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VN 147 Gu assessment
| Question | Answer |
|---|---|
| LAB STUDY: Urine culture & sensitivity | culture - identifies microorganisms in urine. SENSITIVITY - determines w/c antibiotic will be effective |
| LAB STUDY: Urine culture & sensitivity (pt prep) | collect specimen 1st void urine of day. Instruct pt in midstream, clean catch technique. Ref the specimen |
| LAB STUDY: Blood Urea Nitrogen BUN | indicate the kidney's ability to excrete urea, an end product of protein metabolism in. increases with renal failure, GI bleeding, dehydration, & some drugs |
| LAB STUDY: Blood Urea Nitrogen BUN (pt prep) | none |
| LAB STUDY: Urine createnine clearance | estimates glomerular filtration rate. Decreases with renal disease. |
| LAB STUDY: Urine createnine clearance (pt. prep) | provide specimen container. Doc fist void & save all urine for next 12 or 24 hr as ordered. Keep ref. if pt has foley cath, place drain bag in basin of ice and empty into ref hourly |
| LAB STUDY: Serum creatinine | measure kidney's ability to excrete waste based on amt of creatinine in blood. |
| LAB STUDY: Serum creatinine (pt prep) | pt should avoid strenous exercise for 8 hrs and excessive red meat for 24 hours before the test |
| LAB STUDY: Serum electrolytes | detects alterations reflecting inability of kidneys to retain or excrete electrolytes. Na and K elevated and Ca decreased in renal failure. |
| LAB STUDY: Serum electrolytes (pt prep) | none |
| LAB STUDY: Serum electrolytes (post procedure) | check lab reports & notify physician of abnormalities. |
| ULTRASOUND: Abdominal and renal US | uses sound waves to detect cysts, tumors, urinary calculi, urinary tract malformations or obstructions. Can be used to guide needle insertion for closed biopsy. |
| ULTRASOUND: Abdominal and renal US (pt prep) | pt may have to drink 24 to 32 oz fluid within 2 hr procedure so bladder will be full during ultrasound. |
| ULTRASOUND: Abdominal and renal US (pt prep) | tell pt that procedure is painless except for discomfort. Takes about 15 mins. Enema is given if transrectal route is used. Gel is applied to skin. Images are recorded for study. |
| ULTRASOUND: Abdominal and renal US (post procedure) | wash gel off skin if transabdominal route used. |
| RADIOGRAPHIC STUDIES: KUB (Kidneys/ureters, bladder) | provides radiographic view of kidneys, ureters and bladder |
| RADIOGRAPHIC STUDIES: KUB (Kidneys/ureters, bladder) (pt prep) | none |
| RADIOGRAPHIC STUDIES: Intravenous pyelogram (IVP) | uses xray and flurouscope to outline kidneys. Uses contrast medium to show urine flow & obstructions. Detects urinary abnormalities, calculi, ureters & bladder |
| RADIOGRAPHIC STUDIES: Intravenous pyelogram (IVP) (pt prep) | tell pt that "dye" will be injected & radiographs taken to study urinary tract. Give laxatvies & enemas as ordered before test. NPO 8-10 hr before test |
| RADIOGRAPHIC STUDIES: Intravenous pyelogram (IVP) (post procedure) | encourage fluids to flush contrast medium from body. Monitor for signs for iodine allergy: urticaria, rash, nausea, swollen parotid glands. Check injection site for inflammation |
| RADIOGRAPHIC STUDIES: Arteriogram | uses radiographs and contrast medium to examine blood vessels of kidney |
| RADIOGRAPHIC STUDIES: Arteriogram (pt prep) | tell pt that physician will insert catheter into blood vessel (femoral artery) & inject "dye". Radiograph taken as dye circulates through kidneys. NPO 8-12 hrs. laxatives and enemas. |
| RADIOGRAPHIC STUDIES: Arteriogram (pt prep) | anticoagulant drugs withheld before test to reduce rrisk of bleeding. Signed consent required. Premedidate if ordered. Have pt void before sedation |
| RADIOGRAPHIC STUDIES: Arteriogram (post procedure) | assess for signs of bleeding: tachycardia, dyspnea, restlessness, abdominal or flank pain. Check injection site for bleeding. A pressure dressing (SAND BAG) should be in place. |
| RADIOGRAPHIC STUDIES: Arteriogram (post procedure) | monitor respiratory status if sedated. ECG monitoring may be ordered. Monitor pulse, color, warmth and sensation of extremity in w/c catheter was inserted. Bedrest, encourage fluids to eliminate dye. Measure I/O |
| RADIOGRAPHIC STUDIES: Computerized tomography (CT) | creates cross-sectional images of kidneys and other organs to reveal abnormalities. |
| RADIOGRAPHIC STUDIES: Computerized tomography (CT) (pt prep) | inform radiologiest if pt is allergic to contrast media, iodine, or shellfish. Tell pt that procedure is painless and noninvasive. NPO status may be ordered but routine drugs can usually be taken. |
| RADIOGRAPHIC STUDIES: Computerized tomography (CT) (pt prep) | Pt will lie still on a stretcher while doughnut shaped machine movies around pt. contrast dye will sometimes injected intravenously. It can create feeling warmth, salty taste. Sedation can be ordered |
| RADIOGRAPHIC STUDIES: Computerized tomography (CT) (post procedure) | no special care. Inform physician of any signs of allergic response to contrast dye. Give antihistamines as ordered for allergy. |
| RADIOGRAPHIC STUDIES: Magnetic resonance imaging (MRI) | creates soft tissue images using magnets and radio waves |
