NSB103 Health Assessment PDF

NSB103 Health Assessment Urinary and renal health assessment. Prepared and presented by Dr Helen Donovan Kind acknowledgments for contributions to renal and genito urinary slides by Dr Pauline Gillan....

NSB103 Health Assessment Urinary and renal health assessment. Prepared and presented by Dr Helen Donovan Kind acknowledgments for contributions to renal and genito urinary slides by Dr Pauline Gillan. 1 Overview of this lecture Anatomy & Genitourinary system physiology Renal system Health Subjective Assessment Objective Clinical Health Assessment Reasoning Health problems and goals. Cycle 2 Genito urinary System Renal/urinary system + Reproductive systems Kidneys Ureters Urinary bladder Urethra Reproductive organs 3 Female genito urinary anatomy 4 Male genitourinary anatomy Penis; scrotum; testes; spermatic cord Urethra; prostate gland (normal enlargement) Urinary bladder, ureters, kidney. 5 Female external genitalia. 6  The Renal System Functions of the renal system: Fluid and volume regulation Electrolyte balance Acid base regulation Removal of toxins https://www.mycanceriq.ca/Cancers/Kidney Calcium and phosphate homeostasis Red blood cell maturation via erythropoeitin (EPO) 7 Overview of the Renal System 8 Physiology and the kidney. 9 https://naturalscience2.wordpress.com/excretory-system/  Urinary Elimination Urinary Bladder capacity 15 – 50 ml at birth Adult : 500 – 800 mls. Urge to urinate at about 200 mls Assessment urination How often (frequency) How much (volume) Colour (concentration) Odour Consistency Pain Continence https://courses.lumenlearning.com/cuny-kbcc-ap2/chapter/regulation-of-renal-blood-flow/ Specific Gravity 10 Problems with the urinary system. Mechanical Injury (kidney) Loin pain Infection and inflammation Blockage due to: strictures tumours renal calculi. Iatrogenic injury in error. 11 Normal Ranges 12 https://www.pathology.med.umich.edu/static/apps/handbook/Tables/UA.pdf  Subjective Questions – genito urinary system. Gain informed consent prior to the assessment. Use the stages joining, working and termination. Female Male Menstrual History Urinary frequency, urgency, nocturia. Obstetric history Dysuria Menopause Hesitancy and straining Self-care behaviours Prostate- urinary retention Urinary symptoms Nocturia Incontinence (urgency, stress, overflow) Haematuria Burning, frequency, small amounts Polyuria Vaginal discharge Loss in force of stream Incontinence Dysuria – painful urination Past history Urine colour Loin/flank pain Self-care behaviours Suprapubic pain Breast self examination Past genitourinary history Testicular self examination Penis, pain lesions discharge Screening – faecal occult blood; mammogram Scrotum – testicular self examination Sexual activity Sexual activity and contraception use Contraceptive use STI contact STI contact  Objective Renal System Assessment (urine only) Other assessments. ‘Ward’ urine testing – nurse Ultra sound/ CT scans/MRI Microscopic urine examination 24 hour collection of urine Blood pathology tests for system infection Surgical investigative procedures Biopsies of tissues and stones. Urethroscopy (cystoscope) 14 Urine output assessment. Objective Data. Review baseline assessment data Perform hand hygiene Colour: straw coloured Comfort/Privacy/Explain procedure Abnormal: Blood stained? Approach from right hand side of patient; (Haematuria) position supine if possible Dark? (Concentrated) Measure urine output Consistency: clear If IDC- check patency Abnormal: Sediment Observe urine for colour, offensive smell or Smell: non offensive presence of sediment Abnormal: pungent smell Perform urinalysis Volume. Assess fluid volume status (Fluid Balance Chart) Blood clots in the urine Determine frequency of renal assessment based on patient's condition 15 Urine collection methods for investigation. Indwelling catheter Mid stream specimen Intermittent Catheterisation 16  The Role of Urinalysis in Renal Assessment Purpose: Determine the constituents of the urine; Determine the presence of abnormalities Test for: Specific Gravity pH Leucocytes Microscopic blood Nitrites Ketones https://www.medicinenet.com/urinalysis/article.htm Bilirubin Urobilinogen Protein Glucose 17 (Watt, 2017) https://lifeinthefastlane.com/investigations/urinalysis / Urine Colour and odour : hydration levels and haematuria Dark and cloudy: test for blood Frank blood = red: test for blood Fluid Balance Chart Intake and output of food substances and fluid (vomitus, urine, wound drainage) and faecal output. Must be accurate and constantly kept up to date. Ongoing management is based on the accuracy of the Fluid Balance Chart Looking for a positive balance Balance the Fluid Balance Chart to show input and output ratios. Should always have more in that out. Insensible loss ie breathing, sweating. 19  Consider the person and the context. Who is the person? Where are they living? Who supports them? What is their experience? Present, past, family history. Collect Cues and Information. Subjective and objective Data Processing the Information. Compare the data against normal parameters. Analyse, organise, categorising. Identify potential health issues/problems. Relate back to the data for relevance and direction. Set goals in collaboration with the person and their family Each goal is aligned with each potential health issue or problem. 20 Potential Health Problems related to the Genito-Urinary &/or Reproductive System Goal: to improve activity levels by reducing the pain experienced. Activity intolerance related to pain (dysuria) Disturbed body image related to mastectomy Burning Pain during micturition Some goals can Disturbed sleep patterns related to pain and address 2 issues. urinaty tract infection Goal: to reduce Fatigue related to disturbed sleep fatigue levels by reducing sleep Self care deficit due to severe interference with disturbance from activities (loin pain &/or chronic renal disease) pain Discomfort related to contraction of an STI. Reduced skin integrity related to the contraction of an STI If the cause of your health care problem is described Stress related to health literacy deficits clearly, then it is easy to see what changes are needed. Reduced well being related to retention of urine Here the person cannot purchase food due to an activity intolerance from the pain they experience. 21 Bibliography. A & P 2. Human Development (updated 11/10/05). Intro Biology 1. http://faculty.southwest.tn.edu/rburkett/A&P2_reproductive_system_lab.htm accessed 20/3/2012. Crisp, J. & Taylor, C. 2009. Potter and Perry’s Fundamentals of Nursing. 3 rd Ed. Mosby. Elsevier. Crisp, J., Taylor, C., Douglas, C. & Rebeiro, G. 2013. Potter and Perry’s Fundamentals of Nursing. 4 th Ed. Mosby. Elsevier Estes, M., Calleja, P., Theobald, K. and Harvey, T. 2013. Health Assessment and Physical Examination. Cengage Learning. Fraser, D. and Cooper, M. (2009) Myles Textbook for Midwives 15th ed. Churchill Livingstone : Sydney. Henderson,C. & Macdonald, S. (eds) (2004) Mayes’ Midwifery – A textbook for midwives. Baillière Tindall: London. Learn paediatrics. Normal Sexual Maturity Rating. http://learnpediatrics.com/body-systems/endocrine-system/normal-sexual- maturity-rating/ Tanner’s Stages Mayes Midwifery. 2011. 14th Ed. Editors. Macdonald, S. and Magill-Cuerden, J. Baillaire Tindall. Elsevier. Pairman, S., Pincombe, J., Thorogood, C. &Tracy, S. (2006) Midwifery Preparation for Practice. Sydney: Churchill Livingstone. Wilson,S. & Giddens, J. 2009. Health Assessment for Nursing Practice. 4th Edition. Mosby Elsevier. 22