lecture 6: genitourinary (GU) assessment Flashcards
What are the 5 factors influencing micturition (action of urinating):
- disease or disability
- fluid balance
- medication
- pelvic floor muscle tone
- psychological factors
how much urine should a healthy individual produce each hour?
a healthy individual should produce 0.5mL/kg/hr
- patients weight in kg/2
example: patient weighs 82kg, how much urine should he produce per hour?
- 82kg x 0.5mL/kg/hr = 41mL/hr
pelvic floor muscle (PFM) tone: what types of control is it under? what is its role (2)? what can a weak PFM cause?
- PFM is under voluntary and involuntary control
- PFM provide structural support to pelvic organs & prevent urine loss at bladder neck (ex. they help you “hold” it)
- Weak PFM contributes to increase GU problems
what are some psychological factors (feelings)? what do they cause?
- embarrassment
- anxiety
- environmental factors
increase of urgency and/or frequency and/or retention
disease or disability: what causes change in volume or quality of urine produced (2 causes)? what else can affect urination?
signs and symptoms related to site of dysfunction (e.g. glomerulus, renal tubule) causes decreased secretion, filtration, or reabsorption
- ex. DM, nephritis, or UTI
renal obstruction
- signs and symptoms related to the obstruction (from renal pelvis to urethral meatus)
- ex. stones, blood clots, tumours
dementia, immobility/mobility restrictions, and/or neurological changes can all affect urination
influence of growth and development: what are some things to know about infants/children, pregnancy, and aging, regarding urination? (aging has a lot)
infants and children - continence is a issue (ability to control)
pregnancy - hormonal and intra-abdominal pressure
aging - decrease ability to concentrate urine (reabsorption)
- increase incidence of nocturia (wake up at night on regular basis to pee)
- increase frequency relating to decrease muscle tone and decrease bladder capacity
- increase residual urine relating to decrease effectiveness of muscle control voiding
- increase risk for UTI that doesn’t necessarily present the classic way
what would a focused history consist of? (4 things)
- review client’s normal urinary pattern and assess for changes to that norm
- pattern includes frequency, maybe time of day, volume, colour, odour - review associated symptoms
- pain history, describing all parameters in detail
- other systems that may be involved - identify contributing factors
- functional impact
physical examination: inspection (3 things to inspect)
- inspect skin, mucous membranes
- perineum (tiny patch of sensitive skin between genitals and anus): skin breakdown, atrophy
- inspect bladder area
what are some normal characteristics of urine (5 things)?
urinary system is normally a STERILE environment
- clarity
- odour
- volume
- sediment, mucous, blood
- lab test results: urine dip R&M, C&S, cytology kidney function
Who is most common to get a UTI? What are some risk factors?
UTI (urinary tract infection) are fairly common in females, males get them less often
- frequent in young girls
risk factors include:
- incontinence
- catherization
- hygiene
- stasis of urine (risk of recurrent UTI)
- intercourse
- tampon use
- residual urine
what are some signs and symptoms of a UTI? What can a UTI be an underlying cause of in the elderly? What can the urine look like? What is the most common bacterium responsible for UTIs
signs and symptoms:
- burning on urination
- frequency
- urgency
- hematuria (blood in urine)
- foul odour
- pelvic pain
- fever
a UTI can be a underlying cause of delirium in the elderly
the appearance of the urine can include:
- dark colour
- presence of blood (hematuria)
- cloudy
- mucous threads
the most common bacterium responsible for UTIs are E-coli, which lives in the bowel
palpation: where is the bladder located? what is distension? how to palpate? What does distension/distended mean? What does a bladder scan do?
bladder - below symphysis pubic (joint between left and right pelvic bone) in adults, its non-palpable if not distended
- distension, rises above symphysis pubic, midline, may extend to just below umbilicus
- light palpation used, client will feel increased urgency, tenderness, or even pain if distended/full
a distended bladder is full and now has high pressure
a bladder scan is for volume assessment
fluid balance assessment: what is fluid balance? how is it maintained?
fluid balance: a term used to describe the balance of input and output of fluids in the body to allow metabolic processes to function correctly
balance is maintained through intake (food & water) and output (urine, faces, and insensible losses) & sometimes there’s an imbalance
what are some signs of fluid imbalance - fluid overload? explain fluid volume output in fluid overload
- dyspnea
- crackles in the lungs
- pitting edema in lower legs/ankles
- edema in arms/legs (more commonly legs)
- fatigue
- large volumes in & small volumes out
- bloodwork/lab values - diluted/lower concentrations of electrolytes
urine output counter-intuitive (in over hydration output is not large volumes, body holds on to the fluid causing fluid overload)
what are some signs of fluid imbalance - fluid volume deficit (dehydration)
- impaired cognitive function
- headaches
- fatigue
- sunken eyes
- dry skin, dry mucous membranes
- paeds: sunken fontanelles, lack of tears
- hypotension, postural drop, tachycardia, weak thready pulse, cold hands/feed, cap refill delayed
- bloodwork/lab values show higher concentrations of electrolytes
- oliguria - low urine output
