Professional Documents
Culture Documents
Cortez, RN
Clinical Instructor
ANATOMY OF THE GUT SYSTEM
Diagnostic Tests
and Table of
Laboratory
Values
Serum Creatinine
measures effectiveness of
renal function.
end product of muscle
energy metabolism
Normal Value: 0.6 – 1.2 mg/dl (50
– 110 µmol/dL
Increased creatinine levels in the blood suggest diseases or conditions
that affect kidney function. These can include:
Specific Gravity
Evaluates ability of kidneys to concentrate
solutes in urine.
Normal value: 1.010 – 1.025
NOTE: How to prepare for the test
Procedure:
•Performed on a 24-hour urine specimen; it is based
on the finding that vanillylmandelic acid is the major
urinary metabolite of norepinephrine and epinephrine.
Nsg. responsibility
•The nurse should tell the patient to catch the
midstream flow of his/her urine
KUB (kidney, ureter, bladder)
•Demonstrates the size of kidney, ureter, and
bladder for presence of cysts, tumors,and
displacement or obstruction.
Nsg. responsibility
•Establish/maintain fluid and electrolyte balance
•Prevent complication
•Provide emotional support
•Provide information about s\disease
Uric acid
It is the increased urate excretion, fluid
depletion and a low urinary pH.
is used to learn whether the body might be
breaking down cells too quickly or not getting
rid of uric acid quickly enough.
is used to monitor levels of uric acid when
a patient has had chemotherapy or radiation
treatments.
What does the test result mean?
Nsg. responsibility
The nurse should tell the patient to
catch the midstream flow of his/her
urine
Bladder scanning
•This procedure is to inspect the bladder for any
obstruction, tumor etc.
Procedure:
•The patient is scanned with the ultrasonography
machine
Nsg. responsibility
•The nurse should tell the patient to empty
bladder first before the procedure.
Computed Tomograpgy
Scan
Nursing responsibilities:
•Promote / maintain the client’s dignity
•Maintain the client’s sense of control
•Assist the client to become comfortable in
a new environment
Magnetic Resonance Imaging
Nursing responsibilities:
•Supply the MRI medical history questionnaire (S/N 1384) to
the patient for completion if the patient is coherent and an
accurate historian. Notify MRI personnel if the patient is
unconscious, unresponsive, cannot provide reliable history
and there is no family that can provide the information.
•The nursing staff is responsible for placement of an IV lock
and assuring that the MRI medical history questionnaire is
complete prior to transporting the patient to MRI.
•Nursing staff shall also key the order into the Invision
system following computer prompt.
Intravenous Pyelogram
(IVP)
An intravenous pyelogram (IVP) is an x-
ray examination of the kidneys, ureters and
urinary bladder that uses iodinated contrast
material injected into veins.
Renal Angiography
Angiography is the use of an x-ray to look at arteries
in order to detect blockage or narrowing of the
vessels.
How it works
A contrast dye injected via a catheter threaded into the
blood vessels of the kidneys makes them visible on a
x-ray, allowing detection of any abnormalities
affecting the blood supply to the kidneys.
Renal Scanning
A renal scan is a nuclear medicine exam in
which a small amount of radioactive material
(radioisotope) is used to measure the function
of the kidneys.
RESULTS Abnormal
•There is welling or narrowing of the urethra
because of previous infections or an enlarged
prostate gland.
•There are bladder tumors (cancerous or
benign), polyps, ulcers, urinary stones, or
inflammation of the bladder walls.
•Abnormalities in the structure of the
urinary tract present since birth
(congenital) are seen.
•Pelvic organ prolapse is present in a
woman.
IMPORTANCE
A cystoscopy can check for stones, tumors,
bleeding, and infection. Cystoscopy can see areas
of the bladder and urethra that usually do not show
up well on X-rays. Tiny surgical instruments can be
put through the cystoscope to remove samples of
tissue (biopsy) or samples of urine. Cystoscopy also
can be used to treat some bladder problems, such as
removing small bladder stones and some small
growths.
Kidney Biopsy
A kidney biopsy is done using a long thin
needle put through the back (flank) into the
kidney. This is called a percutaneous kidney
biopsy. A tissue sample is taken and sent to a
lab. It is look at under a microscope. The
sample can help your doctor see how healthy
your kidney is and look for any problems.
