Quiz 5: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU

Quiz 5: NURS190 / NURS 190 (Latest 2026 / 2027 Update) Physical Assessment | Questions & Answers | Grade A | 100% Correct – WCU Q: The primary function of the stomach is Answer the chemical and mechanical breakdown of food Q: The small intestine is Answer the body's primary digestive and absorptive organ Q: The vermiform appendix is attached to Answer the large intestine at the cecum Q: The appendix contains masses of lymphoid tissue that make only a minor contribution to immunity; however, when inflamed: Answer The appendix causes significant health problems Q: The main functions of the large intestine are Answer absorbing water from indigestible food residue and eliminating the residue in the form of feces Q: Liver Answer The largest gland of the body, the liver is located in the right upper portion of the abdominal cavity, directly inferior to the diaphragm to just below the costal margin and extends into the left side of the abdomen. Q: The only digestive function of the liver is Answer the production and secretion of bile for fat emulsification Q: The liver has a major role in the metabolism of Answer proteins, fats, and carbohydrates Q: Gallbladder Answer stores bile and assisting in the digestion of fats Q: Pancreas Answer an endocrine and exocrine gland Q: The pancreas as an endocrine gland... Answer secretes insulin, an important factor in carbohydrate metabolism Q: The pancreas as an exocrine gland... Answer releases pancreatic juice, which contains a broad spectrum of enzymes that mixes with bile in the duodenum Q: The four pairs of abdominal muscles, when well toned.... Answer support and protect the abdominal viscera most effectively Q: Muscles of the abdominal wall: Answer -Rectus abdominis -External oblique -Internal oblique -Transverse abdominis Q: Secondary functions of these muscle groups include Answer -Lateral flexion -Rotation -Anterior flexion of the trunk Q: The abdominal aorta continues to Answer the L4 level of the vertebral column, where it bifurcates to form the right and left common iliac arteries Q: Kidneys filter... Answer nitrogenous wastes from blood and producing urine Q: Kidneys produce and secrete... Answer -Produce a biologically active form of vitamin D -Secrete erythropoietin and renin Q: If kidneys do not secrete erythropoietin it may lead to Answer anemia Q: Renin's major function Answer controls blood pressure Q: The slender tubelike structures that carry the urine from the kidneys to the bladder are Answer the ureters Q: Spleen Answer -provides a site for lymphocyte proliferation and immune surveillance and response -filters and cleanses blood, destroying worn-out red blood cells and returning their breakdown products to the liver Q: Common way to assess the abdomen: Answer Mapping: Process of dividing the abdomen into four quadrants or regions for the purpose of examination Q: Quadrants: Answer -Right upper quadrant (RUQ) -Right lower quadrant (RLQ) -Left upper quadrant (LUQ) -Left lower quadrant (LLQ) Q: Right Upper Quadrant Organs Answer Liver Gallbladder Pylorus Duodenum Head of Panacreas (R) kidney and adrenal gland Hepatic flexure of the colon Section of the ascending and transverse colon Q: Right Lower Quadrant Organs Answer Cecum Appendix Right ovary and tube Right ureter Right spermatic cord Q: Left Upper Quadrant Organs Answer Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon Q: Left Lower Quadrant Organs Part of descending colon Answer Sigmoid colon Left ovary and tube Left ureter Left spermatic cord Q: The incidence of infection by Helicobacter pylori, which is a major cause of peptic ulcer disease, is highest among individuals of Answer African American heritage and Mexican Americans Q: Borborygmi Answer Stomach growling-due to bleeding or inflammatory bowel disease Q: Most common reason for borborygmi... Answer Hunger Q: Physical assessment of the abdomen requires Answer inspection, auscultation, and palpation Additional physical assessments include: Answer -Palpate for rebound tenderness -Test for psoas sign -Test for Murphy's sign Psoas sign Answer -Perform this test if you suspect appendicitis or peritonitis (lower abdominal pain) -Flexion of or pain on hyperextension of the hip caused by contact of the psoas muscle plus inflammation; often seen in appendicitis Murphy's sign Answer pain with palpation of