| RADIOGRAPHIC STUDIES: Magnetic resonance imaging (MRI) (pt prep) | tell pt procedure is painless. Must lie still for 30 mins or more. Ask pt if claustrophobic. Give sedation if ordered for agitated or anxious. Remove any metallic objects (jewelry). |
| RADIOGRAPHIC STUDIES: Magnetic resonance imaging (MRI) (pt prep) | inquire whether pt has any implanted devices such as pacemaker or aneurysm clips & notify radiologist. Procedure is contraindicated w some implants. |
| RADIOGRAPHIC STUDIES: Magnetic resonance imaging (MRI) (post procedure) | no special procedure |
| RADIOGRAPHIC STUDIES: Renal scan | uses radioisotopes and xrays to study renal blood flow. Detects infarctions, trauma, atherosclerosis, transplant injection, some renal disease. |
| RADIOGRAPHIC STUDIES: Renal scan (pt prep) | tell pt that isotope will be injected & radiographs taken. Takes about 1 hr. radiation is small and quickly eliminated. |
| RADIOGRAPHIC STUDIES: Renal scan (post procedure) | no special care unless pt is incontinent. Wear gloves to handle urine and change linens. Discard per agency protocol. Continent pts can use toilet. Pregnant caregivers shld avoid pts for 24 hrs. |
| INVASIVE PROCEDURES: Renal biopsy | excision of small amt of kidney tissue for examination. May be obtained though incision (open biopsy) or w special needle (closed biopsy) |
| INVASIVE PROCEDURES: Renal biopsy (pt prep) | physician explains procedure selected. CLOSED - pt is positioned prone w rolled blanket under abdomen for approximately 45 mins. Be sure reports of clotting studies (PT, PTT, platelets) are on chart. |
| INVASIVE PROCEDURES: Renal biopsy (pt prep) | report elevated blood pressure, w/c increases the risk of bleeing. NPO 6 hrs or as ordered. Signed consent is required. |
| INVASIVE PROCEDURES: Renal biopsy (Post procedure) | check pressure dressing for bleeding. Monitor VS for hemorrhage. Position supine w blanket roll or sandbag under flank area. Bed rest for 24 hrs. |
| INVASIVE PROCEDURES: Renal biopsy (Post procedure) | advice pt not to do heavy lifting, exercise or sports for 1-2 wks. Hemoglobin & hematocrit are checked at 6 and 24 hr after biopsy. |
| INVASIVE PROCEDURES: Cystoscopy | uses lighted cystoscope inserted through the urethra to see urethra, bladder and urethral openings. Allows diagnosis of problems, removal of bladder calculi, biopsy. Local or gen anaesthesia may be used. Dye may be injected |
| INVASIVE PROCEDURES: Cystoscopy (pt prep) | signed consent required. Tell pt procedure is done in OR or special room under sterile conditions. For local anaesthesia, liquids may be allowed; NPO before general anaesthesia. |
| INVASIVE PROCEDURES: Cystoscopy (pt prep) | Laxatives or enemas as ordered. Give meds as ordered to reduce anxiety & bladder spasms. Antibiotics may be ordered 2-3 days before procedure and continued several days afterwards. |
| INVASIVE PROCEDURES: Cystoscopy (post procedure) | safety precautions first time up because orthostatic hypotension is common. Monitor i/o, VS, urine color: urine color tinge might be pink to wine colored. Lightens to usual color in 24-48 hr. |
| INVASIVE PROCEDURES: Cystoscopy (post procedure) | report severe pain. Give prescribed analgesics or antispasmodics as ordered, assist with sitz baths or pain or urinary frequency. Encourage 2-3 L of fluids daily. Pink tinge urine is expected for 1-2 days |
| URODYNAMIC STUDIES: Cystogram and Cystourethrogram | uses dye injected into bladder through catheter followed by radiographs to outline bladder and demonstrate reflux of urine from bladder to ureters |
| URODYNAMIC STUDIES: Cystogram and Cystourethrogram (pt prep) | for voiding cystourethrogram, bladder and urethra are radiographed during urination. Rate of urine flow is measured. Tell pt that catheter will be inserted and dye instilled into bladder. |
| URODYNAMIC STUDIES: Cystogram and Cystourethrogram (post procedure) | monitor i/o and VS. encourage increased fluids unless contraindicatd. Observe for allergic reaction to dye. Assess for urinary retention |
| URODYNAMIC STUDIES: Cystometrogram | evaluates bladder stone |
| URODYNAMIC STUDIES: Cystometrogram (pt prep) | tell pt fluid will be instilled into bladder through urethral cath. When pt feels urge to void, cath will be removed. Pt voids, and residual urine is measured. Drugs may be given to test bladder response. |
| URODYNAMIC STUDIES: Cystometrogram (post procedure) | encourage increased fluids unless contraindicated. Monitor I/O. administer durgs as ordered for bladder spasms |
| pH normal values | 4.4-8.0 |
| pH implication < 5.0 | acidosis, starvation, diarrhea |
| pH implication > 7.0 | alkalosis, bacteriuria, UTI |
| specific gravity normal value | 1.010-1.025 |
| specific gravity implication: <1.005: | diabetes insipidus, overhydration, renal disease, severe hypokalemia |
| specific gravity >1.030: | dehydration, diabetes mellitus |
| protein normal values: | normal values: up to 8 mg/dL; reagent strip negative |
| protein implication: | >8 mg/dL: exercise, severe stress, fever, renal disease, malignancy |
Created by:
jekjes
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