Ch 14 Intravenous Flashcards by Donovan Tompkins

Exam:
What is the normal range for creatinine levels?

0.6 to 1.5 mg/dL

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Exam:
What is the average levels for BUN?

8-25mg per 100 ml

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Exam:
What medication do you hold for procedures?

Metformin 48 hours before or after administration of iodinated contrast
(other combinations): glucovance, metaglip, jentadueto, ActoPlus Met, Prandimet, Avandamet)
(other brands: glucophage, fortamet, glumetza, & Riomet)

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Exam:
What is micturition?

the act of voiding or urination

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Exam:
What is incontinence?

involuntary passage (leakage) of urine through the urethra
(failure to control vesical and urethral sphincters)

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Exam:
What is retention?

inability to void: bladder unable to empty
(obstruction in the urethra or lack of sensation to urinate)

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Exam:
What exams/studies would you need to premedicate for?
What medications?
What are examples of procedures?

patients with history of hay fever, asthma, or food allergies
antihistamines (benadryl) + prednisone 12 or more hours prior to procedure
IVU

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Exam:
What position would you use for voiding cystograms?
What are the procedure steps?
What supplies do you need?

supine or erect (makes voiding easier) (women)
30 degree RPO (male, best shown)
**

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Exam:
What drugs would you use to reduce a reaction?

prednisone & Benadryl

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Exam:
What are mild reaction symptoms?

non allergic reactions:
anxiety
lightheadedness
nausea
vomiting
metallic taste (common side effect)
mild erythema
warm flush (common side effect)
itching
mid scattered hives

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exam review:
what is an IVU?

excretory urography
IV injection with contrast through superficial vein in arm

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exam review:
What is a retrograde urography study?

injection through ureteral catheter by urologist as a surgical procedure

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exam review:
What is a retrograde cystography?

contrast flowing to bladder through urethral catheter pushed by gravity

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exam review:
what is a voiding cystourethrography?
what is the positioning?

contrast flowing to from urethral catheter to bladder & withdrawal of catheter for voiding imaging
women: supine (lithotomy) or erect AP
men: 30 degree RPO

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exam review:
what is a retrograde urethrography study?
(RUG)

for males
retrograde injection through Brodney clamp or special catheter

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Exam:
What are moderate reaction symptoms?

true allergic reactions (anaphylactic):
urticaria
possible laryngeal swelling
bronchospasm
angioedema
hypotension
tachycardia >100 beats/min
bradycardia >60 beats/min

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Exam:
what are severe reaction symptoms?

vasovagal (life-threatening reaction):
hypotension (systolic <80)
bradycardia (<50 beats/min)
cardiac arrhythmias
laryngeal swelling
possible convulsions
cardiac arrest
respiratory arrest
no detectable pulse

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Exam:
What is an HSG?
What is it looking for?

contrast study of the uterus to assess the function

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Exam:
Which kidney sits lower than the other?
Why?

right sits more inferior to the left kidney
bc of the presence of the liver

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Exam:
What are the functions of the kidneys?

filter blood & remove waste through urine*

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Exam:
What are the reasons for using a uterus compression study?
Where do you place the compression device? (what level)

enhance filling of pelvicalyceal system/proximal ureters & allows renal collecting system to retain the contrast medium longer
(at ASIS) inflated paddles over outer pelvic brim

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Exam:
How do you position for an IVU?
What is the prep?

Scout: supine (AP) CR is iliac crest
5 min: Supine (AP) (KUB) CR is iliac crest
10-15 min: supine (AP +KUB) CR is iliac crest
20 min: 30 degree LPO/RPO (ureters away from spine) CR is iliac crest
postvoid: prone or erect AP (include bladder)
Prep:
light evening meal before procedure
bowel-cleansing laxative
NPO after midnight
enema on morning of exam

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Exam:
What is an essential component of the kidney?

nephrons

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Exam:
GO OVER LABELING

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Exam: What is the positioning for the retrograde urography? What is the prep?

30 degree RPO special catheter inserted to distal urethra (contrast medium inserted by injection)

Exam: What is a retrograde study? What is an excretory study?

contrast through catheter (retro=backwards) contrast through the vein (intravenous) (forward)

Exam: What organs make up the urinary system?

two kidneys two ureters one urinary bladder one urethra

Exam: Where do the suprarenal glands lie in relation to the urinary system?

superior and medial to each kidney (important glands of the endocrine system located in fatty capsule that surrounds each kidney)

Exam: What position do we need to place the patient in to get the kidneys parallel to the IR?

30 degree LPO/RPO (30 LPO places right kidney parallel) (30 RPO places left kidney parallel)

Exam: What is the name of the functional study of the bladder and urethra?

voiding cystourethrography (VCU)

Exam: When would we not use the uterus compression?

ureteric stones abdominal mass abdominal aortic aneurysm recent abdominal surgery severe abdominal pain acute abdominal trauma (pregnancy)?

