8.3 General Urinary System Assessment
When evaluating a client for possible disorders of the urinary system, the nurse acknowledges individual and population risk factors, cultural influence, and socioeconomic factors that may impact health.
Risk Factors
Several risk factors can contribute to the development of urinary system alterations, and these factors may vary in their impact from person to person[1],[2]:
- Age: As individuals age, the glomerular and tubular membranes thicken, and the tubules also decrease in length, decreasing glomerular filtration. Due to these physiological changes, many older adults experience nocturnal polyuria. Furthermore, most men experience benign prostate enlargement as they age, resulting in bladder outlet obstruction. This obstruction causes incomplete bladder emptying, resulting in symptoms of frequent urination in small amounts throughout the day and night.[3]
- Genetics: Family history of kidney disease can increase the risk of certain kidney conditions, such as polycystic kidney disease and chronic kidney disease.
- Concurrent Medical Conditions:
- Hypertension: Uncontrolled high blood pressure is a leading cause of kidney damage. High blood pressure can damage blood vessels in the kidneys, reducing their ability to function properly.
- Diabetes mellitus, type 1 and type 2: Elevated blood sugar can damage the small blood vessels of the kidneys over time.
- Atherosclerosis: Impacts blood flow to the kidneys.
- Autoimmune diseases: May damage the kidneys due to sustained inflammatory processes.
- Urinary tract infections: Recurrent infections may spread to the kidney, resulting in damage and scarring.
- Urinary obstructions: Blockages in the urinary tracts due to kidney stones, prostate enlargement, or tumors may lead to urinary tract infections and reduced kidney function.
- Drugs & Smoking: Many drugs, including prescription and illicit drugs, can damage the kidneys, especially if used for sustained periods. Smoking increases the risk of hypertension and atherosclerosis, subsequently resulting in damage to the kidneys.
- Toxins: Exposure to heavy metals and solvents may result in damage to the kidneys.
Cultural Factors
Cultural factors can influence various aspects of health, including urinary health. Cultural beliefs and health practices can impact an individual’s lifestyle choices. For example, some cultures may consume diets that are high in salt, processed foods, and protein that can potentially lead to hypertension and increased risk for kidney damage. Individuals who participate in fasting rituals may also sustain dehydration or electrolyte imbalances, which can result in kidney damage. Individuals who elect to use alternative healing methods or traditional medicines, such as specific herbs and rituals, may also experience increased risk to the kidneys. Delays in seeking medical treatment for kidney disorders can result in lasting kidney damage. Additionally, many ethnic groups such as African Americans