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Assessment & Common Signs & Symptoms of
Renal & Urological Disorders
Urological disorders
➢ Urinary tract infection
➢ Cystitis
(Inflammation of urinary
bladder)
➢ Pyelonephritis
(Inflammation of the renal
pelvis & parenchyma)
➢ Urinary Calculi
➢ Urinary tract tumor

Renal
1
...
chronic kidney disease

Extra:
Renal parenchyma: Process of waste excretion takes place
Renal Pelvis: Urine is collected before it is transported to the bladder via the uterus
Upper Urinary Tract: Kidneys & ureters
Lower Tract: Bladder & urethra

Urinary Tract Infection
Any Infection (kidney, ureters, bladder & urethra)

Urinary Calculi (Common cause of upper urinary tract obstruction)
Stones in the urinary tract
Lithiasis: stone formation
Nephrolithiasis: Stones form in kidney
Urolithiasis: nephrolithiasis
Urinary Tract Tumours
A malignancy can develop in any part of urinary tract
Most urinary tract malignancies arise from epithelial tissue
...

2
...

4
...

6
...


Dysuria (painful or difficult urination)
Urinary frequency & urgency (sudden ,compelling need to urinate)
Nocturia
Pyuria
Suprapubic pain & tenderness
Hematuria (bloody urine)
Foul odour

Laboratory Investigations
1
...
Urine Gram Stain:
✓ Identify infecting organism by shape & characteristics (gram-positive or gram-negative)
3
...
WBC with differential:
✓ Detect typical changes associated with infection eg elevated WBC & increase no
...
Intravenous pyelography (IVT) or CT scan:
✓ Evaluate for structure or functional abnormalities
6
...
Cystoscopy
✓ A tissue biopsy may be obtained during procedure & other interventions performed eg
stone removal
8
...
g
...
Assess the OLDCART of pain
2
...
Encourage fluid intake unless
contraindicated
...
Teach how to obtain midstream cleancatch urine specimen
2
...
Discuss prescribed tx plan &
importance of taking prescribe
antibiotic
✓ Prevent recurrent infection &
resistant bacteria
4
...
Measures to prevent future UTI

Restore Normal Urinary Elimination
1
...
Avoid Caffeine, artificial sweeteners,
alcohol
...
Strict aseptic technique & a closed
urinary drainage system when inserting
a IDC
4
...
Use intermittent straight
catheterization to relieve urinary
retention if possible

Urinary Calculi
Signs & Symptoms of Urinary Calculi
1
...

3
...

5
...
Pain
may radiate to suprapubic region, groin & external genitals

Laboratory Investigations
1
...

✓ Urine Ph- Identify type of stone
2
...
Urine calcium, uric acid, and oxalate
✓ Measure amount of these substances over 24 hr period & be assessed to identify
possible causes of lithiasis
...
Serum calcium, phosphate & uric acid
✓ Help identify factors contributing to calculus formation
Diagnostic Investigation
1
...
Renal ultrasonography
✓ To detect stones & evaluate kidneys for possible hydronephrosis
3
...
Cystoscopy
✓ To visualize & possibly remove calculi from the urinary bladder & distal ureters
Management care plan**
Acute Pain
1
...
Administer analgesia
3
...
Use nonpharmacologic management
✓ Positioning
✓ Relaxation techniques
Self-care
1
...
Teach diagnostic & tx procedures
...
Collect & strain all urine, saving any
stones
...
Report stone passage to the physician
& bring stone in for analysis
3
...
Increase fluid intake to 25003500ml/day

Restore urinary elimination
1
...
Maintain patency & integrity of
catheter systems

2
...
Maintain activity level to prevent
urinary stasis & bone resorption
Teach about the relationship btw urinary
calculi & UTI
✓ UTI promotes urolithiasis & thurs
requires prompt treatment to reduce
risk

Urinary Tract Tumours
Signs & Symptoms **
1
...

3
...

5
...
Urinalysis
✓ To evaluate for hematuria
2
...
Ultrasound Bladder
✓ Intravenous pyelography-reveal a rigid deformity of the bladder wall, obstruction of
urine flow at the point of tumor or bladder filling or emptying defects
4
...
CT scan & MRI
✓ To evaluate tumor invasion or metastasis

Management Care Plan **
Promote normal urinary elimination
1
...
Assess for urine leakage from
catheters, stents or drains
...
Ensure gravity drainage of urine
collection device or empty bag 2 hrly

2
...
Encourage fluid intake of 3000ml/day
✓ High urinary output, reduce risk of
infection
...
Monitor urine output close for first 24
hrs after stents/ureteral catheters is
removed
✓ Edema or stricture of ureters may
impede output, leading to
hydronephrosis & kidney
5
...

