Renal Procedures Flashcards
UA indications
Routine screen Assess systemic disorders Metabolic Endocrine Evaluate renal or urinary tract disease Prenatal evaluation
situations where voided sample is not adequate
Vaginitis
Menses
Extremes in age (Adults and Children)
Morbid obesity 400-500lbs, M and F
Specific gravity
comparison to pure water
if it is high, then that means there is more solids (and less water)
leukocyte esterase
enzyme found on WBCs
indicates UTI
best PV when negative (and nitrites negative)
Nitrites
indicates UTI
bacteria converts Nitrates Into Nitrites
best PV when negative (and LE negative)
crystals
caused by supersaturation (most often d/ Calcium Oxylate
no clinical significant
catheter indications
Acute urinary retention
Obtain uncontaminated sample
Diagnostic studies (Urodynamics, cystourethrogram)
Monitor urine output – ICU, postoperatively
Measure residual volume
Surgery on adjacent structures
Urinary tract surgery
Catheter c/i
Known urinary tract obstruction (stricture)
Reconstructive surgery of urethra or bladder neck
Combative or uncooperative patient
Pelvic trauma – suspect urethra injury
Acute infection of the prostrate and/or urethra (relative)
Catheter complications
infection
HU
urethra stricture
suprapubic cath
Bladder neck stricture, contracture or obstruction
Inability to pass urethral catheter
Urethral trauma
Recent urethra or bladder neck surgery
Inability to tolerate or unwilling to self cath
Presence of urethral or prostate infection
Severe phimosis
Collect urine sample - analyze, culture
Relief of urinary retention
more often in males
suprapubic cath c/i
Uncooperative patient
Blood dyscrasia or anti coagulation treatment
Infection or cellulitis of the suprapubic area
suprapubic cath complications
Peri vesicular bleeding
Gross hematuria
Infection – skin, subcutaneous, intra abdominal, bladder
Intestinal perforation
cystoscopy indications
Urinary incontinence Known or suspected malignancy Recurrent UTI’s Pelvic pain symptoms Pelvic trauma Intraoperative assessment of bladder or urethral trauma
cystoscopy c/i
UTI, pyelonephritis ( can cause sepsis)
IVP
xray of kidneys
To detect problems in these areas including kidney stones, cancer, enlarged prostate
Size of stones and tumors are difficult to measure
Extracorporeal Lithotripsy
procedure used to shatter simple stones in the kidney or upper urinary tract. Makes passing stone easier
Intracorporeal lithotripsy
Laser is introduced through the cystoscand stones are broken into small pieces that will pass
higher complications, use after extracoporeal
circumcisions c/i
Hypospadius or epispadius** Atypical genitalia*** Undetermined phenotype (ambiguous genitalia) Less than 12 hours postpartum Illness Prematurity (Relative) Familial bleeding disorder Maternal thrombocytopenia
risks of circumcision
Risks/complications Bleeding** Infection** Trauma to glans or urethra Poor cosmetic result Paraphimosis Degloving of the penile shaft Meatal stenosis - rare
adult circumcision indications
Indications Phimosis Paraphimosis Penile hygiene Recurrent balantitis neoplasia cosmetic reasons are rare
adult circumcision contraindications
Acute inflammation
Infection
Psychiatric disorder
Bleeding dyscrasia
vasectomy c/i
Infection
Coagulation disorder
Inability to palpate or elevate vas deferens
Stress – divorce, financial
Inappropriate reasons for wanting procedure
Concern about ability to perform sexually after the procedure
