This post will cover the Renal System: Diagnostic Tests Part 2 starting with Renography.
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Renography
This is also known as a kidney scan. This test involves an IV injection to get visual imaging of the renal blood flow, glomerular filtration and tubular function.
Renography Preprocedure
Because this is an invasive procedure, you as the nurse must be sure that an informed consent was obtained. Next you will want to assess for allergies, this is vital to know because the IV dye can harm the patient and may be a contraindication. Next, inform the patient that there are no restrictions with diet or fluids before the test. Lastly, before the procedure, let the patient know that they will need to be still during the test.
Renography Postprocedure
Have the patient drink at least 1 liter of fluids to flush out the dye. Assess for any possible allergic reaction. Note that the dye is eliminated within 24 hours. It is especially important to know if patients are incontinent and you need to assist them with cleaning. Because the dye is hazardous, bodily fluids may need to be double bagged for safety.
Cystoscopy and Biopsy Procedure
Biopsy means that a sample of tissue is removed. A cystoscope is used for examining inflammation or tumors of the bladder.
Cystoscopy and Biopsy Pre Procedure
With all invasive procedures, you will want to make sure there is a sign consent by the patient. If there is a biopsy planned during the cystoscopy, be sure to instruct the patient to withhold food and fluids as prescribed. This is also known as “NPO” nothing by mouth. But remember, this is only required if there is a biopsy ordered.
Cystoscopy and Biopsy Post Procedure
This topic is very important to know for exams. The first nursing action after the procedure is monitoring vital signs to make sure the patient is stable. Instruct the patient to increase their fluid intake.
Also monitor the intake and output while assessing their urine for color, clarity and odor. If the patient is having bladder spasms, have the patient do deep breathing exercises and administer medications. If the patient has abdominal or back pain, a tub bath or sitz bath may help the patient relieve their pain.
Educate the patient about what to expect after the procedure. Any burning while voiding, light pink or light tea colored urine and urinary frequency is expected. If they experience any of these, it's nothing to be concerned about. However, if they see bright red urine or clots along with having a fever, this must be reported to the provider because these are signs of infection.
Renal Biopsy
This topic is very important for exams and NCLEX. This test involves an insertion of a needle to obtain tissue from the kidney.
Renal Biopsy Pre Procedure
Before any procedure, you want to obtain vital signs to compare throughout the procedure and after. It is very important to obtain coagulation studies as these indicate if the patient is likely to bleed a lot after the procedure. If you get abnormal results, you must notify the doctor immediately. Next, you want to make sure there is a signed consent. The patient will be placed on a NPO status.
Renal Biopsy Procedure
During the procedure, the patient will be in a prone position which means they will be on their stomach. Remember that the kidneys are behind the abdominal cavity, towards the back. A pillow is placed on their abdomen and shoulders.
Renal Biopsy Post Procedure
Always after a procedure, the first action is to monitor the patient's vital signs. Specifically hypotension because this is an indication for bleeding. Bleeding is a big concern after this procedure so you will also need to apply pressure to the procedure site for at least 30 minutes. Another sign of bleeding is low hematocrit and hemoglobin levels. The patient will need to be on bed rest for up to 6 hours. It's very important that the site clots up as much as possible before any major movement to prevent bleeding. Even after they are clear to go home, educate the patient to avoid heavy lifting and stressful activities for up to 2 weeks. The patient will also need to contact the provider if they have a fever of 100 degrees fahrenheit or blood in the urine.
Let’s Talk About Normal Urinalysis Values
Normal values will be amber yellow color, ammonia odor, a pH between 4.6 to 8.0, an osmolality between 300-1000 and a specific gravity between 1.005-1.030. There should not be any presence of glucose, ketones, protein, bilirubin, casts, bacteria, hemoglobin, myoglobin or cultures for organisms.
Normal Renal Function Values
These values include Blood urea nitrogen, also known as BUN, Serum creatinine and BUN/Creatinine ratio.
A normal BUN level is 10 to 20 mg/dL. A normal Serum Creatinine level for a male is 0.6 to 1.2 and 0.5 to 1.1 mg/dL for a female. The normal BUN/creatinine ratio is 6 t0 25.
Well that concludes this video, join us in the next video as we cover Acute Kidney Injury.
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