diabetes, starvation, bulimia, faulty fat metabolism, other digestive disturbances
livery dysf(x), biliary obstruction, hepatitis
Hemoglobinuria or hematuria indicates
infection, calculi, cancer, trauma, OD of an anticoagulant, bleeding disorder
Routine or Random UA includes....
Glucose & ketones
albumin & blood
What is the normal pH of urine?
epithelial, fatty, or waxy tissue abnormally forced out of the renal tubules.
presence of crystals in the urine
presence of pus in the urine
a urine sample is placed on a cx medium and is allowed to incubate
after an organism is detected in a Cx it is than determined what Rx is the most effective in eradicating it.
pertaining to any bladder
What is the purpose of a BUN?
to determine how efficiently the glomeruli remove nitrogenous wastes that result from protein metabolism
urea; results from protein metabolism
product of protein metabolism
related to muscle mass
excreted by the kidenys
What is the chief nitrogenous waste of protein metabolism?
Glomeruli filtration must be reduced by what for significant elevation of serum creatinine to occur.
creatinine clearance test
* URINE test
*glomerular filtration rate
* renal insufficiency
*often combined with a morning serum creatinine
Main thing creatinine is concerned with?
Uric acid studies are useful for....
gouty arthritis or kidney disease
*this study is generally preformed with a 24 hour specimen
Intravenous Pyelogram (IVP)
x-ray w. radiopaque dye
outline of KUB (kidneys, ureter, & bladder)
*may be preformed along with an IVP
*allows in depth x-ray of the kidneys (the layers and structures within them)
*radiopaque dye & rotating x-ray tube
Diabetic Cautions with Dye
Decreased renal clearance of the dye
@ least 2-4 liters for 24 hours after test
dye can quickly damage the kidneys
**Tests the kidneys themselves by means of radioactive substance
*Tumors may be detected because they pick up more of the radioactive substance
x-ray study of the bladder and urethra
(used with a flouroscope)
*the x-ray cystogram will show the bladder's outline and the ureters if reflux is present.
backflow of urine into the ureters
fluoroscopic test done to dx vesicoureteral reflux
How do the VCUG and cystogram work?
They have a contrast medium instilled into the bladder via urethral catheter. When the pt feels the need to void the catheter is removed and x-rays are taken during the actual voiding process.
reflux of the urine back into the ureters from the bladder.
What does a retrograde pyelogram show?
The kidneys and the ureter
How is this procedure done? (usually in combo with a cystogram)
The bladder is outlined on x-ray film by instillation of a contrast medium into the bladder via a urethral catheter. Smaller catheters are than introduced to the ureters where they than make their way up into the kidneys.
What are the preparations for a retrograde pyelogram?
low residue diet
laxative or enema
normal dye precautions
: occurring or performed in a direction opposite to the normal or forward direction of conduction or flow
radiographic visualization of the renal pelvis of a kidney after injection of a radiopaque substance through the ureter or into a vein
injecting a contrast dye through a catheter into the aorta at the level of the renal blood vessels
allows the dr to view the inside of the bladder through a tubular instrument (cystoscope) which has a mirror and a fiber optic lens on the end
need to obtain specimens from both kidneys
Fluid medium is infused at high pressures so this may cause infected urine to be forced into the kidneys
U/A and Cx should always be done first because of above
Where is cystoscopy usually done at?
in the operating room so routine operations considerations apply here
How should a needle bx for the kidney be done?
client in prone position
with a sandbag under the abdomen (helps to bring the kidney into place)
series of tests that best determines the actual f(x) (and the ability for them to work in sequence) of the following:
detrusor muscle of the bladder
Which is more preferable, urodynamic testing or x-ray procedures that involve dye?
Urodynamic testing (they are safer)
What muscle actually pushes the urine out?
What are the two phases of urodynamic testing
1. filling phase
2. emptying phase
What happens during the filling phase of urodynamics?
sensation of the bladder
stretch of the bladder wall
ability of the bladder & the pelvic muscles to hold in urine
accommodation or compliance
the stretch of the bladder wall
What is involved in the emptying phase of urodynamics (voiding or mictrition)?
Tests how well the bladder empties and what strategies the pt uses to empty the bladder completely
usually the 1st test done in urodynamics
Funneled commode that determines the amount of V and how long it takes the pt to actually void
poor muscle tone
residual urine test
*to see if the client voids all the way
Double voiding technique
used to determine residual urine V; the pt voids and than is required to void again after 5 minutes
What happens during a residual urine test?
A pt is instructed to void;
IMMEDIATELY straight cathed to collect whatever urine remains in the bladder
one that is inserted to obtain a specimen and than removed
*make be used to measure residual volume
*US is than used to determine the amount of residual V
If residual volume is greater that 150-200 mL, what is usually the problem?
A disorder of the bladder or urethra is probably causing urinary retention
Urodynamic Testing may include:
Residual urine V, double voiding technique, and US
Urethral Pressure Prolfile
Measure of bladder pressure during filling is called....
Bladder pressure remains the same during bladder filling until about _____ mL.
Notes about cystometrogram
pt may have to cough or bear down if incontinence testing
leak-point pressure is recorded during this if there is leaking of above
What is leak point pressure useful in determining
to determine whether or not a pt is suitable for anti-incontinence surgery
Urethral Pressure Profile (UPP)
used to evaluate the smooth muscle activity along the urethra
What is done during a UPP (urine pressure profile)
bladder filled with fluid
puller mechanism provides slow, even rate of catheter withdrawel
Urethral wall resistance is than measured
If a low pressure urethra is found, what procedure is appropriate?
a procedure that improves urethral closure is appropriate.
test of pelvic muscle function
can be reversed with dx and tx
caused by medical interventions or tx
true or total incontinence
urinary leakage that is almost continuous
What is the most common cause of true incontinence in men?
other causes of true incontinence
injury to males external urethral muscles
injury to female's perineal muscles
congenital or acquired
extrophy (bladder is exposed on the lower abdomen)
abnormally placed ureteral orifices on the female s
an abnormal passage that leads from an abscess or hollow organ or part to the body surface or from one hollow organ or part to another and that may be surgically created to permit passage of fluids or secretions
urinary leakage following a sudden increase in intra-abdominal pressure
result of upper motor lesions or neuropathies
due to irritation of the bladder wall
happens when the bladder overfills with urine and is not able to release it.