the RUQ during inspiration, indicative of cholecystitis If there is a positive Murphy's sign.... Answer stop the assessment and assess for pain Hyperactive bowel sounds are... Answer -high pitched, rushing, tinkling -common in gastroenteritis and diarrhea Hypoactive bowel sounds are common during Answer post-abdominal surgery & occur in end-stage intestinal obstruction Absence of bowel sounds may indicate Answer paralytic ileus Normal bowl sounds occur from Answer 5 to 30 times/min Normal tones elicited during liver percussion Answer Dullness Normal tones elicited during rib cage percussion Answer Resonance Normal tones elicited during abdomen percussion Answer Tympany Palpating for Rebound Tenderness Answer done if you suspect appendicitis What is the sound of the abdomen during percussion of a pt that is obese? Answer Percussion produces normal tympanic sounds Gaseous distention is the result of... Answer increased production of gas in the intestines Gaseous distention is seen in... Answer paralytic ileus & intestinal obstruction Abdominal Tumor produces... Answer abdominal distention Abdominal tumors create what sound during percussion? Dull Dullness may indicate enlarged uterus, distended urinary bladder, or ascites Dullness in the LLQ may indicate presence of stool in the colon Abdominal tumor distention is common in... ovarian & uterine tumors Sliding Hiatal Hernia *most common -stomach slides or moves into the thoracic cavity through the esophageal hiatus Sliding Hiatal Hernia is more common in... adults Gastritis -inflammation of mucosal lining of the stomach (acute and chronic) -epigastric pain Precipitating Factors for Gastritis Acute: NSAIDs, alcohol abuse, stress, infection Chronic: H.Pylori Autoimmune responses Gastroesophageal Reflux Disease (GERD) -back flow of gastric said to esophagus -heartburn, chest pain Precipitating Factors for GERD food intake, lying down after meals Irritable Bowel Syndrome (IBS) -Problems with GI motility - LLQ accompanied by diarrhea and or constipation -Pain increases after eating and decreases after bowel movement Precipitating Factors for IBS Stress Intolerated foods Caffeine Lactose Intolerance Alcohol Familial linkage Pancreatitis -inflammation of the pancreas -upper abdominal, knifelike, deep epigastric or umbilical area pain Precipitating Factors for Pancreatitis Ductal obstruction Alcohol Use of acetaminophen Infection Taut, glistening skin could indicate ascites Striae (stretch marks) are... slivery, shiny, irregular markings commonly found in pregnant women obese pts, and those with ascites Marked pulsations could indicate... aortic aneurysms or increased pulse pressure medulla of kidney inner portion of kidney, composed of collecting tubules (calyces) and pyramids that empty into the renal pelvis Major Functions of the kidneys -Removes wastes, toxins, and foreign matter from the blood -Promotes fluid and electrolyte balance -Assists in maintenance of blood pressure -Contributes to erythropoiesis and the metabolism of vitamin D In females the urethra... -Is short, about 1.5 inches (3-4 cm) -More easily contaminated with bacteria, especially from the anus In males the urethra... -About 8 inches long (20 cm) -Also carries semen outside the body The costovertebral angle (CVA) Is the area on the lower back formed by the vertebral column and the downward curve of the last posterior rib The costovertebral angle (CVA) helps to determine the Anatomic location of the kidneys and ureters The symphysis pubis -Is the union of the two pubic bones by cartilage at the midline of the body. The bladder is cradled under the symphysis pubis Pregnant females with pressure of the enlarged uterus leads to... increase frequency of urination and incomplete emptying of the bladder, which may lead to a UTI nocturia urination at night (common in older adults) Postmenopausal women and decreased estrogen affects... the strength of the pubic muscles & may lead to urine leakage, reduced acidity & UTIs Assessment Techniques of urinary system •Inspection •Palpation •Percussion hematuria blood in the urine oliguria Decreased urine output hydroureter the distention of the ureter with urine that cannot flow because the ureter is blocked causing spasm & severe pain to shock, infection & impaired renal function; immediate treatment is needed Normal findings when palpating the left kidney... not palpable Do not palpate