The document provides instructions for collecting various types of urine specimens, including clean-catch midstream specimens, specimens from indwelling catheters using closed or open collection methods, and 24-hour urine collections. It also describes procedures for intravenous pyelograms and discusses indications for the test.

2. GOOD
AFTERNOON!!!!

3. Clean-Catch (Midstream) Specimen
• perennial area is washed
Mild antiseptic/liquid
soap
• midstream urine is collected 30 ml
• avoid collecting initial & last few drops
• send specimen laboratory or within 2
hours
Collecting Urine Specimens

4. Sterile Specimen from Indwelling
Catheter
a. From a closed system Method
– clamp drainage tubing about 4”
below junction of drainage tubing
and catheter for 10-30 minutes
– Clean specimen collection port with
alcohol or antiseptic solution
– Collect 3-10 ml of urine with a
sterile syringe
– For self-sealing catheter, insert
needle slowly at 450 angle taking
care not to puncture the other side
of the tubing
Collecting Urine Specimens
b. Open-System Method
-Place line saver under tubing
at junction of catheter and
drainage tubing
-Disinfect the junction before
and after the collection
-Hold the disconnected tube
(catheter and drainage tubing)
1.5-2 inches from each other
-Do not allow the catheter tip to
touch container

5. 24-Hour Urine Collection.
• Urine passed in a 24-hour period is collected
• Measures the amount of certain chemicals the
kidneys clean from the body.
• To see if too little or too much urine is produced.
• Decide on the day and time-usually started in the
morning
• Discard the first voided urine
• Collect all the subsequent urine passed
• At the 24th hour, collect the last sample
• Urine should be kept cool, refrigerated
• Specimen sent to the laboratory within 2 hours after
collection
Collecting Urine Specimens

6. Intravenous pyelogram(IVP)
Visualization of the Urinary system
Kidney
Urethers
Bladders
Aka
Intravenous pyelography (IVP).
Urography.
Pyelography.

7. Intravenous pyelogram(IVP)

8. Intravenous pyelogram(IVP)
detect problems:
 kidney stones
 enlarged prostate
 tumors in the kUB
 surgery on the urinary tract

9. Intravenous pyelogram(IVP)
 Preparation:
Enema( aperients) 24 hours
NPO 6 – 8 hours
Remove : jewelry, dentures, eye glasses
and any
metal objects or clothing
 Patient wears cotton examination gown.
 Bladder emptied immediately before
examination.
 Site: median cubital vein : 20 gauge

10. point of comparison…
- inflammation of Renal
Pelvis/ Renal
Parenchyma
- s/sx:
cystitis s/sx
pain: flank pain – T12 &
L3
Costovertebral
Tenderness
Fever: High
CYSTITIS PYELONEPRHRITIS
- inflammation of the
Urinary Bladder
- s/sx:
Dysuria
Freqyuency
Urgency
Noctoria
Pyuria : cloudy.foul odor
Pain :
suprapubic/hypogastric
Fever: Low Grade

11.  Furniture:
 sturdy & stable
straight back
 seat firm should be NO lower
shallow than the knee height
 sofas & chairs - 17 inches off the ground
 heavy rocking chair with arm rest
 clear plastic chair protector for upholstered
chairs
Parkinson’s Disease

12. Low purine diet……
- indicated for gout, uric acid kidney
stones and uric acid retention
- purpose is to decrease the amount of
purine
FOODS:
AVOID organ meats, fish, lobsters
dried peas and beans, nuts, oatmeal,
whole wheat

13.  GABHS
 Inflammation of kidney
 Periorbital Puffy eyes
 Hematuria(tea colored)
 Hallmark sings/Classics sign
Hypertension
 Plasmapheresis
 Diuretics
 Steroids
 Autoimmune
 Increase glomerolar
permeability
 Hallmark sings/Classics
sign
- Protienuria
- Edema
- Hypercholeteremia
 Plasma Expanders
 Diuretics
 Streroids
Glomerulo-
nephritis
Nephrotic
Sydrome

16. OLDCART METHOD
O- onset of pain
L- location of pain
D- duration of pain
C- characteristic of pain
A- aggravating factors
R –radiation of pain
T- treatment
PQRST mnemonics
P- provoked ( what brought
about pain)
Q- quality of pain
R- region or radiation of
pain
S- severity
T- timing
MNEMONIC
S FOR PAIN
ASSESSME
NT

17. Pulmonary Wedge Pressure
aka: Pulmonary capillary wedge pressure (PCWP)
Pulmonary artery occlusion pressure ( PAOP)
 Catheter Swan-Ganz
 Indication - Diagnose the severity of left ventricular
failure
- Check if Left Ventricle is over stretched,
under
stretched or appropriately stretched
- Quantify the degree of mitral valve stenosis
- Physician can calculate the dose of diuretic
drugs
- Evaluating pulmonary hypertension
- diagnosis of acute respiratory distress
syndrome

18. Pulmonary Wedge Pressure
aka: Pulmonary capillary wedge pressure (PCWP)
Pulmonary artery occlusion pressure ( PAOP)
 Catheter Swan-Ganz
 Indication - Diagnose the severity of left ventricular
failure
- Check if Left Ventricle is over stretched,
under
stretched or appropriately stretched
- Quantify the degree of mitral valve stenosis
- Physician can calculate the dose of diuretic
drugs
- Evaluating pulmonary hypertension
- diagnosis of acute respiratory distress
syndrome

19. skeletal traction

20. Thomas splint

21.  Dribbling, Difficulty starting urine stream
 Retention
 Inability to void after alcohol & cold
exposure
 Frequency
 Urgency
 Small less forceful urine
 Nocturia
 Elevated WBC, and BUN
 Prostate specific antigen (PSA)

