GUT Part 1- Physio Assessment, Labs

8/14/2019 GUT Part 1- Physio Assessment, Labs

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THE URINARY

SYSTEM


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ANATOMY


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THE URINARY SYTEM

The excretory (GUT)

system includes the

kidney, ureters,

urinary bladder,

urethra and the male

and female genitalia


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Kidneys, Ureters, and

Bladder


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Ma le Anatomy


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Female Anatomy


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The Kidney

Two bean-shaped organs that lie in theretroperitoneal space on either side of

the vertebral column at the level ofT12

to L3

Adrenal glands located on top of each

kidney surrounded by capsule and fats

Right is lowerthan the left

Each kidney is composed of:

- Renal parenchyma, Renal sinus and

pelvis and Nephrons


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Kidney: Major Functions

C-ontrols electrolyte and fluid balance

R-egulates homeostasis of blood and

acid-base balanceR-egulates RBC production

E-liminates end products of

metabolism,S-ecretes renin, parathyroid hormones

and Vitamin D


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The Kidney:

NephronFunctional unit of the kidney thatproduces urine by filtration


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The Kidney:

Blood Supply of the Kidney Renal artery- branch of the abdominal

aorta

Renal vein- drains into the inferior

vena cava


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Kidney Circulation


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The Ureters

2 long slender tubes 25-35cms long thatextends from the renal pelvis to pelvic

cavity where they enter the bladderand

propels urine from the kidneys to theurinary bladder

Has smooth muscles and transitional

epithelium and a uterovesical valve thatprevents backflow of urine into ureters

Has innervations from the sympathetic

and parasympathetic


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The Urinary Bladder

Hollow pyramid shaped organ locatedin the pelvis behind the symphysispubis

Composed of muscular, elastic tissuethat makes it distensible

Serves as reservoir of urine (1 to 1.8L;moderately full bladder=500ml)

Lined with transitional epithelium

Internal and external urethralsphincters control the flow of urine


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Fig. 18.17


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The Urethra

Tube extending from the urinary bladderto the external urethral orifice3-5cms (1-2 inches) in females

20 cms (8 inches) in males

3 Parts in Males

1. Prostatic urethra- most dilatable

2. Membranous urethra- least dilatableand shortest

3. Penile urethra- longest


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Ana of Male


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Ana of Female


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PHYSIOLOGY


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Renal Physiology

Urine formation

1. Urinary blood flow2. Glomerular filtration

3. Tubular reabsorption

4. Tubular secretion


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Renal Physiology

Ur in e formatio nGlomerular Filtration

Ultrafiltration of blood by the glomerulus;

beginning of urine formation

Requires hydrostatic pressure supplied

by the heart and assisted by vascular

resistance (glomerular hydrostatic

pressure) and sufficient circulating

volume


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Renal Physiology

Ur in e formatio nGlomerular Filtration

Pressure in Bowmans capsule opposes

hydrostatic pressure and filtration

If glomerular pressure insufficient to

force substances out of the blood into

the tubules filtrate formation stops


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Formation of Urine


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Renal Physiology

Ur in e formatio nTubular Function The tubules and collecting ducts carry

out the functions ofreabsorption,secretion, and excretion

Reabsorption of water and electrolytes is

controlled by antidiuretic hormone (ADH),released by the pituitary, and

aldosterone, secreted by the adrenal

glands


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Renal Physiology

Ur in e formatio nTubular FunctionProximal Convoluted Tubule

- reabsorption of certain constituents ofthe glomerular filtrate: 80% electrolytes

and H2O, all glucose and amino acids,

and bicarbonate;- secretes organic substances and

wastes


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Renal Physiology

Ur in e formatio nTubular FunctionLoop of Henle

- reabsorption ofwater in thedescending limb

- reabsorption ofsodium and chloride

in the ascending limb > descending limb- concentrates and then dilutes urine


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Fig. 18.12


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Fig. 18.13


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Renal PhysiologyUr in e formatio nTubular Function

