Urinary signs and symptoms

Question 1

A sudden compelling urge to urinate, accompanied by bladder pain, is a classic symptom of urinary tract infection. As inflammation decreases bladder capacity, discomfort results from the accumulation of even small amounts of urine. Repeated, frequent voiding in an effort to alleviate this discomfort produces urine output of only a few milliliters at each voiding.
Urgency without bladder pain may point to an upper motor neuron lesion that has disrupted bladder control.

Answer 1

Urinary Urgency

Question 2

onset of urinary urgency and whether he’s ever experienced it before.
Ask about other urologic symptoms, such as dysuria and cloudy urine.
Neurologic symptoms, such as paresthesias. Examine his medical history for recurrent or chronic urinary tract infections or for surgery or procedures involving the urinary tract.
Obtain a clean-catch sample for urinalysis. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for tenderness. If the patient’s history or symptoms suggest neurologic dysfunction, perform a neurologic examination.

Answer 2

Urinary urgency assessment

Question 3

Increased incidence of the urge to void. Usually resulting from decreased bladder capacity, frequency is cardinal sign of urinary tract infection. However, it can also stem from other urologic disorders, neurologic dysfunction, and pressure on the bladder from a nearby tumor or from organ enlargement (as with pregnancy).
may be reported by the patient with polyuria - an increase in total daily urine output

Answer 3

Urinary frequency

Question 4

Ask the patient how many times a day he voids. How does this compare to his previous pattern of voiding? Ask about the onset and duration of the abnormal frequency and about any associated urinary symptoms, such as dysuria, urgency, incontinence, , or bladder cramps. Also ask about any neurologic symptoms, such as muscle weakness, numbness, or tingling. Explore the patient’s medical history for urinary tract infection, other urologic problems or recent urologic procedures, and neurologic disorders. If the patient is male, ask about a history of prostatic enlargement. If the patient is a female of childbearing age, ask whether she is or could be pregnant.
Obtain a clean-catch midstream sample for urinalysis and culture and sensitivity tests. Then palpate the patient’s suprapubic area, abdomen, and flanks, noting any tenderness. Examine his urethral meatus for redness, discharge, or swelling. In a male patient, the doctor may palpate the prostate gland.
If the patient’s medical history reveals symptoms or a history of neurologic disorders, perform a neurologic examination.

Answer 4

Urinary Frequency assessment

Question 5

Painful or difficult urination. It’s often accompanied by urinary frequency, urgency, or hesitancy. Usually, this symptom reflects lower urinary tract infection - a common disorder, especially in women.
Results from lower urinary tract irritation or inflammation, which stimulates nerve endings in the bladder and urethra. The pain’s onset provides clues to its cause, for example: pain just before voiding usually indicates bladder irritation or distention, while pain at the start of urination typically results from bladder outlet irritation. Pain at the end of voiding may signal bladder spasms

Answer 5

Dysuria

Question 6

describe its severity and location. When did the patient first notice it? Did anything precipitate it? Does anything aggravate or alleviate it?
Next, ask about previous urinary or genital tract infections. Has the patient recently undergone invasive procedures, such as cystoscopy or urethral dilatation? Also ask if he has a history of intestinal disease. In the female patient, ask about menstrual disorders and use of products that irritate the urinary tract, such as bubble bath salts, feminine deodorants, contraceptive gels, or perineal lotions.
During the physical examination, inspect the urethral meatus for discharge, irritation, or other abnormalities. Perform a pelvic or rectal examination, as indicated.

Answer 6

Dysuria assessment

Question 7

A cardinal sign of renal and urinary tract disorders, clinically defined as urinary output of less than 400 ml per 24 hours. Typically, this sign occurs abruptly and may herald serious - possibly life-threatening hemodynamic instability. Its causes can be classified as prerenal (decreased renal blood flow), intrarenal (intrinsic renal damage), or postrenal (urinary tract obstruction); the pathophysiology differs for each classification. Associated with a prerenal or postrenal cause is usually promptly reversible with treatment, although it may lead to intrarenal damage if untreated. However, oliguria associated with an intrarenal cause is usually more persistent and may be irreversible.

