Health Assessment of Urinary System (PDF)

Health assessment of urinary system Prepared By Prof. Wafaa Hassan Abdullah Medical Surgical Nursing Faculty of Nursing Menoufia University 2023-2024 ...

Health assessment of urinary system Prepared By Prof. Wafaa Hassan Abdullah Medical Surgical Nursing Faculty of Nursing Menoufia University 2023-2024  Anatomical structure The kidneys lie retroperitoneal on either side of the vertebral column behind the peritoneum and against the deep muscles of the back. Normally the left kidney is higher than the right because of the anatomical position of the liver. Learning objectives: Upon completion of the lecture , the student will be able to : 1. Identify the purposes of the physical examination. 2. Explain the four techniques used in physical examination: inspection, palpation, percussion, and auscultation. 3. Identify expected findings during health assessment. 4. Verbalize the steps used in performing selected examination procedures: Assessing the Kidney , and bladder 5. Describe suggested sequencing to conduct a physical health examination in an orderly fashion. 8. Demonstrate appropriate documentation and reporting of health assessment. 8/2/2024 Prof. Wafaa Hassan 3 Renal failure Blood vessels attached with urinary system  Examining the urinary system First evaluate your patient’s vital signs, weight, and mental status. These observations can provide clues about renal dysfunction. Health history: Any chronic disease may affect urinary system? Does he/she drink alcohol ―how much-how often- last drink ― Smoking‖ how much- how long- cutting down / stoppage/ cessation  Reading Assignment 10 Specific Urology Terminology  Factors influencing urination Sociocultural Psychological Muscle tone Fluid balance Surgical procedures Medication  Main functions of Genitourinary system Renal pelvis Receives urine Ureters Carry urine from the kidneys to the bladder by peristaltic contractions that occur one to five times per minute Bladder Hollow and muscular Container for urine collection External meatus Passageway for urine (and sperm in men) Aorta Supplies blood to the renal arteries Urethra Carries urine from the bladder to the outside of the body Urine formation Process Glomerular Filteration Selective reabsorption Excretion Polycystic kidney  Inspection of the Abdomen Inspect the abdomen with the patient lying supine. The abdomen should be symmetrical and smooth, flat, or concave. Observe the color and shape of the area around the kidneys and bladder. The skin should be free from lesions, bruises, discolorations, and prominent veins.  Palpating the kidneys Remember: Have the patient lie in a supine position. To palpate Kidneys the right kidney, stand on the patient's right side. normally aren’t palpable Place your left hand between the posterior rib unless they’re cage and the iliac crest and place your right hand enlarged/ or thin on the patient’s abdomen. Instruct the patient to person inhale deeply, so his kidney moves downward. As he inhales, press up with your left hand and down with your right, as shown. To palpate the left kidney, reach across the patient’s abdomen, placing your left hand behind his left flank.  Place your right hand over the area of the left kidney. Ask the patient to inhale deeply again. As he does so, pull up with your left hand and press down with your right.  If the kidneys feel enlarged, the patient may have hydronephrosis, cysts, or tumors. In elderly patients, you may be able to palpate both kidneys because of decreased muscle tone and elasticity.  Palpation to urinary bladder Palpation above symphysis pubis An empty bladder is not palpable. The urinary bladder can be palpated only if it is moderately distended feels like a smooth firm round mass rising out of the Micturition/ Voiding abdomen usually at midline. Reflex  When using Deep palpation? If masses are felt: size, location, shape, consistency, tenderness, pulsation, mobility with respiration or with hand If the patient is obese / rigid use the two hands  Percussion of the kidney Percuss the kidneys to check for costovertebral angle tenderness that occurs with inflammation. To percuss the bladder, first ask the patient to empty it. Then have the patient lie in the supine position. Start at the symphysis pubis and percuss upward toward the bladder and over it. You should hear tympany. A dull sound signals retained urine.  Percussion of the kidney Cont; Have the patient sit up. Place the ball of your nondominant hand on the patient’s back at the costovertebral angle of the 12th rib. Strike the ball of that hand with the ulnar surface of your other hand. Use just enough force to cause a painless but perceptible thud.  Percussion of the urinary bladder Urinary bladder percussion is unnecessary unless there is a suspicion of urinary retention. To percuss the urinary bladder, first ask the patient to empty it to check the residual volume. Then have the patient lie in the supine position. Start at the symphysis pubis and percuss upward toward the bladder and over it. The sound changes from tympanic to dull when percussing over the bladder. Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Percussion of the urinary bladder  The ureter It carries urine from the kidneys to the bladder by peristaltic contractions that occur one to five times per minute  Palpating the prostate gland Have the patient lie on his left side, with his right knee and hip flexed or with both knees drawn toward his chest. Inspect the skin of the perineal, anal, and posterior scrotal areas. It should be smooth and unbroken, with no protruding masses. Lubricate the gloved index finger of your dominant hand and insert it into the rectum.  Tell the patient to relax to ease the passage of the finger through the anal sphincter. If he’s having difficulty relaxing the anal sphincter, ask him to bear down as if having a bowel movement while you gently insert your finger. With your finger pad, palpate the prostate gland on the anterior rectal wall just past the anorectal ring. The gland should feel smooth, rubbery, and about the size of a walnut.  Testicular Self-Examination Testes (or testicles) — these are a pair of egg-shaped glands that sit in the The palpation step of assessment scrotum, on the outside of the body. They is a good time to reinforce methods produce sperm and testosterone, which is for doing a monthly Testicular the male sex hormone. Epididymis this is a Self-Examination highly coiled tube that lies at the back of the testes.  References Weber,R.J,Kelley.H.J(2018):HealthAssessmentinNursing,6thed.Philadel phia:LippincottWilliams&Wilkins Kozier&erb’s.(2016).FundamentalsofNursing,concepts,process,andpra ctice.10th ed. Jarvis, C. (2012) Physical examination & health assessment. 6th Edition, Elsevier Saunders, St. Louis. 8/2/2024 prof. Wafaa Hassan 32 8/2/2024 prof. Wafaa Hassan 33