MED SURGE EXAM 4 TABLE NOTES
URINARY SYSTEM (14 QUESTIONS)
44.5 MANIFESTATIONS OF URINARY DISORDERS
o General S/Sx: anorexia, blurred vision, change in weight, chills, cognitive changes, excessive thirst,
fatigue, HA, high BP, N, V
o Edema: ankle, ascites (abdomen), facial, generalized, sacral
o Pain: dysuria (painful urination), flank or CVA (kidney punch test), groin, suprapubic
o Patterns in Urination: change in stream, dribbling, dysuria, hesitancy (difficulty starting/maintaining
urine stream), incontinence (loss of bladder control), nocturia (urinating at night), retention (cannot
empty bladder fully), stress incontinence (leaking during moments of pressure/exercise), urgency
(inflammation/discomfort)
o Urine Output: anuria (lack of urine production, under 100 mL), oliguria (less than 400 ml/day or 20
ml/hour), polyuria (more pee than normal, up to 15 L/day)
o Urine Composition: color (red, brown, yellowish green), concentrated, dilute, hematuria (bloody),
pyuria (pussy)
44.7 ASSESSMENT ABNORMALITIES OF URINARY SYSTEM
o Anuria – no urination, under 100 mL/day; AKI, end stage renal disease, obstruction
o Burning – stinging pain; irritation, UTI, calculi
o Dysuria – pain/difficult urination; UTI, cystitis; calculi
o Enuresis – involuntary nocturnal urination; Lower UTI
o Frequency – increased urination; inflamed bladder, retention with overflow, excess fluid intake, intake
of bladder irritants, calculi
o Hematuria – blood in urine; cancer, blood dyscrasias, kidney disease, UTI, stones, anticoagulant
o Hesitancy – delay or difficulty w/ urination; partial obstruction, BPH
o Incontinence – inability to voluntarily pee; neurogenic bladder, infection, injury
o Nocturia – frequent urination at night; kidney disease, obstruction, heart failure, diabetes, post renal
transplant, excess evening/nighttime fluid intake
o Oliguria – decrease urine, 100-400 mL/24 hours; severe dehydration, shock, transfusion rxn, kidney
disease, end stage kidney failure
o Pain – suprapubic (bladder), urethral (irritation), flank, CVA; infection, retention, foreign body in tract,
urethritis, pyelonephritis, renal colic, stones
o Pneumaturia – passage of urine w/ gas; fistula, gas forming UTI
o Polyuria – large volume of urine; diabetes, diabetes insipidus, kidney disease, diuretics, excess fluid
intake, obstructive sleep apnea
o Retention – inability to urinate even though bladder has excess urine; pelvic surgery, childbirth,
catheter removal, anesthesia, stricture or obstruction, neurogenic bladder
o Stress incontinence – involuntary urination with increased pressure (sneezing, coughing); weak
sphincter control, lack of estrogen, urinary retention
44.8 URINALYSIS
o Bilirubin – abnormal if present; liver disorder (jaundice)
o Casts – abnormal if present; WBC or RBC or bacteria
o Color – amber yellow – abnormal (dark, smoky, green, orange, red, cloudy)
o Culture – abnormal if > 10,000/mL; UTI
o Glucose – abnormal if present; diabetes, pituitary disorder
, o Ketones – abnormal if present; altered CHO/fat metabolism in diabetes/starvation, dehydration, V, D
o Odor – abnormal if ammonia or unpleasant; URI or standing urine
o Osmolarity – 50-1200 mmol/kg; if outside of this range, kidney lost ability to function
o pH – 4.6 – 8, average is 6; if over 8, UTI or urine left at room temp
o protein (random) – abnormal if present; kidney disease, heart failure
o protein (24 hour) – 50-80 mg/day; high protein diet, disease, strenuous exercise, fever, stress,
contamination from vaginal secretion
o RBC – 0-4 hpf – abnormal if under/over = acidosis, stones, cystitis, cancer, TB, UTI, trauma
o Specific gravity – 1.005-1.020
Low = dilute urine, excess diuresis, diabetes insipidus
High = dehydration, albuminuria, glycosuria
Fixed at 1.010 = renal inability to concentrate urine, end stage renal failure
o WBC – 0-5/hpf; if higher than this, UTI or inflammation
44.9/44.10/44.11: DIAGNOSTICS
o URINE STUDIES:
