DIAGNOSTIC

Question 1

Provides important clinical information about kidney function and helps diagnose diseases

Answer 1

Urinalysis

Question 2

Components of urinalysis

Answer 2

-Urine color
-Urine clarity and odor
- Urine pH and specific gravity
- Tests to detect protein, glucose, and ketone bodies in urine
-Microscopic examination of urine sediment after centrifugation to detect RBCs, WBCs, Casts, Crystals, and Bacteria
-Obtain via Mid-strem clean catch

Question 3

Determines whether bacteria are present, as well as their stains and concentration

Answer 3

Urine culture

Question 4

Includes the identification of the antimicrobial therapy that is best suited for a particular stain

Answer 4

Sensitivity

Question 5

Assess the status of kidney function and Evaluate the severity of kidney disease

Answer 5

Renal function tests

Question 6

What are the test for renal functions tests?

Answer 6

-Renal concentration tests
-Creatinine clearance
-Serum creatinine
-Blood urea nitrogen (BUN)

Question 7

An expression of the degree of concentration of the urine that measures the density of a solution tot he density of water

Answer 7

Specific Gravity

Question 8

Measures the number of solute particles in a kilogram of water

Answer 8

Urine osmolality

Question 9

The end product of muscle energy metabolism

Answer 9

Creatinine

Question 10

This test measures effectiveness of renal function

Answer 10

Creatinine

Question 11

The nitrogenous end product of protein metabolism

Answer 11

Urea

Question 12

Serves as an index of renal function

Answer 12

Blood Urea Nitrogen (BUN)

Question 13

Normal creatinine level

Answer 13

0.6-1.2 mg/dl

Question 14

Normal BUN Level

Answer 14

7-18 mg/dl

Question 15

Detects and evaluates progression of kidney disease

Answer 15

Creatinine clearance

Question 16

Creatinine clearance method of collection

Answer 16

24-hour urine specimen

Question 17

The test measures volume of blood cleared of endogenous creatinine in 1 minute- approximate GFR

Answer 17

Creatinine clearance

Question 18

X-ray visualization of KUB

Answer 18

Kidney, Ureter, Bladder (KUB) Studies

Question 19

Performed to delineate the size, shape, and position of kidneys and reveal urinary system abnormalities

Answer 19

KUB Studies

Question 20

Nursing responsibilities when patient is having KUB studies

Answer 20

-Assure the patient that procedure is painless
- Bowel preparation, as ordered- to prevent gas and fecal interference with visualization
(laxative in the evening)
(Enema in AM)

Question 21

Direct visualization of the urethra, bladder wall, trigone, urethral opening through a cystoscope

Answer 21

Cystoscopy

Question 22

Cystoscopy Nursing Responsibilities (Before)

Answer 22

-Secure written consent
- Reinforce teaching that procedure is done under local/general anesthesia
-Force fluid if local anesthesia- To prevent ascending UTI
-NPO if general anesthesia
-Inform that desire to void is felt as cystoscope is inserted
-Place patient in lithotomy during procedure

Question 23

Cystoscopy Nursing Responsibilities (After)

Answer 23

-Bed rest until VS are stable- to prevent orthostatic hypotension
-Pink-tinged urine is NORMAL 24-48 hours after procedure
- Dysuria, frequency and hematuria are common (due to tissue irritation)
- Observe for urinary retention, signs of infection and excessive hematuria. Notify physician
- Monitor VS and I&O
- Hot sitz bath to relieve pelvic discomfort, as ordered
-Force fluids to prevent ascending UTI

Question 24

An IVP shows the kidneys, ureter, and bladder via x-ray imaging as the dye moves through the upper and then the lower urinary system

Answer 24

Intravenous Pyelography

Question 25

Uses a radiopaque contrast agent given via IV

Answer 25

Intravenous Pyelography

Question 26

Intravenous Pyelography Nursing Responsibilities (Before)

