Assessment of the

Urinary Tract
Systems
 Excellentcommunication skills
 Use language the patient can understand
 Avoid medical jargon
 Review risk factors
Health History
 Reason for seeking health care, onset, and it’s
effect on the patient’s quality of life
 Location, character, duration of pain, its
relationship to voiding , precipitate pain, and those
that relieve it.
 History of UTI, past treatment or hospitalization
 Fever or chills
 Previous renal or urinary diagnostic tests or use of
indwelling urinary catheters
Health History
 Dysuria and when during voiding it occurs
 Hesitancy, straining, or pain during or after
urination.
 Urinary incontince (stress incontinance, urge
incontinance, overflow incontinance, or
functional incontinance)
 Hematuria or charge in color or volume of
urine
 Nocturia and its date of onset
Health History
 Renal calculi , passage of stones in urine
 Female patients: number and type of deliveries;
use of forceps; vaginal infection, discharge, or
irritation; contraceptive practices
 History of anuria or other renal problem
 Presence or history of genital lessions or sexually
transmitted disease
 Use of tobacco, alcohol, or recreational drugs
 Any prescription and over the counter medications
Common Symptoms
 Pain , is usually causes by distention of some portion
of the urinary tract as a result of obstructed urine flow
or inflammation and sweelling tissue.
 Changing in voiding. Common problems :
- frequency, urgency, dysuria, hesitatency,
incontinence, enuresis, polyuria, oliguria, and
hematuria.
 GI symptoms, because shared autonomic and sensory
innervetion and renointestinal reflexes
 Unexplained anemia
Past Health, Family, and Social
History
 History of diabetes
 Hypertension → risk for renal dysfunction
 Older men are at risk for prostatic enlargement →
urethral obstruction → urinary tract infections and
renal failure
 Genetics
 Assess the patient’s psychosocial status, level of
anxiety, perceived threats to body image, available
support system, and sociocultural patterns
Physical Assessment
 Skin assessment with abnormal findings
- inspect the skin and mucous membranes, noting
color, turgor, and excretions.
1. Pallor : resultant anemia
2. change in turgor : either excess fluid loss or
retention
3. Edema : fluid volume excess
- uremic frost : client with untreated renal failure
Physical Assessment
 Abdominal assessment with abnormal findings
- inspect the abdomen, noting size, symmetry, masses or
lumps, swelling, prominent veins, distention, glistening,
or skin tightness
1. Enlargement or asymmetry : hernia or
superficial mass
2. Prominent veins : renal dysfunction
3. Distention, glistering, or skin tightness : fluid
retention
4. Ascites
Physical Assessment
 Urinary Meatus Asseesment with Abnormal
findings
- increased redness, swelling, or discharge may
indicate infection or sexually transmitted disease
- ulceration = sexually transmitted disease
- deviation of meatus from the midline : a
congenital defect
 Physical Assessment
 Kidney assessment with abnormal findings
- Auscultate
1. Systolic bruits : renal artery stenosis
- Percuss the kidney
tenderness and pain on percussion of the costovertebral angle
suggest glomerulonephritis
- Palpate the kidney
1. A mass or lump may indicate a tumor or cyst
2. Tenderness and pain : inflammatory process
3. A soft kidney that feels spongy : CKD
4. Bilaterally enlarged kidney : polycystic kidney disease
5. Unequal kidney size : indicate hydronephrosis
Physical Assessment
 Bladder assessment with abnormal findings
- Percuss the bladder for tone and position
1. A dull percussion tone over the bladder
of a client who just urinated may indicate
urinary retention.
- Palpate the bladder for distention
Physical Assessment
 Urethral
- In women, the vulva, urethral meatus, and vagina
are examined
- any types of herniation
- asked to cough and perform a valsava manuever
to assess the urethra’s system of muscular and
ligament support.
