Focus on assessing urinary function and health.
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
Effective questioning about:
Usual urinary patterns
Recent changes in urinary habits
Past or present voiding difficulties
Family history of urinary disorders
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.
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.
Herniation issues such as bladder into the anterior vaginal wall, drooping uterus, and rectal bulging can impact urinary function.
Question: Which finding necessitates providing bathroom access?A. Tenderness over the kidneyB. Ingestion of 8oz of waterC. Abdominal bruit presentD. Dull sound over bladder
Characteristics:
Color, odor, clarity, sediment
Output:
Minimum of 30mL/hour
Continency vs. incontinence
Presence of catheter
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.
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.
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.
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.
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.
Purpose: Diagnose kidney problems through total volume collection.
Procedure: Start at a specified time; keep on ice and discard first morning urine.
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.
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.
Allergy Assessment: Verify iodine allergies.
Nephrotoxicity Monitoring: Increase fluids post-procedure and watch for adverse reactions.
Conditions Include:
Urinary Tract Infections, Pyelonephritis, CAUTI, Urolithiasis, Cancer, Hydronephrosis.
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.
Focus on assessing gastrointestinal function and health.
Key Symptoms: Abdominal pain, dyspepsia, gas, nausea/vomiting, changes in bowel habits, stool characteristics, nutritional history.
Components: Inspection of the soft palate, oral cavity, lips, gums, tongue, pharynx.
Inspection Findings: Color changes, hernias, lesions, ascites, peristaltic activity, discoloration, bruises, striae, and shape evaluations.
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.
Vascular sounds detection for aortic and renal areas indicative of stenosis or obstruction.
Purpose: Assess organ size and density, detect solid masses, indicate normal/abnormal conditions.
Approach: Light palpation for tenderness, deep if indicated. Order of assessment should be consistent: inspection, auscultation, percussion, palpation.
Observations: Muscle tone decreases, saliva and enzyme levels decline, motility changes in intestines.
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.
Normal Parameters: Volume varies, color ranges, odor characteristics, shape distinctions.
Abnormal Indicators: Black stools, narrow shapes, presence of blood/mucus.
Types of Feces: Various stool types from Type 1 (hard lumps) to Type 7 (liquid).
Diagnostic Indicators: Types indicate constipation to diarrhea issues.
Common Tests: FOBT, C. diff testing, stool cultures.
Nursing Considerations: Ensure contamination prevention and proper collection techniques.
Types: Ultrasound, fluoroscopy, CT, MRI.
Considerations: Pre-procedure preparations (NPO, hydration) and contrast precautions.
Procedures: Upper GI and lower GI evaluations, specimen collection, sedation considerations.
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.