the kidneys deeply when.. a pt. has recent kidney transplant or an abdominal aneurysm The bladder is enlarged in males with... urethral obstruction due to hypertrophy or hyperplasia of the prostate Bladder cancer is linked to... smoking Urinary tract infection (UTI) -Bladder most common site but may include kidneys -Common with catheter use for urinary retention or incontinence Dysreflexia -Affects pt.'s with spinal cord injury@ level T7 -Bladder distention causes a sympathetic response that can trigger a potentially life-threatening hypertensive crisis Types of incontinence Functional Reflex Stress Urge Total Incontinence inability to retain urine functional incontinence Unable to reach the toilet in time due to: Environmental, psychosocial or physical factors reflex incontinence Occurs with spinal cord injuries stress incontinence Involuntary urination due to intra-abdominal pressure is increased when coughing, sneezing, straining; aging may also contribute to stress incontinence urge incontinence Consuming large amounts of volume over a short period of time or diminished bladder capacity. total incontinence -Continuous, unpredictable loss of urine -Related to neuro conditions Cholorectal cancer is common in... African Americans Amber (yellow-red) and foamy urine are indicative of... liver disease UTI symptoms in older adults Confusion and lower back pain What vitamins does the liver store? -fat-soluable vitamins: A, D, E, K What pain medication can you give to patients with liver problems? Tylenol (only liver-toxic) -NSAIDs, such as ibuprofen, are both liver and kidney toxic -therefore, tylenol is only toxic to one organ What is Vitamin A good for? -clotting -coagulation -antibodies Gallbladder -storage organ for bile -releases stored bile into duodenum when stimulated -assists in digestion of fats Pancreas -endocrine and exocrine gland -secretes insulin -releases pancreatic juice -assists with digestion of proteins, fats, and carbohydrates Peritoneum -serous membrane in abdominal cavity -muscles of abdominal wall: rectus abdominis, external oblique, internal oblique, and transverse abdominis -weakness will produce herniation Descending Aorta -penetration occurs at the T12 level of the vertebral column -continues to the L4 level of the vertebral column Kidneys, Ureters, & Bladder -filter nitrogenous wastes from blood to produce urine -produce biologically active Vitamin D -secrete erythropoietin and renin -store and release urine Erythropoietin stimulates production of RBCs in the bone marrow Renin -an enzyme that helps control your blood pressure -made by cells in the kidney Spleen -largest lymphoid organ -provides site for lymphocyte proliferation and immune surveillance and response -filters and cleanses blood -should not be palpable Reproductive Organs -females: uterus, fallopian tubes, and ovaries -males: prostate gland; as males get older, their prostate becomes larger (BPH) Benign Prostatic Hyperplasia (BPH) -noncancerous enlargement of the prostate gland -very common, but rarely causes symptoms before age 40 -common cause of urinary retention & obstruction -about half of men between ages 51 and 60 and up to 90% of men older than age 80 have BPH BPH Symptoms -difficulty urinating -frequent urination, especially at night -pain or burning during urination -chills and fever along with urinating problems -straining or pushing when urinating -urine stream is weak -have to start and restart several times -blood in urine Hernias -occur due to increased pressure in a weakened area of the body -abdominal surgery can often cause this Use Bell of Stethoscope to listen for: bruits in the abdominal aorta, renal, iliac, and femoral arteries Mapping process of dividing the abdomen into 4 quadrants or regions for the purpose of examination Quadrants -right upper quadrant (RUQ) -right lower quadrant (RLQ) -left upper quadrant (LUQ) -left lower quadrant (LLQ) -palpate and percuss in these areas Quadrant Landmarks -midsternal line from the xiphoid process through the umbilicus to the pubic bone -horizontal line perpendicular to the first line through the umbilicus -two perpendicular lines form 4 equal quadrants of the abdomen Organs in the RUQ -liver & gallbladder -pyloric sphincter -duodenum -head of pancreas -right adrenal gland -portion of right kidney -hepatic flexure of colon -portions of ascending & transverse colon Organs in the