Manifestations of Urinary System Disorders
General Edema Pain Patterns of Urine Output Urine
Manifestations Urination Composition
- Fatigue - Facial - Dysuria - Frequency - Anuria - Concentrated
- Headaches (periorbital) - Flank or - Urgency - Oliguria - Dilute
- Blurred vision - Ankle costovertebral - Hesitancy of - Polyuria - Hematuria
- Elevated BP - Ascites angle stream - Pyuria
- Anorexia - Anasarca - Groin - Change in - Color (red,
- Nausea and (generalized - Suprapubic stream brown,
vomiting edema) - Retention yellowish
- Chills - Sacral - Dysuria green)
- Itching - Nocturia
- Excessive thirst - Incontinence
- Change in body - Stress
weight incontinence
- Cognitive - Dribbling
changes
Assessment Abnormalities: Urinary System
Finding Description Possible Etiology and Significance
Anuria Technically no urination (24-hr urine Acute kidney injury, end-stage renal disease,
output <100 mL) bilateral ureteral obstruction
Burning on Stinging pain in urethral area Ureteral irritation, urinary tract infection, urethral
urination calculus
Dysuria Painful or difficult urination Sign of UTI, interstitial cystitis, urethral calculus,
and wide variety of pathologic conditions
Enuresis Involuntary nocturnal urination Symptomatic of lower urinary tract disorder
Frequency Increased incidence of urination Acutely inflamed bladder, retention with
overflow, excess fluid intake, intake of bladder
irritants, urethral calculus
Hematuria Blood in the urine Cancer of genitourinary tract, blood dyscrasias,
kidney disease, URT, stones in kidney or ureter,
medications (anticoagulants)
Hesitancy Delay or difficult in initiation Partial urethral obstruction, benign prostatic
urination hyperplasia
Incontinenc Inability to voluntarily control Neurogenic bladder, bladder infection, injury to
e discharge of urine external sphincter
Nocturia Frequency of urination at night Kidney disease with impaired concentrating
ability, bladder obstruction, heart failure, diabetes
mellitus, finding after renal transplant, excessive
evening and nighttime fluid intake
Oliguria Diminished amount of urine in a Severe dehydration, shock, transfusion reaction,
given time (24-hr urine output of 100- kidney disease, end-stage renal disease
400 mL)
Pain Suprapubic pain (related to bladder), Infection, urinary retention, foreign body in
, urethral pain (irritation of bladder urinary tract, urethritis, pyelonephritis, renal
neck), flank (CVA) pain colic or stones
Pneumaturia Passage of urine containing gas Fistula connections between bowl and bladder,
gas-forming urinary tract infections
Polyuria Large volume of urine in a given time Diabetes mellitus, diabetes insipidus, chronic
kidney disease, diuretics, excess fluid intake,
obstructive sleep apnea
Retention Inability to urinate even though Finding after pelvic surgery, childbirth, catheter
bladder contains excessive amount of removal, anesthesia; urethral stricture or
urine obstruction; neurogenic bladder
Stress Involuntary urination with increased Weakness of sphincter control, lack of estrogen,
incontinence pressure (sneezing or coughing) urinary retention
Diagnostic Studies: Urinary System
Study Description and Purpose Nursing Responsibility
Urine Urinalysis General examination of urine to establish Before: Wash perineal area
Studies baseline information or provide date to before collecting specimen
establish a tentative diagnosis and determine During: Try to obtain first
whether further studies are needed urinated morning specimen
After: Ensure specimen is
examined within 1 hr. of
urinating
Creatinine Creatinine is a waste product of protein During: Collect 24-hr urine
clearance breakdown (primarily body muscle mass). specimen. Discard first
Clearance of creatinine by kidney urination when test is started.