- inspect for the presence of urethral or vaginal
discharge
Physical Assessment
- In men
a. inspect the perineum and groin are for
manifestation of skin irritation or excoriation
b. examine gland meatus
c. examine for phimosis
Diagnostic
Evaluation
Urinalysis and Urine Culture
 Urine culture
 Urine clarity and odor
 Urine PH
 Test to detect protein, glucose, and ketone
bodies in the urine
 Microscopic examination of the urine
sediment to detect RBSc ( hematuria), white
blood cell, casts , crystal, and bacteria
Urine color Possible cause
Colorless to pale yellow Dilute urine due to diuretics, alkohol
consumption, diabetes insipidus,
glycosuria, excess fluid intake, renal
disease
Yellow to milky white Pyuria, infection, vaginal cream
Bright yellow Multiple vitamin preparation
Pink to red Hb breakdown, RBC, menses, bladder or
prostate surgery, medications ( phenytoin),
rifampin
Blue, blue green Pseudomonas species organism,
medications ( amitriptyline HCL)
Orange to amber Concentrated urine due to dehydration,
fever; ecxess bilirubin or carotene,
medications ( pyridium, furadantin)
Brown to black Old RBC, bilirubin, extremely
concentrated urine due to dehydration,
medications (iron, quinine,
 Specific gravity
- measures the density of a solution compared to
the density of water
- specific gravity is altered by the presence of
blood, protein, and casts in the urine.
- normal 1.010 to 1.025
 Osmolality
- to measure of the kidney’s ability to dilute and
concentrate urine.
 Renal function tests
- to evaluate the severity of kidney disease and to
assess the status of the patient’s kidney function
- include: renal concentration tests, creatinine
clearance and serum creatinine and blood urea
nitrogen levels.
 Test Purpose
Renal concentration tests
Specific gravity Evaluates ability of kidneys to concentrate
solute in urine
Urine osmolality to measure of the kidney’s ability to dilute
and concentrate urine
These findings may disclose early defects
in renal function
24- hour urine test
Creatinine cleareance detect and evaluates progression of renal
disease
Serum tests
Creatinine level Measures effectiveness of renal function.
Blood urea nitrogen (BUN) Index of renal function
BUN to creatinine ration Evaluated hydration status
Diagnostic Imaging
 Kidney, ureter, and bladder studies
- to delineate the size, shape, and position of the kidney
- to reveal urinary system abnormalities
 General USG
- to detect abnormalities of internal tissue and organs
- abnormalities such as fluid accumulation, masses,
congenital malformations, change in size, and
obstruction
 Bladder USG
- measuring urine volume in the bladder
- indicated for urinary frequency, inability to void after
removal of an indwelling urinary catheter
- assessment of need for catheterization during the initial
stages of an intermittent catheterization training program.
 Computed Tomography and Magnetic Resonance
Imaging
- noninvasive techniques that provide excellent
cross-sectional views of anatomy of the kidney
and urinary tract.
- used to evaluate genitourinary masses,
nephrolithiasis, chronic renal failure , renal or
urinary tract trauma, metastasis disease, and soft
tissue abnormalities.
 Nuclear scans
- use to evaluate acute and chronic renal failure,
renal masses, and blood flow before and after
kidney transplantation.
 IV urography ( IVP, excretory urography)
- used as the initial assessment of many suspected
urologic condition , especially lesions in the
kidney and ureters.
- provided an approximate estimate of renal
function
 Retrograde pyelography
- is used infrequently because of improved techniques in
excretroty urography
 Cystography
- aids in evaluating vesicoureteral reflux ( black-flow of
urine from bledder into one or both ureters)
- assessing for bladder injury
 Voiding cystourethrography
- uses fluoroscopy to visualize the lower urinary tract
and assess urine storage in the bladder.
 Renal angiography
- Provides an images of the renal arteries
 Urologic Endoscopic Procedures
- Cystoscopic examination is used to directly visualize the
urethra and bladder
 Biopsy
1. Renal and Ureteral Brush Biopsy
- to obtain cells and surface tissue fragments for
histologic analysis
2. Kidney biopsy
- help diagnose and evaluate the extent of kidney disease.