"renal procedures" (GU) King 12,4 Flashcards
methods of UA
physical appearance
dipstick evaluation
microscopic evaluation
how do obtain voided male UA sample
expose glans and urethral meatus, cleanse withs sterilizing agent the dry with cloth. collect mid stream
how do obtain voided female UA sample
separate labia to expose urethral meatus
cleanse meatus front to back with sterilizing agent.
collect mid stream
situations where voided sample not adequate
vaginitis, menses, extremes in age, morbid obesity
if patient cannot void, how can you collect UA
urethral, suprapubic or nephrostomy cath
what is name for ped UA it
PUCK
Pediatrick Urine Collection Kit
pink urine?
orange?
blue/green?
brown/black?
pink- blood
orange- medications
blue/green- ingested dyes or pseudomonas
brown/black- myoglobin, bilirubin, rhubarb, medication
what information is on a dipstick
specific gravity ketones pH protein glucose blood bilirubin leukocyte esterase nitrites
what is best indication for + infection on dipstick
+ nitrites
threshold glucose in DM
<180 mg/dL
specific gravity tells you what
state of hydration
epithelial cells in UA could mean what
contamination usually
sometimes cancer
RBC in UA means what
kidney disease, decreased coagulation, cancer, exercise, stones
crystals in UA means what
kidney stones
if there are <2 cells on microscopic eval what is that called? 3-5? 5-9? large amount? packed field?
<2 rare/trace 3-5 occasional 1+ 5-9 frequent 2+ large amt Many 3+ Packed field TNTC/4+
RBC casts
glomerulonephritis with leakage of RBC from glomeruli or severe tubular damage
WBC casts
acute pyelonephritis
what can lead to crystal foramtion in urine
augmentation of [ ] beyond super saturation capacity
decreased supersaturation capacity
crystals causing more crystallization
most common crystals in urine
Ca oxalate
uric acid crytsals are from what
poor dilution volume at an acidic pH
most common bacteria to cause UTI
E coli
24 urine collection tells you what
total protein
Ca Na K
Cr and clearance
urine protein electrophoresis is used for what
bence joines- Multiple myeloma
indications to catheterize bladder
acute urinary retnetion uncontaminated sample Dx studies monitor urine output measure residual volume surgery on adjacent structure urinary tract surgery
contraindications to catheterizing bladder
known obstruction or stricture
reconstructive surgery of urethra or bladder neck
combative or uncoopoerative patient
pelvic trauma
acute infection of prostate and or urethra
what are the complications of catheterization of the bladder
infection, hematuria, urethral stricture
what are the 2 main types of catheters for bladder
foley and straight
sizies of catheters for bladder
16-18 French
how far do you put catheter into bladder
3 inches so that the balloon can be inflated
long term use for catheterization of bladder
chronic retention
neurogenic bladder with retention (cannot self cath)
incontinent with complicated skin breakdown or infection
comfort measure for terminally ill
indications for suprapubic catheterization
bladder neck stricture, contracture or obstruction inability to pass urethral catheter urethral trauma recent urethra of bladder neck surgery inability to tolerate self cath presence urethral or prostate infection severe phimosis collect urine sample, analyze, culture relief urinary retention
contraindicaitons for suprapubic catheterization
uncooperative patient
blood dyscrasia or anti-coagulation Tx
infection or cellulitis or suprapubic area
complications suprapubic cath
peri vesicular bleeding
gross hematuria
infection: skin, subcut, intraabdominal, bladder
intestinal perforation
procedure for suprapubic cath
local anesthetic
1 cm lateral incision 5 cm above pubic symphysis- midline
inserte catheter and obturator inferiorly 60 degrees
advance into bladder dome through rectus sheath
obturator removed, balloon inflated
secure in place and attach drainage bag
what can a bladder scan do
3-D US that measures bladder volume and post void residual volume
What is flow cystometry
2 catheters inserted to bladder, one fills while other measures Pressure
to evaluate urinary incontinence and overactive bladder and urinary retnetion
indicaitons cytoscopy
urinary incontinence known suspected malignancy recurrent UTIs pelvi pain Sx pelvic trauma intraoperative assessment of bladder or urethral trauma
contraindications for cytoscopy
relative UTI or pyelonephritis, can cause sepsis so Tx with antibiotics before
What is IV pyelogram
XR of kidneys, ureters, bladder that use contrast into vein
detects problems with kidneystones, cancer or enlarged prostates
what is extracorporeal lithotripsy
shock waves used to shatter simple stones in kidneys or upper urinary tracts
US waves strike stones
what is intracorporeal lithotripsy
cytoscopy and laser introduced to break stones into small pieces
indications infant circumcision
parental desire based on religious, ethnic anc cultural
may decrease UTI and STI
decrease penile cancer rate
contraindications infant circumcision
hypospadius or epi atypical genitalia undetermined phenotype less than 12 hrs postpartum illness prematurity familial bleeding disorder maternal thrombocytopenia
risks complications infant circumcision
bleeding, infection, trauma to glans or urethra, poor cosmetic result, paraphimosis
degloving penile shaft
meatal stenosis
procedure infant circumcision
no anesthesia, before newborn goes home
indications adult circumcision
phimosis, paraphimosis, penile hygiene, recurrent balantitis, neoplastic foreskin, excessive foreskin redundancy
frenular tears
patient or spouse preference
contraindications adult circumcision
acute inflammation
infection
psychiatric disorder
bleeding disorder
complications adult circumcision
bleeding, hematoma, infeciton, pain with erection, stricture or scarring
wound disruption usually due to erection
indications for vasectomy
undesired fertility
contraindicaitons vasectomy
infection
coagulation disorder
inability to palpate or elevate vas deferens
stress- divorce or financial
innappropriate reasons
concern about ability to perform sexually after the procedure
