Health Assessment - Urinary System

Renal Failure

Acute Renal Failure - three stages: oliguria, diuresis, and recovery Fluid retention, hyperkalemia, hyperphosphatemia, nausea, vomiting. Uremia is classic hallmark of Chronic renal failure. Anorexia, nausea, vomiting, mentation changes, uremic frost, pruritus, weight loss, fatigue, and edema

Renal Tumor

Benign or Malignant (common) Link with smoking Hematuria, flank pain, weight loss, and palpable mass in flank

Urinary Tract Infection (UTI)

Caused by Bacteria (E.coli) Asymptomatic, urgency, frequency, dribbling, pain on urination, suprapubic/lower back pain. Hematuria, cloudy, foul-smelling

Abnormal findings during assessment of general appearance

Clients with kidney disorders look tired and complain of fatigue. Look for signs of circulatory overload (pulmonary edema) or peripheral edema (puffy face/fingers), or indication of pruritus (scratch marks on skin) Elevated nitrogenous wastes (azotemia) contribute to mental confusion

Do you have any of these neurologic diseases: Multiple sclerosis, Parkinson's disease, spinal cord injury, stroke?

Conditions contribute to the retention and stasis of urine, thus placing the client at risk for chronic urinary infection

Landmarks

Costovertebral Angle (CVA) Rectus abdominis Symphysis pubis

Special consideration when palpating the LEFT kidney

Do not mistake an enlarged spleen for an enlarged left kidney. Enlarged left kidney feels smooth and rounded. An enlarged spleen feels sharper with more delineated edge

Changes in Urinary Elimination

Dysreflexia - spinal cord injuries level T7 or higher, cause potentially life-threatening hyertensive crisis Incontinence - Inability to retain urine Functional, reflex, stress, urger, and total Retention - cannot empty bladder

Special consideration when palpating the RIGHT kidney

Enlarged kidney feels smooth and rounded, whereas an enlarged liver is closer to the midline and has a more distinct border Suspect polycystic kidney disease or carcinoma

Do you have any of these problems: High BP, diabetes, frequent bladder infections, kidney stones?

High BP and diabetes - contribute to renal disease

Abnormal findings during palpation of the kidney and flanks

If client reports hematuria/oliguria, nausea, and vomiting, be alert for hydroureter (complication that occurs when renal calculus blocks and dilates the ureter, causing spasm and pain). May lead to shock, infection, impaired renal function. Seek medical collaboration immediately

The Older Adult

Renal blood flow/perfusion decrease Glomeruli capillary system atrophies More at risk for Hyperkalemia Reduced ability to clear medications and acids, reabsorb bicarbonate and glucose, more susceptible to medication toxicity, effects of respiratory/metabolic acidosis, increased concentration of glucose in urine, and fluid loss Males - Benign prostate hypertrophy Females - Urine leakage, reduced acidity, UTI d/t decrease in estrogen Kidneys are more difficult to palpate Nurse should OMIT blunt percussion

Glomerulonephritis

Inflammation of the glomerulus Hematuria with red blood cells casts and proteinuria

Symphysis pubis

Joint formed by the union of the two pubic bones by cartilage at the midline of the body Below is where the bladder lies, if full the bladder rises above the symphysis pubis

Costovertebral Angle (CVA)

Located on the lower back formed by the vertebral column and the downward curve of the last posterior rib Find the lower poles of the kidney and the ureter

Rectus abdominis

Longitudinal pairs of muscles that extend from the pubis to the rib cage on either side Used as guidelines for positioning hands when palpating the kidneys through the abdominal wall

Do you ever get up at night to urinate?

Nocturia may indicate the presence of aging, cardiovascular changes, diuretic therapy, also the amount and timing of fluid intake

Bladder Cancer

Occurs commonly in males Linked to smoking Asymptomatic, hematuria, flank pain, frequent urination

Abnormal findings during inspection of the kidney and flanks

Protrusion or elevation over a costrovertebral angel occurs when the kidney is grossly enlarged or mass is present

Normal Assessment Findings

Renal arteries without bruits Costrovertebral angel and flanks are symmetric, even in color, non-tender. Kidneys are not enlarged, they are rounded, smooth, firm, and non-tender Bladder is non-palpable, percussion reveals tympani above the pubic symphysis

Renal Calculi

Stones that block the urinary tract Pain, radiate, variable in location and severity Spasms, nausea, vomiting, pain on urination, frequency and urgency of urination, gross hematuria