Assessment

HISTORY. Elicit a careful history about urinary patterns to determine a history of burning sensations or abnormal color. The patient may be completely anuric (no urine flow) or experience polyuria (large urine output) or nocturia (excessive urination at night) because of a partial urinary obstruction. Determine any recent history of mild or severe renal or flank pain that radiates to the groin. Ask about vomiting, nausea, or abdominal fullness. Ask a male patient if he has had prostate difficulties. Establish any history of blood clots, bladder problems, or prior urinary difficulties. Some patients will report very mild or even no symptoms.

PHYSICAL EXAMINATION. Inspect the flank area for asymmetry, which indicates the presence of a renal mass. Inspect the male urethra for stenosis, injury, or phimosis (narrowing so that the foreskin cannot be pushed back over the glans penis). A genitourinary (GU) exam is performed in the female patient to inspect and palpate for vaginal, uterine, and rectal lesions. When the flank area is palpated, you may feel a large fluctuating soft mass in the kidney area that represents the collection of urine in the renal pelvis. Palpate the abdomen to help identify tender areas. If the hydronephrosis is the result of bladder obstruction, markedly distended urinary bladder may be felt. Gentle pressure on the urinary bladder may result in leaking urine from the urethra because of bladder overflow. Rectal examination may reveal enlargement of the prostate or renal or pelvic masses.

PSYCHOSOCIAL. Although hydronephrosis is a treatable condition, the patient is likely to be upset and anxious. Many find GU examinations embarrassing. Urinary catheterization can also be a stressful event, particularly if it is performed by someone of the opposite gender. If the patient's renal condition has been permanently affected, determine the patient's ability to cope with a serious chronic condition.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Serum creatinine

0.5-1.2 mg/dL

<2.0 mg/dL If renal damage has occurred

Decreased ability of glomerulus to filter creatinine leads to accumulation in the blood

Biood urea nitrogen

5-20 mg/dL

May be elevated

Urinary tract obstruction with diffusion of urea nitrogen back into bloodstream through renal tubules may occur

Urinalysis and culture

Minimal numbers of red and white blood cells; no bacteria; clear urine with no occult blood and no protein.

Urinary tract Infection may occur with presence of bacteria and abnormally Increased numbers of red and white blood cells; colony counts as low as 100-10,000 bacteria/mL may indicate infection; bacteriuria: more than one organism per oil-immersion field; pyuria—more than eight leukocytes per highpower field

Urinary retention may lead to infection

Other Tests: Serum electrolytes, Intravenous pyelogram (IVP; excretory urogram), retrograde pyelogram, renal ultrasound, radionuclide studies.

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