Chapter 9 Presentation Cath Scott Overly Cysto Bio 120 UTI UC RP
cath - Catheteriztion Insertion of a tube through the urethra and into the urinary bladder for the purpose of withdrawing urine or inserting dye.
Male Catheterization QuickTimeª and a decompressor are needed to see this picture.
Female Catheterization QuickTimeª and a decompressor are needed to see this picture.
Purpose: Intermittent Catheterization To obtain a sterile urine specimen for diagnostic evaluation; to empty bladder content when the patient is unable to void due to urinary retention, bladder distention, and obstruction, or to measure residual urine after urination. To instill medication for a localized therapeutic effect and to instill contrast material (dye) into the bladder through the urethral catheter for cystourethralgraphy (x- ray of the bladder and urethra). To empty the bladder for increased space in the pelvic cavity to protect the bladder during labor and delivery and pelvic and abdominal surgery. monitor the urinary output and fluid balances of critically ill patients.
Indwelling Catheterization Indicated as palliative care for terminally ill or severely impaired incontinent patients, for whom bed and clothing changes are uncomfortable, and as a way to manage skin ulceration caused or exacerbated by incontinence. Used to maintain a continuous out flow of urine for patients undergoing surgical procedures that cause a delay in bladder sensation, and for persons with chronic neurological disorders that cause paralysis or loss of sensation in the perineal area. Bladder outlet obstruction, and for patients with an initial episode of acute urinary retention to allow the bladder to regain its tone.
cysto- Cytoscopy Visual examination of the urinary bladder using an instrument called a cystoscope. QuickTimeª and a decompressor are needed to see this picture.
Procedure During a cystoscopy procedure, the doctor uses a hollow scope (cystoscope) equipped with a lens to carefully examine the lining of your bladder and your urethra. The cystoscope is inserted into your urethra and slowly advanced into your bladder.
Procedure Asked to empty bladder Receive sedative or anesthtic Numbing jelly applied to urethra Small scope used for investigating signs and symptoms Large scope to take tissue samples or pass tools into bladder Sterile solution used to inflate bladder to get a better view
Why it’s done? Investigate causes of bladder signs and symptoms Diagnosing bladder and urinary tract diseases and conditions Treating bladder diseases and conditions Diagnosing an enlarged prostate
UTI - Urinary Tract Infection Infection, usually from bacteria, of any organ of the urinary system. Most oftern begins with cystitis and may ascend into the ureters and kidneys. Most common in women because of their shorter urethra.
Symptoms Strong, persistent urge to urinate Burning sensation when urinating Passing frequent, small amounts of urine Cloudy urine Strong smelling urine In women- Pelvic pain In men- Rectal pain
Types of Infections and symptoms Kidneys (acute pyelonephritis) upper back and side pain high fever shaking and chills nausea vomiting
Types and Symptoms Bladder (cystitis) pelvic pressure lower abdomen discomfort frequent, painful urination blood in urine
Types and Symptoms Urethra (urethritis) Burning in urination
Tests and Diagnosis Urine Culture and Sensitivity Retrograde pyelogram Cytoscopy KUB (Kidneys, ureters, bladder)
uc- Urine Culture A diagnostic laboratory test performed to determine the presence of bacteria in the urine.
Methods The most common is the midstream clean- catch technique. Hands should be washed before beginning. For females, the external genitalia are washed two or three times with a cleansing agent and rinsed with water. In males, the external head of the penis is similarly cleansed and rinsed. The patient is then instructed to begin to urinate, and the urine is collected midstream into a sterile container. In infants, a urinary collection bag is attached over the labia in girls or a boys penis to collect the specimen.
Methods Another method is the catheterized urine specimen in which a lubricated catheter is inserted through the urethra into the bladder. This avoids contamination from the urethra or external genitalia. If the patient already has a urinary catheter in place, a urine specimen may be collected by clamping the tubing below the collection port and using a sterile needle and syringe to obtain the urine sample; urine cannot be taken from the drainage bag, as it is not fresh and has had an opportunity to grow bacteria at room temperature. On rare occasions, the health care provider may collect a urine sample by inserting a needle directly into the bladder (suprapubic tap) and draining the urine; this method is used only when a sample is needed quickly.
Test Results Negative culture results showing no bacterial growth are available after 24 hours. Positive results require 24-72 hours to complete identification of the number and type of bacteria found.
RP - Retrograde Pyelogram Diagnostic X-ray in which dye is inserted through the urethra to outline the bladder, ureters, and renal pelvis.
Reason for procedure retrograde pyelogram may be used in people suspected to have an obstruction, such as a tumor, stone, blood clot, or stricture in the kidneys or ureters. It evaluates the lower portion of the ureter to which urine flow is obstructed. also used to evaluate placement of a catheter or a ureteral stent. The procedure may also be performed on people with impaired kidney function.
Advantage An advantage of the retrograde pyelogram is that it can be performed even if the patient is allergic to contrast dye because a minimal amount of the contrast dye is absorbed by the body (unlike another more common test called an intravenous pyelogram).
Procedure outpatient basis or as part of your stay in a hospital. An intravenous (IV) line may be inserted in your arm or hand. Youll be asked to lie face up on the X-ray table and place your legs in stirrups. You may receive a sedative or general anesthesia in the IV prior to the insertion of the endoscope. An endoscope will be inserted through the urethral opening and advanced into the bladder. Once the endoscope is in place, the bladder can be examined and a catheter may be inserted into one or both ureters.
Procedure The contrast dye will be injected through the catheters.A series of X-rays will be taken at timed intervals. The catheter will be removed. The physician will check for retention of the contrast dye.
Retrograde Pyelogram X- Ray Upper and lower half of right retrograde pyelogram shows hydronephrosis (yellow arrow), filling QuickTimeª and a defect at head of decompressor are needed to see this picture. contrast column in ureter (red arrow) and "goblet" shaped dilatation distal to filling defect
After Procedure After the procedure, youll be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and youre alert, youll be taken to your hospital room or discharged to your home.Your urine output will be monitored closely for volume and signs of blood. It may be red from even a small amount of blood. This is considered normal and doesnt necessarily indicate a problem. You may be instructed to continue monitoring your urine output for a day or so once youre at home.You may experience pain when you urinate. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding.
Sources Fremgen, Bonnie F., & Suzanne S. Frucht. (2009). Medical Terminology a living language (4th ed.). New Jersey: Pearson Education www.myoclinic.org/urology www.yalemedicalgroup.org