Creatinine Clearance: creatinine is a waste product of protein breakdown; M (107-139
mL/min) W (87-107 mL/min); collect 24 hour urine test, discard first urination of test, have
patient urinate at end of 24 hour and save for test, collect all urine during 24 hour period,
measure serum creatinine during test period
Residual Urine: determines amount of urine left in bladder after urinating; immediately after
patient urinates, catheterize patient or use bladder US, if large amount of residual urine
retained, HCP may want catheter left in bladder
o BLOOD STUDIES:
BUN: 10-20 mg/dL – detects renal problems caused by concentration of urea in blood which is
dependent on rate that kidney excretes urea; infection/fever/GI bleeding/trauma/ athletic
activity/excessive mx breakdown can increase BUN; too high means kidney is not working well
Creatinine: M (0.6-1.2 mg/dL) F (0.5-1.1 mg/dL) – more reliable than BUN for kidney function,
product of mx and protein metabolism; too much means creatinine is not being filtered and
removed properly
o RADIOLOGIC PROCEDURES:
KUB: “kidneys, ureters, bladder”; x-ray exam of abd and pelvis; delineates size, shape,
position, can see stones and foreign bodies
No special pre- op care
CT: visualizes kidneys, ureters, bladder; can detect tumors, abscesses, suprarenal masses,
obstructions; with or without iodine contrast
Before: evaluate renal function before contrast is used, assess if patient is allergic to
shellfish b/c iodine, may need to be NPO for 4 hours
During: contrast may give warm/flushed feeling, lie completely still
After: encourage plenty of fluids
Renal Arteriogram: visualizes renal blood vessels; diagnose tumors or stenosis, etc; catheter
is inserted into femoral artery and passed up the aorta to renal arteries, contrast media is
injected to outline renal blood supply
Before: cathartic or enema may be used night before, assess for iodine sensitivity,
transient warm feeling may be felt from contrast injection
URINARY SYSTEM (14 QUESTIONS)
44.5 MANIFESTATIONS OF URINARY DISORDERS
o General S/Sx: anorexia, blurred vision, change in weight, chills, cognitive changes, excessive thirst,
fatigue, HA, high BP, N, V
o Edema: ankle, ascites (abdomen), facial, generalized, sacral
o Pain: dysuria (painful urination), flank or CVA (kidney punch test), groin, suprapubic
o Patterns in Urination: change in stream, dribbling, dysuria, hesitancy (difficulty starting/maintaining
urine stream), incontinence (loss of bladder control), nocturia (urinating at night), retention (cannot
empty bladder fully), stress incontinence (leaking during moments of pressure/exercise), urgency
(inflammation/discomfort)
o Urine Output: anuria (lack of urine production, under 100 mL), oliguria (less than 400 ml/day or 20
ml/hour), polyuria (more pee than normal, up to 15 L/day)
o Urine Composition: color (red, brown, yellowish green), concentrated, dilute, hematuria (bloody),
pyuria (pussy)
44.7 ASSESSMENT ABNORMALITIES OF URINARY SYSTEM
o Anuria – no urination, under 100 mL/day; AKI, end stage renal disease, obstruction
o Burning – stinging pain; irritation, UTI, calculi
o Dysuria – pain/difficult urination; UTI, cystitis; calculi
o Enuresis – involuntary nocturnal urination; Lower UTI
o Frequency – increased urination; inflamed bladder, retention with overflow, excess fluid intake, intake
of bladder irritants, calculi
o Hematuria – blood in urine; cancer, blood dyscrasias, kidney disease, UTI, stones, anticoagulant
o Hesitancy – delay or difficulty w/ urination; partial obstruction, BPH
o Incontinence – inability to voluntarily pee; neurogenic bladder, infection, injury
o Nocturia – frequent urination at night; kidney disease, obstruction, heart failure, diabetes, post renal
transplant, excess evening/nighttime fluid intake
o Oliguria – decrease urine, 100-400 mL/24 hours; severe dehydration, shock, transfusion rxn, kidney
disease, end stage kidney failure
