1. how long taking? any changes?
2. drugs for diabetes mellitus, hypertension, cardiac disorders, hormonal disorders, cancer,
arthritis, psychiatric disorders, potential causes of renal dysfunction
D. Any over the counter drugs or herbal supplements laxatives, analgesics, NSAID's,
St. John's Wort
E. Ask the pt about chemical exposures at the work place, exposure to hydrocarbons, heavy
metals, Pb, mercury, Cl gas.
F. Ask the pt about any protein / albumen in urine, any BP meds, any high BP readings
VI. Physical Assessment
A. skin & mucosal membranes turgor (hydration), urinary incontinence skin breakdown
B. kidneys infected / inflamed flank or back pain nurse assesses for tenderness
costo-vertebral angle (spine & 12th rib) LeMone
C. bladder -on inspection the nurse may note swelling or convex curviture of lower abdomen -
using light palpation, partially filled bladder is smooth rounded when apply pressure pt can
feel pain, tenderness, urge to urinate.
D. Urethra meatus inspect for discharge, inflammation & lesions
VII. Common types of Urinary alterations
A. Urgency feel need to void full bladder, irritation, inflammation from infection,
noncompliant urethra, sphincter, or psychological stress
B. dysuria difficult / painful urination (trauma inflammation of urethral sphincter
C. frequency interval 2hrs. - increased fluid intake, bladder inflammation, bladder
pressure, pregnancy, psychological stress
D. Hesitancy difficulty in initiating urination prostate enlargement, anxiety, urethral edema
E. Polyuria void large amounts urine or frequent excess fluid intake, diabetes mellitus, diabetes
insipidus (low ADH or reduced sensitivity to ADH.
F. Oliguria diminished urinary output relative to intake, kidney function (30 mL/hr) need at least
240 mL/day. factors dehydration, renal failure, UTI, increased ADH, CHF
G. nocturia frequent night urination excessive fluid intake before bedtime. esp. caffeine,
alcohol, renal disease, aging, prostate enlargement
H. dribbling leakage of urine despite voluntary control of urination stress, incontinence,
overflow from urinary retention
I. Incontinence involuntary loss of urine multiple factors unstable urethra, loss of pelvic
muscle tone, estrogen depletion, fecal impaction, neurological impairment
J. hematuria blood in urine neoplasms of kidney or bladder, glomerular disease, infection of
kidney, bladder, trauma, calculi, stones, bleeding disorder (hemophilia)
K. retention accumulation of urine in bladder (100mL) inability to empty fully obstruction,
bladder inflammation, decreased sensory activity, necrogenic bladder, prostate enlargement,
post-anesthesia effect, side effect of meds, (anticholinergic, antidepressants)
Review diagnostic test in LeMone
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