Reduce risk of Infection
1
...
Monitor signs of infection
✓ Elevated Temperature, cloudy or
foul-smelling urine, haematuria, N
& V)
3
...
Encourage looking, touching & caring
of the stoma & appliance ASAP
...

2
...

✓ Atmosphere of openness &
acceptance facilitates expression of
concerns & anxieties related to
changed body image
3
...


Management of common signs & symptoms of renal & urological disorders: Polyuria, Dysuria,
Haematuria & Oliguria
Physiology of Dysuria
Dysuria
✓ Pain during voiding caused by urethral or bladder inflammation
...

✓ Inflammation or stricture of the urethra causes difficulty in starting & burning on
urination
✓ Irritation of the trigone causes bladder contraction, leading to frequent & painful
urination
...
Pain while urinating (sharp, burning sensation)

2
...

4
...


Frequent urination
Pain near bladder & loss of bladder control
Fever, chills, foul smelling vaginal discharge
Pain/irritation near the opening of the urethra

Haematuria
Signs & Symptoms of Haematuria **
✓ If caused by enlarged prostate, may accompanied by slow urinary stream, urinary frequency
& urgency or sense of incomplete emptying of bladder
✓ Caused by UTI or kidney infection, accompanied by fever, abdominal pain or flank pain
✓ Caused by kidney stones can by associated with sharp pain in the flank radiating to the groin
Physiology of Haematuria
✓ Blood in urine-indication of injury/disease of kidney or other structure of UT
...
Bleed caused of physical injuries,
obstructions, infections, or strictures
✓ Bladder: May contain clots
...

Polyuria
Physiology
✓ Polyuria-excessive excretion of urine
✓ Results of drinking excessive amounts of fluids contain caffeine/alcohol ( polydipsia)
✓ Overactive bladder, enlarged prostate & urinary tract infections
Polyuria & Renal Failure
Kidney
✓ filter blood throughout the body, help remove waste products & excessive water in blood
...
Hence, urine output drop or
increase suddenly
...

2
...

4
...


Calcium channel blockers: Open BV & lead body make urine more
Diuretics: Help move water & salts out of body
Lithium: Medication for bipolar disorder can damage kidney
SSRIs: Used to tx depression but can prevent body from making ADH
Tetracycline: Demeclocycline, a form of antibiotic, can affect ADH production

Signs & Symptoms – Polyuria *
1
...

3
...

✓

Excessive urination associated with polydipsia & nocturnal
Weight loss
Malaise: polyuria can cause severe dehydration
Blood pressure fluctuations
Polyuria cause dehydration lead to increase HR or decrease in BP due to postural
hypotension
...

✓ Oliguria cause by not drinking enough water, fluid loss through dehydration
...
Severe burns may interfere with the production of urine
...

Oliguria is categorized based on the factors that causes it
...
Prerenal oliguria: when kidney undergoes hypoperfusion because of decrease intake of fluid,
dehydration, diarrhoea, excessive bleeding, or sepsis
...
Renal oliguria: due to damaged kidney caused by medication, rhabdomyolysis or
hypoperfusion
...
Post renal oliguria: is caused when the urine flow is obstructed by conditions eg an enlarged
prostate, a neoplastic tumor, a haematoma or a collection of solidified fluid
...
Other causes: acute pyelonephritis, chronic renal failure in final stages
...


Signs & Symptoms of Oliguria **
Primary Symptoms:
1
...
Urine dark colour ( deeper yellow color eg amber)
3
...

o Symptoms: severe pain in flanks, pubic region & external genitalia, &
nausea, vomiting, distended abdomen & increase bowel sounds, fever &
chills
➢ Acute glomerulonephritis may trigger onset of oliguria
...

o Symptoms: Fatigue , lethargy, hypotension, severe weakness of muscles,
nausea, anorexia, extreme thirst, dizziness, sunken eyeballs
➢ Patient who has oliguria after surgical procedure
o Body response to blood/fluid loss, dehydration stemming from fever,
vomiting, diarrhea, & inadequate intake of fluid, severe infection results I
toxic shock , urinary obstruction caused by an enlarged prostate or reaction
to post-operation med eg anticholinergic, diuretics & methotrexate
Laboratory & Diagnostic Investigations

1
...
Imaging tests: Obstruction is suspected or an abnormality of the internal organs of the
urinary tract
3
...
Cystoscopy: to look inside the bladder
5
...

6
...
Urine cultures: bacteria from urine sample are grown in laboratory, done to diagnose UTI
...
Urinalysis: clean-catch or sterile method: to detect & measure level of various substances in
urine
Imaging tests
1
...
To look for blockages in kidney/bladder to determine if bladder retains
urine after urinating, determine the size of prostate gland & provide images that help guide
where to obtain sample for biopsies of the prostate or kidney
...
Doppler ultrasonography: provides info on blood flow, which helps doctors determine the
cause of erectile dysfunction & testicular disorders e
...
testicular torsion & epididymitis
3
...
CT Angiography: Useful for evaluating many UT conditions
5
...
Also, provide
images of blood vessels (MRA)
...
Retrograde urography: A radiopaque contrast agent is introduced directly into ureters
...

7
...

➢ UTI + used because it can be combined with treatments that repair blood vessels affected by
certain disorders, such as severe bleeding or abnormal connections between blood vessels
(vascular fistulas)
...
Bladder biopsy: diagnose bladder cancer, interstitial cystitis
...
If a person has a UTI, bladder biopsy usually is not done until the infection is cleared
...
Kidney Function Test:
1
...
Creatinine clearance: a more accurate test that measures creatinine level in
the blood
...

3
...

4
...
Cleanse perineal area& keep dry
...
Recommend good hand washing & proper perineal care
3
...

4
...

5
...

Haematuria
1
...

✓ Signs of UT or kidney infection that can potentiate sepsis
...
Obtain periodic urinalysis & urine culture &sensitivity as indicated
...

3
...

✓ Multistrip dipstick can provide a quick determination of ph
...

Polyuria
1
...
Compare urine output with fluid intake
...
Note reports of urinary frequency, urgency, burning, incontinence, nocturia & size, or force
of urinary stream
➢ Information about degree of interference with elimination/ indicate bladder infection
...
Assess usual pattern of urination & occurrence of incontinence
...
But large urine volume during sleep
4
...

5
...

➢ These chemicals known to be bladder irritants, increase detrusor overactivity, result in
excessive excretion of urine
...
Palpate bladder for distension & observes for overflow
...

2
...
Catheterized as indicated
...

4
...

5
...

6
...

➢ Decrease risk of developing UTI
7
...
Stress incontinence: Urine leaks when u exert pressure on the bladder by
coughing/sneezing/laughing/ lifting something heavy
...
Urge incontinence: Sudden, intense urge to urinate followed by an involuntary loss of urine
...

3
...

4
...
eg severe arthritis: may not button pants quickly enough
...
Mixed incontinence: experience more than a type of urinary incontinence
Signs & Symptoms (Emotional & Sensory signs)
✓ Emotional signs: Anger, low self-esteem, low confidence, socially less active
✓ Sensory signs: Wet undergarments, smell of urine, itching/irritation & inflammation of the
perineum
Signs & Symptoms of different types of incontinence
...
Stress incontinence:
✓ Urine escapes when triggered, abdomen pressure maybe felt before urine leak,
unpredictable leakage, no nocturia, no urgency to urinate
2
...
Overflow Incontinence:
✓ No strong urge to urinate, bladder never empties & does slowly, small amount of leaks
continuously, urine leakage in sleep
4
...
Mixed incontinence: ( stress incontinence + urge incontinence)
✓ Overactive bladder, mild to moderate urine loss with physical activity, urgency, nocturia
Laboratory tests for Urinary incontinence
1
...
Urinalysis
✓ To rule out hematuria, proteinuria & glycosuria
3
...
Bladder stress test
✓ Stimulates accidental release of urine that may occur when cough, sneeze or exercise
...
Pad test
✓ To determine how much urine is leaking
...
X-rays/Ultrasound
✓ To examine changes in the position of bladder & urethra when urinate/cough or strain
Urodynamic Testing (done if surgery/tx ineffective)
1
...

2
...

3
...

Possible differential diagnosis: Congenital cause, meningomyelocele, CNS/ spinal cord trauma,
stroke & chronic neurologic disorders
Management Care Plan
Urinary incontinence + preventive measure for recurrent
1
...
Asses pt’s recognition of the need to void
...
Assess potentially reversible causes of acute/transient urinary incontinence
...
Set toileting schedule
...
Eliminate environmental barriers to toileting
...

✓ Not a disease, a condition that maybe related to other health problems
Signs & Symptoms
Acute urinary retention
✓ Inability to urinate
...

✓ Swelling of lower abdomen

Chronic urinary retention
✓ Inability to completely empty bladder
✓ Frequent urination in small amounts
✓ A slow urine steam
...
Urine culture: to detect possible UTI related to impaired bladder function
2
...
Prostate-specific antigen (PSA) : Blood test done as a screen for prostate cancer
...