Distal Convoluted Tubule

- secretes potassium, hydrogen ions,and ammonia

- reabsorbs H2O (regulated by ADHand aldosterone) back into the tubule

- reabsorbs bicarbonate

- regulates calcium and phosphateconcentrations


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Renal Physiology

Ur in e formatio nTubular FunctionCollecting Ducts

- receives urine from distal convolutedtubules

- reabsorbs water (regulated by ADH)

back in vessels


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Fig. 18.14


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Renal Physiology

Ur in e formatio n As fluid flows through the proximal

tubules, water and solutes reabsorption

starts

Normal adult produces 1 to 1.5 liter/day

of urine

The process ofselective reabsorptiondetermines the amount of water and

solutes to be secreted


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Renin-Angiotensin System


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ASSESSMENT


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GU T Asse ssm entNursing History

Reason for seeking care

Current illnessPrevious illness

Family History

Social HistorySexual history


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GU T Asse ssm entHealth History

Presenting Problem: symptoms may

include

1. Pain in flank, groin; dysuria

2. Changes in urination patterns:

frequency, nocturia, hesitancy ofstream, urgency, dribbling,

incontinence, retention


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Presenting Problem: symptoms may

include

3. Changes in urinary output: polyuria,

oliguria, anuria

4. Changes in color/consistency ofurine: dilute, concentrated, malodorous;

hematuria, pyuria


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Lifestyle:

- Occupation (type of employment,

exposure to chemicals such as carbontetrachloride, ethylene glycol)

- Level of activity

- Exercise

Nutrition/Diet: water, calcium, dairy

product intake


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Family History

- Hypertension, diabetes mellitus, renal

disease, gout, connective tissuedisorders, urinary tract infections (UTIs),

renal calculi


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GU T Asse ssm entPhysical Examination

Inspect skin for color, turgor, and

mobility; purpuric lesions, integrity

Inspect mouth for color, moisture, odor,

ulcerations

Inspect abdomen, and palpate bladder

for distension; percuss bladder for

tympany or dullness (if full)


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GU T Asse ssm entPhysical Examination

Inspect face for edema, particularly

periorbital edema

Inspect extremities for edema

Determine rate, rhythm, and depth of

respirations

Inspect muscles for tremors, atrophy


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GUT Assessment

PHYSICAL EXAMINATION

Inspection

Auscultation

Percussion

Palpation


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GUT Assessment

Key Signs and Symptoms ofUrological Problems

EDEMA

associated with fluid retention

renal dysfunctions usually

produce ANASARCA

check for weight daily ( weight

increase of 1 Kg = 1 Liter of fluid

retained)


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GUT Assessment

Key Signs and Symptoms of

Urological Problems

PAINSuprapubic pain= bladder

Colicky pain on the flank= kidney


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GUT Assessment


HEMATURIAPainless hematuria may indicate

URINARY CANCER!

Early-stream hematuria= urethrallesion

Late-stream hematuria= bladderlesion


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GUT Assessment


Urological Problems

DYSURIAPain with urination= lower urinary

tract infection


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GUT Assessment


POLYURIAMore than 2 Liters urine per day

OLIGURIA

Less than 400 mL per dayANURIA

Less than 50 mL per day


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GUT Assessment


Urological Problems

Urinary Urgency

Urinary Retention

Urinary Frequency


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GUT Assessment

IrritationDysuria

FrequencyUrgency

Nocturia

Strangury


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GUT Assessment

PainFlank or lumbar

Inguinal or iliacInitiation of voiding

End of voiding


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GUT Assessment

Uri ne ChangesPneumaturia

ProteinuriaKetonuria

Glycosuria

Hematuria


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GUT Assessment

Incontinence

Stress

UrgeOverflow

Total

MixedEnuresis


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LABORATORYDIAGNOSTICS


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

1. Urinalysis: Interventions

- Wash perineal area & use a clean container

- Obtain 10 to 15 mL of the first morningsample

- Specimen should be examined within 1 hourof voiding. Note that refrigerated samples may

alter the specific gravity

- If the client is menstruatin , indicate this on


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Collection of Urine


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Collection of Urine

Specimen

Clean catch (midstream) urine specimen

A. Cleanse perineal area

1. Females: spread labia and cleanse

meatus front to back using antiseptic sponges

2. Males: retract foreskin (if uncircumcised)

and cleanse glans with antiseptic sponges

B. Have client initiate urine stream then stopC. Collect specimen in a sterile container

D. Have client complete urination but not in

specimen container

Collection of Urine


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Collection of Urine

Specimen

24-hour urine specimen- Preferred method for creatinine clearance test

INTERVENTIONS:

