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