A guide to help the students review themselves about the A & P of the urinary system. it also helps in collecting history and appraise the client suffering from various urinary tract disorders or diseases.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine.
Urinary diversion procedures are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin.
These procedures are primarily performed when a bladder tumor necessitates removal of the entire bladder (cystectomy).
Urinary diversion has also been used in managing pelvic malignancy, birth defects, strictures, trauma to ureters and urethra, neurogenic bladder, chronic infection causing severe ureteral and renal damage, and intractable interstitial cystitis and as a last resort in managing incontinence.
There are two categories of urinary diversion:
1. Cutaneous urinary diversion : in which urine drains through an opening created in the abdominal wall and skin.
2. Continent urinary diversion : in which a portion of the intestine is used to create a new reservoir for urine.
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine.
Urinary diversion procedures are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin.
These procedures are primarily performed when a bladder tumor necessitates removal of the entire bladder (cystectomy).
Urinary diversion has also been used in managing pelvic malignancy, birth defects, strictures, trauma to ureters and urethra, neurogenic bladder, chronic infection causing severe ureteral and renal damage, and intractable interstitial cystitis and as a last resort in managing incontinence.
There are two categories of urinary diversion:
1. Cutaneous urinary diversion : in which urine drains through an opening created in the abdominal wall and skin.
2. Continent urinary diversion : in which a portion of the intestine is used to create a new reservoir for urine.
definition of hydronephrosis,
causes and types of hydronephrosis
pathophysiology of hydronephrosis
clinical manifestation and diagnostic test for hydronephrosis
management
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
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Anatomy of urinary tract with special reference to anatomy of kidney and
nephrons, functions of kidney and urinary tract, physiology of urine formation,
micturition reflex and role of kidneys in acid base balance, role of RAS in kidney
and disorders of kidney.
Play is mandatory for every child, let the age of the child be 0 or 18 years.
This topic will help you to recognize the importance and types of play. Further, it also important to know about play materials that is to be used at various age group.
Babitha's Notes on anemia's & bleeding disordersBabitha Devu
This note will help you in knowing about childhood anemia's like iron deficiency, SCD etc.. also some of the bleeding disorders are also explained in this.
Childhood is a period where the needs vary according to age.
For a pediatric nurse when dealing with children they should be aware of the needs of a healthy child.
Notes on nutritional needs of children & infantsBabitha Devu
There are various methods of feeding a child. Like breastfeeding, weaning & artificial feeding.
All the types of feeding which help to fulfill the nutritional need of a child as per the increase in age are elaborated in this presentation.
Mother & Child is a vulnerable group. But many areas concerned with the health of these groups are preventable. This presentation helps you identify preventive aspects in pediatrics.
Notes on unit 02 - growth & development introductionBabitha Devu
It is a platform for pediatric nurses to review the introduction about growth & development, its theories, principles and how to assess these parameters.
Dear all,
Recording & Reporting are very important in the nursing profession. As a nurse, we have to be very conscious of it to prevent further complications.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. LEARNING OBJECTIVES
After studying this chapter, you
should be able to:
Compare and contrast kidney
anatomy and function.
Demonstrate the physical
assessment of urinary system.
Use laboratory data to distinguish
between dehydration and renal
impairment.
3. INTRODUCTION
The renal system includes the kidneys and the entire uri-
nary tract. The ureters, bladder, and urethra provide
a drainage route for the excretion of urine. Structural or
functional problems in the kidney or urinary tract
usually alter fluid, electrolyte, and acid-base balance.
Assessment of the client at risk for or with actual
problems of the renal system begins with a history and
physical assessment. A clear understanding of the
anatomy, physiology, and diagnostic tests of the renal
system will help the nurse in problem solving about
renal function in the clinical setting. It also assist the
nurse in teaching the client about the purpose of tests
and in preparing the client for assessment.
4. ANATOMY OVERVIEW
GROSS ANATOMY
Normally, two kidneys are located in
the retroperitoneal space (behind the
peritoneum, not really in the abdominal
cavity), one on either side of the vertebral
column.
5.
6. KIDNEYS
The adult kidney is 4 to 5 inches (11 to 13 cm) long, 2 to
3 inches (5 to 7 cm) wide, and about 1 inch (2.5 to 3 cm)
thick. It weighs about 8 ounces (250 g). The left kidney is
slightly longer and narrower than the right kidney. Kidney
size is usually determined via ultrasound. Larger-than-
usual kidneys may indicate renal obstruction or polycystic
disease, whereas smaller-than-usual kidneys may indicate
chronic renal disease.
