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Positioning Lecture Material > Genitourinary System > Flashcards

Genitourinary System Flashcards

1
Q

What are the contraindications of an IVU?

A

hypersensitivity to contrast media
pregnancy
renal failure
all other diseases discussed during patient hx

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2
Q

What questions must you ask the pt prior to a contrast injection?

A

LMP?
allerigies to food, drugs or iodine (esp shellfish)?
hay fever, asthma or hives?
ever had contrast injection before?
weight?
diabetic? taking glucophage/glucovance?
do you have: hypertension, heart disease, hepatic/renal disease, pheochromocytoma, multiple myeloma, sickle cell anemia, or anuria?

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3
Q

What are the names of the drugs that diabetics may be concerned with taking?

A

glucophage/glucovance/metformin

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4
Q

Whats the difference between ionic and non ionic contrast? Are the both iodinated?

A

Both iodinated
Ionic=higher osmolality, less expensive, brand name is hypaque
Nonionic=low osmolality, more expensive, brand name omnipaque, less likely to cause a reaction

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5
Q

What is the basic routine for an IVU?

A 
AP scout
Nephrotomogram 1min after injection
5 min AP supine
10-15 min AP supine
20 min RPO/LPO
AP post void recumbent or erect
*special view: AP ureteric compression
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6
Q

What are the indications for an IVU?

A 
abdominal/pelvic mass
renal or urethral calculi
kidney trauma
flank pain
hematuria
hypertension
renal failure
UTI
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7
Q

What is the basic routine for a retrograde urography?

A
  • a catheter is inserted through one or both ureters w/ tip at the renal pelvis.
  • scout is taken to check placement of catheter
  • next radiograph is called the pyelogram, when the dr inject 3-5 cc’s of contrast into one or both renal pelvis’s.
  • final radiograph is called the ureterogram, dr withdraws catheters and simultaneously injects contrast into one or both ureters.
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8
Q

What is the basic routine a retrograde cystogram?

A

AP w/ 15 degree caudal angle

both 45-60 degree obliques

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9
Q

When does the timing sequence for the IVU begin?

A

at the start time of the injection

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10
Q

What is a cystogram? Why is it performed?

A
  • A nonfunctional radiographic exam of the bladder after instilation of contrast via urethral catheter.
  • Performed to rule out trauma, calculi, tumor, and inflammatory disease of the bladder
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11
Q

Describe the cystogram procedure:

A
  • Catheterization is performed under aseptic conditions and bladder is drained of residual urine
  • Bladder is filled with diluted contrast which flows in by gravity
  • once bladder is full fluoro and/or overheads may be done
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12
Q

What is a cystourethrogram? Why is it performed? Describe the cystourethrogram procedure:

A
  • functional study of the bladder and urethra
  • performed for incontinence or trauma after a routine cystogram
  • the catheter is gently removed and the pt is imaged while voiding.
  • females in AP position
  • males in 30 degree RPO
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13
Q

What are the mild symptoms of a contrast reaction? What should the technologist do?

A 
nausea/ vomiting
hives, itching, sneezing
extravasation
weakness, sweatiness, dizziness
-comfort/reassure pt, tell them to breath slow and deeply, alert nurse if hives start
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14
Q

What are the moderate symptoms of a contrast reaction? What should the technologist do?

A

excessive hives, excessive vomiting, tachycardia

-tech should call for medical assistance

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15
Q

What are the severe symptoms of a contrast reaction? What should the technologist do?

A 
very low BP
cardiac/respiratory arrest
loss of consciousness
convulsions
laryngeal edema
cyanosis
dyspnea
profound shock
-tech should declare medical emergency
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16
Q

What is ureteric compression? How is it performed and what position will demonstrate the same thing?

A
  • used to enhance filling of the pelvicalyceal system and proximal ureters
  • two paddles are placed over the outer pelvic brim, once contrast is injected the paddles are inflated and remain in place.
  • prolongs nephron phase of IVU to 5 min
  • when air pressure is released from paddles, a post release 14x17 supine film is taken
17
Q

Which studies are functional? Nonfunctional? Antegrade? Retrograde?