Answer 7

oliguria

Question 8

Begin by asking the patient about his usual daily voiding pattern, including frequency and amount. When did he first notice changes in this pattern and in the color, odor, or consistency of his urine? Ask about pain or burning on urination. Note his normal daily fluid intake. Has he recently been drinking more or less? Has he had recent episodes of diarrhea or vomiting that might cause fluid loss? Next, explore associated complaints, especially fatigue, loss of appetite, thirst, dyspnea, chest pain, or recent weight gain. Check for a history of renal, urinary tract, or cardiovascular disorders. Note recent traumatic injury or surgery associated with significant blood loss, as well as recent blood transfusions. Was the patient exposed to nephrotoxic agents, such as heavy metals, organic solvents, anesthetics, or radiographic contrast media? Next, obtain a drug history.

Begin the physical examination by taking the patient’s vital signs and weighing him. Assess his overall appearance for edema. Palpate both kidneys for tenderness and enlargement, and percuss for costovertebral angle (CVA) tenderness. Also inspect the flank area for edema or erythema. Auscultate the heart and lungs for abnormal sounds, and over the periumbilical area for renal artery bruits. Obtain a urine sample and inspect it for abnormal color, odor, or sediment. Use reagent strips to test for glucose, protein, and blood. Also, use a urinometer to measure specific gravity.

Answer 8

Oliguria assessment

Question 9

Clinically defined as urine output of less than 75 ml daily, indicates either urinary tract obstruction or acute renal failure due to various mechanisms. Fortunately, anuria rarely occurs - even in renal failure, the kidneys usually produce at least 75 ml of urine daily. Because urine output is easily measured, anuria rarely goes undetected. However, without immediate treatment, can rapidly cause uremia and other complications of urinary retention.

Answer 9

anuria

Question 10

After detection, your priorities are to determine if urine formation is occurring and to intervene appropriately. First, prepare to catheterize the patient to relieve any lower urinary tract obstruction and to check for residual urine. You may find that an obstruction hinders catheter insertion and that urine return is cloudy and foul-smelling. If you collect more than 75 ml of urine, suspect lower urinary tract obstruction; less than 75 ml, suspect renal dysfunction or obstruction higher in the urinary tract.
Next, take the patient’s vital signs and obtain a complete patient history. Start by asking about any changes in the patient’s usual voiding pattern. Determine the amount of fluid normally ingested each day, the amount of fluid ingested in the last 24 to 48 hours, and the time and amount of his last urination. Review the patient’s medical history, noting especially previous kidney disease, urinary tract obstruction or infection, prostate enlargement, renal calculi, neurogenic bladder, or congenital abnormalities. Ask about recent abdominal, renal, or urinary tract surgery. Also ask about drug use.
Inspect and palpate the abdomen for symmetry, distention, or bulging. Inspect the flank area for edema or erythema. Percuss and palpate the bladder. Palpate the kidneys both anteriorly and posteriorly, and percuss them at the costovertebral angle. Auscultate over the renal arteries, listening for bruits.

Answer 10

Anuria assessment

Question 11

A relatively common sign, daily production and excretion of more than 2,500 ml (2.5 liters) of urine. It is usually reported by the patient as increased voidings, especially when it occurs at night. Aggravated by overhydration, consumption of caffeine or alcohol, and excessive ingestion of salt, glucose, or other hyperosmolar substances. Most commonly results from drugs, such as diuretics, and from psychological, neurologic, and renal disorders. It can reflect central nervous system dysfunction that diminishes or suppresses secretion of antidiuretic hormone (ADH), which regulates fluid balance. Or, when ADH levels are normal, it can reflect renal impairment. In both of these pathophysiologic mechanisms, the renal tubules fail to reabsorb sufficient water

Answer 11

Polyuria

Question 12

at risk for developing hypovolemia, evaluate fluid status first. Take vital signs, noting especially increased body temperature, tachycardia, and orthostatic hypotension. Inspect for dry skin and mucous membranes, decreased skin turgor and elasticity, and reduced perspiration. Is the patient unusually tired or thirsty? Has he recently lost more than 5% of his body weight? If you detect these effects of hypovolemia, notify the doctor and infuse replacement fluids. If the patient doesn’t display signs of hypovolemia, explore the frequency and pattern of the polyuria. When did it begin? How long has it lasted? Was it precipitated by a certain event? Ask the patient to describe the pattern and amount of his daily fluid intake. Find out about any current or past psychiatric disorders and chronic hypokalemia or hypercalcemia. Check for a history of visual deficits, headaches, or head trauma, which may precede diabetes insipidus. Also check for a history of urinary tract obstruction, diabetes mellitus, and renal disorders. Find out the schedule and dosage of any drugs the patient is currently taking.