Exam: What study measures the functional aspects of the urinary system?

intravenous urography (excretory urography or IVU (true functional aka intravenous pyelography)

Exam: Why do we empty the bladder before doing a IVU study?

a bladder to full could rupture & urine already in the bladder dilutes the contrast medium

Exam: what is the retrograde urography exam? (definition)

non-functional examination of the urinary system contrast injected via catheter inserted into the ureters

Exam: what angle does the kidney sit to the midsagittal plane?

20 degrees from the midsagittal plane due to the psoas major muscles (vertical angle)

Exam: where should the tourniquet be placed in relation to the injection site?

3-4 inches above injection site

Exam: What is acute renal failure?

(Can’t filter waste from the blood) inability of a kidney to excrete metabolites & inability to retain electrolytes (at normal plasma levels & under normal conditions)

exam review: Three purposes for an IVU?

visualize portion of urinary system assess function of kidneys evaluate urinary system pathology

Exam: What is oliguria?

diminished amount of urine in relation to fluid intake low urine output (less than 400mL in 24 hr)

Exam: What is retention?

inability to void: bladder unable to empty (due to obstruction in urethra or lack of sensation to urinate)

Exam: What is anuria?

complete cessation of urinary secretion by the kidneys (kidneys producing none-little urine due to a blockage)

Exam: At what level does the kidney lie in an adult body?? Where in relation to the abdomen?

T11-T12 (between xiphoid process (T10) and iliac crest (L3-L4) (Left kidney T11-T12) (Bottom right is at L3) retroperitoneal

Exam: what is the positioning for a male retrograde urethrogram? Why do we do this?

30 degree RPO to see the entire male urinary system free of superimposition

Exam: What is the bladder capactity?

350ml-500ml

Exam: What views shows the ureters without obstruction (superimposition)?

LPO & RPO

Jeopardy: What is the purpose of premedication before a study?

To prevent contrast reactions

Jeopardy: Where are the kidneys located?

Midway between the xiphoid process and the iliac crest

Jeopardy: What is the name of the leakage of contrast outside of the vessel and into surrounding tissue?

extravasation

Jeopardy: This exam may be performed to demonstrate uterine position, uterine lesions, and uterine tubal obstruction?

HSG study (hysterosalpinography)

Jeopardy: What calyx's form the renal pelvis?

major & minor

Jeopardy: What drug combination is given to patients before an IVU to reduce the risk of a reaction?

prednisone + Benadryl

Jeopardy: What type of contrast reaction affects the entire body or a specific organ system?

systemic reaction

Jeopardy: What is it called when there is a diminished amount of urine being excreted?

oliguria

Jeopardy: What is a life-threatening condition that leads to complete cessation of the urinary secretion?

anuria

Jeopardy: What is the capacity of the adult bladder?

350-500ml

Jeopardy: What is the device used and positioned at the level of ASIS?

ureteral compression device

Jeopardy: what type of contrast media dissociates into separate ions when injected?

ionic contrast media

Jeopardy: What blood chemistry level should read 8-25 mg/100mL if in normal range?

BUN

Jeopardy: the tourniquet should be applied:

3-4 inches proximal (above) the injection site

Jeopardy: What are the levels that should not exceed 25 mg per 100mL?

BUN

Jeopardy: Which of the following is not a reason to be pretreated before a contrast enema?

itching

Jeopardy: We must verify ____ ____ for patients with _____ before resuming metformin?

kidney function diabetes

Jeopardy: The right kidney sits ____ to the left kidney due to the liver

inferior

Jeopardy: for a male retrograde urethrogram the patient position should be?

30 degree RPO

Jeopardy: Which study injects contrast through a catheter into the renal pelvis?

retrograde urethrogram (RUG)

Jeopardy: What drug should be withheld for 48 hours following a contrast study?

metformin

Jeopardy: What is the purpose for voiding a cystourethrogram?

to evaluate the patient's ability to urinate

Jeopardy: What position is best to see the ureters without obstruction?

RPO/ LPO

Jeopardy: What is the name of the action urination?

micturition

Jeopardy: Metallic taste and temporary hot flashes are what kind of reaction to contrast media?

side affects (mild)

Jeopardy: STUDY PICTURE OF RENAL CHART

Exam review: What is metformin?

Drug treatment for non-insulin dependent diabetes mellitus

Exam review: What is nephroptosis?

Abnormal positional change of the kidneys

What are these procedures? Retrograde urethrography:

male procedure, 30 RPO to demonstrate full urethra to access trauma/obstruction with brodney clamp

What are these procedures? Voiding cystourethrography (VCU)

functional study of bladder + urethra to access ability to urinate trauma & incontinence (bladder + urethra)

What are these procedures? Retrograde urography:

nonfunctional system of urinary system minor surgical procedure performed by urologist

What are these procedures? Retrograde cystography:

nonfunctional study of the bladder via urethral catheter only gravity is pushing (just bladder)

What are these procedures? voiding cystourethrography: