Assessment of Urinary System

Structures and Functions of Urinary System

The upper urinary system consists of two kidneys and two ureters. The lower urinary system consists of a urinary bladder and a urethra (Fig. 45-
1). Urine is formed in the kidneys, drains through the ureters to be stored in the bladder, and then passes from the body through the urethra.
FIG. 45-1 Organs of the urinary system. A, Upper urinary tract in relation to other anatomic structures. B, Male urethra
in relation to other pelvic structures. C, Female urethra.

Assessment of Urinary System

Subjective Data

Important Health Information

Past Health History.

Question the patient about the presence or history of diseases that are related to renal or other
urologic problems. Some of these diseases are hypertension, diabetes mellitus, gout and other
metabolic problems, connective tissue disorders (e.g., systemic lupus erythematosus, systemic
sclerosis [scleroderma]), skin or upper respiratory tract infections of streptococcal origi7n,
tuberculosis, viral hepatitis, congenital disorders, neurologic conditions (e.g., stroke, back
injury), or trauma. Note specific urinary problems such as cancer, infections, benign prostatic
hyperplasia, and calculi.

1. Inspection
 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 Discomfort
b. Stimulate Voiding

Normal: Bladder is not palpable

Abnormal: 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. Can c. Bed pan

b. Urinal

 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 voiding
b. Use cotton ball with soapsuds or antiseptic once (1 stroke; betadine) then discard
c. Usually procedure is repeated 3x with different cotton balls (1 stroke then discard)
d. Clean from Top to Bottom to prevent contamination from the anus
e. 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. Can c. Urinal
b. Bedpan d. 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 bacteria
b. Multiplying bacteria may split urea content
c. Produces Alkaline urine
d. 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 bathroom

2. 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 pan
b. Urinal
5. Avoid not to splash b/c preservatives can be caustic
6. Large container should be refrigerated or placed in a bucket of ice during 24 hour collection
7. 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 tube
b. 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 Gravity

Overhydration 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 night
b. 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 antibiotics
b. ↑ No. of Microorganisms = Resistance to antibiotics

Characteristics of Urine
 Criteria Normal Abnormal
Physical
Amount in 24 hours 1,000 – 1,500ml <1,000 or >1,500ml
Color Clear and pale to deep yellow (yellow Dark amber, cloudy, dark
color is d/t UROCHROME, pigment orange, red, dark brown
d/t destruction of Hemoglobin.
Clarity Clear liquid Mucus plugs, thick
Odor Slightly Aromatic Offensive
Chemical
Sterility No microorganisms (+) microorganisms
PH Slightly Acidic (4.5 – 6) <4.5 or >6
Specific Gravity
(SG of Pure Water is 1.0) 1.001 – 1.025 <1.001 or >1.025
Microscopic
Glucose NOT PRESENT PRESENT
Ketones NOT PRESENT PRESENT
Blood NOT PRESENT PRESENT
Protein (Albumin) NOT PRESENT PRESENT
Bile NOT PRESENT PRESENT
Pus (WBC and Bacteria) NOT PRESENT PRESENT
Epithelial Cast (group of NOT PRESENT PRESENT
cells)