(usually due to nerve damage as in diabetes or other trauma)
palpate bladder to get it to express urine
Stress & Urge incontinence
increase sphincter tone to prevent leakage on the way to BR
May need to wear a pad at first
3-6 mo w.o improvement than they may be eligible for surgery
Biofeedback to determine how well the pt is actually doing kegals
small electrode attached to a generator is placed in the vagina or rectum
impulse=contract no impulse=relax
non-surgical option for females with stress urinary incontinence
device that is inserted into the vagina to support everything
may be left in there for 4-8 wks
surgical ureteral reimplantation
correct abnormally placed ureteral orifices
Purpose of Surgeries Involving the Bladder
Elevating the neck of the bladder & suturing it in place to restore curve
Closing an open neck
artificial sphincter for those with non working urethra
reread book page 1182
increasing the bladder size surgically
Interstim (implantable electrical stimulation)
fine electrode attached to the sacral spinal cord to deliver an electrical current that is believed to both relax the bladder and block the sensation of urgency
Nursing Considerations for urge and reflex incontinence:
Teach to empty the bladder completely
Biofeedback and kegal exercises
help with caths
Uirnary bladder infections
(UTI) Urinary Tract Infection
Instead of bearing down to empty the bladder, what is a better technique?
What should a female with a prolapsed bladder do to help to empty it?
the pt can lift the base of the bladder by using a finger in the vagina to tip it into a position that will help in emptying it.
Self ________ may be nec for long term management of incontinence
What may be the only presenting sign of UTI in older adults?
Change in mental status. (may be severe)
Remember that they metabolize everything, including Rx, more slowly.
The pt complains of a heavy feeling in the abdomen or perineum. This may be indicative of what?
During antibiotic tx fluid intake is ___- ___L per day unless contraindicated.
3-4 liters per day
Why is it recommended that one take 2 G of vitamin C if they have a UTI?
To acidify the urine and kill the bacteria
Chronic Cystitus (Recurrent UTI)
long term antibiotics (3-6 months)
difficult or painful discharge of urine
inflammation of the renal pelvis and medulla and is the most common form of kidney disease. Usually migrates from somewhere else in the body
Signs and Symptoms of acute pyelonephritis
rapid onset of fever and chills
What is the tx for acute pyelonephritis?
antimicrobial tx for at least 10-14 days
What are the signs of infection?
fever, chills, flank pain
Persistant acute infections or obstruction
*May lead to permenant damage
*tx with aggressive antimicrobial
*can cause death
disease of the bladder that may be inflammatory and autoimmune in nature
The lining of the bladder becomes "leaky" and allows irritants from the urine to come in contact with the muscular wall of the bladder
Interstitial Cystitis (IC)
Signs & symptoms of Interstitial Cystitus
Pelvic pain & painful intercourse
voiding is not painful but provides relief
Urine is free of bacteria
Onset is usually associated with UTI or instrumentation
Dx of Interstitial Cystitus
hydrodistention of the bladder combined with the below
Tx of Interstitial Cystitus
*symptomatic, no cure
*Elmiron for 3-6 months with instillations of cocktails of drugs into bladder
* May have extreme pain, esp with intercourse
Glomerulonephritis (Bright's Disease)
Group of diseases in which the kidneys are damaged and partyly destroyed by the inflammation of the glomeruli
May result in an antigen and antibody response, causing an autoimmune disorder
appears approx - weeks after an UTI or Scarlet fever
Most common in children
Signs and symptoms of acute glomerulonephritis
pale, puffy face and edema
get up many times to void
Dx of acute glmerulonephritis
H/A and irritability
Tx of acute glumerulonephritis
Can develop at any time w/o any signs
Signs and symptoms of glomerulonephritis
course of the disease may last - yrs
anemia, hypertension, CHF
blurred vision follwed by blindness
urinary obstructions block the outflow of the kidneys. may be acute or chronic
Calculi ( stones)
the formation of stony concretions in the body (as in the urinary tract or gallbladder)
Uric acid elevations can lead to what type of arthritis?
Kidney stone pain is ofter called what?
(ESWL) Extracorporeal Shock Wave Lithography
used in cases of kidney stones or upper ureter . If the stone is in the lower ureter (not used in the lower because it is more delicate down there) it can be pushed up into the upper part and can than be treated with ESWL
Stab wound made in the flank and cath inserted
Us probe inserted into the cath and the waves are directed to break up the stone
Cath left in for a few days until edema goes away
Urethroscopic Calculi Removal
Stone basket is inserted and the stone is pulled out
Crushing of the stones so that they may pass
A stent is than placed so that is may support and allow drainage
surgical removal of calculi in the ureter
Monocystic Kidney disease
single cyst that is usually benign and asyptomatic
Polycystic Kidney disease
Multiple cys that are also benign that tend to run in families
Usually dx after birth the masses grow so large that they may often be palpable
cancer of the kidney
primary cancer of the kidney
Kidney Cancer Info
Aggressive and almost always malignant
painless hematuria and palpable mass
removal of affected kidney
men ages 50-70 yrs
Caffeine and artificial sweetner intake may increase risks
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