Urinary System Assessment

1. Upper vs lower upper= 2 kidneys and 2 ureters

lower= urinary bladder and a urethra
- urine is formed in the kidneys, drains through the ureters to
be stored in the bladder, and the n passes form body through
urethrra
2. Kidneys - principal organs
1. regulate the volume and composition of EC
2. excrete waste products from the body
- also function to control BP, produce erythropoietin, acti-
vate vitamin D, regulate acid-base balance Macrostructure-
right kidney is lower than the left, an adrenal gland lies on top
of each kidney- each kidney is surrounded by fat and CT that
cushions and supports
- fibrous membrane called the capsule covers the surface of
each kidney- protects
- the hilus: serves as the entry site for the renal artery and
nerves, and exit site for veins
- outer layer = cortex
- inner layer = medulla
- the medulla consists of a number of pyramids, the
apices/tops of pyramids = papillae, though which urine passes
to enter the calyces, the minor calyces merge to form major --
> renal pelvis --> drains through ureter to the bladder. The
renal pelvis stores a small volume of urine
3-5mL
Microstructure
- the nephron is the functional unit, each kidney has 1
million
- each nephron has the glomerulus, Bowman's capsule and a
tubular system. The tubular system has proximal convoluted
tubule, loop of Henle, distal convoluted tubule, and collecting
tubules

3. Kidneys - blood flow to the kidneys, approx. 1200mL.min accounts for

Blood Supply 25% of cardiac output
- blood reaches kidneys via renal artery --> afferent arteri- ole
--> which divides into a capillary network, the glomeru- lus
which is a tuft of 50 capillaries which unite to form
1/
 Urinary System Assessment

efferent arterioles which splits --> peritubular capillaries,

which surround the tubular system
- all peritubular capillaries drain into the venous system, the
renal vein empties into the inferior VC
4. Glomerulus selective filtration

5. Proximal Tubule Reabsorption of 80% of electrolytes and water, glucose,

amino acids, HCO3-, secretion of H+ and creatinine

6. Loop of Henle Reabsorption of Na+ and Cl- in ascending limb and water in
descending limb
- concetration of filtrate
7. Distal Tubule - secretion of K+, H+ and ammonia
- reabsorption of water- regulated by ADH, and reabsorp- tion
of HCO3--
- regulation of Ca2+ and PO42- by parathyroid hormone
- regulation of sodium and potassium by aldosterone

8. Collecting duct reabsorption of water- ADH required

9. Glomerular - urine formation begins here where blood is filtered

Function = a semipermeable membrane that allows filtration
- the hydrostatic pressure of the blood causes a portion of
blood to be filtered across the semipermeable membrane into
Bowman's capsule, where the filtered portion of the blood
begins to pass down the tubule
- filtration is more rapid in the glomerulus than in ordinary
tissue capillaries, because the glomerulus membrane is ports
- the ultra filtrate is similar in composition to blood expcet
lacks blood cells, platelets, and large plasma proteins (note in
many kidney disease, capillary permeability is increased
which permits plasma proteins and blood cells to pass in
urine)
- the amount of blood filtered each minute by glomeruli =
Glomerular filtration rate, normal = 125mL/min
- the peritubular capillary network reabsorbs most of the

2/
 Urinary System Assessment

glomerulus filtrate before it reaches the collecting duct,

therefore only 1mL/min on average is excreted as urine
10. Tubular Function - the tubules and collecting ducts carry out functions by
means or reabsorption and secretion
- reabsorption= passage of substance from the lumen of the
tubules through the tubule cells and into the capillar- ies-
active and passive transport
- tubular secretion= passage of substance from the capil- laries
through the tubular cells into the men of the tubule

11. Proximal Con- - about 80% of electrolytes are reabsorbed

voluted - normally, all the glucose, amino acids, and small proteins are
Tubule reabsorbed
Function - most by active transport
- H+ and creatinine are secreted into the filtrate

- as reabsorption continues in the loop of Henle, water is

12. Loop of Henle conserved, which is important for concentrating the filtrate
Function
- permeable to water and moderately permeable to sodium
13. Descending urea, and other solutes
Loop of Henle

