Post on 06-Jan-2016
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Week 8
Abdominal Assessment:Urinary Elimination
Learning Objectives
1. Describe and list factors that affect elimination.
2. Explain common physical assessment procedures used to evaluate elimination health of patients across the lifespan.
3. Identify priority elimination assessment findings.
4. Differentiate normal elimination assessment from abnormal findings.
5. Explain the process for assessment of the abdomen and bowel/bladder elimination.
Elimination:
The process of and ability to rid the body of waste.
What are some factors that might have an effect on
elimination?
Assessment Interview
*Voiding pattern
*Description of urine and any changes (color, quantity, etc.)
*Urinary elimination problems (such as pain, urgency, frequency, burning, etc.)
* Factors influencing urinary elimination
Pain with urination may not be directly related to
urinary tract – it could be due to an STD or vaginal
irritation
Abdominal & Genitourinary Assessment
First: Inspect
Inspection - Distended Bladder
Inguinal Hernia in Scrotum
Hypospadias is a birth (congenital) defect in which the opening of the urethra is on the underside of the
penis.
Congenital Urethral Fistula abnormal passage that that occurs during the development in-utero
between the urethra and the penile skin, somewhere beneath the normal urethral opening.
During urination two streams of urine may be obvious — one coming from the urethral opening
and the other from the site of the abnormal opening (fistula).
Second: Auscultate abdomen for bowel sounds in all for
quadrants
Third: Percuss
Percussion detects fluid, air, and any fluid-filled or solid masses.
Pain that occurs with percussion over the flank could be kidney-related
Fourth: Palpation
Palpation: light, moderate, and deep
Back pain, especially unilateral could be kidney pain
Perfusion can be altered due to an obstruction or tear
Our bodies should always be making urine. In the presence of an obstruction the urine
cannot get out.
Urine should be straw-colored to pale yellow, and clear, without odor.
*Assess for color, clarity, and amount; note
the presence of odor
Note that increased frequency in older adults,
along with nocturia = increased risk for falls
Nocturia- the need to get up in the night to urinate
Pregnancy creates pressure on the bladder due to the location and increasing size of the
uterus
Uterine Prolapse
Prolapse- to fall out of place
Prolapsed Bladder
Prostate enlargement may obstruct (block) urine flow
Developmental Considerations
of Urinary EliminationDevelopmental Factors:*Infants•Output•Frequency•Control
*Preschoolers•Independent toileting•Modeling, reminders•Instructions for wiping (front to back for girls)
Elizabeth Escalona, 23, admitted gluing her 2-year-old daughter to a wall and beating her over potty training. (CNN)
MOBILE, Alabama - The North Texas mom who pled guilty to gluing her toddler daughter’s hands to a wall, kicking her in the stomach and beating her over “potty training” has been sentenced to 99 years in prison, according to CBS DFW.
According to the report, State District Judge Larry Mitchell told Elizabeth Escalona that in spite of the ‘heartbreaking’ and ‘compelling’ evidence presented on both sides, “to me, it comes down to a single, salient fact: you savagely beat your child to the edge of death… for this you must be punished.”
Pleading for leniency Escalona took to the stand Thursday where she admitted that she’d behaved “like a monster” but also said she deserved to be given “a second chance.”
Developmental Considerations (cont.)
*School-age children• Patterns• Enuresis (involuntary voiding of urine)•Nocturnal enuresis
*Older adults• Patterns•Muscle weakness•Nocturnal frequency
Developmental Considerations (cont.)
*Age-related changes
•Renal function declines•Impaired excretion of drugs•Bladder more fibrous•Autonomic regulation decreases•Age-related weakening•Risk for hyponatremia
Other Factors that Affect Urinary Elimination
•Psychosocial factors•Fluid and food intake•Medications
AnticholinergicsAntidepressantsAntihistaminesAntihypertensivesAntiparkinsonism Beta-adrenergicsOpioids
Other Factors Affecting Urinary Elimination (cont.)
•Muscle tone•Pathologic conditions•Surgical and diagnostic •Procedures•Trauma /spinal cord injuries
End of Week 8