Perform a neurologic examination, noting especially any change in the patient’s level of consciousness (LOC). Then palpate the bladder and inspect the urethral meatus. Obtain a urine specimen and check its specific gravity.

Answer 12

Polyuria assessment

Question 13

A cardinal sign of renal and urinary tract disorders, Abnormal presence of blood in the urine. By strict definition, it means three or more red blood cells per high-power microscopic field in the urine. Microscopic _______ is confirmed by an occult blood indicator, whereas macroscopic _______ is immediately visible. However, macroscopic __________ must be distinguished from pseudohematuria (see Confirming Hematuria.). Hematuria is a common sign that may be continuous or intermittent, is often accompanied by pain, and may be aggravated by prolonged standing or walking.
May be classified by the stage of urination it predominantly affects. Bleeding at the start of urination - initial hematuria - usually indicates urethral pathology; bleeding at the end of urination - terminal hematuria - usually indicates pathology of the bladder neck, posterior urethra, or prostate. Bleeding throughout urination - total hematuria - usually indicates pathology above the bladder neck. Another clue to the source of the bleeding is the color of hematuria. Generally, dark or brownish blood indicates renal or upper urinary tract bleeding, whereas bright red blood indicates lower urinary tract bleeding.
May result from one of two mechanisms: rupture or perforation of vessels in the renal system or urinary tract, or impaired glomerular filtration, which allows red blood cells to seep into the urine. Although it usually results from renal and urinary tract disorders, hematuria may also result from certain gastrointestinal, prostate, vaginal, or coagulation disorders, or from the effects of drugs. Invasive therapy or diagnostic tests that involve manipulative instrumentation of the renal and urologic systems may also cause hematuria. Non-pathologic hematuria may result from fever and hypercatabolic states. Transient hematuria may also follow strenuous exercise.

Answer 13

Hematuria

Question 14

After detecting hematuria, take a pertinent health history. Ask the patient when the macroscopic hematuria began. Does it vary in severity between voidings? Is it worse at the beginning, middle, or end of urination? Is the patient passing any clots? Find out if hematuria has occurred before. To rule out artifactitious hematuria, ask about bleeding hemorrhoids or the onset of menses, if appropriate.
Ask about recent abdominal or flank trauma. Has the patient been exercising strenuously? Note a history of renal, urinary, prostatic or coagulation disorders. Then obtain a drug history.
Begin the physical examination by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle (CVA) to elicit tenderness. Check the urinary meatus for bleeding or other abnormalities. Using a chemical reagent strip, test a urine sample for protein. Finally, vaginal or digital rectal examination may be required.

Answer 14

Hematuria Assessment

Question 15

Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes, erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It is characteristic of urinary tract infection but can also result from prolonged storage of a urine specimen at room temperature

Answer 15

urine cloudiness

Question 16

Ask about symptoms of urinary tract infection, such as dysuria, urinary urgency or frequency, or pain in the flank, lower back, or suprapubic area. Also ask about recurrent urinary tract infections, or recent surgery or treatment involving the urinary tract.
Obtain a urine sample to check for pus or mucus using the three glass technique. Using a reagent strip, test for blood, glucose, and pH. Palpate the suprapubic area and the flanks for tenderness.
If you note cloudy urine in a patient with an indwelling (Foley) catheter, especially with concurrent fever, remove the catheter immediately (or change it if the patient must have one in place).

Answer 16

urine cloudiness assessment

Question 17

Pain in the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or throbbing pain, and may be unilateral or bilateral and constant or intermittent. It is aggravated by costovertebral angle (CVA) percussion and, in patients with renal or urinary tract obstruction, by increased fluid intake or ingestion of alcohol, caffeine, and diuretic drugs. Unaffected by position changestypically responds only to analgesics or, of course, to treatment of the underlying disorder.

Answer 17

flank pain

Question 18

If the patient has suffered trauma, quickly assess for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Grey Turner’s sign, and signs of shock (such as tachycardia and cool, clammy skin). If you find any of these signs and symptoms, emergency medical intervention is required. An indwelling (Foley) catheter is used to monitor urinary output and assess hematuria. Blood samples are obtained for typing and cross matching, complete blood count, and electrolyte levels.

