Assessment of Urinary System

1. I nspection Position: Supine Inspect lower abdomen. A bulge in lower central abdomen may be present if there’s bladder

distention. When bladder contains <500 ml = no bulge present When bladder contains >700 ml = bulge present extending to umbilical region. Not appreciated in obese patients.

Normal: No distention and no bulge Abnormal: Bulging above symphisis pubis

2. Percussion Most reliable in evaluating degree of bladder distention Percuss from umbilicus going downward to symphisis pubis

Normal: Hollow Sound (if bladder is empty or contain <150 ml of fluid)Abnormal: Dull Sound (if bladder contains > 150 ml of fluid)

3. Palpation Using fingertips of both hands deeply but gently from the umbilicus going downward to symphisis

pubis to feel the top edge of bladder. Performed deeply in gentle manner to avoid:

a. Pain and Discomfortb. Stimulate Voiding

Normal: Bladder is not palpableAbnormal: Smooth, rounded edge of bladder can be felt (>150 ml of urine)

COLLECTION OF URINE SPECIMEN

1. Random Urine Specimen Collection Sterile urine is not required Can be collected thru:

a. Canb. Urinal

c. Bed pan

Ideal for Routine Urinalysis Should not be contaminated with feces or debris of tissue If woman has menstruation, note findings of specimen Label the specimen and send to laboratory not more than 1 hour.

2. Clean Catch Midstream Urine or Midstream Voided Urine Sterile urine is required. Should be free from microorganisms Ideal for Urine Culture and Sensitivity Test Urinary Meatus should be free from microorganisms:

a. Clean perineum with soap or antiseptic before voidingb. Use cotton ball with soapsuds or antiseptic once (1 stroke; betadine) then discardc. Usually procedure is repeated 3x with different cotton balls (1 stroke then discard)d. Clean from Top to Bottom to prevent contamination from the anuse. Men – clean tip of penis in a circular motion.

Ask the client to stop urinary flow and void midstream into the sterile container. Sterile container is required and can be collected thru the ff:

a. Canb. Bedpan

c. Urinald. Plastic Adhesive Bag

Label specimen and send to Laboratory no > 1 hour. If specimen can’t be transported, refrigerate to prevent changes in urine.

Urine Test is not accurate: a. Multiplication of bacteriab. Multiplying bacteria may split urea contentc. Produces Alkaline urined. Decomposition of Urine composition

3. 24 Hour Urine Specimen or Time Urine Specimen

Purposes:

1. To measure accurately the kidney excretion substances Protein in urine or albumin Creatinine Uric Acid Uribilinogen Amylase Hormones (corticosteroids & estriol)

2. To check disorder of Glucose Metabolism (ex. Diabetes)3. To assess ability of kidney to concentrate and dilute urine throughout the day.

Note:

1. Save all urine (small or large amounts) in bed or bathroom2. Laboratory provides a large container that contains preservatives to prevent breakdown of

constituents. 3. Collection of urine is started after the patient’s 1st void urine. 4. Collected using the ff: (then transferred to 24 hour collection container)

a. Bed panb. Urinal

5. Avoid not to splash b/c preservatives can be caustic6. Large container should be refrigerated or placed in a bucket of ice during 24 hour collection7. At the end of 24 hour, let the patient empty his bladder then transfer urine to 24 hour

collection container. Label the container and send to laboratory.

URINE TESTS

1. Specific gravity Is the weight and concentration of urine as compared to water. Measured using Urinometer which is calibrated to float into 1.000 mark in distilled water. Procedure:

a. Place urine into a test tubeb. Place urinometer in the tube to float in the urine.c. Specific gravity can be read when meniscus of urine hits the urinometer marking.

Normal Specific Gravity: 1.010 – 1.025 g/ml

Low Specific Gravity High Specific GravityOverhydration Fluid Volume Deficit

Pathologic condition that affects the ability of kidney to concentrate urine.

2. Urinalysis Most common urine test that provides characteristics of urine and its components. Can be performed on any random specimen (20 – 30 ml of urine) Can be collected anytime of the day but 1st void morning urine specimen is preferred b/c:

a. 1st void urine is more concentrated b/c clients is usually w/o fluids during nightb. Influence of diet and activity is minimized.

3. Urine Culture and Sensitivity Test To identify the microorganisms that cause UTI To identify antibiotics that can kill microorganisms Allows bacteria to grow and multiply in 48 hours (2 days). Additional 24 hours is needed to

identify exact microorganism and lab test can see w/c antibiotics will inhibit its growth Results

a. ↓ No. of Microorganisms = Sensitive to antibioticsb. ↑ No. of Microorganisms = Resistance to antibiotics

Characteristics of Urine

Criteria Normal AbnormalPhysicalAmount in 24 hours 1,000 – 1,500ml <1,000 or >1,500mlColor Clear and pale to deep yellow (yellow

color is d/t UROCHROME, pigment d/t destruction of Hemoglobin.

Dark amber, cloudy, dark orange, red, dark brown

Clarity Clear liquid Mucus plugs, thickOdor Slightly Aromatic OffensiveChemicalSterility No microorganisms (+) microorganismsPH Slightly Acidic (4.5 – 6) <4.5 or >6Specific Gravity (SG of Pure Water is 1.0) 1.001 – 1.025 <1.001 or >1.025MicroscopicGlucose NOT PRESENT PRESENTKetones NOT PRESENT PRESENTBlood NOT PRESENT PRESENT Protein (Albumin) NOT PRESENT PRESENTBile NOT PRESENT PRESENTPus (WBC and Bacteria) NOT PRESENT PRESENTEpithelial Cast (group of cells)

NOT PRESENT PRESENT