14. Ascending Limb Chlorid ions are reabsorbed and sodium ions

15. 2 Important 1. final regulation of water balance

func- tions of 2. acid base balance
dis- - ADH is required for water reabsorption in the kidney- makes
tal the convoluted tubules and collecting ducts perme- able to
convoluted water, this allows water to be reabsorbed into the peritubular
tubules capillaries and returned to the circulation

- decrease in plasma osmolality are decide in anterior

hypothalamus by osmoreceptors which send neural input to
16. Osmoreceptors super optic nuclei in the hypothalamus
importance - these cells have neuronal axons that terminate in the
posterior pottery gland and act to inhibit secretion o ADH, in
absence of ADH tubules are essentially impermeable to water,
thus any water in the tubules leaves the body as urine
3/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb

17. Aldosterone - released from adrenal cortex's acts on the distal tubule to
im- portance cause reabsorption of Na+ and water
- in exchange, K+ is excreted
18. Myocyte cells release ANP- atrial natriuretic peptide, in response to atrial
in the Right distention which is a result of an increase plasma volume
atrium - ANP acts on kidneys to increase sodium excretion
- ANP inhibits renin, ADH and suppresses aldosterone

- parathyroid hormone is released from the parathyroid

19. Renal gland in response to low serum calcium
Tubules and - PTH maintains serum calcium levels by causing increase
Calcium tubular reabsorption of calcium and decrease tubular re-
absorption of phosphate
- major effects on bone metabolism
- vitamin D is a hormone that can be obtained in the diet or
synthesized by the action of ultraviolet radiation on choles-
terol on the skin- these forms of vitamin D are inactive and
require steps- 1. activation in the liver, 2 activation occurs in
the kidneys also
- active vitamin D is essentail for absorption of calcium
from GI tract

20. Renin - produced and secreted by the kidney's juxtaglomerular cells

- released into bloodstream in response to decreased renal
perfusion, decreased arterial BP, decreased ECF, decreased
serum Na+ concetration, and increased uri- nary Na+
concetration
- angiotensinongen (from the liver) --> activated to an-
giotensin I by renin
- angiotensin I is converted to II by ACE- Ace is located on
the inner surface of ALL blood vessels, with high levels in the
lungs
- AGII stipulates release of aldosterone from the adrenal
cortex, which causes sodium and water retention, leading to
increased ECF volume
- AGII also increases peripheral vasoconstriction
- release of renin is inhibited by an elevation in BP

4/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb

21. Prostaglandins - many body tissues synthesize PGs from precursor, ara-
chiodinc acid
- in the kidney, PG synthesis occurs in the medulla
- have vasodilating actions, increasing renal blood flow,
promote Na+ excretion
- counteract vasoconstrictor effect of AGII and norepi
- may lower BP by decreasing vascular resistance
22. Ureters - tubes that carry urine from the renal pelvis to the bladder
- smooth muscle fibers contract to promote the peristaltic one
way flow of urine through the ureters
- distention, neurologic and endocrine influences and
drugs can affect these muscle contraction
- renal pelvis only holds 3-5mL, kidney damage can result
from a backflow of more than that amount of urine
- the Ureterovesical junctions rely on ureter's angle of blad- der
penetration and muscle fiber attachments to prevent backflow
of urine into the ascending infection
- when bladder pressure rises like with voiding or cough- ing,
muscle fibers that the ureter shares with the bladder base
contract first, promoting ureteral lumen closure, next contracts
and the base ensuring UVJ closure and preven- tion of urine
reflux through the junction
23. Bladder - stretchable organ positioned behind the pubis and ante- rior
to the vagina and rectum
- primary function= reservoir for urine and to eliminate
waste
- normal adult urine output is 1500mL/day
- the volume of urine produced at night is less than half to that
formed during the day because of hormones-- this diurnal
pattern is normal
- typically an individual will urinate 5-6x during the day and
occasionally at night
24. Bladder- Trigone - triangular area formed by the 2 ureteral openings and the
bladder neck
- affixed to the pelvis by ligaments
- the bladder muscle= detrusor is composed of layers of