If the patient’s condition isn’t critical, take a thorough history. Ask about the onset of the pain and apparent precipitating events. Have the patient describe the location, intensity, pattern, and duration of the pain. Find out if anything aggravates or alleviates it.
Ask the patient about any changes in his normal pattern of fluid intake and urinary output. Explore his history for urinary tract infection or obstruction, renal disease, or recent streptococcal infection.
During the physical examination, palpate the patient’s flank area and percuss the CVA to determine the extent of pain.

Answer 18

flank pain assessment

Question 19

This elicited symptom indicates sudden distention of the renal capsule. It almost always accompanies unelicited, dull, constant flank pain in the costovertebral angle (CVA) just lateral to the sacrospinalis muscle and below the 12th rib. This associated pain typically travels anteriorly in the subcostal region toward the umbilicus.
Percussing the elicits tenderness. A patient who doesn’t have this symptom will perceive a thudding, jarring, or pressure-like sensation when tested, but no pain. A patient with a disorder that distends the renal capsule will experience intense pain as the renal capsule stretches and stimulates the afferent nerves, which emanate from the spinal cord at levels T11 through L2 and innervate the kidney.

Answer 19

COSTOVERTEBRAL ANGLE (CVA) TENDERNESS

Question 20

After detecting tenderness, assess the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about his voiding habits: How frequently does he urinate, and in what amounts? Has he noticed any change in intake or output? If so, when did he notice the change? (Be sure to ask about fluid intake before judging his output abnormal.) Is there any nocturia? Ask about pain or burning during urination or difficulty starting a stream. Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient’s experiencing pain in his flank, abdomen, or back, when did he first notice the pain? How severe is it, and where is it located?
Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Ask about a history of renovascular disorders, such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient’s vital signs. Fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, or palpable masses.

Answer 20

COSTOVERTEBRAL ANGLE (CVA) TENDERNESS assessment

Question 21

difficulty starting a urinary stream - can result from a urinary tract infection, a partial lower urinary tract obstruction, a neuromuscular disorder, or use of certain drugs. Occurring at all ages and in both sexes, it’s most common in older men with prostatic enlargement. usually arises gradually, often going unnoticed until urinary retention causes bladder distention and discomfort.

Answer 21

Urinary hesitancy

Question 22

Ask the patient when he first noticed and if he’s ever had the problem before. Ask about other urinary problems, especially reduced force or interruption of the urinary stream. Ask the patient if he’s ever been treated for a prostate problem or urinary tract infection or obstruction. Obtain a drug history.
Inspect the patient’s urethral meatus for inflammation, discharge, and any other abnormalities. Test sensation in the perineum. Obtain a clean-catch sample for urinalysis. In a male patient, digital palpation of the prostate gland may be required.

Answer 22

urinary hesitancy assessment

Question 23

This excretion from the urinary meatus may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection. In children, urethral discharge usually indicates sexual abuse.

Answer 23

urethral discharge

Question 24

Ask the patient when he first noticed the discharge, and have him describe its color, consistency, and quantity. Does he have any pain on urination? Any difficulty initiating a urinary stream? Ask about other associated symptoms, such as fever, chills, and perineal fullness. Explore his history for any incidence of prostate problems, sexually transmitted disease, or urinary tract infection. Ask if he’s had recent sexual contacts or a new sexual partner. Inspect the patient’s urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. Then obtain a urine sample for urinalysis and possibly a three-glass urine sample. In a male patient, the doctor may palpate the prostate gland.

Answer 24

urethral discharge assessment

Question 25

uncontrollable passage of urine, results from bladder abnormalities or neurologic disorders. A common urologic sign, incontinence may be transient or permanent, and may involve large volumes of urine or scant dribbling. It can be classified as stress, overflow, urge, or total incontinence. Stress incontinence refers to intermittent leakage resulting from a sudden physical strain, such as a cough, sneeze, or quick movement. Overflow incontinence is a dribble resulting from urinary retention, which fills the bladder and prevents it from contracting with sufficient force to expel a urinary stream. Urge incontinence refers to the inability to suppress a sudden urge to urinate. Total incontinence is continuous leakage resulting from the bladder’s inability to retain any urine.

