Health Assessment (Lecture)

STUDENT ACTIVITY SHEET

BS NURSING / FIRST YEAR
Session # 17

LESSON TITLE: The Gastrointestinal and Renal Systems

(Part 2)
LEARNING OUTCOMES: Materials:

Upon completion of this lesson, the nursing student can: Book, pen and notebook, index card/class list

1. Identify the structures and function of the gastrointestinal

and renal systems;
2. Identify the four quadrants and the organs in each
quadrant; References: Bates’ Nursing Guide to Physical
3. Collect an accurate health history of the GI and renal Examination and History Taking (Second Edition)
systems; by Beth Hogan-Quigley, Mary Louise Palm, and
4. Describe the physical examination techniques and the Lynn Bickley.
order performed to evaluate the GI and renal systems.

MAIN LESSON (60 minutes)

The students will study and read Chapter 16 of their book about this lesson:

The Urinary Tract (The students will review about the anatomy and physiologic of the urinary system from their
anatomy book)

Suprapubic Pain
 Disorders in the urinary tract may cause pain in either the abdomen or the back. Bladder disorders may cause
suprapubic pain. In bladder infection, pain in the lower abdomen is typically dull and pressure-like.
 In sudden overdistention of the bladder, pain is often agonizing; in contrast, chronic bladder distention is usually
painless.
 Pain of sudden overdistention accompanies acute urinary retention.

Dysuria, Urgency, or Frequency

 Infection or irritation of either the bladder or urethra often provokes several symptoms. Frequently there is pain on
urination, usually felt as a burning sensation. Some clinicians refer to this as dysuria, whereas others reserve the
term dysuria for difficulty voiding.
 Women may report internal urethral discomfort, sometimes described as a pressure or an external burning from
the flow of urine across irritated or inflamed labia. Men typically feel a burning sensation proximal to the glans
penis. In contrast, prostatic pain is felt in the perineum and occasionally in the rectum.
 Painful urination accompanies cystitis or urethritis.
 If dysuria, consider bladder stones, foreign bodies, tumors; also acute prostatitis. In women, internal burning
occurs in urethritis, and external burning in vulvovaginitis.
 Urinary urgency is an unusually intense and immediate desire to void, sometimes leading to involuntary voiding or
urge incontinence.
 Urinary frequency, or abnormally frequent voiding, may occur. Ask about any related fever or chills, blood in the
urine, or any pain in the abdomen, flank, or back. Men with partial obstruction to urinary outflow often report
hesitancy in starting the urine stream, straining to void, reduced caliber and force of the urinary stream, or
dribbling as voiding is completed.
 Urgency suggests bladder infection or irritation. In men, painful urination without frequency or urgency suggests
urethritis.

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Polyuria and Nocturia
 Polyuria refers to a significant increase in 24-hour urine volume, roughly defined as exceeding 3 liters. It should
be distinguished from urinary frequency, which can involve voiding in high amounts, seen in polyuria, or in small
amounts, as in infection.
 Nocturia refers to urinary frequency at night, sometimes defined as awakening the patient more than once; urine
volumes may be large or small. Clarify the patient’s daily fluid intake.

Urinary Incontinence
 Up to 30% of older patients are concerned about urinary incontinence, an involuntary loss of urine that may
become socially embarrassing or cause problems with hygiene. If the patient reports incontinence, ask:
 When does it happen? How often?
 Do you leak small amounts of urine with increased intra-abdominal
 pressure from coughing, sneezing, laughing, or lifting?
 Is it difficult to hold the urine once there is an urge to void?
 Is a large amount of urine lost?
 Is there a sensation of bladder fullness? Frequent leakage?
 Do you void small amounts of urine but have difficulty emptying the bladder?

Stress Incontinence
 Stress incontinence with increased intra-abdominal pressure suggests decreased contractility of urethral sphincter
or poor support of bladder neck; urge incontinence, if unable to hold the urine, suggests detrusor overactivity;
overflow incontinence, when the bladder cannot be emptied until bladder pressure exceeds urethral pressure,
indicates anatomic obstruction by prostatic hypertrophy or stricture, or neurogenic abnormalities.