approximates the GFR (urine creatinine x Save urine from all subsequent
urine volume / serum creatinine) urinations for 24 hr. Instruct
Reference interval: 70-135 mL/min patient to urinate at end of 24
hr. and add specimen to
collection. Ensure that all
serum creatinine is determined
during 24-hr period
Residual Determines amount of urine left in bladder During: Immediately after
urine after urinating. Finding may be abnormal in patient urinates, catheterize
problems with bladder innervation, sphincter patient or use bladder
impairment, BPH, or urethral strictures ultrasound equipment. If a
Reference interval: <50 mL urine (increased large amount of residual urine
w/ age) is obtained, HCP may want
catheter left in bladder
Blood Blood urea Used to detect renal problems. Concentration
Studies nitrogen of urea in blood is regulated by rate at which
(BUN) kidney excretes urea. Nonrenal factors may
cause an increased BUN (rapid cell
destruction from infections, fever, GI
, bleeding, trauma, athletic activity, and
excessive muscle breakdown)
Reference interval: 6-20 mg/dL
Creatinine More reliable than BUN as a determinant of
renal function. Creatinine is end product of
muscle and protein metabolism and is
released at a constant rate
Reference interval: 0.6-1.3 mg/dL
Radiologic Kidneys, X-ray examination of abdomen and pelvis
Procedure ureters, delineates size, shape, and position of
s bladder kidneys, ureter, and bladder. Radiopaque
(KUB) stones and foreign bodies can be seen
CT Provides visualization of kidneys, ureters,
and bladder. Can detect tumors, abscesses,
suprarenal masses, and obstructions. Can be
done w/ or w/o contrast media. Contrast is
iodine based
Renal Visualized renal blood vessel. Can assist in
arteriogram diagnosing renal artery stenosis, additional
or missing renal blood vessel, and
renovascular hypertension. Can assist in
differentiating between a renal cyst and renal
tumor. Also included in workup of a
potential renal transplant donor. A catheter is
inserted into the femoral artery and passed
up the aorta to level of renal arteries.
Contrast media is injected to outline renal
blood supply.
Renal Used to detect renal or perirenal masses
ultrasound (tumors, cysts) and obstructions. Small
external ultrasound probe is placed on
patient’s skin. Conductive gel is applied to
skin. Noninvasive procedure involves
passing sound waves into body structures
and recording images as they are reflected
back. Computer interprets tissue density
based on sound waves and displays it in
picture form. It can be used safely in patients
w/ renal failure.
Intravenou Visualizes urinary tract after IV injection of
s contrast media. Size and shape of kidneys,
pyelogram ureters, and bladder can be evaluated. Cysts,
(IVP) tumors, and ureteral obstructions (strictures)
cause a distortion in normal appearance of
these structures. Patient w/ decreased renal
function should not have IVP because
General Edema Pain Patterns of Urine Output Urine
Manifestations Urination Composition
- Fatigue - Facial - Dysuria - Frequency - Anuria - Concentrated
- Headaches (periorbital) - Flank or - Urgency - Oliguria - Dilute
- Blurred vision - Ankle costovertebral - Hesitancy of - Polyuria - Hematuria
- Elevated BP - Ascites angle stream - Pyuria
- Anorexia - Anasarca - Groin - Change in - Color (red,
- Nausea and (generalized - Suprapubic stream brown,
vomiting edema) - Retention yellowish
- Chills - Sacral - Dysuria green)
- Itching - Nocturia
- Excessive thirst - Incontinence
- Change in body - Stress
weight incontinence
- Cognitive - Dribbling
changes
Assessment Abnormalities: Urinary System
Finding Description Possible Etiology and Significance
Anuria Technically no urination (24-hr urine Acute kidney injury, end-stage renal disease,
output <100 mL) bilateral ureteral obstruction
Burning on Stinging pain in urethral area Ureteral irritation, urinary tract infection, urethral
urination calculus
Dysuria Painful or difficult urination Sign of UTI, interstitial cystitis, urethral calculus,
and wide variety of pathologic conditions
Enuresis Involuntary nocturnal urination Symptomatic of lower urinary tract disorder
Frequency Increased incidence of urination Acutely inflamed bladder, retention with
overflow, excess fluid intake, intake of bladder
irritants, urethral calculus
Hematuria Blood in the urine Cancer of genitourinary tract, blood dyscrasias,
kidney disease, URT, stones in kidney or ureter,
medications (anticoagulants)
Hesitancy Delay or difficult in initiation Partial urethral obstruction, benign prostatic
urination hyperplasia
Incontinenc Inability to voluntarily control Neurogenic bladder, bladder infection, injury to
e discharge of urine external sphincter
Nocturia Frequency of urination at night Kidney disease with impaired concentrating