Several layers of protective, supportive tissue surround
the kidney. On the outer surface of the kidney is a layer of
fibrous tissue called the renal capsule. This capsule covers
most of the kidney except the hilum, the area in which the
renal artery enters and the renal vein and ureter exit.
The renal capsule is surrounded by layers of fat and
connective tissue (Gerota's fascia).
7. KIDNEYS
Lying beneath the renal capsule is functional renal
tissue composed of two distinct sections: the cortex and the
medulla. The renal cortex, or outer tissue layer, is in direct
contact with the renal capsule. The medulla, or medullary
tissue, lies below the cortex in the shape of many fans. Each
"fan" is called a pyramid, and there are 12 to 18 pyramids
per kidney. The renal columns (columns of Bertin) are
cortical tissue that dip down into the interior of the kidney
and separate the pyramids.
The tip, or end, of each pyramid is called
the papilla. The papillae drain urine into the collecting
system. A cuplike structure called a calyx collects the urine
at the end of each papilla. The calices merge together to
form the renal pelvis, which narrows to become the ureter.
8. KIDNEYS
The kidneys receive 20% to 25% of the total cardiac
output. Renal blood flow per minute varies from about
600 to 1300 mL/min. The blood supply to each kidney
is usually delivered by a single renal artery, which
branches from the abdominal aorta. The renal artery
separates into progressively smaller arteries, supplying
all areas of the renal tissue (parenchyma) and the
nephrons. The smallest arteries, the afferent arterioles,
feed the nephrons directly to form urine. Venous blood
from the kidneys starts with the capillaries surrounding
each nephron. These capillaries drain into progressively
larger veins, with blood eventually returned to the
inferior vena cava through the renal vein.
9.
10. MICROSCOPIC ANATOMY
The nephron is the functional unit of the kidney, and
it is here that urine is actually formed from blood.
There are about 1 million nephrons per kidney, and
each nephron separately makes urine from blood.
There are two types of nephrons: cortical nephrons
and juxtamedullary nephrons. The cortical nephrons
are short, with all parts located in the renal cortex. The
juxtamedullary nephrons (about 20% of all nephrons)
are longer, and their tubes and associated blood
vessels dip deeply into the medulla. The purpose of the
juxtamedullary nephrons is to concentrate urine during
times of low fluid intake. The ability to concentrate
urine allows for the maximum excretion of waste
products with less fluid loss.
11.
12. MICROSCOPIC ANATOMY
Each nephron is a tubular structure with distinct parts . The
tubular component of the nephron begins with Bowman's
capsule, a saclike structure that surrounds the glomerulus.
The tubular tissue of Bowman's capsule narrows into
the proximal convoluted tubule (PCT). The PCT twists and
turns, finally straightening into the descending limb of
the loop of Henle. The descending loop of Henle dips in the
direction of the medulla but forms a hairpin loop and
comes back up into the cortex.
As the loop of Henle changes direction, two segments
are identified in the ascending limb of the loop of Henle: the
thin and thick segments. The distal convoluted tubule
(DCT) is formed from the thick segment of the ascending
limb of the loop of Henle. The DCT ends in one of
many collecting ducts located in the kidney tissue. The urine
in the collecting ducts passes through the papillae and
13. URETERS
Each kidney has a single ureter, a hollow tube like
structure that connects the renal pelvis with the urinary
bladder. The ureter is about 1/2 inch (1.25 cm) in diameter
and about 12 to 18 inches (30 to 45 cm) in length.
The ureter tunnels through bladder tissue for a few cen-
timeters before opening into the bladder in an area
referred to as the trigone.
The ureter is composed of three layers: an inner lining
of mucous membrane (urothelium), a middle layer of
smooth muscle fibers, and an outer layer of fibrous
tissue. The outer layer of the ureter contains the blood
supply. The middle layer of ureteral tissue contains
longitudinal and circular muscle fibers. These muscle
fibers are under the control of a variety of nerve pathways
from the lower spinal cord.
14.