Answer 26

-Secure written consent -NPO 6 to 8 hours -Bowel Preparation -Assess allergy to seafoods and/or iodine -Epinephrine at bedside (Anaphylactic shock is a potential complication)

Question 27

Intravenous Pyelography Nursing Responsibilities (After)

Answer 27

-Monitor VS -Increased fluid intake- to help excrete dye - Inform patient that a burning sensation on voiding may be experienced - Monitor for signs of delayed allergic reaction

Question 28

A contrast agent is then injected via cystoscope

Answer 28

Retrogade Pyelography

Question 29

Indications for retrograde pyelography are:

Answer 29

-IVP does not provide adequate visualization of the collecting systems - ESWL -Allergy to IV constant agent

Question 30

Nursing responsibilities of retrograde pyelography (before)

Answer 30

-Secure written consent - Assess for allergy to dye - Inform patient that discomfort may be felt during procedure - Prepare epinephrine at bedside

Question 31

Nursing responsibilities of retrograde pyelography (after)

Answer 31

-Monitor VS -Monitor for urinary retention, infection, and prolonged hematuria. Notify physician -Increase fluid intake to prevent UTI and to excrete dye

Question 32

Also known as Renal Arteriography

Answer 32

Renal Angiography

Question 33

It provides X-ray image of the renal arteries

Answer 33

Renal Angioraphy

Question 34

A contrast agent is injected to opacify renal arterial supply

Answer 34

Renal Angiography

Question 35

Indications for Renal Angiography

Answer 35

-Evaluate renal blood flow in suspected renal trauma - Differentiate renal cysts from tumors -Evaluate hypertension

Question 36

Renal Angiography Nursing Responsibilities (Before)

Answer 36

- Bowel Preparation - Shave injection site (groin for femoral, axilla for axillary) -Mark peripheral pulse sites- for easy access during postprocedural assessment

Question 37

Renal Angiography Nursing Responsibilities (After)

Answer 37

- Monitor VS until stable -If axillary approach was done, take BP on opposite arm - Assess injection site for swelling and hematoma - Assess neurovascular status of operative extremity and compare with uninvolved extremity - Cold compress to injection site to decrease edema and pain - Sandbag over catheter insertion site- to further prevent bleeding -Bed rest x 24 hours, no sitting -Monitor urine output- to assess renal function

Question 38

A small section of the renal cortex is obtained either percutaneously (needle biopsy) or by open biopsy through a small flank incision

Answer 38

Kidney Biopsy

Question 39

Kidney Biopsy Indications

Answer 39

- Unexplained acute kidney injury - Persistent proteinuria or hematuria - Transplant rejection - Glomerulopathies

Question 40

Kidney Biopsy Contraindications

Answer 40

- Bleeding tendencies - Uncontrolled HTN - Sepsis - Solitary kidney - Large polycystic kidney - Kidney neoplasm - UTI - Morbid obesity

Question 41

Kidney Biopsy Nursing Responsibilities (Before)

Answer 41

- Check coagulation studies (to identify any risk of posy biopsy bleeding) - Secure written consent - NPO for 6 to 8 hours -Obtain urine specimen for baseline - Establish an IV line

Question 42

Kidney Biopsy Nursing Responsibilities (Before) If needle biopsy:

Answer 42

-Position: Prone with sandbag under the abdomen - Instruct patient to breathe in and hold that breath while needle is being inserted (to prevent kidney from moving) - Sedation will be given and skin biopsy site will be infiltrated with local anesthetic

Question 43

Kidney Biopsy Nursing Responsibilities (Before) If open biopsy:

Answer 43

- Position: Prone - Similar preparation with major abdominal surgeries

Question 44

Kidney Biopsy Nursing Responsibilities (After)

Answer 44

-Monitor VS and for signs and symptoms of internal bleeding - IV fluids as prescribed (to help clear the kidneys and prevent clot formation) - Bed rest and pressure dressings should be maintained for the prescribed period of time -Urine may contain blood for the first 24 to 48 hours -Analgesics, as prescribe