Answer 25

urinary incontinence

Question 26

Ask the patient when he first noticed and whether it began suddenly or gradually. Have him describe his typical urinary pattern: does incontinence usually occur during the day or at night? Does he have any urinary control, or is he totally incontinent? If he sometimes urinates with control, ask him the usual times and amounts voided. Determine his normal fluid intake. Ask about other urinary problems, such as hesitancy, frequency, urgency, nocturia, and decreased force or interruption of the urinary stream. Also ask if he’s ever sought treatment for incontinence or found a way to deal with it himself.
Obtain a medical history, especially noting urinary tract infection, prostate conditions, spinal injury or tumor, cerebrovascular accident, or surgery involving the bladder, prostate, or pelvic floor.
After completing the history, have the patient empty his bladder. Inspect the urethral meatus for obvious inflammation or anatomic defect. Have female patients bear down; note any urine leakage. Gently palpate the abdomen for bladder distention, which signals urinary retention. Perform a complete neurologic assessment, noting motor and sensory function and obvious muscle atrophy.

Answer 26

URINARY INCONTINENCE assessment

Question 27

abnormal enlargement of the bladder - results from an inability to excrete urine, causing its accumulation. Distention can result from mechanical and anatomic obstructions, neuromuscular disorders and drugs. Relatively common in all ages and both sexes, it occurs most frequently in older men with prostate disorders leading to urine retention.
Typically, bladder distention occurs gradually, but occasionally its onset may be sudden. Gradual distention usually remains asymptomatic until stretching of the bladder produces discomfort. Acute distention produces perineal fullness, pressure, and pain. If severe distention isn’t corrected promptly by catheterization or massage, the bladder rises within the abdomen, its walls become thin, and the risk of rupture increases.
Bladder distention is aggravated by intake of caffeine, alcohol, large quantities of fluid and diuretics.

Answer 27

bladder distention

Question 28

If the patient has severe distension, insert an indwelling urethral catheter to help relieve discomfort and prevent bladder rupture.
If distention isn’t severe, begin your assessment by reviewing the patient’s voiding patterns. Find out the time and amount of his last voiding and the amount of fluid consumed since then. Ask if the patient has difficultv initiating urination. Does he ever use Valsalva’s or Crede’s maneuver to initiate it? Also, ask if urination occurs with urgency or without warning and if it causes pain or irritation. Remember to ask about the force and continuity of the patient’s urinary stream and if he feels that his bladder is empty after voiding.
Explore the patient’s history for urinary tract obstruction or infections; venereal disease; neurologic, intestinal or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders. Note his drug history as well, including use of over-the-counter preparations.
Take the patient’s vital signs, and percuss and palpate the bladder. (Remember that an empty bladder can’t be palpated through the abdominal wall.) Inspect the urethral meatus and measure its diameter. Describe the appearance and amount of any discharge. Test for perineal sensation, anal sphincter tone and, in the male patient, examine the prostate.

Answer 28

bladder distention assessment

Question 29

excessive urination at night - may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles that control urination. Normally, more urine is concentrated during the night than during the day. As a result, most people excrete three to four times more urine during the day, and can sleep for 6 to 8 hours during the night without being awakened. In nocturia, the patient may awaken one or more times during the night to empty his bladder and excrete 700 ml or more of urine.
results from renal and lower urinary tract disorders, it may result from certain cardiovascular, endocrine, and metabolic disorders. This common sign may also result from drugs that induce diuresis, particularly when they’re taken at night, and from the ingestion of large quantities of fluids, especially caffeinated beverages or alcohol, at bedtime.

Answer 29

nocturia

Question 30

Begin your assessment by exploring the history of the patient. When did it begin? How often does it occur? Can the patient identity a specific pattern? Precipitating factors? Also note the volume of urine voided. Ask the patient about any change in the color, odor, or consistency of his urine. Has he changed his usual pattern or volume of fluid intake? Next, explore associated symptoms. Ask about pain or burning on urination, difficulty initiating a urinary stream, costovertebral angle tenderness, and flank, upper abdominal, or suprapubic pain.
Determine if the patient or his family has a history of renal or urinary tract disorders or endocrine and metabolic diseases, particularly diabetes. Is the patient taking drugs that increase urinary output, such as diuretics, cardiac glycosides, and antihypertensives?
Focus your physical examination on palpating and percussing the kidneys, the costovertebral angle and the bladder. Carefully inspect the urinary meatus. Inspect a urine specimen for color, odor, and the presence of sediment.