5/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
intertwined smooth muscle fibers capable of considerable
distention during bladder filling and contraction during
emptying- it is attached tot he abdominal wall by the liga-
ment- arches- as the bladder fills it therefore rises towards the
umbilicus

25. How much - on average, 200-250 mL of urine causes moderate dis-

urine in the tention and the urge to urinate
bladder causes - when quantity reaches 400-600mL the person feels un-
disten- tion comfortable
- blader capacity varies but ranges 600-1000mL

26. Bladder is - transitional epithelium and is referred to as the urothelium

lined with - resistant to absorption of urine
- therefore urinary wastes produced by the kidneys do NOT
leak out of the urinary system after they leave the kidneys

27. Urethra - small tube that incorporates the smooth muscle of the
bladder neck and extends to the started muscle of the
external meatus
- primary function is to serve as a conduit for urine from the
bladder to the outside of the body during voiding and to
control voiding
- female urethra is 1-2in long and lies behind the symph- ysis
pubis anterior to the vagina
- male- 8-10in long originates at the bladder neck and
extend the length of the penis

28. Urethrovesical - together the bladder, urethra, and pelvic floor muscles = this
Unit - voluntary control of this unit = continence
- stimulating and inhibiting impulses are sent from the brain
through the thoracolumbar and sacral areas of the spinal cord
to control voiding
- distention of the bladder stimulates stretch receptors
within the bladder wall
- impulses are transmitted to the sacral SC and brain
causing a desire to urinate
- if the time to void is not appropriate, inhibitor impulses in

6/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
the brain are stimulated and transmitted back through the
thoracolumbar and sacral nerves innervating the ladder
- in a coordinated fashion, the detrusor muscle accom-
modates to the pressure (does not contract) while the
sphincter and pelvic floor muscles tighten (contract) to
resist bladder pressure
- if voiding is appropriate, carbine inhibition is voluntarily
suppressed, and impulses are transmitted via the SC for the
bladder neck, sphincter, and pelvic floor muscles to relax and
for the bladder to contract- sphincter closes and detrusor
muscles relax when bladder is empty

29. Gerontologic - 20-30% decrease in size and weight in the kidney be-
Considerations tween 30-90 years old
Paragraph - by 70s, glomerular have lost 30-50% of their function
- despite these changes, older people maintain fluid home-
ostasis unless diseased or stress
- decreased renal blood flow, in part due to atherosclero- sis,
resulting decreased GFR
- alterations in hormones- ADH, aldosterone, ANP result in
decreased urinary concetration, and alterations in the
excretion of water, sodium and avoid, and potassium
- under normal conditions aging kidney an maintain home-
ostasis but may not
- female urethra, bladder, vagina, pelvic floor have loss of
elasticity and muscle support- older women prone to
bladder infections and incontince
- prostate enlarges as men age may affect urinary pat- terns-
causing hesitancy, retention, slow stream and- blaider
infection
- constipation= common compliant in older adults, can
affect urination

30. Gerontologic Kidney

Considerations - decrease amount of renal tissue, decreased nephrons,
Chart decreased function in loop of Henle
--> less palpable kidney, decreased creatinine clearance,
elevated BUN, elevated serum creatine, alterations in drug
excretion, nocturia, decreased ability to concentrate urine,

7/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
less concentrated urine
Ureter, Bladder, Urethra
- decreased elasticity, weakening of urinary sphincter, de-
creased bladder capacity, estrogen deficiency leading to
thin dry vagina, increased bladder contractions, prostatic
enlargement
- palpable bladder after urination because of retention
- stress incontince especially during valsalva maneuver-
dribbling of urine after urination
- frequency, urgency, nocturia,
stress or overactive bladder
31. Assessment - past health history
- medications
- surgery

32. Objective- In- skin- yew gray, changes in turgor

spection mouth- dry order
- face and extremities- generalized or peripheral edema
weight- weight gain secondary to edema
- fatigue lethargy

