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Renal and Urinary diagnostic test
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| Urinalysis includes both chemical and microscopic analysis of the urine. Chemical analysis generally is performed by dipstick. | Microscopic analysis is used to identify cells ( blood cells or bacteria), casts ( protein structures that develop in the tubules of the kidneys), or crystals. Use midstream clean- catch technique to collect specimen in a sterile container. Provide appropriate teaching for the client to obtain the specimen. Use sterile technique to obtain a specimen from the drainage tubing if an indwelling catheter is in place. |
| Culture and sensitivity | Urine is placed in or on an appropriate growth medium. If pathogens are present, they are microscopically identified. When combined with sensitivity testing, the specimen is grown in or on media containing disks of various antibiotics to identify those drugs that inhibit bacterial growth. Obtain a specimen either by midstream clean- catch technique, straight catheterization, or from an indwelling catheter using sterile technique. Promptly send the specimen to the laboratory. |
| Urine albumin to creatinine ratio | This test is used to detect and monitor proteinuria in clients at risk for chronic kidney disease. Obtain a single urine specimen from the first voiding of the day. |
| 24- Hour urine tests | 24 hr Urine creatinine and protein are used to help identify kidney disease. Protein molecules generally are too large to be filtered through the glomerular membrane, thus little protein is normally present in urine. Increased levels indicate kidney disease, urinary tract infection, or other serious conditions. Obtain specimen container with appropriate preservative ( if indicated) from the laboratory. Determine whether specimen should be kept refrigerated or on ice during collection period. Follow procedures outlined in Box 28- 3 for client teaching and specimen collection. |
| pyelography | Before the procedure: Informed consent is required. Assess and clarify understanding of the procedure. Ask about and report allergies to seafood, iodine, or x- ray contrast media. Teach or administer preprocedure laxatives as ordered. Allow clear liquids only for 8 hours before the test. After the procedure: Monitor vital signs and urinary output. Report signs of reaction to contrast media such as dyspnea, tachycardia, itching, hives, or flushing. Check injection site for redness, pain, and warmth. Apply warm packs to the site if indicated. Client teaching: IVP uses x- rays to show the structures of the kidney, ureters, and bladder by injecting a dye that is rapidly excreted in the urine. The test takes about 30 minutes. As the dye is injected, you may experience flushing or burning, nausea, and a metallic taste. Immediately notify the physician if you develop a rash, difficulty breathing, rapid heart rate, or hives. Increase fluid intake after the test is completed. |
| Renal arteriogram | Before the procedure: Informed consent is required. Assess and clarify understanding of the procedure. Ask about and report allergies to seafood, iodine, or x- ray contrast media. Teach or administer laxatives and/ or cleansing enemas as ordered ( usually preceding evening). No food or fluids are allowed for 8– 12 hours before the test. Withhold anticoagulants as ordered. After the procedure: Monitor vital signs, peripheral pulses, and urinary output. Monitor for bleeding from the femoral artery. Limit activities for 24 hours. This test uses dye injected into the renal artery to show the blood vessels and structure of the kidneys on x- rays. You may receive a light sedative before the procedure, as well as a local anesthetic where the arterial catheter is inserted. The test takes 1 to 2 hours to complete. After the test is completed, you will be on bedrest or lim-ited activity for 24 hours. Immediately report bleeding from the catheter site, rapid heart rate, difficulty breathing, rash, or itching to your nurse or care provider. |
| Renal Scan | Informed consent is required. Clarify and reinforce teaching. Obtain weight. Provide 2 to 3 glasses of water before the procedure and encourage fluids after. Have client void before the procedure. Instruct to flush toilet immediately after voiding and to wash hands thoroughly to minimize exposure to radioactivity after the procedure. No pregnant personnel should care for client for 24 hours after the procedure. Increase fluid intake before and after the renal scan. No special diet or other preparation is required. A dilute radioactive substance will be injected to allow visualization of the kidneys. The test takes 1 to 4 hours. No anesthesia is required, and there will be no pain or discomfort other than that associated with remaining still for a period of time. |
| Cystoscopy | direct visualization of the urethra and bladder using an endoscope, is used to diagnose conditions such as urethral strictures, bladder stones, tumors, and congenital abnormalities. This invasive examination is performed in an endoscopy laboratory or cystoscopy room of the surgical suite.. Informed consent is required. Assess and clarify understanding of the procedure and its purpose. Teach or assist with bowel preparation as ordered. Withhold food and fluids for 8 hours before the proce-dure as ordered. Administer sedation and other medications as ordered. The procedure takes about 30 to 45 minutes. Local or general anesthesia is used. You may feel pressure or an urge to urinate as the scope is inserted. Do not attempt to stand up without assistance after the procedure because you may feel dizzy or faint. Burning on urination for a day or two after the procedure is considered normal. Contact your doctor immediately if you have bright red bleeding, low urine output, abdominal or flank pain, chills, or fever. Warm sitz baths and medications help relieve discomfort. Increase fluid intake to decrease pain, ease voiding, and reduce the risk of infection. Laxatives may be ordered to prevent constipation and straining after the procedure. |
| Uroflowmetry | is a noninvasive test that measures the volume and rate of urine flow. For this test, the client voids into a toilet equipped with a funnel and uroflowmeter. Before the test, the client is instructed to drink fluids and avoid urination for several hours. The client is placed in a specially equipped bathroom and advised to avoid discarding toilet tissue into the funnel or collection container. Privacy is provided, and the client voids into the urometer funnel without straining. In a cystometrogram ( CMG, or voiding cystogram), a measured amount of fluid is instilled into the bladder, and pressures during filling and voiding are measured. The client is asked to identify when the urge to void is felt, and when it is no longer possible to delay urination. |
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Nursing Instructor |
Milwaukee Area Technical College |
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