Elimination Assessments

Page 3: Urinary Assessment

• Focus on assessing urinary function and health.

Page 4: Subjective Urinary Assessment

• History of Present Illness: Previous urinary tract infections (UTIs), kidney stones, past surgical procedures.

• Family History: Conditions like hypertension, diabetes, and bladder cancer.

• Symptom Inquiry:

  • Dysuria (painful urination)

  • Frequency of urination

  • Incontinence

  • Nocturia (nighttime urination)

  • Anuria (absence of urination)

  • Urgency to urinate

• Urinary Characteristics:

  • Hematuria (blood in urine)

  • Appearance: clear vs. cloudy

  • Odor

• Medication History

Page 5: Communication in Urinary Assessment

• Effective questioning about:

  • Usual urinary patterns

  • Recent changes in urinary habits

  • Past or present voiding difficulties

  • Family history of urinary disorders

Page 6: Physical Assessment - Urinary System

• Inspection:

  • Check for herniation/prolapse in women, edema, urethral issues.

• Palpation:

  • Assess costovertebral angle tenderness for pyelonephritis or stones.

  • Check bladder distention and prostate gland.

Page 7: Continued Urinary Assessment Techniques

• Percussion:

  • Blunt percussion of kidneys to assess tenderness

  • Dull sound = residual urine; Tympanic sound = empty bladder

• Auscultation:

  • Listen for renal artery bruits indicating turbulent blood flow.

Page 8: Relevant Anatomy for Urinary Update

• Herniation issues such as bladder into the anterior vaginal wall, drooping uterus, and rectal bulging can impact urinary function.

Page 9: Practice Question - Urinary Assessment

• Question: Which finding necessitates providing bathroom access?A. Tenderness over the kidneyB. Ingestion of 8oz of waterC. Abdominal bruit presentD. Dull sound over bladder

Page 10: Assessing Urine Characteristics

• Characteristics:

  • Color, odor, clarity, sediment

• Output:

  • Minimum of 30mL/hour

  • Continency vs. incontinence

  • Presence of catheter

Page 11: Implications of Urine Color

• Color Guides:

  • Colorless or pale yellow: Excess fluid, diabetes insipidus.

  • Yellow to milky: Infections, vaginal creams.

  • Bright yellow: Vitamin excess.

  • Pink to red: Blood, certain foods, medications.

  • Blue/green: Medications or infections.

  • Orange to amber: Dehydration, bilirubin presence.

  • Brown to black: Old blood, certain medications.

Page 12: Urinalysis (UA) Overview

• Process: Clean catch vs. sterile specimen collection.

• Assessment Parameters:

  • Color, clarity, odor, pH, specific gravity, and tests for proteins, glucose, ketones.

  • Microscopic exams for hematuria, pyuria, etc.

• Sample Requirements: Minimum of 10mL for testing.

Page 13: Urinalysis Collection Methods

• Clean Catch Method: Vital for accurate results.

• Foley Catheter: Collect immediately after insertion.

• Sterile Specimen via Catheter: Necessitated in incontinent patients.

• Pediatric Collection: Via catheter until voluntary control is achieved.

Page 14: Interpreting Urinalysis Findings

• Common Indicators:

  • Hematuria: Infections, stones, or tumors.

  • Proteinuria: Glomerular damage or malignancy.

  • Specific Gravity: Hydration levels.

  • Abnormalities in patients with UTIs: Leukocytes, hematuria, nitrites, and more.

Page 15: Renal Function Testing

• BUN (Blood Urea Nitrogen): Normal: 10-20 mg/dL; elevated indicates dysfunction.

• Creatinine Levels: Male: 0.6-1.2 mg/dL; Female: 0.5-1.1 mg/dL.

• GFR (Glomerular Filtration Rate): Normal: 90-120 mL/min; low indicates kidney issues.

Page 16: 24-hour Urine Collection

• Purpose: Diagnose kidney problems through total volume collection.

• Procedure: Start at a specified time; keep on ice and discard first morning urine.

Page 17: Diagnostic Tests for GU

• Tests Include:

  • X-rays, Ultrasound, CT, MRI for organ structure.

  • Intravenous Pyelogram: Visualizes blood flow through urinary tract.