33. Objective Palpa- - Costovertebral Angle- formed by the rib cage and verte-
tion bral column
- the normal left size kidney is rarely palpable because the
spleen lies directly on top of it
- occasionally, the lower pole of the right kidney is palpa-
ble- smooth rounded mass that descends on inspiration
- if not palpable note its size, contour and tenderness
- kidney enlargement suggests neoplasm or serious renal
disease
- urinary bladder is NOT palpable unless it is distended
with urine- smooth round firm organ sensitive to palpation

34. Percussion - tenderness in the flank area may be detected by fist

percussion- kidney punch
- normally a firm blow to the flank should NOT elicit pain,
if it is may be infection
- bladder not normally permissible until it contains 150mL
of urine, if fill dullness is heard above the symphysis pubis

8/
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb

35. Auscultation - the bell may be used to osculate over CVAs and upper
abdomen quadrants
- abdominal aorta for bruit--> impaired blood flow to kid-
neys

36. Review 20-30 % loss in size & weight of kidney between 30-90 yrs
Gerontol- ogy Loss most in cortex
Considera- By 7th decade 30-50% of glomeruli have lost function It
tions- her slide, shrinks, looses its ability
extra important Usually do okay, until they encounter diseases or other
physiologic stressors

Blood flow to & within kidney decreases

Decreased renal blood flow
Decreased GFR
Decreased ability to conserve Na+, dilute or concentrate
urine, excrete acid load

- sculleries of glomerulus and renal vasculature

37. Gernotology - decreased blood flow
Concerns - decreased GFR
- altered tubular function
- acid base imbalance
- medications
- hypernatremia
- FVD
- thirst mechanism- almost gone --> dehydration
- decreased bladder wall contractility
- BPH -enlarged prostate male only
- vaginal and urethral tissue atrophy

Women
38. Women vs. - estrone levels decrease with age, tissues become less elastic,
men changes thin, less vasculature- older women prone to ure- thral
irritation and bladder infections and incontinence, Men
- prostates enlarge- hesitancy, retention, slow stream,
bladder infections

9 / 20
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb

39. Urinalysis gener- one of first studies done to evaluate

al - although a specimen may be collected at any time of
the day for a routine urinalysis, it is best to obtain the first
specimen urinated in the morning
- this concentrated specimen is more likely to contain
abnormal constitutes if they are present in the urine
- specimen should be examined within 1 hour of urinat-
ing- otherwise, bacteria multiply rapidly, RBCs homeless
casts- mods of renal tubes disintegrate and urine be-
comes alkaline
- if cannot send to lab, refrigerate it

40. Creatine Clear- - creatinine is a waste product produced by muscle break-

ance- paragraph down
- urinary excretion of ct is a measure of active muscle
tissue in the body, not of body weight
- individuals with larger muscle mass have high values
- because almost all creatinine in the blood is normally
excreted by the kidneys, creatinine clearance is the most
accurate indicator of renal function******
- the result of a creatine clearance test closely approxi-
mates GFR
- creatinine levels remain constant for each person be-
cause not sig affected by protein ingestion, muscular ex-
ercise, water intake etc.
normal creatine clearance ranges from 70-135 mL.min
- after age 40, the creatinine clearance rate decreases at
a rate of 1mL/min.yr

41. Urodynamic - measure urinary tract function

Studies - urodynamic tests study the storage of urine within the
paragraph bladder and the flow or urine through the urinary tract to
outside body

42. Anuria technically no urination

24-hr urine output <100 mL

43. Enuresis Involuntary nocturnal urination

10 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
44. Incontinence inability to voluntarily control discharge of urine- bladder
infection or injury to external sphincter
45. Nocturia frequency of urination at night
46. Oliguria Diminished amount of urine in a given time
24hr urine output of 100-400 mL

47. Pneumaturia Passage of urine containing gas

48. Polyuria large amounts of urine in a given time

49. Urinalysis- Chart General examination of urine to establish baseline infor-

mation or to provide data to establish diagnosis
Nursing
- try to obtain first urinated morning specimen
- ensure it is examined 1 hr of urinating
- before collecting, wash perineal area if soiled
- does not identify the organism, but determines if bacteria are
present

50. Creatinine - creatine is a waste product of protein breakdown, clear- ance

clear- ance- by kidney estimates GFR
chart Reference: 70-135
Nursing
- collect 24 hour urine specimen
- discard first urination when test is started
- save urine from all subsequent urination for 24 hours
- instruct patient to urinate at end of 24 hours and add
specimen to collection
- ensure serum creatine is determined during 24 hours
period

- measures specific components- like electrolytes, glucose etc.