LUQ -left lobe of liver -spleen -stomach -body of pancreas -left adrenal gland -portion of left kidney -splenic flexure of colon -portions of transverse & descending colon Organs in the RLQ -lower pole of right kidney -cecum and appendix -portion of ascending colon -ovary and uterine tube -right spermatic cord -right ureter Organs in the LLQ -lower pole of left kidney -sigmoid colon -portion of descending colon -ovary and uterine tube -left spermatic cord -left ureter -patients 65+ who are constipated, you will hear dullness in this quadrant (stool is in there) Hypogastric (Pubic) Region -where bladder is located -a full bladder will sound dull on auscultation -uterus (during pregnancy) located here Hepatitis A -route of transmission: oral-fecal -not life-threatening -when traveling to 3rd world countries, avoid uncooked foods (seafood) -eat food that is fully cooked Hepatitis B -route of transmission: blood, open sores, or body fluids of someone who has the Hep B virus -can cause scarring of the liver, liver failure, and cancer -can be fatal if not treated Hepatitis C -route of transmission: needles (IV drug use), blood (dirty needles or unscreened blood), tattoos, mother to baby by pregnancy, labor, or nursing Umbilical Hernia -most common type in children -cause a protrusion at the umbilicus and is visible at birth -more common in African American children and among infants who are born prematurely -majority of these hernias close before age 5 -require no medical attention unless they incarcerate, cause symptoms, enlarge or persist after age 5 years Infectious Mononucleosis ("Mono") -most common in school-aged children -parents are advised not to kiss children on the lips The Pregnant Female -enlarging of the abdomen -fundal height measurements -GI discomfort -skin changes such as striae gravidarum (stretch marks) -muscles may lose tone -20 weeks gestation usually around the umbilicus The Older Adult -rounding and protrusion of abdomen due to increased adipose tissue distribution, decreased muscle tone and reduced fibroconnective tissue Constipation in the Older Adult Common problem in this population due to: -decreased GI motility -impaired physical mobility -medications (anticholinergics, opioids, calcium supplements & NSAIDs) -cognitive disorders (confusion, dementia) Focused Interview: Subjective Data Questions to ask: -changes within the last month, year, appetite -weight -bowel habits, stool color, consistency -family diagnosed with abdominal disease or infection -symptoms: N/V, dysplasia, pain/behavior -recent travel Assessment Techniques Must be in this sequence: 1) Inspection 2) Auscultation (prevents distortion of bowel sounds) 3) Percussion 4) Palpation Inspection 1) Contour -Normal: flat, rounded, or scaphoid 2) Position of umbilicus -Normal: center of abdomen; inverted or protruding 3) Skin color -Normal: consistent in color & luster with skin of the rest of body -smooth, moist, & free of lesions 4) Location & characteristics of lesions, scars, abdominal markings 5)Symmetry, bulging, mass -1st: standing at client's side -2nd: standing at foot of examination table -Compare right & left sides -Normal: symmetric (shape, size, contour) 6) Observe abdominal wall for movement -Abnormal: Pulsations or peristaltic waves Scaphoid Contour of Abdomen -abnormal finding -sometimes called a "concave abdomen" -the horizontal line now curves inward toward the vertebral column, giving the abdomen a sunken appearance -in the adult, this contour is seen in very thin people Protuberant Contour of Abdomen -abnormal finding -similar to the "rounded abdomen", only greater -this contour is anticipated in pregnancy -also seen in the adult with obesity, ascites, and other conditions Auscultation Bowel sounds: start at RLQ -character/frequency -60 seconds -Normal: irregular, gurgling, high-pitch -occur from 5-320 times/minute Vascular sounds (bell): aortic, renal, iliac, femoral Friction rubs: normal finding; coarse, grating sound (liver, spleen); normally not heard What do you do if you don't hear any bowel sounds after listening for 60 seconds? -listen for an additional 5 minutes until you hear something -if you still hear nothing, keep patient NPO, call another RN to confirm findings -if the second RN cannot hear any bowel sounds either, call the provider Abnormal Findings: Bowel Sounds -Borborygmi: stomach growling; hungry (high-pitched