i bc27f85be50b71b1 (176 page)

(.fNITOLlRII'ARY SYSTEM

565

Table 9-2. Urllle Abnormalities

Ahnormality

Etlolog),

Glycosuria (presence of

Ilyperglycemia and probable diabetes mellitus.

glucoc;e)

Proteinuria (presence of

Prorems arc usually too large ro be filrered;

proreins)

therefore, permeability has abnormally

increased.

Can occur wah acute or chronic renal failure,

nephrotic syndrome. high protein diet, stren

-

uous exercise, dehydrarion, fever, or emotional srress.

Hem<1turia (presence of

Possible urinary tract bleeding or kidney dishlood and red blood

eases (calculi, cystitis, neoplasm glomerulo

,

cells)

nephritis, or miliary tuberculosis).

Bacteriuria (presence of

Generally indicares urinary tract infecrion.

bacreria)

Urine is generally cloudy in appearance, wirh

the possible presence of white blood cells.

Ketonuria (presence of

Can result from diabetes, a high-prorein diet,

ketones)·

dehydration, vomiting, or severe diarrhea.

Bilirubmuria (presence of

Usually an early indicator of liver disease and

bilirubin)

hepatocellular jaundice.

CrYMais (end producr" of

Can occur wirh urolithiasis, toxic damage to

food metabolism)

the kidneys, or chronic renal failure.

"Ketones arc formed from protcm and fat membolism, and tracc amounts III (he urine

41re norm,\1.

Soun::e'i: D.na from VC Scanlon, T Sander .. (cds). Essentials of Anawmy and Physiology

(2nd cd). Philadelphl.l: I;A Davis. 1995;416; P Bates. Nursing Assessment: Urinary System. In SM Lewl\, 1\11\1 Ileltkempcr. SR Dirksen (cds), :-'Iedical-Surgical Nursing: Asscssmenl and Managemelll of Climcal Problcms (5th cd). St. Louis: Mosby,

2000;12H; and L�I Malarke,,, ME �kMorrow (eds). Nurse's Manual of Laboratory

Tem and Dlagnostll.:: Procedurc� (2nd cd). Philadelphia: Saunders, 2000;38-43.

Cr clearance, also called a 24-hour urine test, specifically measures

glomerular filtration rate. Decreased clearance (indicated by elevated

levels) indicates decteased renal function. The normal range of Cr

clearance is 75-135 ml per minute."-'

Blood Urea Nitrogen

As an end product of protein and amino acid metabolism, increased

blood urea nitrogen (BUN) levels can be indicative of any of the follow-

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AClITE CARE HANDBOOK FOR PIIYSICAI THFRAPISTS

ing: decreased renal function or fluid intake, increased muscle catabolism, increased prorein intake, or acute infection. Levels of BUN need to be correlated with plasma Cr levels to implicate renal dysfunction,

because BUN level can be affected by decreased fluid intake, increased

muscle catabolism, increased protein intake, and acute infection. Alterations in BUN and Cr level can also lead to an alteration in the patient's mental status. Normal BUN levels are 5-30 mg/dl.4-6

Clinical Tip

Noting BUN and Cr levels on a daily basis for any changes

may help explain changes in the patient'S mental status,

participation in physical therapy sessions, or both.

Radiographic Examination

Kidneys, Ureters, and Bladder X-Ray

An x-ray of the kidneys, ureters, and bladder is generally performed as an

initial screening rool for genitourinary disorders. The size, shape, and

position of the renal, ureteral, and bladder structures are delineated to

help identify renal calculi (kidlley stolles), tumor growth or shrinkage

(chrollic pyelollephritis), and calcifications in the bladder wall. An x-ray

of the kidneys, ureters, and bladder can also be performed when internal

hemorrhage is suspected after major traumatic incidents. Identification of

any of these disorders requires further evaluation'·!

Clinical Tip

This x-ray procedure is often abbreviated KUB.

Pyelography

Radiopaque dyes are used to radiographically examine the urinary

system. Two types of tests are performed: excretory urography (intravenous pyelography) and retrograde urography. Excretory urography is performed more commonly than retrograde urography.

Excretory IIrography consists of (J) taking a baseline radiograph

of the genitourinary system, (2) intravenous injection of contrast dye,

and (3) sequential radiographs to evaluate the size, shape, and location of urinary tract structures and to evaluate renal excretory func-

GENITOURINARY SYSTEM

567

tion. The location of urinary obstruction or cause of nontraumatic

hematuria may be also be identified with this procedure.'·s

Retrograde IIrography consists of passing a catheter or cystoscope

into the bladder and then proximally into the ureters before injecting

the COntraSt dye. This procedure is usually performed in conjunction

with a cystoscopic examination and is indicated when urinary obstruction or trauma to the genitourinary system is suspected. Evaluation of urethral stent or catheter placement can also be performed with this

procedure.3-S

Renal Arteriography alld Venography

Renal arteriography and venography consist of injecting radiopaque

dye into the renal artery (arteriography) or vein (venography) through

a catheter that is inserted into the femoral or brachial artery or femoral vein. Arterial and venous blood supply to and from the kidneys can then be examined radiographically. Indications for arteriography

include suspected aneurysm, renovascular hypertension and trauma,

palpable renal masses, chronic pyelonephritis, renal abscesses, and

determination of the suitability of a (donor) kidney for renal transplantation. Indications for venography include renovascular hypertension, renal vein thrombosis, and renal cell carcinoma.s,7

Clinical Tip

Patients who are scheduled for procedures involving contrast dye are generally restricted from eating or drinking 8

hours before the procedure. A patient who is scheduled for

an afternoon procedure may therefore be fatigued earlier

in rhe day and may want to defer a scheduled therapy session. Modifying the intended therapy session and respecting the person's wishes at this time are both suitable alternatives.

Bladder Examination: Cystoscopy and Panendoscopy

Cystoscopy consists of passing a flexible, fiberoptic scope through the

urethra into the bladder ro examine the bladder neck, urothelial lining, and ureteral orifices. The patient is generally placed under general or local anesthesia during this procedure. Cystoscopy is performed to

examine the causes of hematuria and dysuria, as well as for tumor or

polyp removal.S-7 Panendoscopy is a similar procedure to cystoscopy