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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.