hyperactive), may be due to bleeding or inflammatory bowel disease -Hyperactive: gastroenteritis & diarrhea -Hypoactive: following abdominal surgery, occur in end-stage intestinal obstruction -Absence: paralytic ileus -Paralytic ileus or intestinal obstruction require immediate attention -Bruits: a sign of stenosis, aneurisms -heard during systole & diastole: arterial occlusion Percussion of Abdomen -tympany: abdomen & gastric bubble -dull: liver or spleen -dull: patients with ascites -urine in bladder: dull -stool in colon: dull -over an organ: dull Tones during Liver Percussion Dullness: -below costal margin: liver enlargement or downward displacement (respiratory disease) -above 5th or 6th intercostal space (hepatomegaly) or displacement (ascites, mass) Blumberg's Sign -sharp, stabbing pain as the compressed area returns to a non-compressed state -this finding occurs in peritoneal irritation and requires immediate medical attention Rovsing's Sign -pain referred to McBurney's point 1-2" above anterosuperior iliac spine (line between ileum & umbilicus) on palpation of left lower abdomen -Suggestive: peritoneal irritation in appendicitis Ascites -abnormal collection of fluid in peritoneal cavity -occurs in: cirrhosis, CHF, renal failure, nephrosis, peritonitis, neoplastic diseases, & many types of cancer Percussion Pattern for Ascites -patient in supine position -percuss at the midline to elicit tympany -continue to percuss in lateral direction away from the midline and listen for dullness -mark the skin, identifying possible levels of fluid Alternative Method: Percussion Pattern for Ascites -Shifting dullness: position patient on the right or left side -percuss the abdomen -because fluid settles, anticipate tympany at superior level and dullness at lower levels -Suspect ascites: weigh patient and measure abdominal girth Testing for Psoas Sign -perform this test when lower abdominal pain is present and you suspect appendicitis -with the patient in a supine position, place your left hand just above the level of the patient's right knee -ask the patient to raise the leg to meet your hand -flexion of the hip causes contraction of the psoas muscle -pain=appendicitis Testing for Murphy's Sign -while palpating the liver, ask the patient to take a deep breath & hold it -diaphragm descends, pushing the liver and gallbladder toward your hand -in a healthy patient, liver palpation is painless -sharp abdominal pain (in RUQ) and need to halt the examination is a positive Murphy's sign -occurs in patients with cholecystitis -Normal: no abdominal pain Hyperactive Bowel Sounds -located in any quadrant -gastroenteritis, diarrhea Hyperactive Bowel Sounds followed by Absence of Sound -located in any quadrant -paralytic ileus High-pitched Bowel Sounds with Cramping -located in any quadrant -intestinal obstruction Systolic Bruit (blowing) -located in midline below xiphoid process: aortic arterial obstruction -left and right lower costal borders at midclavicular line: stenosis of renal arteries -left and right abdomen at midclavicular line between umbilicus and anterior iliac spine: stenosis of iliac arteries Venous Hum -continuous tone -located in epigastrium and around umbilicus -portal hypertension Friction Rub -harsh, grating -located in left and right upper quadrants; over liver and spleen -tumor or inflammation of organ Umbilical Hernias -abnormal finding -rectus muscle separates or weakens causing abdominal structures (intestines) to push through -more common in children Ventral/Incisional Hernias -abnormal finding -causes: obesity, repeated surgeries, post-op infection, impaired wound healing, poor nutrition Hiatal Hernias -abnormal finding -weakening in diaphragm allowing portion of stomach/esophagus to move into thoracic cavity -Classified as: sliding or rolling -more common in adults than children Hepatic Cancer -malignant growth of liver -often preceded by cirrhosis related to alcohol abuse, autoimmune diseases of the liver, or Hep B and C infections -the use of the liver in the metabolism of drugs leads to limited treatment options Pancreatic Cancer -malignant growth of the pancreas -metastasizes very rapidly and has poor prognosis -although smoking is a major risk factor, age, race and genetic disposition are also contributing factors Stomach Cancer -malignant growth of the stomach -often advanced stage before diagnosed -influenced by dietary