Wk 5 Urinary Labs and Diagnostics Flashcards
(128 cards)
1
Q
What does turbid mean concerning urine?
A
Very cloudy urine
2
Q
Who has cloudy urine?
A
Someone who has a UTI
3
Q
What does amber or honey colored urine indicate?
A
Dehydration
4
Q
What does syrup or a brown ale colored urine indicate?
A
Liver disease or severe dehydration
5
Q
What does pink to reddish colored urine indicate?
A
Hematuria Kidney disease Tumors UTI Prostate problems etc
6
Q
What does urine that looks dark brown like Coca Cola indicate?
A
Obstructive jaundice
7
Q
What causes the dark brown Coca Cola colored urine?
A
Water soluble bilirubin in the urine
8
Q
What is the normal serum creatinine?
A
0.5-1.2 mg/dL
9
Q
What is the most reliable indicator of renal function?
A
serum creatinine
10
Q
The BUN is not specific to the __
A
kidneys
11
Q
Creatinine is specific to the __
A
kidneys
12
Q
What is creatinine?
A
Breakdown of muscle and protein metabolism
13
Q
Creatinine is released at a __ rate
A
consistent
14
Q
When would you see a creatinine level that was too low? (Below 0.5 mg/dL)
A
Muscle atrophy, malnourished
15
Q
What is the normal range for blood urea nitrogen?
A
10-20 mg/dL
16
Q
What are 3 things that can cause an elevated BUN?
A
High nitrogen/high protein tube feeds/diet
GI bleed
Hydration status
17
Q
Why does a high nitrogen diet raise BUN?
A
Nitrogen is the end product of protein breakdown
18
Q
Why would a GI bleed raise BUN levels?
A
Blood is protein rich, so you will digest the blood in the GI tract and it will drive up the BUN
19
Q
If a patient has an elevated BUN and NOT an elevated creatinine, what could be the cause? (3)
A
High nitrogen/protein diet
GI bleed
Hydration status
20
Q
How might the nurse determine if the patient is experiencing a GI bleed and that is the reason for the elevated BUN?
A
Look at their H&H and see if it is going down
21
Q
If someone is very hydrated, what effect would this have on BUN?
A
It would decrease the BUN, the BUN would be diluted
22
Q
If someone is very dehydrated, what effect would this have on BUN?
A
It would raise the BUN, the BUN would be concentrated
23
Q
What is the normal potassium range?
A
3.5-5 mEq/L
24
Q
The kidneys secrete the majority of what electrolyte?
A
Potassium
25
If a patient has kidney disease, they will have __-kalemia
hyper
26
Which electrolyte is one of the first to become abnormal with kidney disease?
potassium
27
What potassium level does a patient experience cardiac dysrhythmias and muscle weakness?
Greater than 6 mEq/L
28
If a patient's potassium level is greater than 6 mEq/L, what symptoms might they have? (2)
dysrhythmias
| muscle weakness
29
What is the normal range for calcium?
9-10.5 mEq/L
30
In chronic kidney disease, what do calcium levels look like?
They are decreased
31
Why are calcium levels decreased in chronic kidney disease?
There is decreased reabsorption
32
What does decreased reabsorption of calcium lead to in chronic kidney disease?
Renal osetodystrophy
33
What is renal osteodystrophy?
Weakening of the bones
34
A patient with chronic kidney disease is at risk for __ breaks
Bone
35
What is the normal range for phosphorous?
3.0-4.5 mEq/L
36
What is the chemical abbreviation for phosphorous?
PO4++
37
What is phosphorous inversely related to?
Calcium
38
What is calcium inversely related to?
Phosphorous
39
What two electrolytes are inversely related?
Calcium and phosphorous
40
What do phosphorous levels look like in a patient with chronic kidney disease?
They are high
41
Why are phosphorous levels high in a patient with chronic kidney disease?
Because the calcium levels are low due to decreased reabsorption
42
What is the normal range for serum magnesium?
1.3-2.1 mEq/L
43
What do magnesium levels look like in chronic kidney disease?
They are high
44
When is the best time to do a UA?
first in the morning
45
Why should you do a UA in the morning?
Because it is most concentrated at that time
46
How soon should a UA be given to the lab?
Within the hour
47
What should urine NOT have on a UA?
```
Bilirubin
Glucose
Ketones
Protein
WBC
RBC
```
48
What is the normal pH of urine?
4.6-6.0
49
What is the normal range for urine specific gravity?
1.010-1.030
50
What is the normal odor for urine?
Aromatic
51
Is aromatic smelling urine expected or unexpected?
Expected
52
What does glucose in the urine indicated?
Possible diabetes
53
What does a urine specific gravity measure?
Measures the concentration of solutes in the urine
54
What does a low urine specific gravity mean?
Patient is very hydrated
55
What does a high urine specific gravity mean?
Patient is dehydrated
56
What would a urine specific gravity look like for a patient who is very hydrated?
Low, diluted
57
What would a urine specific gravity look like for a patient who is very dehydrated?
High, concentrated
58
Is an ammonia-like odor an expected or unexpected finding for urine?
Unexpected
59
What is a creatinine clearance?
measures how well creatinine is removed from your blood by your kidneys
60
The creatinine clearance test approximates __
GFR
61
What is the definition of the GFR?
Amount of blood filtered per minute by the glomeruli
62
The amount of blood filtered per minute by the glomeruli is the...
GFR
63
How do we use to test for a creatinine clearance?
24 hour urine
64
A 24 hour urine should be kept
COLD!
