DIAGNOSTIC Flashcards
Provides important clinical information about kidney function and helps diagnose diseases
Urinalysis
Components of urinalysis
-Urine color
-Urine clarity and odor
- Urine pH and specific gravity
- Tests to detect protein, glucose, and ketone bodies in urine
-Microscopic examination of urine sediment after centrifugation to detect RBCs, WBCs, Casts, Crystals, and Bacteria
-Obtain via Mid-strem clean catch
Determines whether bacteria are present, as well as their stains and concentration
Urine culture
Includes the identification of the antimicrobial therapy that is best suited for a particular stain
Sensitivity
Assess the status of kidney function and Evaluate the severity of kidney disease
Renal function tests
What are the test for renal functions tests?
-Renal concentration tests
-Creatinine clearance
-Serum creatinine
-Blood urea nitrogen (BUN)
An expression of the degree of concentration of the urine that measures the density of a solution tot he density of water
Specific Gravity
Measures the number of solute particles in a kilogram of water
Urine osmolality
The end product of muscle energy metabolism
Creatinine
This test measures effectiveness of renal function
Creatinine
The nitrogenous end product of protein metabolism
Urea
Serves as an index of renal function
Blood Urea Nitrogen (BUN)
Normal creatinine level
0.6-1.2 mg/dl
Normal BUN Level
7-18 mg/dl
Detects and evaluates progression of kidney disease
Creatinine clearance
Creatinine clearance method of collection
24-hour urine specimen
The test measures volume of blood cleared of endogenous creatinine in 1 minute- approximate GFR
Creatinine clearance
X-ray visualization of KUB
Kidney, Ureter, Bladder (KUB) Studies
Performed to delineate the size, shape, and position of kidneys and reveal urinary system abnormalities
KUB Studies
Nursing responsibilities when patient is having KUB studies
-Assure the patient that procedure is painless
- Bowel preparation, as ordered- to prevent gas and fecal interference with visualization
(laxative in the evening)
(Enema in AM)
Direct visualization of the urethra, bladder wall, trigone, urethral opening through a cystoscope
Cystoscopy
Cystoscopy Nursing Responsibilities (Before)
-Secure written consent
- Reinforce teaching that procedure is done under local/general anesthesia
-Force fluid if local anesthesia- To prevent ascending UTI
-NPO if general anesthesia
-Inform that desire to void is felt as cystoscope is inserted
-Place patient in lithotomy during procedure
Cystoscopy Nursing Responsibilities (After)
-Bed rest until VS are stable- to prevent orthostatic hypotension
-Pink-tinged urine is NORMAL 24-48 hours after procedure
- Dysuria, frequency and hematuria are common (due to tissue irritation)
- Observe for urinary retention, signs of infection and excessive hematuria. Notify physician
- Monitor VS and I&O
- Hot sitz bath to relieve pelvic discomfort, as ordered
-Force fluids to prevent ascending UTI
An IVP shows the kidneys, ureter, and bladder via x-ray imaging as the dye moves through the upper and then the lower urinary system
Intravenous Pyelography
Uses a radiopaque contrast agent given via IV
Intravenous Pyelography
Intravenous Pyelography Nursing Responsibilities (Before)
-Secure written consent
-NPO 6 to 8 hours
-Bowel Preparation
-Assess allergy to seafoods and/or iodine
-Epinephrine at bedside (Anaphylactic shock is a potential complication)
Intravenous Pyelography Nursing Responsibilities (After)
-Monitor VS
-Increased fluid intake- to help excrete dye
- Inform patient that a burning sensation on voiding may be experienced
- Monitor for signs of delayed allergic reaction
A contrast agent is then injected via cystoscope
Retrogade Pyelography
Indications for retrograde pyelography are:
-IVP does not provide adequate visualization of the collecting systems
- ESWL
-Allergy to IV constant agent
Nursing responsibilities of retrograde pyelography (before)
-Secure written consent
- Assess for allergy to dye
- Inform patient that discomfort may be felt during procedure
- Prepare epinephrine at bedside
Nursing responsibilities of retrograde pyelography (after)
-Monitor VS
-Monitor for urinary retention, infection, and prolonged hematuria. Notify physician
-Increase fluid intake to prevent UTI and to excrete dye
Also known as Renal Arteriography
Renal Angiography
It provides X-ray image of the renal arteries
Renal Angioraphy
A contrast agent is injected to opacify renal arterial supply
Renal Angiography
Indications for Renal Angiography
-Evaluate renal blood flow in suspected renal trauma
- Differentiate renal cysts from tumors
-Evaluate hypertension
Renal Angiography Nursing Responsibilities (Before)
- Bowel Preparation
- Shave injection site (groin for femoral, axilla for axillary)
-Mark peripheral pulse sites- for easy access during postprocedural assessment
Renal Angiography Nursing Responsibilities (After)
- Monitor VS until stable
-If axillary approach was done, take BP on opposite arm - Assess injection site for swelling and hematoma
- Assess neurovascular status of operative extremity and compare with uninvolved extremity
- Cold compress to injection site to decrease edema and pain
- Sandbag over catheter insertion site- to further prevent bleeding
-Bed rest x 24 hours, no sitting
-Monitor urine output- to assess renal function
A small section of the renal cortex is obtained either percutaneously (needle biopsy) or by open biopsy through a small flank incision
Kidney Biopsy
Kidney Biopsy Indications
- Unexplained acute kidney injury
- Persistent proteinuria or hematuria
- Transplant rejection
- Glomerulopathies
Kidney Biopsy Contraindications
- Bleeding tendencies
- Uncontrolled HTN
- Sepsis
- Solitary kidney
- Large polycystic kidney
- Kidney neoplasm
- UTI
- Morbid obesity
Kidney Biopsy Nursing Responsibilities (Before)
- Check coagulation studies (to identify any risk of posy biopsy bleeding)
- Secure written consent
- NPO for 6 to 8 hours
-Obtain urine specimen for baseline - Establish an IV line
Kidney Biopsy Nursing Responsibilities (Before) If needle biopsy:
-Position: Prone with sandbag under the abdomen
- Instruct patient to breathe in and hold that breath while needle is being inserted (to prevent kidney from moving)
- Sedation will be given and skin biopsy site will be infiltrated with local anesthetic
Kidney Biopsy Nursing Responsibilities (Before) If open biopsy:
- Position: Prone
- Similar preparation with major abdominal surgeries
Kidney Biopsy Nursing Responsibilities (After)
-Monitor VS and for signs and symptoms of internal bleeding
- IV fluids as prescribed (to help clear the kidneys and prevent clot formation)
- Bed rest and pressure dressings should be maintained for the prescribed period of time
-Urine may contain blood for the first 24 to 48 hours
-Analgesics, as prescribe