habits Colorectal Cancer -one of the most common types -malignant lesion on any part of the large intestine, sigmoid colon, or rectum -linked to chronic constipation -those with a family history are recommended to get colonoscopies earlier than the age of 50 (sometimes by age 45) Ulcerative Colitis -recurrent inflammatory process causing ulcer formation in lower portions of large intestine and colon -most common in adolescents and young adults -ulcerative areas abscess and later become necrotic Crohn's Disease -chronic inflammatory process of the intestine involving any part of the lower intestinal tract -characterized by "skipped" sections of involvement -most common in young adults and usually has an insidious onset -transverse fissures develop in the bowel, producing a characteristic "cobblestone" appearance Esophagitis -inflammatory process of the esophagus -caused by a variety of irritants -causes: smoking, alcohol abuse, reflux of gastric contents, and ingestion of extremely hot or cold foods and liquids Peritonitis -local or generalized inflammatory process of the peritoneal membrane of the abdomen -precipitant: perforation of an organ (ruptured duodenal ulcer), internal bleeding (ruptured ectopic pregnancy), trauma (stab wound to abdomen), infectious process (pelvic inflammatory disease) -abdomen will feel hard/rigid/"board-like" Appendicitis -acute inflammation of vermiform appendix -pain in epigastric and periumbilical area -localized in RLQ -sudden onset -caused by obstruction (fecal stone, adhesions) Cholecystitis -acute or chronic inflammation of wall of gallbladder -pain in RUQ, radiates to right scapula -sudden onset -caused by fatty meals, and/or obstruction of a duct in cholelithiasis Diverticulitis -inflammation of diverticula (outpouches of mucosa through intestinal wall) -cramping in LLQ -radiates to back -caused by ingestion of fiber-rich diet, stress Duodenal Ulcer -breaks in mucosa of duodenum -aching, gnawing, epigastric pain -caused by stress, use of NSAIDs Ectopic Pregnancy -implantation of blastocyte outside of the uterus, generally in the fallopian tube -"fullness" in rectal area -abdominal cramping, unilateral pain -caused from tubal damage, pelvic infection, hormonal disorders, lifting, bowel movements Gastritis -inflammation of mucosal lining of stomach (acute or chronic) -epigastric pain -Acute: NSAIDs, alcohol abuse, stress, infection -Chronic: H. pylori -Autoimmune responses Gastroesophageal Reflux Disorder (GERD) -backflow of gastric acid to the esophagus -heartburn, chest pain -caused by food intake, lying down after meals Intestinal Obstruction -blockage of normal movements of bowel contents -Small intestine: aching -Large intestine: spasmodic pain -Neurogenic: diffuse abdominal discomfort (manipulation of bowel during surgery, peritoneal irritation) -Mechanical: colicky pain associated with distention (physical block from impaction, hernia, volvulus) Irritable Bowel Syndrome (IBS, Spastic Colon) -problems with GI motility -pain located in LLQ accompanied by diarrhea and/or constipation -pain increases after eating and decreases after bowel movement -caused by stress, intolerated foods, caffeine, lactose intolerance, alcohol, familial linkage Pancreatitis -inflammation of the pancreas -upper abdominal area, "knifelike", deep epigastric or umbilical area pain -caused by ductal obstruction, alcohol abuse, use of acetaminophen, infection Kidneys -located in retroperitoneal space with upper portion protected by lower rib cage -bean-shaped organ -right kidney is displaced downward by the liver and sits slightly lower than the left kidney Glomeruli tufts of capillaries that filter more than 1 liter of fluid each minute Functions of the Kidneys -removes wastes, toxins, and foreign matter from the blood -promotes fluid and electrolyte balance -assists in maintenance of blood pressure -contributes to erythropoiesis and the metabolism of Vitamin D Renal Arteries require oxygen, nutrients and receive about 25% of the cardiac output Vasta Recta helps to concentrate urine Ureters -mucus-lined narrow tubes -function to transport urine from the kidney to the urinary bladder -middle layer contains smooth muscle with peristaltic action that propels urine to the urinary bladder Detrusor Muscle -expands and contracts, acting as a reservoir -temporarily stores urine Costovertebral Angle (CVA) -area on the lower