  • Cystoscopy for enhanced visualization.

  • Biopsy implications for suspected malignancies.

Page 18: Cystoscopy Insights

• Procedure Overview: Utilizes a cystoscope for internal visualization.

• Considerations: NPO after midnight, monitor for retention, potential UTI, manage discomfort, and watch for blood in urine post-procedure.

Page 19: Nursing Considerations for Contrast Usage

• Allergy Assessment: Verify iodine allergies.

• Nephrotoxicity Monitoring: Increase fluids post-procedure and watch for adverse reactions.

Page 20: Tests That Can Detect

• Conditions Include:

  • Urinary Tract Infections, Pyelonephritis, CAUTI, Urolithiasis, Cancer, Hydronephrosis.

Page 21: Case Study Example

• Scenario: Assess an 84-year-old post-cystoscopy patient.

• Questions to Ask: Fluid intake, urine appearance, family history, pattern changes.

• Assessments: Check for bladder distension, use percussion.

• Diagnostics Considerations: Urinalysis, ultrasound, BUN, creatinine tests.

• Interventions: Warm compresses, fluid management, bathroom assistance, anticipation of symptomatic improvement.

Page 22: Introduction to GI Assessment

• Focus on assessing gastrointestinal function and health.

Page 23: Subjective GI Assessment

• Key Symptoms: Abdominal pain, dyspepsia, gas, nausea/vomiting, changes in bowel habits, stool characteristics, nutritional history.

Page 24: Oral Cavity Assessment

• Components: Inspection of the soft palate, oral cavity, lips, gums, tongue, pharynx.

Page 25: Abdominal Assessment Techniques

• Inspection Findings: Color changes, hernias, lesions, ascites, peristaltic activity, discoloration, bruises, striae, and shape evaluations.

Page 26: Abdominal Auscultation

• Sound Types: Regular (5-35 sounds/min), hyperactive (>35 sounds), hypoactive (<5 sounds), absent sounds (confirming full 5 mins).

• Vascular Sounds: Listen for bruits indicating vascular issues.

Page 27: Continued Abdominal Auscultation

• Vascular sounds detection for aortic and renal areas indicative of stenosis or obstruction.

Page 28: Abdominal Percussion Techniques

• Purpose: Assess organ size and density, detect solid masses, indicate normal/abnormal conditions.

Page 29: Abdominal Palpation Techniques

• Approach: Light palpation for tenderness, deep if indicated. Order of assessment should be consistent: inspection, auscultation, percussion, palpation.

Page 30: GI Assessment Changes with Aging

• Observations: Muscle tone decreases, saliva and enzyme levels decline, motility changes in intestines.

Page 31: Practice Question - GI Assessment

• Scenario: What action follows abdominal observation in a client with diarrhea?A. Percussion for liverB. Auscultation for bruitsC. Light touch for tendernessD. Help to bathroom.

Page 32: Stool Assessment Characteristics

• Normal Parameters: Volume varies, color ranges, odor characteristics, shape distinctions.

• Abnormal Indicators: Black stools, narrow shapes, presence of blood/mucus.

Page 33: Bristol Stool Chart Overview

• Types of Feces: Various stool types from Type 1 (hard lumps) to Type 7 (liquid).

• Diagnostic Indicators: Types indicate constipation to diarrhea issues.

Page 34: GI Diagnostics - Stool Tests

• Common Tests: FOBT, C. diff testing, stool cultures.

• Nursing Considerations: Ensure contamination prevention and proper collection techniques.

Page 35: GI Diagnostics - Imaging Studies Overview

• Types: Ultrasound, fluoroscopy, CT, MRI.

• Considerations: Pre-procedure preparations (NPO, hydration) and contrast precautions.

Page 36: GI Diagnostics - Endoscopic Procedures Overview

• Procedures: Upper GI and lower GI evaluations, specimen collection, sedation considerations.

Page 37: Practice Question - Stool Collection

• Correct Procedure Statements:A. Avoid contamination from toilet bowl.B. Do not include toilet paper.C. Encourage prior bathroom visit.D. Use bedpan for sample collection.E. Clean commode before collection.F. Labs require 45mL sample.