- Have client void and discard specimen; notetime

- Collect all subsequent urine specimens for 24

hours- If specimen is accidentally discarded, the test

must be restarted

- Record exact start and finish collection; include

date and times

Collection of Urine


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Collection of Urine

Specimen

Random urine sample

Urine straining

Double catch

Catheter

Diversionary Method


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Collection of Urine

SpecimenIt involves overall characteristics of urine:

Appearance

normal urine is clear

cloudy = due to pus, blood, bacteria and lymph

fluid

Odornormal is faint aromatic odor

offensive odor = bacterial action

Collection of Urine


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Collection of Urine

SpecimenColornormal is clear yellow or amberstraw colored = diluted

highly colored = concentrated urine due toinsufficient fluid intakecloudy or smoky = infection, spermatozoared or red brown = hematuria, bleeding or

drugs and foodyellow-brown or green-brown = obstructivejaundice or lesion from bile ductdark-brown or black = malignant melanoma

or leukemia


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Collection of Urine

SpecimenpH

maintain normal hydrogen ion

concentration in plasma and ECFmust be measured in fresh urine because

the breakdown of urine to ammonia causes

urine to become alkali

normal pH is around 6 (acid) or 4.6-7.5

Check: ketones, glucose and

albumin


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Collection of Urine

SpecimenSpecific Gravity Determination

Reflects ability of the kidneys to

concentrate or dilute urine, normal range isfrom 1.005-1.025 (1.003- 1.030)

INTERVENTIONS:

Specific gravity can be measured bymultiple dipstick (most common method),

refractometer(an instrument used in the

laboratory setting) orurinometer(least

accurate method)


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Collection of Urine


INTERVENTIONS:

Factors that interfere with an accuratereading include radiopaque contrast

agents, glucose, and proteins

An increase in specific gravity occurs withinsufficient fluid intake, decreased renal

perfusion, or the presence of SIADH


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Collection of Urine


INTERVENTIONS:

A decrease in specific gravity occurs withincreased fluid intake, renal failure (diuretic

phase) and diabetes insipidus

Cold specimens may produce a false highreading


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Collection of Urine

SpecimenOsmolality

more precise test than specific gravity

1-2 ml urine are requirednormal range is from 300-1090 mOsm/kg

(number of particles per unit volume of

water)

GUT LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

Urine Culture and Sensitivity-

examination for bacterial infections of urinarytract that identifies the presence of

microorganisms and determines the specific

antibiotics that will treat the existing

microorganism appropriatelyINTERVENTIONS:

- Clean perineal area and urinary meatus

with bacteriostatic solution

GUT LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

1. Urine Culture and Sensitivity-

INTERVENTIONS: - Collect midstream sample in a sterile

container

- Send the collected specimen to thelaboratory immediately

- Note that urine from the client who forced

fluids may be too diluted to provide a positive

GUT LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

1. Urine Culture and Sensitivity-

INTERVENTIONS: - Identify any sources of peritoneal

contaminants during the collection of the

specimen, such as the hands, skin, clothing,hair, or vaginal or rectal secretions

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

Residual Urine-amount of urine left in

bladder after voiding measured via catheter(permanent or temporary) in bladder

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Urine Studies:

Creatinine Clearance- determineamount of creatinine (waste product of protein

breakdown) in the urine over 24 hours,

measures overall renal function

INTERVENTIONS:

- Encourage adequate fluids before andduring the test

- Instruct the client, as prescribed, to

avoid tea, coffee, and medications during


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GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Blood Studies:

BUN: measures renal ability to excrete

urea nitrogen Serum creatinine: specific test for renal

disorders; reflects ability of kidneys to

excrete creatinine Bicarbonate

Calcium

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Blood Studies:

1. Phosphorus

2. Potassium

3. Sodium

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Blood Urea Nitrogen (BUN) primary end product of protein metabolism

and is excreted by the kidneys

an elevation of BUN may indicate chronic

renal disease

not specific for the kidney function

normal value= 20-30 mg/dl

assess concentration of urea in the blood

can be reabsorbed by the kidney tubules

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Serum Creatinine is more specific forrenal function test is not affected by dietary intake or hydration

status normal value 0.5-1.5 mg/dl can not be reabsorbed by the kidney tubules assess GFR can be elevated in cases of glomerulonephritis

Pyelonephritis, acute tubular necrosis

nephrotoxicity, renal insufficiency and renalfailure.

GUT LABORATORY


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GUT: LABORATORY

DIAGNOSTICSKUB Radiograph Initial procedure for KUB disorders

An X-ray film of the urinary system andadjacent structures that is used to detect

urinary calculuses

INTERVENTIONS: No specific preparation is necessary

GUT LABORATORY


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GUT: LABORATORY

DIAGNOSTICSKUB Ultrasound Non-invasive method

NPO for 6 to 8 hours Is a noninvasive method of determining

renal damage, stones in the urinary tract

and measuring the volume of urine in thebladder

May be performed for evaluating urinary

frequency or inability to urinate


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GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Computed Tomography

INTERVENTIONS (CT Scan):

Instruct the client in the need to lie still andflat during the test

Instruct the client to hold his or her breath

when requested

Initiate an IV line if prescribed

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Computed Tomography


Assess for claustrophobia

Inform the client of possible mechanical

noises as the scanning occurs

Inform the client that there may be a hot,

flushed sensation and a metallic taste in

the mouth when the dye is injected

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Computed Tomography


Note some clients may be given the dyeeven if they report an allergy and are

treated with an antihistamine and

corticosteroids before the injection to

reduce the severity of a reaction

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Computed Tomography

INTERVENTIONS (CT Scan): Post-

Procedure Provide replacement fluids because diuresis

from the dye is expected

Monitor for an allergic reaction to the dye

Assess dye injection site for bleeding or

hematoma, and monitor extremity for color,

warmth, and the presence of distal pulses

GUT: LABORATORY


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GUT: LABORATORY

DIAGNOSTICS

Magnetic Resonance Imaging Non-invasive imaging methods that provide

more detailed cross-sectional views of the

kidney and urinary tract that identifies types

of tissues, tumors, and vascular

abnormalities

INTERVENTIONS (MRI): Pre-Procedure Remove all metal objects from the client

Remove IV fluid pumps during the test

GUT: LABORATORY


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GU O O

DIAGNOSTICSMagnetic Resonance Imaging

INTERVENTIONS (MRI): Pre-Procedure

Determine whether the client has a

pacemaker, implanted defibrillator, or metalimplants such as a hip prosthesis or vascular

clips because these clients cannot have this

test performed

Provide precautions for the client who is

attached to pulse oximeter because it can

cause a burn during testing if coiled around

the body or a body part

GUT: LABORATORY


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DIAGNOSTICS

Magnetic Resonance Imaging


Provide an assessment of the client withclaustrophobia

Administer medication as prescribed for the

client with claustrophobia

Determine whether a contrast agent is to beused, and follow the prescription related to

