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Health & Physical Assessment in Nursing First Edition. Donita D’Amico and Colleen Barbarito. Chapter 20 Urinary System. LEARNING OBJECTIVE ONE. LEARNING OBJECTIVE ONE. Urinary System Kidneys Ureters Bladder Urethra.

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Health physical assessment in nursing first edition
Health & Physical Assessment in NursingFirst Edition

Donita D’AmicoandColleen Barbarito

Chapter 20

Urinary System



Learning objective one1
LEARNING OBJECTIVE ONE

  • Urinary System

    • Kidneys

    • Ureters

    • Bladder

    • Urethra


Figure 20 1 the urinary system a anterior view of the urinary organs of a female
Figure 20.1 The urinary system. A. Anterior view of the urinary organs of a female.

A


Figure 20 1 continued the urinary system b relationship of the kidneys to the vertebrae
Figure 20.1 (continued)The urinary system. B. Relationship of the kidneys to the vertebrae.

B



Figure 20 2 internal anatomy of the kidney
Figure 20.2 Internal anatomy of the kidney.


Learning objective one3
LEARNING OBJECTIVE ONE

  • Kidneys

    • Location

    • Renal arteries

    • Renal capsule

    • Hilus

    • Medulla

    • Pyramids

    • Calyces

    • Collecting tubules


Learning objective one4
LEARNING OBJECTIVE ONE

  • Kidneys

    • Renal pelvis

    • Cortex

    • Nephrons

    • Glomeruli

    • Functions

      • Removes wastes, toxins, and foreign matter from the blood

      • Promotes fluid and electrolyte balance

      • Assists in maintenance of blood pressure

      • Contributes to erythropoesis and the metabolism of vitamin D


Learning objective one5
LEARNING OBJECTIVE ONE

  • Ureters

    • Function


Learning objective one6
LEARNING OBJECTIVE ONE

  • Urinary Bladder

    • Detrusor muscle

    • Functions

      • Temporarily store urine

      • Contract for urine release


Learning objective one7
LEARNING OBJECTIVE ONE

  • Urethra

    • Female

    • Male



Learning objective two1
LEARNING OBJECTIVE TWO

  • Landmarks for Physical Assessment of the Urinary System

    • Costovertebral angle


Figure 20 3a landmarks for urinary assessment a the costovertebral angle
Figure 20.3A Landmarks for urinary assessment. A. The costovertebral angle.

A


Learning objective two2
LEARNING OBJECTIVE TWO

  • Landmarks for Physical Assessment of the Urinary System

    • Symphysis pubis


Figure 20.3B Landmarks for urinary assessment. B. The rectus abdominis muscles and the symphysis pubis.

B


Learning objective two3
LEARNING OBJECTIVE TWO

  • Costovertebral Angle - Area on the Lower Back Formed by the Vertebral Column and Downward Curve of the Last Posterior Rib

    • Anatomical location of the kidneys and ureters


Learning objective two4
LEARNING OBJECTIVE TWO

  • Rectus Abdominis Muscles - Longitudinal Muscles Extending from the Pubis to the Ribs on Either Side of the Midline

    • Guides the location kidney palpation


Learning objective two5
LEARNING OBJECTIVE TWO

  • Symphysis Pubis - Joint Formed by the Union of Two Pubic Bones at the Midline

    • Bladder is cradled under this structure



Learning objective three1
LEARNING OBJECTIVE THREE

  • Focused Interview

    • General questions


Learning objective three2
LEARNING OBJECTIVE THREE

  • Specific Questions

    • Illness or infection

    • Symptoms

    • Pain

    • Behaviors

    • Infants and children

    • Pregnant female

    • Older adult

    • Environment



Learning objective four1
LEARNING OBJECTIVE FOUR

  • Equipment

    • Examination gown and drape

    • Examination gloves

    • Stethoscope

    • Specimen container


Learning objective four2
LEARNING OBJECTIVE FOUR

  • Other Considerations

    • Age

    • Gender

    • Culture



Learning objective five1
LEARNING OBJECTIVE FIVE

  • Physical Assessment of the Urinary System

    • Techniques

      • Inspection

      • Palpation

      • Percussion


Learning objective five2
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Assessment of hydration status and skin color

    • Inspection of the abdomen


Figure 20 5 inspecting the abdomen from the foot of the bed
Figure 20.5Inspecting the abdomen from the foot of the bed.


Learning objective five3
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Auscultation of the right and left renal arteries


Figure 20 6 auscultating the renal arteries
Figure 20.6Auscultating the renal arteries.


Learning objective five4
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Inspection of the costovertebral angles

    • Inspection of the flanks

    • Palpation of the costovertebral angles


Figure 20 7 palpating the costovertebral angle
Figure 20.7Palpating the costovertebral angle.