51. Composite collected over a period from 2 hours to 24
Urine collection Nursing
- instruct the patient to urinate and to discard the first urine
specimen
- not start time
- save all

11 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
52. Urine Culture
- at end as patient to urinate and add that
- must be refrigerate or preservatives added
- confirms suspected UTI and identifies organisms
- normally, bladder is sterile but urethra contains few WBC
>10^5 = indicates infection
<10,000 no infection
>100,000 indicates infection
Nursing
- use sterile container for collection of urine
- touch only outside of container
- for women separate labia with one hand and clean mea-
tus with other hand using at least 3 sponges in a front to
back motion
- for men retract foreskin and cleans glands with at least 3
sponges
- after cleaning instruct patient to start urinating and then
continue voiding into sterile container- the initial urine
flushes to most contaminants in the urethra
- catheterization may be needed
- ideally from first void of the day and not after recent
void/bowel movement
- mid stream sample recommend in males and females
- most presses is straight cauterization

53. Concetration evaluates renal concetration measured by specific gravity

Test reference: 1.003-1.030
Nursing
- instruct patient to fast after given time in evening
- collet 3 urine specimens at hourly intervals in the morning

54. Residual Urine determines amount of urine left in bladder after urinating
<50mL urine
nursing
- immediately after urinates use bladder ultrasound

55. BUN- blood urea - used to detect renal problems

nitrogen - concetration of urea in the blood is regulated by rate at
which kidneys excrete urea
reference 6-20 mg/dL
12 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
Nursing
- when interpreting be aware that non renal factors may
cause increase- fever, GI bleed, etc.
56. Creatinine More reliable than BUN as determinant of renal function
- = end product of muscle and protein metabolism
0.6-1.3
Nursing
- explain test and watch for post puncture bleeding

57. BUN/Ct ratio - increased ratio due to decrease in blood flow to kidneys,
GI bleed
12:1 or 20:1

58. Uric Acid screening for kidney diseases

- watch for post puncture bleeding

59. Sodium - main extracellular electrolyte determining blood volume

- usually stay normal until late stages of renal failure
135-145
- explain and watch for post puncture bleeding

60. Potassium kidneys excrete potassium

3.5-5
>6= cardiac dysrhtyhmias
one of the first electrolytes to become abnormal
watch for bleeding

61. Calcium total
- main mineral in bone and aids in muscle contraction,
neurotransmission and clotting
- in kidney disease, decreased reabsorption --> renal os-
teodystrophy
8.6-10.2
post puncture bleeding

62. Phosphorus inversely related to calcium

- ln disease levels are elevated because the kidney is
primary excretory organ
2.4-4.4
bleeding again watch for

13 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb

63. Bicarbonate most patients in renal failure have metabolic acidosis and low
serum HCO3- levels
Normal 22-26
explain and watch for bleeding
64. Kidneys, ureters, - show size
bladder xray - can be done portable or radiology
KUB - radiopaque stones
- perform bowel prep if ordered

65. Intravenous visualizes urinary tract after IV injection in contrast media

Pyelogram - size, cysts tumors
Nursing
- evening before give cathartic or enma to empty colon of
feces and gas
- assess for iodine sensitivity
- lying on table having serious of X-rays
- during injection may feel flushed, salty taste
- after procedure force fluids to flush out
- avoid caffeine beverages, smoking for 2 hours prior and
for for 1 hour prior