15. URINARY BLADDER
The urinary bladder is a muscular sac. The upper surface
lies next to the peritoneal cavity. In men, the bladder is in
front of the rectum. In women, the bladder is in front of the
vagina. The bladder lies directly behind the pubic
symphysis, the connecting point for pelvic bone structures.
The bladder is composed of the body (the rounded sac por-
tion) and the bladder neck (posterior urethra), which con-
nects to the bladder body. The bladder has three linings, an
inner lining of epithelial cells (urothelium), middle layers
of smooth muscle (detrusor muscle), and an outer lining.
The trigone is an area on the inner aspect of the posterior
bladder wall between the points of ureteral entry
(ureterovesical junctions [UVJs]) and the urethra.
16. URINARY BLADDER
The internal urethral sphincter is composed
of the smooth detrusor muscle of the bladder
neck and elastic tissue. The external urethral
sphincter is composed of skeletal muscle that
surrounds the urethra. In men, the external
sphincter surrounds the urethra at the base of
the prostate gland. In women, the external
sphincter is at the base of the bladder. The
pudendal nerve from the spinal cord controls
the external sphincter.
17. URETHRA
The urethra is a narrow, tube like structure lined with
mucous membranes and epithelial cells. The urethral
meatus, or opening, is the terminal point of the urethra. In
men, the urethra is about 6 to 8 inches (15 to 20 cm) long,
with the urethral meatus is located at the tip of the penis.
Three sections make up the male urethra:
The prostatic urethra, which traverses the prostate
gland from the urinary bladder
The membranous urethra, which traverses the wall of
the pelvic floor
The cavernous urethra, which is external and
extends through the length of the penis
In women, the urethra is about 1 to 1.5 inches (2.5 to
3.75 cm) long and exits the urinary bladder through the
pelvic floor. The urethral meatus lies slightly below the
clitoris and directly in front of the vagina and rectum.
18. FUNCTION OF THE URINARY SYSTEM
KIDNEY – regulate blood
volume and composition,
regulate pH, produce 2
hormones and excrete waste
URETERS- transport urine
from kidney to urinary
bladder
URINARY BLADDER- store
urine and expels through
urethra
URETHRA- discharge urine
from the body
19. ASSESSMENT TECHNIQUES
History
One way to assess renal and urologic function
is to use Gordon's Functional Health Patterns
(Gordon, 2000). The patterns most pertinent
to the renal system are Nutritional/ Metabolic
and Elimination (Chart in next slide).
20.
21. ASSESSMENT TECHNIQUES
History
DEMOGRAPHIC DATA
Age, gender, race, and ethnicity are important in the
overall history of the client with suspected renal or urinary
dysfunction. A sudden onset of hypertension in clients older
than 50 years of age suggests possible kidney disease. Clinical
evidence of adult polycystic kidney disease typically occurs
in clients in their 40s or 50s. In men older than 50 years,
altered urine patterns suggest prostatic disease.
Anatomic gender differences make some disorders worse or
more common. For example, men rarely have urinary
tract infections unless there are abnormalities, such as
ureteral reflux or prostatic enlargement. Women have a
shorter urethra and therefore more commonly
experience cystitis (bladder infection) because bacteria pass
more readily into the bladder.
22. ASSESSMENT TECHNIQUES
History
PERSONAL AND FAMILY HISTORY
The family history of the client with a suspected
kidney or urologic problem is significant because
some disorders have a familial inheritance
pattern.
The client is asked about any previous renal or
urologic disorders, including tumors, infections,
stones, or urologic surgery. A history of any
chronic health problems, such as diabetes
mellitus or hypertension, may contribute to the
development of renal disease.
23. ASSESSMENT TECHNIQUES
History
PERSONAL AND FAMILY HISTORY
The use of over-the-counter (OTC) drugs or
agents, including vitamin and mineral
supplements and replacements, laxatives,
analgesics, and nonsteroidal anti-
inflammatory drugs (NS AIDs) is explored. Many
of these drugs affect renal function. The long-
term use of NSAIDs, especially combination
agents, can seriously reduce renal function.
The client is specifically asked whether he or she
has ever been told about the presence of protein
or albumin in the urine.
24. ASSESSMENT TECHNIQUES
History
PERSONAL AND FAMILY HISTORY
Additional information is obtained about the
following:
Chemical or environmental toxin exposure in occupa-
tional or other settings
Recent travel to geographic regions that pose
infectious disease risks
Recent physical injuries
Trauma
Sexual contacts
A history of altered patterns of urinary elimination
25. DIET
The excessive intake or omission of certain categories
of foods is noted.