RESULTS
Normal
•The structure and cells of the
kidney look normal. There are no
signs of inflammation, scar
tissue, infection, or cancer.
Abnormal
•The sample may show signs of scarring due
to infection, poor blood flow,
glomerulonephritis, a kidney infection
(pyelonephritis), or signs of other diseases
that affect the body, such as systemic lupus
erythematosus. Kidney tissue may show
tumors that were not expected, such as Wilms'
tumor (which occurs in early childhood) and
renal cell cancer (which is most common after
age 40).
Complete Blood Count (CBC)
CBC gives important information about the
kinds and numbers of cells in the blood,
especially red blood cells, white blood cells,
and platelets. A CBC helps your health
professional check any symptoms, such as
weakness, fatigue, or bruising, you may have.
A CBC also helps him or her diagnose
conditions, such as anemia, infection, and
many other disorders.
Erythropoietin Test
Alternative Names:
Serum erythropoietin; EPO
•Acute Pain
Another common nursing diagnosis for clients with
cystitis is Acute Pain related to irritation and
inflammation of bladder and urethral mucosa.
Diagnostic test findings
•Urine culture and sensitivity: positive
identification of organisms (Escherichia
coli, Proteus vulgaris, Streptococcus
faecalis)
•Urine chemistry: hematuria, pyuria,;
increased protein, leukocytes, specific
gravity
Cytoscopy: obstruction or deformity
Assessment findings
•Frequency of urination
•Urgency of urination
•Burning or pain on urination
•Lower abdominal discomfort
•Dark, odoriferous urine
•Flank tenderness or suprapubic pain
•Nocturia (need to get up during the night in order to
urinate, thus interrupting sleep)
•Low-grade fever
•Urge to bear down during urination
•Dysuria (refers to painful urination)
•Dribbling
Medical management
•Diet: acid-ash diet with increased intake of fluids and
vitamin C
•Activity: as tolerated
•Monitoring: vital signs and intake and output
•Laboratory studies: specific gravity, urine culture and
sensitivity
•Treatment: Sitz baths
•Antibiotics: co- trimoxizole (Bactrim), cephalexin (Keflex)
•Analgesic: oxycodone (Tylox)
•Urinary antiseptic: Phenazopyridine (Pyridium)
•Antipyretic: acetaminophen (Tylenol)
Nursing interventions
•Maintain the patients diet
•Encourage fluids (cranberry or orange juice) to 3qt
(3L)/day
•Assess renal status
•Monitor and record vital signs, I/O, and laboratory
studies
•Administer medications, as prescribed
•Allay patient’s anxiety
•Maintain treatments: sitz baths, perineal care
•Encourage voiding every 2 to 3 hours
•Individualize home care instructions
Avoid coffee, tea, alcohol and cola
Increase fluid intake to 3 qt (3L)/ day using
orange juice and cranberry juice
Void every 2 to 3 hours and after
intercourse
Perform perineal care correctly
Avoid bubble baths, vaginal deodorants ant
tub baths
C.PYELENOPHRITIS
Infections of the upper urinary tract are called
pyelonephritis. This is an infection of renal pelvis,
tubules, (tubes), in the kidneys. The bacteria may
enter through the bladder via the ureters or through
blood stream. Pyelonephritis describes a syndrome
caused by the inflammation (irritation, swelling,
pain, damage) of the tubes (renal tubules) that carry
urine from the kidneys to the bladder (upper urinary
tract) and the renal (kidney) interstitium (tissue
surrounding the renal structures).
Pyelonephritis can be acute (sudden) or chronic
(prolonged) in nature.
•Acute pyelenophritis often occurs after bacterial
contamination of the urethra or after introduction of
an instrument, such as catheter or a cytoscope.
•Chronic pyelenophritis is more likely to occur
after chronic obstruction with reflux or chronic
disorders. It is slowly progressive and usually is
associated with recurrent acute attacks, although the
client may not have a history of acute
pyelenophritis.
Causes
•Enteric bacteria
•Ureterovesical reflux
•Urinary tract obstruction
•Pregnancy
•Trauma
•UTI
•Incorrect aseptic technique
•Diabetes mellitus
•Staphylococcal or streptococcal infections
Pathophysiology
•Bacterial infection from a second source
spreads to the renal pelvis, causing an
inflammatory response.
