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(.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