the administration of food, fluids, and

medications

GUT: LABORATORY


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DIAGNOSTICS

Magnetic Resonance Imaging


Instruct the client that he or she will need toremain still during the procedure

INTERVENTIONS: Post-Procedure

Client may resume normal activities Expect diuresis if a contrast agent was used

GUT: LABORATORY


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DIAGNOSTICS

Intravenous Pyelogram A radiopaque dye is injected that outlines the

renal system to identify abnormalitiesINTERVENTIONS: Pre-Procedure

Obtain an informed consent

Assess the client for allergies to iodine,seafood, and radiopaque dyes

Withhold food and fluids after midnight on the

night before the test


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IVP

GUT: LABORATORY


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DIAGNOSTICS

Intravenous Pyelogram

INTERVENTIONS: Pre-Procedure

Administer laxatives as prescribed Inform the client about possible throat

irritation, flushing of the face, warmth, or a

salty taste during the test


Monitor vital signs

Assess the venipuncture site for bleeding

GUT: LABORATORY


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DIAGNOSTICS

Intravenous Pyelogram


Monitor urinary output Instruct the client to drink at least 1 L of fluid

unless contraindicated

Monitor for signs of a possible allergicreaction to the dye used during the test

GUT: LABORATORY


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DIAGNOSTICS

Renal Angiography The injection of a radiopaque dye through a

catheter for examination of the renal arterial

supply


Obtain an informed consent

Assess the client for allergies to iodine,seafood, and radiopaque dyes

Inform the client about the possible burning

feeling along the vessel when the dye is used

GUT: LABORATORY


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DIAGNOSTICS

Renal Angiography


Withhold food and fluids after midnight on the

night before the test

Instruct the client to void immediately before

the procedure

Administer enemas as prescribed Shave injection sites as prescribed

Assess and mark the peripheral pulses

GUT: LABORATORY


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DIAGNOSTICS

Renal Angiography


Assess vital signs and peripheral pulses

Provide bed rest and use of a sandbag at the

insertion site for 4 to 8 hours

Assess the color and temperature of the

involved extremity Inspect the catheter insertion site for bleeding

or swelling

GUT: LABORATORY


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DIAGNOSTICS

Renal Angiography


Encourage increased fluids unless

contraindicated

Monitor urinary output

GUT: LABORATORY


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DIAGNOSTICS

Renal Scan An IV injection of a radioisotope for visual

imaging of renal blood flow

INTERVENTIONS: Pre-Procedure Obtain an informed consent form

Assess for allergies

Assist with administering radioisotope asnecessary

Instruct the client that he or she will be

required to remain motionless during the test

GUT: LABORATORY


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DIAGNOSTICS

Renal Scan


Instruct the client that imaging may be

repeated at various intervals before the test is

complete


Encourage fluid intake unless contraindicated

Assess the client for signs of delayed allergic

reaction such as itching and hives

GUT: LABORATORY


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DIAGNOSTICS

Renal Scan


Note that the radioactivity is eliminated in 24

hours

Follow standard precautions when caring for

incontinent clients and double-bag client

linens per agency policy


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Cystometrogram


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Cystometrogram

GUT: LABORATORY


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DIAGNOSTICS

Cystoscopy and Biopsy The bladder mucosa, ureteral orifice and

urethra is examined for inflammation,

calculuses, or tumors by means ofcystoscope; a biopsy may be obtained


Obtain an informed consent If biopsy is planned, withhold food and fluids

after midnight on the night before the test

C stoscopic E amination


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Cystoscopic Examination

GUT: LABORATORY


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DIAGNOSTICS

Cystoscopy and Biopsy


If a cystoscopy alone is planned, no special

preparation is necessary

And the procedure may be performed in the

physicians office

Post-procedure includes increasing fluidintake

GUT: LABORATORY


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DIAGNOSTICS

Cystoscopy and Biopsy


Monitor vital signs

Increase fluid intake and output

Encourage deep-breathing exercises to

relieve bladder spasms

Administer analgesics as prescribed

Administer sitz baths for back and abdominal

pain


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GUT: LABORATORY


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DIAGNOSTICS

Renal BiopsyINTERVENTIONS: During the Procedure

Position the client prone with a pillow under the

abdomen and shoulders Hold breath when the kidney is about to

puncture

INTERVENTIONS: Post-Procedure Monitor vital signs

Place the client in the supine position and on

bed rest for 8 hours as prescribed


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Renal Biopsy

GUT: LABORATORY


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DIAGNOSTICS

Renal Biopsy


Monitor hemoglobin and hematocrit

Avoid palpation and manipulation on the area

Monitor complications:

Colicky pain = clot in the ureter/s

Flank pain = bleeding in the muscleEvaluate hematuria = collect serial

urine specimen

GUT: LABORATORY


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DIAGNOSTICS

Renal Biopsy


Provide pressure to the biopsy site for 30

minutes

Check the biopsy site for bleeding

Encourage fluid intake of 1500 to 2000 mL as

prescribed Instruct the client to avoid heavy lifting and

GUT Part 1- Physio Assessment, Labs

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Transcript of GUT Part 1- Physio Assessment, Labs