-
urinalysis
- general examination of urine to establish baseline info, a tentative diagnosis & to determine further studies.
- include color, odor, presence of protein, ketones, bilirubin; specific gravitiy, osmolarity, pH, RBCs, WBCs, casts, culture of organisms
- nurse: obtain first morning urine, clean soile perineal area b4, specimen examined within 1hr of urinating
-
composite urine collection
- measures specific components: e-, glucose, protein, ketosteroids, catecholamines, creatinine, minerals
- collected over a period range 2-24hr
- urinate & discard first urine noted the start of the test; save subsequent urinations in desired container for a desired period, at the end of the period, ask the pt to urinate and this urine is added to a the container. may refrigerate or add preservatives to the container
-
creatinine clearance
- creatinine is the waste product of protein breakdown mostly from muscle mass
- collect 24hr urine, same as composite urine collection
- ensure creatinine clearance is determined during 24-hr period
-
IVP
- IntraVenous Pyelogram
- visualized urinary tract after injection of contrast media to see presence, position, size, shape of kidneys, ureters, bladder
- not indicated for decreased renal function pt b/c contrast media is nephrotoxic
- the night b4 give cathartic or enema to empty colon of feces & gas
- assess allergy for iodine, shellfish, seafoods
- X-ray procedure
- may have warmth, flushed face, salty taste during injection of dye
- force fluids post op to flush out iodine
-
retrograde pyelogram
- X-ray of urinary tract taken after injection of contrast into the kidneys
- done if IVP does not do its job, or pt allergic to iodine or decreased renal function
- a cystoscope is inserted through the ureteral catheter which is inserted into the renal pelvis
- prepare pt the same as IVP
- may experience pain, discomfort from distention of pelvis, anesthesia may be given
-
VCUG
- Voiding CystoUrethroGram
- voiding study of the bladder neck & urethra. the bladder is filled with contrast media. fluoroscopic films are taken to visualize the bladder & urethra
- detect abnormalities of lower urinary tract
- explain the procedure
-
renal biopsy
- to determine type of renal disease & its progress
- percutaneous biopsy by inserting the needle into lower lobe of kidney with CT, ultrasound guidance
- not indicated for single kidney, bleeding disorders, uncontrolled HTN
- consent form
- type & crossmatch blood
- pre-op: assess coagulation studies, medicaiton hx, CBC, hct, PTT, bleeding & clotting time, not taking warfarin or Coumadin
- post-op: pressure dressing for 30-60 min
- bed rest 24hr
- VS every 5-10 min first hour
- assess for flank pain, hypotension, decreasing hct, increased temp, chills, urinary frequency, dysuria, serial urine specimen
- urine dipstick to test hematuria
- inspect for bleeding
- avoid lifting heavy objects for 5-7 days
- do not take anticoagulant until allowed
-
cystoscopy
- inspects the interior bladder with a lighted scope (cystoscope)
- used to to insert ureteral catheters, remove calculi, obtain biopsy specimen, treat bleeding lesions
- lithotomy position: lying on your back with knees bent and thighs apart
- local/general anesthesia
- pre-op: force fluid or IV fluid, consent form, pre-op med
- post-op: may have burning on urination, pink-tinged urine, urinary frequency
- orthostatic hypotension -> don't let pt walk alone
- discomfort -> sitz baths, heat, mild analgesics
-
cystogram
- visualizes bladder & evaluates vesicoureteral reflux
- evaluates neurogenic bladder & recurrent UTI
- contrast media is instilled into bladder via cystoscope of catheter
- if done cystoscope, same as cystoscopy care
-
cystometrogram
- evaluates bladder tone, sensations of filling & bladder detrusor stability.
- insertion of catheter, instill water/saline into the bladder
- record bladder pressure
- during instillation ask pt about the sensation of filling: first desire to urinate, strong desire, perception of bladder fullness
- observe for urinary infection post-op
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