o Pain – suprapubic (bladder), urethral (irritation), flank, CVA; infection, retention, foreign body in tract,
urethritis, pyelonephritis, renal colic, stones
o Pneumaturia – passage of urine w/ gas; fistula, gas forming UTI
o Polyuria – large volume of urine; diabetes, diabetes insipidus, kidney disease, diuretics, excess fluid
intake, obstructive sleep apnea
o Retention – inability to urinate even though bladder has excess urine; pelvic surgery, childbirth,
catheter removal, anesthesia, stricture or obstruction, neurogenic bladder
o Stress incontinence – involuntary urination with increased pressure (sneezing, coughing); weak
sphincter control, lack of estrogen, urinary retention
44.8 URINALYSIS
o Bilirubin – abnormal if present; liver disorder (jaundice)
o Casts – abnormal if present; WBC or RBC or bacteria
o Color – amber yellow – abnormal (dark, smoky, green, orange, red, cloudy)
o Culture – abnormal if > 10,000/mL; UTI
o Glucose – abnormal if present; diabetes, pituitary disorder
, o Ketones – abnormal if present; altered CHO/fat metabolism in diabetes/starvation, dehydration, V, D
o Odor – abnormal if ammonia or unpleasant; URI or standing urine
o Osmolarity – 50-1200 mmol/kg; if outside of this range, kidney lost ability to function
o pH – 4.6 – 8, average is 6; if over 8, UTI or urine left at room temp
o protein (random) – abnormal if present; kidney disease, heart failure
o protein (24 hour) – 50-80 mg/day; high protein diet, disease, strenuous exercise, fever, stress,
contamination from vaginal secretion
o RBC – 0-4 hpf – abnormal if under/over = acidosis, stones, cystitis, cancer, TB, UTI, trauma
o Specific gravity – 1.005-1.020
Low = dilute urine, excess diuresis, diabetes insipidus
High = dehydration, albuminuria, glycosuria
Fixed at 1.010 = renal inability to concentrate urine, end stage renal failure
o WBC – 0-5/hpf; if higher than this, UTI or inflammation
44.9/44.10/44.11: DIAGNOSTICS
o URINE STUDIES:
Creatinine Clearance: creatinine is a waste product of protein breakdown; M (107-139
mL/min) W (87-107 mL/min); collect 24 hour urine test, discard first urination of test, have
patient urinate at end of 24 hour and save for test, collect all urine during 24 hour period,
measure serum creatinine during test period
Residual Urine: determines amount of urine left in bladder after urinating; immediately after
patient urinates, catheterize patient or use bladder US, if large amount of residual urine
retained, HCP may want catheter left in bladder
o BLOOD STUDIES:
BUN: 10-20 mg/dL – detects renal problems caused by concentration of urea in blood which is
dependent on rate that kidney excretes urea; infection/fever/GI bleeding/trauma/ athletic
activity/excessive mx breakdown can increase BUN; too high means kidney is not working well
Creatinine: M (0.6-1.2 mg/dL) F (0.5-1.1 mg/dL) – more reliable than BUN for kidney function,
product of mx and protein metabolism; too much means creatinine is not being filtered and
removed properly
o RADIOLOGIC PROCEDURES:
KUB: “kidneys, ureters, bladder”; x-ray exam of abd and pelvis; delineates size, shape,
position, can see stones and foreign bodies
No special pre- op care
CT: visualizes kidneys, ureters, bladder; can detect tumors, abscesses, suprarenal masses,
obstructions; with or without iodine contrast
Before: evaluate renal function before contrast is used, assess if patient is allergic to
shellfish b/c iodine, may need to be NPO for 4 hours
During: contrast may give warm/flushed feeling, lie completely still
After: encourage plenty of fluids
Renal Arteriogram: visualizes renal blood vessels; diagnose tumors or stenosis, etc; catheter
is inserted into femoral artery and passed up the aorta to renal arteries, contrast media is
injected to outline renal blood supply
Before: cathartic or enema may be used night before, assess for iodine sensitivity,
transient warm feeling may be felt from contrast injection