Information about food and fluid intake is obtained.
If the client has followed a diet for weight reduction,
the details of the diet plan are pertinent.
Changes in appetite, alterations in taste acuity, and an
inability to discriminate tastes are important. These
symptoms are associated with the accumulation of
nitrogenous waste products from renal failure.
Changes in thirst or fluid intake may also produce
changes in urine output or other evidence of urologic
disorders. Endocrine disorders may also produce
changes in thirst, fluid intake, and urine output
26. SOCIOECONOMIC STATUS
People with limited income or no health
insurance often ignore physical ailments or
delay seeking health care.
The information that a client has about the
disease and its symptoms may relate to
educational level.
The client's health beliefs affect the approach
to health and illness. Cultural background or
religious affiliation may influence the belief
system.
27. CURRENT HEALTH PROBLEMS
The effects of renal failure result in changes in all
body systems. Therefore all of the client's current
health problems are documented.
The client is asked about any changes in the
appearance (color, odor, clarity) of the urine,
pattern of urination, ability to initiate or control
voiding, and other unusual symptoms.
The client is asked about changes in urination
patterns, such as nocturia, frequency, or an
increase or decrease in the amount of urine. The
normal urine output for adults is 1 mL/kg/hr, or
approximately 1500 to 2000 mL/day.
28. CURRENT HEALTH PROBLEMS
Urinary incontience or retention
Flank region pain
Uremia
Fatigue
Itching
Symptoms of dehydration
30. PHYSICAL ASSESSMENT
The physical assessment of the client with a
known or suspected renal or urologic disorder
includes an assessment of general appearance,
a general review of body systems, and specific
structure and functions of the renal/urinary
systems.
31. PHYSICAL ASSESSMENT
GENERAL APPEARANCE
Checks for a yellowish skin colour and the presence of
any rashes, bruising, or other discoloration. The skin and
tissues may show edema, which with renal disorders may be
detected in the pedal (foot), pretibial (shin), sacral tissues,
and around the eyes.
The lungs are auscultated to determine whether fluid is
present.
Weight and blood pressure measurements are obtained for
comparison purposes.
The nurse assesses the client's general level of consciousness
and level of alertness, noting deficits in concentration,
thought processes, or memory. Family members may
report subtle changes. Such cognitive changes may be the
result of an insufficient clearance of waste products.
32. PHYSICAL ASSESSMENT
ASSESSMENT OF THE KIDNEYS, URETERS, AND BLADDER
Inspection
The nurse inspects the abdomen and the flank regions
with the client in both the supine and the sitting position. The
client is observed for asymmetry (e.g., swelling) or
discoloration (e.g., bruising or redness) in the flank region,
especially in the area of the costovertebral angle (CVA). The
CVA is located between the lower portion of the twelveth rib
and the vertebral column.
33. PHYSICAL ASSESSMENT
ASSESSMENT OF THE
KIDNEYS, URETERS, AND
BLADDER
Auscultation
The nurse listens for a bruit over
each renal artery on the mid-
clavicular line. A bruit is an
audible swishing sound produced
when the volume of blood or the
diameter of the blood vessel
changes. A bruit is usually
associated with blood
flow through a narrowed vessel, as
in renal artery stenosis.
34. PHYSICAL ASSESSMENT
ASSESSMENT OF THE KIDNEYS, URETERS, AND BLADDER
Palpation
Renal palpation identifies masses and areas of tenderness
in or around the kidney. The abdomen is lightly palpated in all
quadrants. The nurse asks about areas of tenderness or
discomfort and examines non-tender areas first. The outline
of the bladder may be seen as high as the umbilicus in clients
with severe bladder distention. Special training and practice
under the guidance of a qualified practitioner are necessary;
therefore appropriate education is essential before attempting
the procedure. If tumor or aneurysm is suspected, palpation
may harm the client.
35.
36. PHYSICAL ASSESSMENT
ASSESSMENT OF THE KIDNEYS, URETERS, AND BLADDER
Palpation
Because the kidneys are deep, posterior structures, palpation
is easier in thin clients who have little abdominal
musculature. For palpation of the right kidney, the client
assumes a supine position while the nurse places one hand
under the right flank and the other hand over the abdomen
below the lower right part of the rib cage. The lower hand
raises the flank, and the upper hand depresses the anterior
abdomen as the client takes a deep breath. The left kidney is
deeper and rarely palpable. A transplanted kidney is readily
palpable in either the lower right or left abdominal quadrant.
