hand over the 12th rib at the costovertebral angle on the person’s back.
Thump that hand with the ulnar edge of the other fist. Normally a thud is felt but no pain.
Sharp pain occurs with an inflamed kidney.

13. Palpation for the kidneys
It should be noted that a kidney does not move discernibly on inspiration and if significantly enlarged, may be bimanually palpable i.e. it can be “bounced” between your hands.
To examine for the kidneys, one hand should be placed on the abdomen and should remain fixed; the other hand is then placed posteriorly, and is used to 'flick' the kidney between your hands.

14. Search for R kidney as L normally not palpable.
Place hand under patient’s R kidney, feel with opposite hand on abdomen (hands in “duck-bill” position) Press 2 hands together firmly, ask pt to take deep breath, you feel no change.
Costo-Vertebral Angle- tenderness
Place ball of hand at CVA, strike it with ulnar surface of right (Sharp pain occurs with inflammation.

15. Palpation technique of kidney

16. Palpation of the costovertebral angle and flanks reveals tenderness or masses.
Blunt percussion at the costovertebral angle produces pain or discomfort in the presence of kidney disease.
The kidneys are not easily palpated except in the presence of enlargement or disease.
The bladder is assessed for distention and surface characteristics.
Percussion above the symphysis pubis is carried out to determine the location and degree of fullness.

17. Costovertebral angle tenderness

18. Abnormal findings
Abnormal findings in the urinary system include bladder cancer, glomerulonephritis, renal calculi, renal tumor, renal failure, and urinary tract infection.
Changes in urinary elimination include dysreflexia, incontinence, and urinary retention.

19. Some terms definitions
caculi
Stones that block the urinary track, usually composed of calcium, struvite, or a combination of magnesium, ammonium, phosphate, and uric acid content in water.
glomerulus
Tufts of capillaries of the kidneys that filter more than one liter (1L) of fluid each minute

20. hematuria Blood in the urine
nocturia Nighttime urination
oliguria Diminished volume of urine. less than 400ml/day
ANNURIA urine output less than 50ml/day
Pyuria presence of pus in urine
Urgency strong desire to urinate
Noctoria excessive urination at night
Incontinence involuntary loss of urine

21. 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 ketene

22. A sample of your urine is taken.
The nurse will stick a small plastic stick with special chemicals at one end into urine.
The stick will change colour at one end, which will check how much sugar, ketone, or blood if any, is present.

23. Thank you