66. Renal arte- - visualizes renal blood vessels

riogram- an- - can assist in diagnosis renal artery stenosis
giogram - cyst vs. tumor
- contrst media is injected
*catheter is inserted into femoral artery
Nurisng
Before procedure- prepare with cathartic or enema, iodine
sensitivity, feel warm etc.
After procedure- place a pressure dressing over femora
artery injection site*** observe for bleeding, have maintain
bed rest with affect leg straight*********
- take peripheral pulses in the involved leg every 30-60
minutes to detect occlusion caused by thrombus
- she said to be NPO

67. Antegrade Pyelo-

gram

14 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
evaulates upper urinary tract when patient has allergy to
contrast media
- explain procedure prepare for IVP
68. Renal ultrasound - used to detect masses cysts, some probe is placed in skin
- conductive gel is applied
- noninvasive procedure
- computer interprets tissue density
- explain
- because radiation exposure is avoided, a number of
images can be obtained
- bowel prep is NOT required

69. CT scan excellent visualization of kidney, kidney size, tumor

- advantage of ultrasound is ability to distinguish subtle
differences in density
- use of IV contest media helps differentiate masses
Nursing- ask about iodine sensitivity, instruct to lie still,
sedation if unable to cooperate

70. mRI visualization of kidneys

- not proven useful for urinary calculi or calcified tumors
explain- remove all metal objects
contraindications
- presence of implanted magnetic clips
-prosthesis or pacemakers

71. Loopogram detects obstructions, leaks, reflux

- because urinary diversions are created with bowel, risk
of absorption of contrast media
- explain
- monitor for reactions to contrast media

72. Cystoscopy type of endoscopy

- inspects interior of bladder with tubular lighted scope=
cityscape
- can be sued to insert ureteral catheters, remove calcium,
obtain biopsy
- may be done using LOCAL or GENERAL anesthesia

15 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
depending on patient
- lithotomy osier is used***
Nursing
Before force fluids or give IV fluids if GENERAL anesthesia
to be used, ensure concept form is signed ****** explain
After- explain that burning on urination, pink-tinged urine and
urinary frequency are expected effects*****
- observe for bright red bleeding which is NOT normal
- do NOT let patient walk alone immediately after proce-
dure because orthostatic hypotension may occur
- offer warm sitz baths, heat, mild analgesics to avoid
discomfort
73. Urinalysis- Color Normal- amber yellow
abnormal- dark, smoky color, yellow brown, to love green,
orange red, coldness, colorless
74. Urinalysis- Odor Normal= aromatic
Abnormal- ammonia like odor, unpleasant order

75. Urinalysis Pro- Normal- Random protein dipstick 0 trace 24-

tein hour protein quantitative <150 mg/day
Abnormal- persistent proteinuria
76. Urinalysis normal- none
Glu- cose Abnormal- glycosuria
77. Urinalysis- normal- none
Ke- tones abnormal- present
78. Urinalysis- Normal- none
Biliru- bin abnormal-present
79. Urinalysis Normal: 1.003-1.030
Spe- cific Abnormal- low, high, fixed at 1.010
gravity
Normal 300-1300
80. Urinalysis- Abnormal <300 or >1300
Os- molality

81. Urinalysis- pH
16 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
Normal- 4-8 average is 6
Abnormal >8
82. Urinalysis- RBC normal 0-4/hpf
abnormal <4.0 or >4/hpf
83. Urinalysis WBC Normal 0-5/hpf
Abnormal >5 hpf
84. Urinalysis Casts Normal- none
Abnormal- present
- casts are a product of RBC and WBC breakdown in the renal
tubules which result in cast snap objects indicative of WBC
and or RBC

85. Urinalysis Normal- no organisms in bladder, <10^4 organisms result of

Cul- ture for normal urethral flora
organ- isms Abnormal- bacterial counts > 10^5
86. Urinalysis - certain bacteria in the urine are able to convert nitrates into
Ni- trites nitrites presence of nitrites is indicative of presence of this
bacteria