The kidney should feel smooth, firm, and nontender.
37. PHYSICAL ASSESSMENT
ASSESSMENT OF THE KIDNEYS, URETERS, AND BLADDER
Percussion
A distended bladder sounds dull when percussed. After gently
palpating to determine the general outline of the distended
bladder, the nurse begins percussion on the skin of the lower
abdomen and continues in the direction of the umbilicus
until dull sounds are no longer produced.
38. PHYSICAL ASSESSMENT
ASSESSMENT OF THE URETHRA
Using a good light source and wearing gloves, the nurse
inspects the urethra by examining the meatus and
surrounding tissues. Any unusual discharge such as
blood, mucus, and purulent drainage is noted. The
skin and mucous membranes of surrounding tissues
are inspected, and the presence of lesions, rashes, or
other abnormalities of the penis or scrotum or of
the labia or vaginal orifice is documented. Urethral
irritation is suspected when the client reports
discomfort with urination.
39. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Blood Tests
SERUM CREATININE
Normal levels of creatinine in the blood are approximately
0.6 to 1.2 milligrams (mg) per decilitre (dL) in
adult males
0.5 to 1.1 milligrams per decilitre in adult females.
Serum creatinine is a measurement of the end product
of muscle and protein metabolism. No common
pathologic condition other than renal disease results
in an increase in serum creatinine level. The
serum creatinine level does not increase until at least
50% of the renal function is lost.
40. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Blood Tests
BLOOD UREA NITROGEN
Blood urea nitrogen (BUN) measures the renal excretion
of urea nitrogen, a by-product of protein metabolism. When
liver and kidney dysfunction are both present, urea nitrogen
levels are actually decreased; this decrease reflects the liver
failure but not the kidney failure. The BUN level is not always
elevated with kidney disease and is not the most reliable
indicator of kidney function. However, an elevated BUN level
is highly suggestive of kidney dysfunction.
7 to 20 mg/dL (2.5 to 7.1 mmol/L)
41. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Urine Tests
URINALYSIS
COLOR, ODOR, AND TURBIDITY.
SPECIFIC GRAVITY. 1.000 (the specific gravity of water) to
greater than 1.035.
pH. A pH value less than 7 is considered acidic, and a value
greater than 7 is considered alkaline.
GLUCOSE. < 0.5g/day
KETONE BODIES. Three types of ketone bodies are acetone,
acetoacetic acid, and beta-hydroxybutyric acid. Ketone
bodies are by-products of the incomplete metabolism of fatty
acids. Normally there are no ketones in urine.
42. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Urine Tests
URINALYSIS
PROTEIN. Protein, such as albumin, is not normally present
in the urine. 8 – 18 mg/dl is normal.
SEDIMENT. Urine sediment refers to particles in the urine.
These particles include cells, casts, crystals, and bacteria.
o CELLS. Types of cells abnormally present in the urine may
include tubular cells (from the tubule of the
nephron), epithelial cells (from the lining of the urinary
tract), red blood cells (RBCs), and white blood cells (WBCs).
o CASTS. Casts are structures formed around other particles.
There may be casts of cells, bacteria, or protein.
43. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Urine Tests
URINALYSIS
SEDIMENT.
o CRYSTALS. Crystals in the urine come from various
salts. These particles may be a result of diet, drugs, or disease.
The salts may be composed of calcium, oxalate, urea,
phosphate, magnesium, or other substances. Certain drugs,
such as the sulfates, can also produce crystals.
o BACTERIA. Bacteria in a urine sample multiply quickly, so the
specimen must be analyzed promptly. Normally urine is
sterile
44. DIAGNOSTIC ASSESSMENT
LABORATORY TESTS
Urine Tests
URINE FOR CULTURE AND SENSITIVITY
CREATININE CLEARANCE TEST. Creatinine clearance is a
calculation of glomerular filtration rate.
The range for normal creatinine clearance is 90 to 139 mL/min
for adult males and 80 to 125 mL/min for females.
URINE ELECTROLYTES. analysis of urine electrolyte levels
(e.g., sodium and chloride).
OSMOLALITY