Learning objective five5
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Percussion of the costovertebral angles


Figure 20 8 blunt percussion over the left costovertebral angle
Figure 20.8Blunt percussion over the left costovertebral angle.


Learning objective five6
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Palpation of the kidneys


Figure 20 9 palpating the left kidney
Figure 20.9Palpating the left kidney.


Learning objective five7
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Palpation of the bladder


Figure 20 10 palpating the bladder
Figure 20.10Palpating the bladder.


Learning objective five8
LEARNING OBJECTIVE FIVE

  • Areas of the Urinary System Assessment

    • Percussion of the bladder



Learning objective six1
LEARNING OBJECTIVE SIX

  • Abnormal Findings in the Urinary System

    • Bladder cancer

    • Kidney and urinary tract infections

    • Renal calculi

    • Renal tumors

    • Renal failure

    • Changes in urinary elimination


Learning objective six2
LEARNING OBJECTIVE SIX

  • Bladder Cancer

    • More common in men than women

    • Linked to smoking


Learning objective six3
LEARNING OBJECTIVE SIX

  • Glomerulonephritits and Urinary Tract Infections


Learning objective six4
LEARNING OBJECTIVE SIX

  • Renal Calculi


Learning objective six5
LEARNING OBJECTIVE SIX

  • Renal Tumors

    • Benign

    • Malignant

    • Linked to smoking


Learning objective six6
LEARNING OBJECTIVE SIX

  • Renal Failure

    • Acute

      • Oliguria

      • Diuresis

      • Recovery

    • Chronic

      • Uremia


Learning objective six7
LEARNING OBJECTIVE SIX

  • Changes in Urinary Elimination

    • Dysreflexia

    • Incontinence

      • Functional

      • Reflex

      • Stress

      • Urge

      • Total

    • Urinary retention



Learning objective seven1
LEARNING OBJECTIVE SEVEN

  • Special Considerations - Developmental, Psychosocial, Cultural, and Environmental


Learning objective seven2
LEARNING OBJECTIVE SEVEN

  • Developmental Considerations - Pediatric

    • Renal blood flow and glomerular filtration rate increasing at birth

    • Infants and children having a fragile fluid and electrolyte balance

    • Illnesses involving dehydration leading to acidosis and fluid imbalance

    • Bed-wetting


Learning objective seven3
LEARNING OBJECTIVE SEVEN

  • Developmental Considerations - Pregnant Female

    • Pressure of the enlarging uterus

    • Postpartum edema of the bladder


Learning objective seven4
LEARNING OBJECTIVE SEVEN

  • Developmental Considerations - Geriatric

    • Decrease in renal blood flow and perfusion

    • Decrease in ability to concentrate and dilute urine

    • Reduction in ability to clear medications and acids

    • Reduction in ability to reabsorb bicarbonate and glucose

    • Effects of acidosis

    • Increased glycosuria

    • Fluid loss

    • Incontinence


Learning objective seven5
LEARNING OBJECTIVE SEVEN

  • Developmental Considerations - Geriatric

    • Urinary retention

    • Nocturia

    • Benign prostatic hypertrophy

    • Postmenopausal women and decreased estrogen


Learning objective seven6
LEARNING OBJECTIVE SEVEN

  • Psychosocial Considerations

    • Incontinence, altering self - image

    • Urinary tract infections may result from sexual trauma

    • Hesitation to discuss urinary system function


Learning objective seven7
LEARNING OBJECTIVE SEVEN

  • Cultural and Environmental Considerations

    • Race

    • Ethnicity

    • Geography

    • Hypertension

    • Diabetes

    • Renal calculi



Learning objective eight1
LEARNING OBJECTIVE EIGHT

  • Focus Areas Outlined in the Healthy People 2010

    • Chronic end - stage renal disease

    • Diabetes


Learning objective eight2
LEARNING OBJECTIVE EIGHT

  • Key Objectives for Chronic End - stage Renal Disease

    • Decrease the rate of new cases of ESRD

    • Increase the number of dialysis patients on waiting lists for transplant

    • Decrease kidney failure due to diabetes


Learning objective eight3
LEARNING OBJECTIVE EIGHT

  • Key Objectives for Diabetes

    • Prevent diabetes

    • Increase the number of diabetics who receive formal education

    • Increase the number of diabetics with annual testing for urinary microalbumin

    • Reduce death rates associated with diabetes



Learning objective nine1
LEARNING OBJECTIVE NINE

  • Critical Thinking and the Nursing Process


Learning objective nine2
LEARNING OBJECTIVE NINE

  • Learning Needs and Teaching Plans


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