i bc27f85be50b71b1 (175 page)

lll-A.6 for a description of a Foley catheter.)

• Urinary urgency (can indicate bladder, urethtal, or prostate

infection)

•

Incontinence (an inability to control voiding, can indicate

sphincter and autonomic dysfunction)

Clinical Tip

• If the patient has a history of urinary incontinence, a

condom catheter (for men) or adult diapers (for men and

women) can be applied before mobility treatment to aid in

completion of the session.

•

As a side effect of the medication phenazopyridine

(Pyridium), a patient's urine may turn rust-colored and be

misinterpreted as hematuria. However, any new onset of

possible hematuria should always be alerted to the medical

team for proper delineation of the cause.

Observation

The presence of abdominal or pelvic distention, peripheral edema,

incisions, scars, tubes, drains, and catheters should be noted when

performing patient inspection, because these may reflect current

pathology and recent interventions. Patients with genitourinary disor·

ders may also present with skin changes, such a pallor or rough, dry

skin' The physical therapist must handle external tubes and drains

carefully during positioning or functional mobility treatments.

Clinjcal Tip

•

Securing tubes and drains with a pin Ot a clamp ro a

patient's gown duting a mobility session can help prevent

accidental displacement (see Appendix Table lll-A.6).

GENITOURINARY SYSTEM

563

• Moving tubes and drains out of the way during bed

mobility prevents the patient from possibly rolling onto

them (see Appendix Table lll-A.6).

• Take caution in handling patients with skin changes

from dehydration to prevent any skin tears that can lead

[0 infection formation.

Palpation

The kidneys and a distended bladder are the only palpable structures

of the genitourinary system. Distention or inflammation of the kidneys results in sharp or dull pain (depending on severity) with palpation. Kidney enlargement may be indicative of renal carcinoma.2,"1

Percussion

Pain and tenderness that are present with fist percussion of the kidneys can be indicative of kidney infection or polycystic kidney disease.

Fist percussion is performed by the examiner's striking the fist of one

hand against the dorsal surface of the other hand, which is placed

along the costovertebral angle of the patient.·

Auscultation

Auscultation is performed to examine the blood flow to the kidneys

from the abdominal aorta and the renal arteries. The presence of

bruits (mllrlllllrs) can indicate impaired perfusion to the kidneys,

which can lead to renal dysfunction. Placement of the stethoscope is

generally in the area of the costovertebral angles and the upper

abdominal quadrants. Refer to Figure 8-2 for a diagram of the

abdominal quadrants.·

Diagllostic Tests'

Urinalysis

Urinalysis is a very common diagnostic tool used not only to examine

the genitourinary system, but also to help evaluate for the presence of

·The reference range of various laboratory values can vary among different

facilities. Be sure [Q verify the reference values located in the laboratory test

section of the medical record.

564

AClTIe CARE HANDBOOK FOR I)HYSICAL THERAPISTS

other sysremic diseases. Urine specimens can be collected by bladder

catheterization or suprapubic aspiration of bladder urine, or by having the patient void into a sterile specimen container. Urinalysis is performed to examine the following3-s:

•

Urine color, c1ariry, and odor

•

Specific gravity, osmolarity, or both (concentration of unne

ranges from 300 [dilute] to 1,300 Iconcentratedl mOsm/kg)

•

pH (4.5-8.0)

•

Presence of glucose, ketones, proteins, bilirubin, urobilinogen,

occulr blood, red blood cells, white blood cells, crystals, casts, bacteria or other microorganisms, enzymes, and electrolytes Urine abnormaliries are summarized in Table 9-2.

Clinical Tip

•

If the patient is having his or her urine collected (to

measure hormone and metabolite levels), the physical therapist should have the patient use the predesignated receptacle if the patient needs to urinate during a physical therapy session. This will ensure that the collection is not

interrupted.

•

The predesignated receptacle can be a urinal for men or

a collection "hat" placed on the toilet or commode for

women.

•

Urine may also be collected through the day to measure

the patient's urine output relative to the patient'S fluid

intake (input). This provides a general estimate of the

patient'S renal function. Measurements of the patient's

input and output are often abbreviated 1I0s.

Creatinine Tests

Two measurements of Cr (end product of muscle metabolism) are

performed: measurements of plasma Cr and Cr clearance. Plasma Cr

is measured by drawing a sample of venous blood. Increased levels

are indicative of decreased renal function. The reference range of

plasma Cr is 0.5-1.5 mg/dJ.