Answer 30

nocturia assessment

Question 31

refers to nighttime urinary incontinence in a girl over age 5 or a boy over age 6. Rarely, this sign may continue into adulthood. It is most common in boys and may be classified as primary or secondary. Primary enuresis describes the child who has never achieved bladder control; Secondary enuresis describes the child who achieved bladder control for at least 3 months but has lost it.
Among factors that may contribute are delayed development of detrusor muscle control, unusually deep or sound sleep, failure to produce ADH at night, organic disorders such as urinary tract infection or obstruction, and psychological stress. Probably the most important factor, psychological stress commonly results from the birth of a sibling, the death of a parent or loved one, or premature, rigorous toilet training. The child may be too embarrassed or ashamed to discuss intensifies psychological stress and makes it more likely - thus creating a vicious cycle.

Answer 31

enuresis

Question 32

When taking a history, include the parents as well as the child. First, determine the number of nights each week or month that the child wets the bed. Is there a family history of enuresis? Ask about the child’s daily fluid intake. Does he drink much after supper? What are his typical sleep and voiding patterns? Find out if the child’s ever had control of his bladder. If so, try to pinpoint what may have precipitated enuresis, such as an organic disorder or psychological stress. Does the bedwetting occur at home and away from home? Ask the parents how they have tried to manage the problem and have them describe the child’s toilet training. Observe the child’s and parents’ attitudes toward bedwetting. Finally, ask the child if it hurts when he urinates.
Next, perform a physical examination to detect signs of neurologic or urinary tract disorders. Observe the child’s gait to assess for motor dysfunction. Also test sensory function in the legs. Inspect the urethral meatus for erythema and obtain a urine specimen. A rectal examination may be required to assess sphincter control

Answer 32

enuresis assessment

Question 33

fine white powder, believed to be urate crystals, that covers the skin - is a characteristic sign of end-stage renal failure, or uremia. Urea compounds and other waste substances that can’t be excreted by the kidneys in urine are excreted in sweat, and remain as powdery deposits on the skin when the sweat evaporates. The frost typically appears on the face, neck, axillae, groin and genitalia.
Because of advances in managing renal failure, uremic frost is now relatively rare. However, it does occur in patients with chronic renal failure who, because of their advanced age or the severity of their accompanying illnesses (such as extensive neurologic deterioration), do not undergo dialysis.

Answer 33

uremic frost

Question 34

usually appears well after a diagnosis of chronic renal failure has been established. As a result, your assessment will be limited to inspecting the skin to determine the extent.

Answer 34

uremic frost assessment

Question 35

urinous or fishy breath - typically occurs in end-stage chronic renal failure. This sign improves slightly after hemodialysis and persists throughout the disorder’s course, but isn’t of great concern.
eflects the long-term metabolic disturbances and biochemical abnormalities associated with uremia and end-stage chronic renal failure. Metabolic end products, blown off by the lungs, produce the ammonia odor, but a specific uremic toxin has not yet been identified. In animals, breath odor analysis has revealed toxic metabolites, such as dimethylamine and trimethylamine, which contribute to the fishy odor. The source of these amines, although still unclear, may be intestinal bacteria acting on dietary chlorine.

Answer 35

ammonia breath odor

uremic fetor

Question 36

When you detected, the diagnosis of chronic renal failure is well established. However, you’ll need to assess for associated GI symptoms so that palliative care and support can be individualized.
Inspect the patient’s oral cavity for bleeding, swollen gums or tongue, and for ulceration with drainage. Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, or loss of appetite at the sight of food. Ask about early morning vomiting. Since GI bleeding is common in chronic renal failure, ask about bowel habits, noting especially melenous stools or constipation.
Take the patient’s vital signs. Note any abnormal hypertension (the patient with end-stage chronic renal failure is usually somewhat hypertensive) or significant hypotension. Assess for other signs of shock (such as tachycardia, tachypnea and cool, clammy skin) and altered mental status. Any significant changes can indicate complications, such as massive GI bleeding or pericarditis with tamponade.

Answer 36

uremic fetor

ammonia breath odor assessment