ability, bladder obstruction, heart failure, diabetes
mellitus, finding after renal transplant, excessive
evening and nighttime fluid intake
Oliguria Diminished amount of urine in a Severe dehydration, shock, transfusion reaction,
given time (24-hr urine output of 100- kidney disease, end-stage renal disease
400 mL)
Pain Suprapubic pain (related to bladder), Infection, urinary retention, foreign body in
, urethral pain (irritation of bladder urinary tract, urethritis, pyelonephritis, renal
neck), flank (CVA) pain colic or stones
Pneumaturia Passage of urine containing gas Fistula connections between bowl and bladder,
gas-forming urinary tract infections
Polyuria Large volume of urine in a given time Diabetes mellitus, diabetes insipidus, chronic
kidney disease, diuretics, excess fluid intake,
obstructive sleep apnea
Retention Inability to urinate even though Finding after pelvic surgery, childbirth, catheter
bladder contains excessive amount of removal, anesthesia; urethral stricture or
urine obstruction; neurogenic bladder
Stress Involuntary urination with increased Weakness of sphincter control, lack of estrogen,
incontinence pressure (sneezing or coughing) urinary retention
Diagnostic Studies: Urinary System
Study Description and Purpose Nursing Responsibility
Urine Urinalysis General examination of urine to establish Before: Wash perineal area
Studies baseline information or provide date to before collecting specimen
establish a tentative diagnosis and determine During: Try to obtain first
whether further studies are needed urinated morning specimen
After: Ensure specimen is
examined within 1 hr. of
urinating
Creatinine Creatinine is a waste product of protein During: Collect 24-hr urine
clearance breakdown (primarily body muscle mass). specimen. Discard first
Clearance of creatinine by kidney urination when test is started.
approximates the GFR (urine creatinine x Save urine from all subsequent
urine volume / serum creatinine) urinations for 24 hr. Instruct
Reference interval: 70-135 mL/min patient to urinate at end of 24
hr. and add specimen to
collection. Ensure that all
serum creatinine is determined
during 24-hr period
Residual Determines amount of urine left in bladder During: Immediately after
urine after urinating. Finding may be abnormal in patient urinates, catheterize
problems with bladder innervation, sphincter patient or use bladder
impairment, BPH, or urethral strictures ultrasound equipment. If a
Reference interval: <50 mL urine (increased large amount of residual urine
w/ age) is obtained, HCP may want
catheter left in bladder
Blood Blood urea Used to detect renal problems. Concentration
Studies nitrogen of urea in blood is regulated by rate at which
(BUN) kidney excretes urea. Nonrenal factors may
cause an increased BUN (rapid cell
destruction from infections, fever, GI
, bleeding, trauma, athletic activity, and
excessive muscle breakdown)
Reference interval: 6-20 mg/dL
Creatinine More reliable than BUN as a determinant of
renal function. Creatinine is end product of
muscle and protein metabolism and is
released at a constant rate
Reference interval: 0.6-1.3 mg/dL
Radiologic Kidneys, X-ray examination of abdomen and pelvis
Procedure ureters, delineates size, shape, and position of
s bladder kidneys, ureter, and bladder. Radiopaque
(KUB) stones and foreign bodies can be seen
CT Provides visualization of kidneys, ureters,
and bladder. Can detect tumors, abscesses,
suprarenal masses, and obstructions. Can be
done w/ or w/o contrast media. Contrast is
iodine based
Renal Visualized renal blood vessel. Can assist in
arteriogram diagnosing renal artery stenosis, additional
or missing renal blood vessel, and
renovascular hypertension. Can assist in
differentiating between a renal cyst and renal
tumor. Also included in workup of a
potential renal transplant donor. A catheter is
inserted into the femoral artery and passed
up the aorta to level of renal arteries.
Contrast media is injected to outline renal
blood supply.
Renal Used to detect renal or perirenal masses
ultrasound (tumors, cysts) and obstructions. Small
external ultrasound probe is placed on
patient’s skin. Conductive gel is applied to
skin. Noninvasive procedure involves
passing sound waves into body structures
and recording images as they are reflected
back. Computer interprets tissue density
based on sound waves and displays it in
picture form. It can be used safely in patients
w/ renal failure.
Intravenou Visualizes urinary tract after IV injection of
s contrast media. Size and shape of kidneys,
pyelogram ureters, and bladder can be evaluated. Cysts,
(IVP) tumors, and ureteral obstructions (strictures)
cause a distortion in normal appearance of
these structures. Patient w/ decreased renal
function should not have IVP because