Diagnostic Tests
1
...
CT scan: help find stones/ any blockage in the urine flow
Possible differential diagnosis:
Benign prostatic hypertrophy, acute inflammation, bladder calculi, surgery, medication, neurologeic b
Management of care plan
1
...

2
...
Hence blood circulation to kidney alters its capillary to filter &
concentrates substances
...
Techniques to facilitate voiding:
✓ Promote fluids if not contraindicated
...

✓ Upright position to facilitate successful voiding
...
Encourage void 4 hrly-empties bladder & reduce risk of urinary retention
...
Perform Crede’s Maneuverer: enhances urinary bladder pressure & this induces relaxation of
sphincter to allow voiding
...
Encourage to take bethanechol (Urecholine)
7
...


Benign prostatic hyperplasia & management of prostatic surgery & bladder washout
✓ Benign prostatic hyperplasia (BPH) : Non-malignant enlargement of the prostate gland
✓ Benign hyperplasia (increased number of cells) begins at 40 to 45 years of age & continues
slowly through the rest of life
...

2
...

4
...

6
...
Serum creatine: assess kidney damage
2
...

3
...
PSA is a glycoprotein
produced only in the cytoplasm of benign & malignant prostate cells, the serum level
corresponds with the volume of both benign & malignant prostate tissue
...

1
...

2
...
Risk for deficient fluid volume: secondary to post obstruction diuresis from rapid drainage of
a chronically overdistended bladder, endocrine, & electrolyte imbalances (renal dysfunction)
Transurethral resection of the prostate (TURP)
➢
➢
➢
➢

Surgical procedure
Obstructing Prostate tissue is removed
...

Other possible complications: Incontinence, impotence, retrograde ejaculation

Management care plan for BPH + management of prostatic surgery (TURP) & bladder washout
Urinary retention
1
...
Note diminished urinary output
✓ Urinary retention increases pressure within the ureters & kidneys, may caused renal
insufficiency
...
Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated
...

3
...
Observe hypertension, peripheral & dependent oedema, changes in in
mentation
...

✓ Loss of kidney function results in decreased fluid elimination & accumulation of toxic
wastes, may progress to complete renal shutdown
...
Observe signs of post obstructive diuresis (increase urine output & hypotension)
✓ May lead to serious dehydration, lower blood volume, shock, electrolyte loss &
anuria
...
Sitz bath as indicated
...

6
...

✓ Alpha-adrenergic antagonists e
...
terazosin: for outflow obstruction
✓ Antispasmodics e
...
oxybutynin: Relieves bladder spasms related to irritation by
catheter

7
...

9
...


✓ Rectal suppositories: Muscle relaxation & relieve spasms
...
Assess pain, note location & intensity, duration : effectiveness of interventions
2
...

3
...
Comfort measures: Back rub, comfort position, use relaxation therapy & diversional
activities
...

5
...
Insert catheter & attach single drainage
...

7
...

8
...

✓ Antispasmodic & bladder sedatives relieves bladder irritability

Management of prostatic surgery (TURB)
1
...

2
...
Assess fluid volume excess & hyponatremia called turp syndrome, which is manifested by
hyponatremia, decreased haematocrit, hypertension, bradycardia, nausea & confusion
...
If pt does not have continuous bladder irrigation/washout, irrigate IDC if instructed
✓ Usually when urine is frankly bloody or has numerous larger blood clots or when
bladder spasms increase
✓ Usually use sterile irrigating solutions until obstruction is relieved or urine is clear ,
Ensure equal input & output of irrigating fluid
...
Following catheter removal, assess amount, colour, consistency of urine
...
And tht urine may contain small blood
clots after catheter removal

Transitions of Care -TURP
Discharged planning:
•

Change from the daytime leg drainage bag to a larger night drainage bag
...


•

Avoid strapping the leg bag on too tightly, which can decrease venous return and
increase risk for thrombophlebitis and embolic complications such as pulmonary
emboli
...


•

Empty the leg bag every 3 to 4 hours during waking hours to prevent overfilling
...


Management of pt undergoing bladder washout
If the patient has continuous bladder irrigation/washout,
✓ Assess the catheter and the drainage tubing at regular intervals
...

✓ Assess the urinary output every 1 to 2 hours for color, consistency, amount, and
presence of blood clots; assess for bladder spasms
...

✓ Bladder distention resulting from output obstruction increases the risk of bleeding
Irrigating fluids are continuously infused and drained at a rate to keep urine light
pink or colorless
...
)



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