65
How do you start a 24 hour urine?
Have the patient void and discard first urine
66
Which urine do you keep in a 24 hour urine, first or the last?
Keep the last
67
What test should also be collected during a 24 hour urine?
Serum creatinine
68
What test does the National Kidney Foundation recommend to use to assess GFR?
calculated eGFR from a prediction equation
69
Why does the National Kidney Foundation not recommend 24 hour urine as a test for GFR?
Impractical and failure to collect entire specimen
70
What 4 factors does an eGFR take into consideration?
Age
Gender
Weight
Ethnicity
71
What can be used at the bedside to non invasively assess how much urine is in the bladder?
Bladder scan
72
What does a bladder scanner do?
Calculated presence of residual urine
73
What does a clean-catch urine do?
Confirms suspected UTI and identifies causative agents
74
How should a patient do a clean catch?
Clean urethra, collect urine 1-2 seconds after voiding starts
75
What is a cystoscopy?
When the provider takes a look at the inside of the bladder with a scope
76
What is the main goal of a cystoscopy?
To inspect interior of bladder wall
77
What is it called when a HCP uses a scope to look at the inside of the bladder?
Cystoscopy
78
What position would a patient be in during a cystoscopy?
Lithotomy
79
What needs to be signed before a cystoscopy?
Consent form
80
Is it normal to have burning after a cystoscopy?
Yes
81
Is it expected to have pink-tinged urine after a cystoscopy?
Yes
82
Is it expected to have polyuria after a cystoscopy?
Yes
83
Is it expected to have bright red blood in the urine after a cystoscopy?
No
84
What does KUB stand for?
Kidney, ureter, bladder
85
What is a KUB procedure?
X-ray of the abdomen and pelvis
86
What is an x-ray of the pelvis/abdomen typically called?
KUB
87
What might be ordered for the patient before a KUB?
Bowel prep
88
Why would a provider order bowel prep for a patient going to have a KUB done?
The stool may occlude the view
89
What does a KUB do?
Delineates size, shape, and position of the kidneys
90
What else does a KUB show?
Radiopaque stones
91
What is an intravenous pyelogram abbreviated as?
IVP
92
What does an IVP require?
Bowel prep
93
What is the pyelogram referring to for an IVP?
The renal pelvis
94
What sensitivity should you check for before an IVP?
Iodine sensitivity
95
Why should you check for iodine sensitivity before an IVP?
Because it uses contrast to see the renal pelvis
96
What is there a risk for when a patient has an IVP?
Anaphylaxis
97
Why is a patient at risk for anaphylaxis during an IVP?
They could be allergic to the iodine in the contrast
98
What is a nursing consideration for IVP?
Tell the patient to expect a flushed feeling when being injected with the IV contrast
99
What should happen AFTER the IVP?
Force fluids
100
Why are fluids forced after an IVP?
The contrast used can be nephrotoxic
101
When should an IVP not be gone?
If the patient has an elevated creatinine
102
What are 3 reasons a patient will have a retrograde pyelogram?
IVP doesn't visualize adequately
Pt allergic to contrast
Pt has decreased renal function
103
What is a retrograde pyelogram?
Take cystoscope, look up through ureteral catheters and look at the renal pelvis that way
104
Is the prep different from retrograde versus intravenous pyelogram?
No
105
What are the complications of a retrograde pyelogram?
Anaphylaxis
| Nephrotoxicity
106
Are the complications of a retrograde pyelogram the same as an intravenous pyelogram?
Yes
107
If a patient has an anaphylactic allergy to the dye used, how are they able to have a retrograde pyelogram?
Because the dye doesn't enter systemic circulation
108
When would a renal biopsy be done?
Suspicions of cancer
109
What is needed to be signed before a renal biopsy?
Consent form
110
What should the nurse assess before a patient has a renal biopsy?
Coagulation history
111
What labs would a nurse look at before a patient has a renal biopsy? (3)
PT/INR
| Platelets
112
What is the major risk to be concerned about for a patient having a renal biopsy?
Bleeding because the kidneys are very vascular
113
What 2 drugs should a patient going for a renal biopsy not have?
Aspirin
| Warfarin
114
What position is a patient in during a renal biopsy?
They are on their side, hip is flexed toward the ceiling because it opens up the CV space for the provider to get close to the kidney
115
After a patient had a renal biopsy, what type of dressing will they have?
Pressure dressing
116
How long should a pressure dressing be on the patient after a renal biopsy?
30-60 minutes
117
How long is a patient on bed rest after a renal biopsy?
24 hrs
118
What should a nurse take with in the 1st hour after a renal biopsy?
Vital signs every 5-10 minutes
119
Why are vital signs taken every 5-10 mins after a renal biopsy?
To assess for internal bleeding
120
If a patient has internal bleeding, what will be one of the first vital signs to reflect that?
Tachycardia
121
What will the blood pressure look like for a patient who has internal bleeding?
It will be normal until it can no longer compensate and then it will drop
122
What will the nurse assess for on a patient who has just had a renal biopsy? (2)
Flank pain
| Bleeding
123
Where is your flank?
Soft part of your back just below the ribs (kidneys are here)
124
A patient should avoid what for 7 days after a renal biopsy?
Heavy lifting
125
What is a non-contrast spiral CT also called?
CT/KUB
126
What is a CT/KUB also called?
Non-contrast spiral CT
127
What is the gold standard for diagnosing renal colic symptoms?
CT/KUB
128
What are 3 advantages of a CT/KUB?
Quick
Non-invasive
no IV contrast
