Renal Procedures Flashcards
reading **
PCM lab manual page 170
urinalysis
assess systemic disorders - metabolic and endocrine
evaluate renal or urinary tract disease
prenatal evaluation
metabolic problems
likely to end up in urine
urinalysis methods
1 physical appearance
-color and clarity
2 dipstick
3 microscopic evaluation
male voiding sample
clean glans of penis
-collect mid-stream
female voiding sample
cleanse urethral meatus
collect mid-stream urine in sterile container
no voided sample of urinalysis**
vaginitis
menses
extremes in age
morbid obesity
patient cannot void
catheter urine sample
can also use needle - suprapubic
Puck
pediatric urine collection kit
pink urine
blood
orange urine
meds
blue-green urine
pseudomonas
brown/black urine
myoglobin
bilirubin
rhubarb
medication
cloudy urine
excess protein or cellular material
also with infection
state of hydration
specific gravity
diabetes or starvation
ketones
kidney disease or UTI
pH
kidney disease
protein
diabetes
glucose - threshold 180**
kidney disease, clot disorder, stone, cancer
blood in urine
liver damage
bilirubin
nitrites in urine
lots of bacteria
leukocyte esterase
UTI
leukocyte and nitrate positive
74% predictive value for UTI
negative leukocyte and nitrate
97% predictive value for NO UTI
micro eval of urinalysis
WBC - infection RBC epithelial cells - contamination** casts crystals - kidney stones bacteria or yeast infection
rare trace
<2 cells
occasional
1+
3-5 cells
frequent
2+
5-9 cells
many
3+
large amount of cells
TNTC
4+
packed field
RBC in urine
bleeding disorder cancer glomerulonephritis stones exercise
WBC in urine
90% infections
RBC cast
glomerulonephritis
WBC cast
acute pyelonephritis
crystal formation
1 augmented concentration
calcium oxalate - supersaturation
2 decreased supersaturayion capacity
3 presence of crystals with promoter effect
gout
uric acid crystals
UTI
E. coli
Cr clearance
with urine
bence jones proteins
multiple myeloma
urine protein electrophoresis
measure of fluid status
catheterization of bladder
stricture of urinary tract
CI for catheter
pelvic trauma
CI for catheter
fx pelvis
complications of catheter
infection and hematuria
foley catheter
2 ports - 1 is balloon
if it stays long time
straight catheter
urine sample - brief catheter
long term catheter
chronic retention
neurogenic bladder with retention
incontinent with complicated skin breakdown or infection
comfort measures for terminally ill
suprapubic catheterization
generally males - longer urethra
if can’t do urethral catheter
CI suprapubic catheterization
uncooperative pt
anti-coag tx
infection in this region of skin
suprapubic catheterization procedure
1cm lateral 5cm above pubic symphysis**
insert directed inferiorly at 60 degrees
percutaneous suprapubic aspiration
just to get out urine sample
not good for draining
baldder scan
ultrasound
-can outline extent of bladder size
volume of bladder
flow cystometry
two catheters inserted
fills bladder while other measures pressure
cystoscopy
way of looking into bladder
need to anesthetize
urinary incontinence or suspected tumor
cystoscopy
CI of cystoscopy
UTI or pyelonephritis
IVP
intravenous pyelogram
X-ray of kidneys, ureters, bladder which uses contrast material - iodine based
stones, cancer, enlarged prostate
size of stones/tumors - difficult to measure
start at
37 minutes
suprapubic catheterization
generally males - longer urethra
if can’t do urethral catheter
CI suprapubic catheterization
uncooperative pt
anti-coag tx
infection in this region of skin
suprapubic catheterization procedure
1cm lateral 5cm above pubic symphysis**
insert directed inferiorly at 60 degrees
percutaneous suprapubic aspiration
just to get out urine sample
not good for draining
baldder scan
ultrasound
-can outline extent of bladder size
volume of bladder
flow cystometry
two catheters inserted
fills bladder while other measures pressure
cystoscopy
way of looking into bladder
need to anesthetize
urinary incontinence or suspected tumor
cystoscopy
CI of cystoscopy
UTI or pyelonephritis
IVP
intravenous pyelogram
X-ray of kidneys, ureters, bladder which uses contrast material - iodine based
stones, cancer, enlarged prostate
size of stones/tumors - difficult to measure
start at
37 minutes
suprapubic catheterization
generally males - longer urethra
if can’t do urethral catheter
CI suprapubic catheterization
uncooperative pt
anti-coag tx
infection in this region of skin
suprapubic catheterization procedure
1cm lateral 5cm above pubic symphysis**
insert directed inferiorly at 60 degrees
percutaneous suprapubic aspiration
just to get out urine sample
not good for draining
baldder scan
ultrasound
-can outline extent of bladder size
volume of bladder
flow cystometry
two catheters inserted
fills bladder while other measures pressure
cystoscopy
way of looking into bladder
need to anesthetize
urinary incontinence or suspected tumor
cystoscopy
CI of cystoscopy
UTI or pyelonephritis
IVP
intravenous pyelogram
X-ray of kidneys, ureters, bladder which uses contrast material - iodine based
stones, cancer, enlarged prostate
size of stones/tumors - difficult to measure
extracorporeal lithotripsy
ESWL - to break up kidney stones
ultrasonic waves passed through body
pulverize into small fragments
intracorporeal lithotripsy
patient under cystoscopy
laser to break stones
infant circumcision
benefits outweight risks - american academy of pediatrics
CI for circumcision
hypospadium or epispadius
-can use foreskin to relocate urethra
atypical genitalia - cant tell male or female
gomco clamp
for circumcision
metal bell
best for good lookin dick.
adult circumcision
phimosis, paraphimosi, recurrent balantitis
recurrent infections
CI - psych disorder
adult circumcision complication
wound disruption with erection
undesired fertility
indication for vasectomy
CI for vasectomy
stress - divorce, financial
infection, coag disorder