Functional Incontinence:
 Functional incontinence may arise from impaired cognition, musculoskeletal problems, or immobility.

Hematuria
 Blood in the urine, or hematuria, is an important cause for concern. When visible to the naked eye, it is called
gross hematuria. The urine may appear frankly bloody.
 Blood may be detected only during microscopic urinalysis, known as microscopic hematuria. Smaller amounts of
blood may tinge the urine with a pinkish or brownish cast.
 In women, be sure to distinguish menstrual blood from hematuria. If the urine is reddish, ask about ingestion of
beets or medications that might discolor the urine.
 Test the urine with a dipstick and microscopic examination before you settle on the term hematuria.

Kidney or Flank Pain; Ureteral Pain

 Disorders of the urinary tract may also cause kidney pain, often reported as flank pain, which is on the side of the
body between the upper abdomen and the back. It may radiate anteriorly toward the umbilicus.
 Kidney pain is a visceral pain usually produced by distention of the renal capsule and typically dull, aching, and
steady. Kidney pain, fever, and chills occur in acute pyelonephritis.
 Ureteral pain is dramatically different. It is usually severe and colicky, originating at the costovertebral angle and
radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or
labium. Ureteral pain results from sudden distention of the ureter and associated distention of the renal pelvis.
Ask about any associated fever, chills, or hematuria.
 Renal or ureteral colic is caused by sudden obstruction of a ureter, for example, from urinary stones or blood
clots.

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CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:

Multiple Choice

1. Patients with bladder disorders may cause pain to occur in which of the following areas
a. Left iliac
b. Right iliac
c. Flank area
d. Suprapubic area

ANSWER:

RATIONALE:

2. In men experiencing prostatic pain the pain may be felt

a. Proximal to the glans penis
b. At the perineum
c. At the suprapubic area
d. Distal to the glans penis

ANSWER:

RATIONALE:

3. Pain associated with a urinary tract infection in a patient is often described as

a. Gnawing pain
b. Stabbing pain
c. Burning pain
d. Searing pain

ANSWER:

RATIONALE: .

4. Usually men who have a urinary tract infection is also suspected to have which of the following coexisting
disease?
a. Prostate cancer
b. Kidney stones
c. Sexually transmitted infection
d. Kidney failure

ANSWER:

RATIONALE:

5. Which of the following beverages is related to having urinary frequency in a patient?

a. Milk
b. Orange juice
c. Smoothies
d. Coffee

ANSWER:

RATIONALE:

6. In men, painful urination without frequency or urgency strongly suggests of which of the following urinary
conditions?
a. Nephritis
b. Urethritis

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 c. Uteritis
d. Cystitis

ANSWER:

RATIONALE:

7. Polyuria refers to a significant increase in 24-hour urine volume which usually exceeds
a. 3 liters
b. 0.8 liter
c. 1.5 liters
d. 2 liters

ANSWER:

RATIONALE: .

8. Which of the following cardiovascular diseases can cause the patient to suffer from nocturia or increased
urination at night?
a. Angina pectoris
b. Coronary artery disease
c. Hypertension
d. Heart failure

ANSWER:

RATIONALE:

9. Urinary incontinence may be experienced by patients during which of the following situations?
a. Coughing
b. Sneezing
c. Laughing
d. All of the above

ANSWER:

RATIONALE:

10. Which of the following best describes ureteral pain?

a. It is a visceral pain that is typically dull, aching, and steady.
b. It is usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into
the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium.
c. It is the pain felt on the side of the body between the upper abdomen and the back. It may radiate
anteriorly toward the umbilicus.
d. It is pain that is felt in the perineum and occasionally in the rectum.

ANSWER:

RATIONALE:

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LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Wrapping Up- Student Reflection:

1. Using 1 whole sheet of paper, your instructor will ask the you to write some key things they were able to get from this
Session and will explain why.
2. After completion of the task, the instructor will randomly call 3-5 representatives from the class to share their input.

*All these must be done giving importance to social, distancing, hygienic practices, and wearing of mask at all times.

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