"renal procedures" (GU) King 12,4

Question 1

methods of UA

Answer 1

physical appearance
dipstick evaluation
microscopic evaluation

Question 2

how do obtain voided male UA sample

Answer 2

expose glans and urethral meatus, cleanse withs sterilizing agent the dry with cloth. collect mid stream

Question 3

how do obtain voided female UA sample

Answer 3

separate labia to expose urethral meatus
cleanse meatus front to back with sterilizing agent.
collect mid stream

Question 4

situations where voided sample not adequate

Answer 4

vaginitis, menses, extremes in age, morbid obesity

Question 5

if patient cannot void, how can you collect UA

Answer 5

urethral, suprapubic or nephrostomy cath

Question 6

what is name for ped UA it

Answer 6

PUCK

Pediatrick Urine Collection Kit

Question 7

pink urine?
orange?
blue/green?
brown/black?

Answer 7

pink- blood
orange- medications
blue/green- ingested dyes or pseudomonas
brown/black- myoglobin, bilirubin, rhubarb, medication

Question 8

what information is on a dipstick

Answer 8

specific gravity
ketones
pH
protein
glucose
blood
bilirubin
leukocyte esterase
nitrites

Question 9

what is best indication for + infection on dipstick

Answer 9

+ nitrites

Question 10

threshold glucose in DM

Answer 10

<180 mg/dL

Question 11

specific gravity tells you what

Answer 11

state of hydration

Question 12

epithelial cells in UA could mean what

Answer 12

contamination usually

sometimes cancer

Question 13

RBC in UA means what

Answer 13

kidney disease, decreased coagulation, cancer, exercise, stones

Question 14

crystals in UA means what

Answer 14

kidney stones

Question 15

if there are <2 cells on microscopic eval what is that called?
3-5?
5-9?
large amount?
packed field?

Answer 15

<2 rare/trace
3-5 occasional 1+
5-9 frequent 2+
large amt Many 3+
Packed field TNTC/4+

Question 16

RBC casts

Answer 16

glomerulonephritis with leakage of RBC from glomeruli or severe tubular damage

Question 17

WBC casts

Answer 17

acute pyelonephritis

Question 18

what can lead to crystal foramtion in urine

Answer 18

augmentation of [ ] beyond super saturation capacity
decreased supersaturation capacity
crystals causing more crystallization

Question 19

most common crystals in urine

Answer 19

Ca oxalate

Question 20

uric acid crytsals are from what

Answer 20

poor dilution volume at an acidic pH

Question 21

most common bacteria to cause UTI

Answer 21

E coli

Question 22

24 urine collection tells you what

Answer 22

total protein
Ca Na K
Cr and clearance

Question 23

urine protein electrophoresis is used for what

Answer 23

bence joines- Multiple myeloma

Question 24

indications to catheterize bladder

Answer 24

acute urinary retnetion
uncontaminated sample
Dx studies
monitor urine output
measure residual volume
surgery on adjacent structure
urinary tract surgery

Question 25

contraindications to catheterizing bladder

Answer 25

known obstruction or stricture reconstructive surgery of urethra or bladder neck combative or uncoopoerative patient pelvic trauma acute infection of prostate and or urethra

Question 26

what are the complications of catheterization of the bladder

Answer 26

infection, hematuria, urethral stricture

Question 27

what are the 2 main types of catheters for bladder

Answer 27

foley and straight

Question 28

sizies of catheters for bladder

Answer 28

16-18 French

Question 29

how far do you put catheter into bladder

Answer 29

3 inches so that the balloon can be inflated

Question 30

long term use for catheterization of bladder

Answer 30

chronic retention neurogenic bladder with retention (cannot self cath) incontinent with complicated skin breakdown or infection comfort measure for terminally ill

Question 31

indications for suprapubic catheterization

Answer 31

``` 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 ```

Question 32

contraindicaitons for suprapubic catheterization

Answer 32

uncooperative patient blood dyscrasia or anti-coagulation Tx infection or cellulitis or suprapubic area

Question 33

complications suprapubic cath

Answer 33

peri vesicular bleeding gross hematuria infection: skin, subcut, intraabdominal, bladder intestinal perforation

Question 34

procedure for suprapubic cath

Answer 34

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

Question 35

what can a bladder scan do

Answer 35

3-D US that measures bladder volume and post void residual volume

Question 36

What is flow cystometry

Answer 36

2 catheters inserted to bladder, one fills while other measures Pressure to evaluate urinary incontinence and overactive bladder and urinary retnetion

Question 37

indicaitons cytoscopy

Answer 37

``` urinary incontinence known suspected malignancy recurrent UTIs pelvi pain Sx pelvic trauma intraoperative assessment of bladder or urethral trauma ```

Question 38

contraindications for cytoscopy

Answer 38

relative UTI or pyelonephritis, can cause sepsis so Tx with antibiotics before

Question 39

What is IV pyelogram

Answer 39

XR of kidneys, ureters, bladder that use contrast into vein | detects problems with kidneystones, cancer or enlarged prostates

Question 40

what is extracorporeal lithotripsy

Answer 40

shock waves used to shatter simple stones in kidneys or upper urinary tracts US waves strike stones

Question 41

what is intracorporeal lithotripsy

Answer 41

cytoscopy and laser introduced to break stones into small pieces

Question 42

indications infant circumcision

Answer 42

parental desire based on religious, ethnic anc cultural may decrease UTI and STI decrease penile cancer rate

Question 43

contraindications infant circumcision

Answer 43

``` hypospadius or epi atypical genitalia undetermined phenotype less than 12 hrs postpartum illness prematurity familial bleeding disorder maternal thrombocytopenia ```

Question 44

risks complications infant circumcision

Answer 44

bleeding, infection, trauma to glans or urethra, poor cosmetic result, paraphimosis degloving penile shaft meatal stenosis

Question 45

procedure infant circumcision

Answer 45

no anesthesia, before newborn goes home

Question 46

indications adult circumcision

Answer 46

phimosis, paraphimosis, penile hygiene, recurrent balantitis, neoplastic foreskin, excessive foreskin redundancy frenular tears patient or spouse preference

Question 47

contraindications adult circumcision

Answer 47

acute inflammation infection psychiatric disorder bleeding disorder

Question 48

complications adult circumcision

Answer 48

bleeding, hematoma, infeciton, pain with erection, stricture or scarring wound disruption usually due to erection

Question 49

indications for vasectomy

Answer 49

undesired fertility

Question 50

contraindicaitons vasectomy

Answer 50

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