A

Functional=IVU (antegrade) and voiding cystourethrogram

Non=retrograde urography and retrograde cystogram

18
Q

What are the ureteric points of constriction?

A
  • ureteropelvic junction=where renal pelvis narrows at proximal ureter
  • brim of pelvis=where iliac blood vessels cross over ureters
  • ureterovesical junction=where ureters meet bladder *most common point of restriction
19
Q

What do the BUN and creatinine measure? What is the importance of them? What does BUN stand for?

A

-they measure kidney function
-high levels may indicate renal failure or tumor and also increase chances of an adverse reaction to contrast.
-blood urea nitrogen normal level: 8-25mg/100mL
creatinine normal level: 0.6 to 1.5 mg/dl

20
Q

What anatomy is best demonstrated on an IVU oblique?

A

the upside kidney and the downside ureter

21
Q

How should the IVU be scheduled?

A

can be done same day as BE but IVU must be done first

22
Q

Why is tomography used? How does it work?

A
  • to demonstrate a specific layer of tissue or an object that is superimposed by other tissues or objects.
  • the X-ray tube and IR move about a fulcrum point to demonstrate a clear image of an object lying in the focal plane and blurring the structures above and below it
23
Q

What is a fixed fulcrum? Variable fulcrum?

A
  • fixed=pt and table are moved up or down (SID) to image desired plane
  • variable=patient position (SID) is fixed
24
Q

How are the tomo cuts determined for the IVU?

A
  • requires thicker cuts
  • circular tube motion is prefered
  • usually taken immediately following bolus injection
25
Q

What is lithotripsy?

A

technique using sound waves to shatter large kidney and/or billiard stones into smaller particles so they can pass through and exit the body.

26
Q

What is micturition? Retention?

A
  • voiding

- inability to void

27
Q

What is nephroptosis? Renal agenesis?

A
  • excessive downward movement of the kidney when the pt is erect.
  • Absence of a functioning kidney
28
Q

Explain the difference in a side effect versus a reaction:

A

side effect=expected outcome of injected contrast media

reaction=an unexpected outcome of injected contrast media

29
Q

What is best demonstrated on an oblique view of the bladder?

A

shows urinary bladder not superimposed by lower limbs

30
Q

What are the components needed for room prep for an IVU?

A 
emesis basin
tourniquets
needles, iv infusion tubing, syringes
gauze, tape
saline
gloves
shielding
epinepherine/benadryl
alcohol or betadine
contrast
table pad
31
Q

Where do the kidneys lie with the pt supine on expiration?

A

-half way between the ziphoid process and iliac crest, and between T11 and L3.

32
Q

What will happen to the kidneys when the pt is upright or takes a deep inspiration?

A

kidneys will drop 2”

33
Q

Where do the kidneys lie in the body in respect to the anterior ribs, liver and spleen? What urinary structures are retroperitoneal? infraperitoneal?

A
  • posterior
  • kidneys and proximal ureters
  • distal ureters, bladder, urethra
34
Q

What are the contraindications for a hysterosalpingogram?

A

pregnancy
acute pelvic inflammatory disease
active uterine bleeding

35
Q

Why is a hysterosalpingogram performed?

A
  • assessment of infertility and to diagnose any functional or structural defects, detect polyps or fibroids, and to evaluate uterine tube after surgery.
  • the therapeutic injection of contrast media may dilate or straighten a narrow or occluded uterine tube
36
Q

When should a hystero be scheduled?

A

once menstrual flow has concluded but before ovulation, so 7-10 days after period starts.

37
Q

What is the room prep for a hystero?

A 
chuck on table
stirrups
vaginal speculum w/ lube
basin, medicine cup, cotton balls
sterile drapes, sponge holding forceps 
syringe, needles, catheter tubing
sterile gloves and contrast media
38
Q

Describe the hystero procedure:

A
  • pt is in lithotomy position
  • balloon catheter is inserted into cervical canal
  • syringe w/ contrast is attached to the catheter and under fluoro contrast is injected into the uterine cavity
  • if uterine tubes are patent, contrast will flow into the peritoneal cavity.

Positioning Lecture Material (10 decks)

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