renal diagnostic studies

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Author:
thaoherbie
ID:
210052
Filename:
renal diagnostic studies
Updated:
2013-03-28 16:48:03
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nursing
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renal diagnostic studies
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  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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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