Transcript Female urinary system Nurs .230 Dr essmat gemaey

Female urinary system
Nurs .230
Dr essmat gemaey
King Saud University
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.
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
Equipment
Includes
An examination gown
Clean nonsterile examination gloves
A stethoscope, and a specimen container.
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.
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
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?
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.
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Assess skin turgor for
dehydration, which may
accompany diabetes or
diuretic use.
Palpate abdomen for
bladder distention.
Inspect urine specimen for
color and odor.
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. •
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.
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.
Palpation technique of kidney
• 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.
Costovertebral angle tenderness
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.
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
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
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
.A sample of your urine is taken .1
The nurse will stick a small plastic stick .2
with special chemicals at one end into
.urine
The stick will change colour at one end, .3
which will check how much sugar,
.ketone, or blood if any, is present