back formed by the vertebral column and downward curve of the last posterior rib -anatomic location of kidneys and ureters -abnormal finding: pain and tenderness End-Stage Renal Disease occurs when -GFR is less than 15 -lower than 15=dialysis Cryptorchidism -the failure of one or both testicles to descend through the inguinal canal during the final stages of fetal development -more common in premature infants & is detectable at birth Labial Adhesions -when the labia minora fuse together -common in preadolescent females because decreased estrogen levels result in labial and genital atrophy -becomes a medical concern if there is blockage of urinary flow or it results in recurrent UTIs The Older Adult: Urinary -decrease in renal blood flow and perfusion -decrease in ability to concentrate and dilute urine -reduction in ability to clear medications and acids -reduction in ability to reabsorb bicarbonate and glucose -effects of respiratory or metabolic acidosis -increased glycosuria -fluid loss -incontinence Urinary Retention -inability to empty bladder -elevated BUN & Creatinine -intake greater than output Nocturia nighttime urination (especially males) Postmenopausal Women -decreased estrogen -affects strength of pubic muscles -may lead to urine leakage, reduced acidity (lower urinary tract) and UTI Urinary Tract Infection (UTI): S&S -painful urination (burning) -frequent or intense urge to urinate -pain or pressure in back or lower abdomen -cloudy, dark, bloody, or strange-smelling urine -fever or chills (sign the infection may have reached your kidney) -bladder is the most common site -common with catheter use for urinary retention or incontinence Stasis -feeling "too busy" to empty bladder as needed -Result: infection HTN and DM occur with greater frequency in (ethnic group) Hispanics & African Americans Renal Calculi occur with greater frequency in (ethnic group) Caucasians & obese people Subjective Data Questions: Urinary -normal pattern, any changes -ability to empty bladder completely -control of urination (continent/incontinent) -family member diagnosed with kidney or bladder disease or infection -Problems/Issues: high BP, DM, frequent bladder infections, kidney stones -pain or discomfort with urination -back, sides, abdomen Assessment Techniques: Urinary 1) Inspection 2) Palpation 3) Percussion Do not palpate or percuss: -any patient reporting pain or discomfort in pelvic region Neuroblastoma or Wilms' Tumor tumor of kidney Azotemia -elevated nitrogenous wastes in blood contribute to mental confusion Auscultation: Kidney & Flanks -auscultate right & left renal arteries to assess circulatory sounds -Bell of stethoscope over extended MCL on either side of abdominal aorta -auscultate both right & left -Normal: no Bruit's -Bruit: narrowing or obstruction of a blood vessel Percussion of Costovertebral Angles -blunt or indirect -left palm flat over left costovertebral angle -thump back of left hand with ulnar surface of right fist-gentle thud Bladder Cancer -abnormal finding -occurs more frequently in males than females -smoking is linked to this disease -sometimes patients are asymptomatic -flank pain -dysuria Glomerulonephritis -inflammation of the glomerulus -fatigue -change in urinary patterns -HTN -generalized edema -hematuria -proteinuria Renal Calculi (Kidney Stones) -stones that block the urinary tract -composed of calcium, struvite, or a combination of magnesium, ammonium, phosphate and uric acid -nausea -dysuria -increased urinary urgency -vomiting Renal Tumor -benign -more commonly malignant -linked to smoking -flank pain -lethargy Renal Failure -acute or chronic -if acute, it may progress to chronic -acute stage that does not progress includes 3 stages: oliguria, diuresis, and recovery -anorexia -nausea -pruritus -fatigue Urine Output -Normal: 40 mL/hr -Less than 30 mL/hr= Oliguria -Less than 20 mL/hr= Anuria Types of Incontinence (5) -functional -reflex -stress -urge -total Functional Incontinence -unable to reach toilet in time -environmental, psychosocial, physical factors Reflex Incontinence -spinal cord damage -involuntarily lost Stress Incontinence -involuntary urination -intra-abdominal pressure: cough, sneeze, strain -most common type in older adults Urge Incontinence -consuming significant volume of liquids within a short time -diminished bladder capacity Total Incontinence related to a neurological condition