Know This Urinary Elimination Labs and Diagnostic Procedures PDF

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Describes what is important in lab and diagnostics within the urinary system...

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NURS 3105 Foundations of Patient-Centered Care Know This! Urinary Elimination Lab and Diagnostic Testing To assess a client’s urinary elimination, you will review the results of lab tests and diagnostic tests/procedures that the provider has ordered. In this course, we’ll start with some basic tests that you will see ordered frequently for your clients. Memorize this information. If you want to know more, read about these in Pagana and in Diagnostic Testing in the Urinary Elimination chapter. Common examples of reasons for a client to have these tests and reasons for abnormal results are given here. Over time, you will learn and see many others. Labs Urinalysis Normal urine is clear and pale yellow to amber in color. Abnormal findings in the urinalysis may explain the reason for cloudy urine or changes in color. For each item below know: – the normal value – the examples of common reasons for the abnormal values. Normal result Meaning of abnormal Specific Gravity 1.005-1.030 1.030 Dehydration Urine Osmolality Don’t need to memorize Abnormal: different stages of renal disease Elevated: dehydration Protein Negative Positive: renal disease Glucose Negative Positive: abnormal glucose metabolism, such as diabetes Ketones Negative Positive: poorly controlled diabetes Red blood cells 0, 1, or 2 3 or more: UTI, cancer in the urinary tract, or trauma Bilirubin Negative Gallbladder disease Nitrite Negative Positive: UTI Leukocyte esterase Negative Positive: UTI White blood cells (WBCs) Negative Positive: UTI Bacteria Negative Positive: UTI or contaminated specimen Was the specimen collected correctly?

** Can you list the ways that nurses will regularly collect urine for this test? Other labs These two labs are measured by drawing a blood specimen that is sent to the lab. They are called “renal function tests.” Normal Meaning of abnormal BUN “Blood urea nitrogen” 10 -20 mg/dL > 20 mg/dL Under urea nitrogen in – Renal disease Pagana – Liver disease – Bleeding in the GI tract – Dehydration 1.2 mg/dL Creatinine 0.5 – 1.2 mg/dL – Renal dysfunction values differ slightly for male/female, but this range – dehydration will let you identify significant abnormals for any client for now

Diagnostic Procedures As a nurse, you will constantly be preparing your clients for procedures that will help in diagnosing problems the client has. Here are a few that are related to urinary elimination. Learn the names, purposes, patient preparation and teaching, and nursing care after the procedure. You’ll be hearing about several of these again in later topics. Test

Why is it done?

How do you prep the client? What do you teach the client?

“CT scan” “CAT scan” abdomen/pelvi s

To see: – kidney stones – masses, such as renal tumors and cysts – Lots of other things…

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IVP (intravenous pyelogram)

To see: – the shape and size of kidneys, ureter, and bladder

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Indirect Visualization Scan may be done with or without a dye called “IV contrast.” Contrast may be given so masses are more easily seen. So you must ask if the client has allergies to shellfish or iodine because they may also be allergic to the dye. Check for results of renal function tests (What are they?!?) Confirm that consent has been given May need IV started Tell the patient that, while the dye is given, it is normal to: o have a salty taste in the mouth o feel flushed, warm, or nauseated for a few moments Patient may need to be NPO (nothing to eat or drink) for several hours before the exam Tell the patient that exam takes about 30 minutes because lots of pictures to see where the dye is showing up. This test is based on “IV contrast” being

How do you care for the client after the procedure? What do you teach the client? – –

Push fluid intake. Watch for allergic reaction to dye.

Other things to know

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Push fluid intake. Watch for allergic

Test is done in a special room in radiology. The dye used can be nephrotoxic (what does that mean?), so we must know what the client’s creatinine is before the test. Increasing fluid after the procedure helps to protect the kidneys by diluting and speeding excretion of the dye.

SEE CT scan above. Retrograde pyelogram is done for similar reasons, but now the

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Ultrasound (abdominal)

KUB

if the kidneys are excreting urine normally

To assess the location, shape of the kidney To see cysts/tumors/stones

To see the structures of the kidneys, ureters, and bladder

given so you must always ask if the client has allergies to shellfish or iodine because they may also be allergic to the dye. – Check for results of renal function tests (What are they?!?) – Confirm that consent has been given – May need IV started – Tell the patient that, while the dye is given, it is normal to: o have a salty taste in the mouth o feel flushed, warm, or nauseated for a few moments – Patient may need to be NPO (nothing to eat or drink) for several hours before the exam Help client to undress if needed.

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reaction to dye. Monitor amount and color of urine output.

No special care

dye is delivered through a tube inserted into bladder.

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Help client to undress if needed.

No special care

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Test is done in radiology or at the bedside. Pelvic ultrasound may be done to see the bladder. Patient will need to drink about 300 mLs liquid and NOT VOID before exam to fill the bladder. This is a simple XRay completed in radiology or at the bedside. Also called a “flat plate.”

Cystoscopy

To directly see the urethra and lining of the bladder To collect tissue to test for abnormal cells and even remove small tumors

Direct Visualization Confirm informed consent. Tell the client that the physician will insert a tube (the “scope) through the urethra into the bladder.

Assess amount and color of urine output Report – or teach client to reportbright red color and clots; pink urine is normal. Encourage fluids.

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Test completed in radiology or the urologist’s office. Whenever you see “scopy” in the name of a procedure, you know that the provider will be inserting a scope – a tube that the provider will look through to see the tissue and structures at the other end of it – into some opening in the client’s body....