SAS 17

• The students will study and read Chapter 16 of their book about this lesson: The Urinary Tract.
• Disorders in the urinary tract may cause pain in either the abdomen or the back.
• Bladder disorders may cause suprapubic pain.
• All these must be done giving importance to social, distancing, hygienic practices, and wearing of mask at all times.
• After completion of the task, the instructor will randomly call 3 - 5 representatives from the class to share their input.
• In bladder infection, pain in the lower abdomen is typically dull and pressure-like.
• Sudden overdistention of the bladder often causes agonizing pain.
• Pain of sudden overdistention accompanies acute urinary retention.
• Infection or irritation of either the bladder or urethra often provokes several symptoms, including pain on urination, usually felt as a burning sensation.
• Women may report internal urethral discomfort, sometimes described as a pressure or an external burning from the flow of urine across irritated or inflamed labia.
• Men typically feel a burning sensation proximal to the glans penis.
• Prostatic pain is felt in the perineum and occasionally in the rectum.
• Painful urination accompanies cystitis or urethritis.
• If dysuria, consider bladder stones, foreign bodies, tumors; also acute prostatitis.
• Urinary urgency is an unusually intense and immediate desire to void, sometimes leading to involuntary voiding or urge incontinence.
• Urinary frequency, or abnormally frequent voiding, may occur.
• Ask about any related fever or chills, blood in the urine, or any pain in the abdomen, flank, or back.
• Men with partial obstruction to urinary outflow often report hesitancy in starting the urine stream, straining to void, reduced caliber and force of the urinary stream, or dribbling as voiding is completed.
• Urgency suggests bladder infection or irritation.
• In men, painful urination without frequency or urgency suggests urethritis.
• Blood in the urine, or hematuria, is an important cause for concern.
• Test the urine with a dipstick and microscopic examination before you settle on the term hematuria.
• Smaller amounts of blood may tinge the urine with a pinkish or brownish cast.
• When visible to the naked eye, hematuria is called gross hematuria.
• Disorders of the urinary tract may also cause kidney pain, often reported as flank pain, which is on the side of the body between the upper abdomen and the back.
• Urinary incontinence is an involuntary loss of urine that may become socially embarrassing or cause problems with hygiene.
• Nocturia refers to urinary frequency at night, sometimes defined as awakening the patient more than once; urine volumes may be large or small.
• If the urine is reddish, ask about ingestion of beets or medications that might discolor the urine.
• Ask about any associated fever, chills, or hematuria.
• Kidney pain, fever, and chills occur in a cute pyelonephritis.
• If the patient reports incontinence, ask when it happens, how often, if small amounts of urine leak with increased intra-abdominal pressure from coughing, sneezing, laughing, or lifting, if it's difficult to hold the urine once there is an urge to void, if a large amount of urine is lost, if there is a sensation of bladder fullness or frequent leakage, or if the patient voids small amounts of urine but has difficulty emptying the bladder.
• Blood may be detected only during microscopic urinalysis, known as microscopic hematuria.
• In women, be sure to distinguish menstrual blood from hematuria.
• Ureteral pain is usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium.
• Functional incontinence may arise from impaired cognition, musculoskeletal problems, or immobility.
• Ureteral pain results from sudden distention of the ureter and associated distention of the renal pelvis.
• Kidney pain is a visceral pain usually produced by distention of the renal capsule and typically dull, aching, and steady.
• Ureteral pain is dramatically different from kidney pain.
• Stress incontinence with increased intra-abdominal pressure suggests decreased contractility of urethral sphincter or poor support of bladder neck; urge incontinence, if unable to hold the urine, suggests detrusor overactivity; overflow incontinence, when the bladder cannot be emptied until bladder pressure exceeds urethral pressure, indicates anatomic obstruction by prostatic hypertrophy or stricture, or neurogenic abnormalities.
• In men, painful urination without frequency or urgency strongly suggests of urethritis, cystitis, uteritis, or nephritis.