The document provides guidelines for assessing the urinary system. It outlines collecting subjective data about the patient's medical history and symptoms related to renal and urinary problems. Objective data to collect includes inspection of the skin, mouth, face, extremities and abdomen. The physical exam involves palpation of the costovertebral angle to check for kidney tenderness or masses, percussion over the kidney areas, and auscultation of the abdomen to check for abnormal sounds.

1. RENAL ASSESSMENT

2. Assessment of Urinary System
SUBJCECTIVE DATA
• Patient should be questioned about the presence or history of
disease that are related to renal or urologic problems like HTN,
DM ,gout, infections of streptococci origin , congenital disorders
or trauma.
• Ask for specific urinary problems such as cancer , infections,
BPH , calculi
• An assessment of patient current and past use of medications
are important
• Collect history of hospitalization related to renal and urologic
diseases and all urinary problems in past pregnancies.
• Past surgeries , particularly pelvic surgeries or urinary tract
instrumentation should be documented .

3. SUBJCECTIVE DATA
Nutritional – metabolic pattern
• Collect detail of usual quantity and type of fluid
• Dehydration may contribute to urinary infections , calculi
formation and renal failure.
• Large intake of diary products and protein leads to calculi
formation
Elimination pattern
• Ask for day time voiding frequency and frequency of nocturia.
• Ask for frequency, urgency, incontinence, retention of urine
• Bowel function should also be evaluated because fecal
incontinence may signal neurological causes of bladder
problem.

4. ASSESSMENT OF URINARY SYSTEM - OBJECTIVE
DATA
Nurse should assess for changes in the
following:
• Skin : pallor, yellow gray cast, excoriation,
changing turgor , bruises , texture ( dry,
rough)
• Mouth: stomatitis , ammonia breath odor
• Face & extremities: generalized edema,
peripheral edema, bladder distention,
masses

5. • Abdomen: skin changes described earlier, as
well as striae, abdominal contour for midline
mass in lower abdomen (may indicate urinary
retention) or unilateral mass (may indicate
enlargement of one or both kidney from large
tumor).
• Weight: weight gain secondary to edema,
weight loss and muscle wasting in renal failure.
• General state of health: fatigue, lethargy,
diminished alertness.

6. Inspection
• Assessment of the kidneys,
ureters, and bladder:- 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 twelweth rib and the
vertebral column.
PHYSICAL EXAMINATION

7. PHYSICAL EXAMINATION
Palpation
• Identifies masses and areas of
tenderness
• Land mark of locating kidney is
costovertebral angle (CVA ).
• To palpate right kidney , the examiners
left hand is placed behind and support
the patients right side between the rib
cage and the iliac crest.
• The right flank is elevated with the left
hand , and the right hand is used to
palpate deeply for the right kidney.
• If the kidneys are palpable , its size,
contour and tenderness should be
noted
• Urinary bladder is normally not
palpable unless it is distended with
urine.

8. PHYSICAL EXAMINATION
Percussion
• Percuss on posterior CVA
margin
• Normally a firm blow in the
flank area should not elicit pain.
• If CVA tenderness and pain are
present , it may indicate kidney
infections or polycystic kidney
disease .
• Normally bladder is not
percussible until it contain 150
ml of urine.
• If bladder is full , dullness is
heard above the symphisis
pubis.

9. PHYSICAL EXAMINATION
AUSCULTATION
• Bell of stethoscope used
to auscultate over both
CVAs and in the upper
abdominal quadrants
• Abdominal aorta and
renal arteries are
auscultated for a bruit
(an abnormal murmur)
which indicate impaired
blood flow to the kidney