•Cell destruction from trauma to the renal
pelvis initiates an acute inflammatory
response.
Complications
•Chronic renal failure
•Hypertension
•Septicemia
Clinical manifestations
Characterized by enlarged kidney, focal parenchyma
abscesses and accumulation of polymorph nuclear
lymphocytes around and in the renal tubules
Nursing Diagnosis
•Risk for Deficient Fluid Volume. A common diagnosis is Risk for
Deficient Fluid Volume related to fever, nausea, vomiting, and
possible diarrhea.
•Acute Pain. Another common nursing diagnosis is acute pain related
to an inflammatory process in the kidney and possible colic.
•Readiness for Enhanced Self- Care. Client teaching is important to
promote self-care and to prevent recurrent teachings. Write the
diagnosis Readiness for Enhanced Self-Care to prevent recurrent
infections.
Diagnostic test findings
•Excretory urography (which consists of imaging the
kidneys and urinary tracts before and after the
administration of intravenous contrast material): atrophy,
blockage, or deformity of kidney
•Urine culture and sensitivity: bacteria
•Urine chemistry: pyuria, hematuria; leukocytes, WBCs,
and casts; specific gravity greater than 1.025; albiminuria
•Hematology( study of blood): increased WBCs
•24-hour urine collection: decrease creatinine clearance
Assessment findings
•Elevated temperature
•Chills
•Nausea and vomiting
•Flank pain
•Chronic fatigue
•Bladder irritability
•Hypertension
•Dysuria
•Burning on urination
•Frequency of urination
•Urgency of urination
•Headache
•Anorexia
•Weight loss
•Odoriferous, concentrated urine
Medical management
•Diet: soft, high-calorie, low protein
•IV therapy: saline lock, electrolyte and fluid replacement
•Activity: as tolerated
•Monitoring: vital signs, I/O, urine pH, and specific gravity
•Laboratory studies: WBCs, urine protein, and urine culture and
sensitivity
•Treatments: warm, moist compress to flank
•Fluid intake: 3qt (3L)/day
•Analgesic: meperidine (Demerol)
•Antibiotics: cefazolin (Ancef0, cefoxitin (Mefoxin), co- trimoxizole
(Bactrim)
•Urinary antiseptics: phenazopyridine (Pyridium)
•Antiemetic: prochlorperazine (Compazine)
•Alkalinizers: potassium acetate, sodium bicarbonate
•Sedative: oxazepam (Serax)
•Peritoneal dialysis and hemodialysis
Nursing interventions
•Maintain the patient’s diet
•Encourage fluids 3qt (3L)/ day
•Assess renal status and fluid balance
•Monitor and record vital signs, I/O, laboratory studies, daily weight, specific
gravity, and urine for blood, protein, and pH
•Administer medications, as prescribed
•Allay the patient’s anxiety
•Provide hot, moist compresses and warm baths
•Prevent chilling
•Provide rest periods
•Provide skin, mouth and perineal care
•Encourage frequent voiding
•Individualize home care instructions
Void frequently
Return to the physician immediately if symptoms reoccur
Take prescribed medications for entire duration of prescription
D.Glomerulonephritis
Glumerulonephritis is a disease that affects the
glumeruli of both kidneys. Etiologic factors are
many and varied; they include immunologic
reactions (lupus erythematosus, streptococcal
infection), vascular injury (hypertension), metabolic
disease (diabetes mellitus), and disseminated
intravascular coagulation (DIC). Glomerulonephritis
exists in acute, latent and chronic forms.
Acute glomerulonephritis
Acute glomerulonephritis is inflammation of
the glumerular capillary membrane. Acute
glumerulonephritis can result from systemic
diseases or primary glomerular diseases, but
acute postreptococcal glomerulonephritis (also
known as acute ploriferative
glomerulonephritis) is the most common form.
•Chronic Glumerulonephritis
Chronic Glumerulonephritis is typically the end stage of
other glomerular disorders such as RGPN, lupus nephritis,
or diabetic nephropathy. In many cases, however, no
previous glomerular disease has been identified.