87. Urodynamics - set of tests designed to measure urinary tract function- how
well by can eliminate the urine
1. less invasive- urinary flow study
2. more invascive
- cystometrogram
- sphincter electromyography
- voiding pressure flow study
- videorodynamics
- whitaker study
88. Urine Flow study - type of urodynamics
- meausre urine volume in a single voiding expelled in a
period of time
- used to assess degree of outflow obstruction, assess
bladder or sphincter dysfunction, evaluates treatment
normal max flow for men 20-25mL/sec, women
25-30mL/sec

17 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
- age can affect it
nursing
- explain procedure
- ask to start with comfortably full bladder
- try to empty completely
- measure residual urine volume
89. Cystometrogram types of urodynamic study
- evaluates bladder's capacity to contract and exel urine
- involves insertion of catheter and installation of water or
salon solution into bladder
- measurements of pressure exerted against bladder wall ar
recorded
- if abnormal pressure i.e. measured, a second tube is
inserted into the rectum or vagina
- especially detrusor muscle if there is a spinal cord injury
could affect this
nursing
- explain procedure
- during the infusion ask patient about sensation of bladder
filling and first desire urge to urinate
- observe for infections after

90. After bladder especially over 800cc

scan > mL indi-
cates Foley

91. Sphincter EMG type of urodynamic stdy

- recording of electrical activity created when the NS stim-
ulates muscle tissue
- by placing needles, percutaneous wire near the urethra the
clinical ca assess pelvic floor muscle activity
- and response of the muscles to coughing, bladder filling and
other measures

92. Voiding pressure type of urodynamic study

study - combines urinary flow rate, cystometric pressure and a
spinster EMG for evaluation
- it is to be completed by assisting the patient to a spe-

18 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
cialized toilet to urinate while the various tubes and EMG
apparatus are in place

93. Viderourodynam type of urodynamics

- ics - combo of cystometrogram, sphincter EMG, urinary flow
study with anatomic imaging of lower urinary tract via
fluoroscopy
- used in selected cases

94. Radionuclide type of urodynamic study

Cystography - detects and grades vesicoureteral reflux
- small dose of radioisotope tracer instilled into bladder via
catheter

95. Whitaker study type of urodynamic study

- measures the pressure difference between the renal pelvis
and the bladder
- ureteral obstruction can be assessed ***
- percutaneous access is gained to the renal pelvis by
placing a catheter in the renal pelvis catheter is also placed
in the bladder
- fluid is perfused through percuteansout tube or needle at
10ml/hr
- pressure managements are combined with fluoroscopic
imagining to identify level of obstruction
96. Renal Scan - evaluates anatomic structures, perfusion and function of
kidney
***Radioactive isotopes are injected IV
- radiation detector probes are placed over kidney and
radioisotope distribution in kidney is scanned and mapped
- shows location cysts and tumors
- also monitor function of kidney transplant
Nursing
- requires no dietary or activity restriction
- inform patient that NO PAIN or discomfort should be felt

97. Renal Biopsy - obtains renal tissue for examination to determine kidney
disease or flow up
- technique is usually done as a skin percutaneous biopsy

19 /
 Urinary System Assessment
Study online at https://quizlet.com/_2rr7gb
through needed insertion into lower lobe of kidney
- can be performed with CT or ultrasound guidance
- absolute contraindications: bleeding disorders, single
kidney, uncontrolled hypertension
Nursing
- type and crossmatch patient blood, ensure concept is
signed
Before
- ascertain coagulation status throughout patient history,
medication history, CBC, hemoatcrit, PT time and bleeding and
clothing time. Patient should NOT BE TAKING Aspirin or
Warfarin- usually stop 5 days before
After
- apply pressure dressing and keep patient on affected side
for 30-60 minutes
- bed rest for 24 hours**
- vital signs every 5-10 mins for the first hour
- assess for flank pain, hypotension, decreasing hemat- ocrit,
fever, chills,
- urine dipstick can be used to test for bleeding in the urine
- instruct patient to avoid lifting heavy objects for 5-7 days
and to not take anticoagulant drugs until allowed by HCP

98. Dipstick - determines protein in urine

reference- 0 protein
- dip end of stick in urine and reed results

99. A high specific dehydration

urine gravity
indi- cates

20 /