23.  ASYMPTOMATIC for 5 or more years after
 Early symptoms resemble a FLULIKE
illness
 MALIGNANCIES: Kaposi’s sarcoma, skin
cancer
 laboratory tests
- Enzyme-linked immunosorbent assay (ELISA)
- Western Blot
- Rapid HIV tests (30 minutestest)

24. Pregnancy Induced
Hypertension
Types BP Proteinuria Edema Other S/Sx
Mild 140/90
(increase
of 30/15)
1+ to 2+ Slight in
upper
extermities
Wt gain
2nd tri 2 lbs/week
3rd tri 1 lb/week
Severe
160/110
3 to 4 + Pulmonary
Peripheral
Edema
Epigastric Pain
Hepatic Dysfunction
Oliguria<500ml/24
Eclampsia
up 4+ -same- CONVULSION
COMA

25. Anorexia Nervosa Bulimia Nervosa
15% loss of BW
BMI<17.5 kg/m
Strict dieters
Indulges in strenous
exercises
Pre-occupation with foods
Amenorrhea for 3 cycles
 binge-purge
Russel’s sign
Teeth missing lower
incisors
Abusive of laxative,
enema, diuretics
Rectal
bleeding/constipation
Do’s
•Small frequent feedings
•Monitor I&O, weight gain
•Stay with client during meal
or atleast 1 hr after
•Accompany to the
Don’ts
•Express feeling of
shock/disgust
•Don’t compare with others
•Don’t allow long time meals
(set 30 mins. meal time)

26. Spina Bifida

27. IV Therapy
Phlebitis
Inflammatory response to damage to
the intimal layer of the vein caused by
mechanical or physiochemical forces.
S/sx of infection
A palpable venous cord indicates
advanced stage of phlebitis. When identified,
remove the PIV .
Phlebitis Scale
0 = No Symptoms
1 = Erythema
2 = Pain
3 = Streak Formation, venous
cord
4 = Purulent Drainage,
palpable venous cord
Infiltration
Inadvertant administration of
medication or solution into tissue
surrounding the vein. It’s called
Extravasion if vesicant medication is
administered into the surrounding
tissue.
Infiltration: Most commonly identified
complication of PIV therapy with a
reported incidence of 23% to 78%.
.
Infiltration Scale
0 = No Symptoms
1 = Some Edema, Cool
2 = 1-6 inch Edema, Cool,
Pain
3 = > 6 inch edema, pain,
numb
4 = Pitting Edema,
Circulatory impairment
The difference
between Phlebitis
and Infiltration

29. …just remember this
rADiAtIoN SaFeTy
- Label potentially radioactive material
- Limit time spent near the source 30
mins/day
- Distance from the source 6 feet away
- Shield Device Lead Apron
- Room Private Room
- Dislodge Implant
1. Long handle forceps
2. place in lead lined container
3. report

30. Nerve
Injury
Paralysis/Effects
C1 to C5 Paralysis of muscles used for breathing and of all arm and leg muscles;
usually fatal.
C5 to C6
Legs paralyzed; slight ability to flex arms.
C5: Weakness - shoulder abduction (raising the arm).
C6: Weakness: elbow flexion, wrist extension.
C6 to C7
Paralysis of legs and part of wrists and hands; shoulder movement and
elbow bending are relatively preserved.
Weakness: shoulder abduction.
C7: Weakness in elbow extension, wrist flexion
C8 to T1 Legs and trunk paralyzed; eyelids droop; loss of sweating on the
forehead (Horner's syndrome); arms relatively normal; hands paralyzed.
C8: Weakness in thumb extension, wrist ulnar deviation (rotate away from
the thumb)
T2 to T4 Legs and trunk paralyzed; loss of feeling below nipples.
T5 to T8 Legs and lower trunk paralyzed; loss of feeling below the rib cage.
T9 to T11 Legs paralyzed; loss of feeling below umbilicus (belly button).
T12 to L1 Paralysis and loss of feeling below the groin.
L2 to L5 Different patterns of leg weakness and numbness.
S1 to S2 Different patterns of leg weakness and numbness
S3 to S5 Loss of bladder and bowel control; numbness in the perineum.

31. Bronchial Hygiene Therapy (BHT)

32. Chest physiotherapy
 includes postural drainage, chest percussion
and vibration, and breathing exercises
 to remove bronchial secretions, improve
ventilation, and increase the efficiency of the
respiratory muscles
 Postural drainage uses specific positions that
allow the force of gravity to assist in the
removal of bronchial secretions; before meals
and at bedtime; remain in each position for 10
to 15 minutes

33. Chest physiotherapy
 Percussion is carried out by cupping the hands
and lightly striking the chest wall; 3 to 5
minutes; percussion over chest drainage
tubes, the sternum, spine, liver, kidneys,
spleen, or breasts is avoided
 Vibration is the technique of applying manual
compression and tremor to the chest wall
during the exhalation phase of respiration;
helps to increase the velocity of the air expired
from the small airways, thus freeing the mucus.

34. …tractions & pins

35. BMI vs Weight to Height Table

36. BMI
 Imperial BMI Formula
The imperial bmi formula accepts weight measurements in
pounds & height measurements in either inches or feet.
1 foot = 12 inches
inches² = inches * inches
 Metric Imperial BMI Formula
The metric bmi formula accepts weight measurements in
kilograms & height measurements in either cm's or
meters.
1 meter = 100cms
meters² = meters * meters
Imperial BMI ( lbs/inches² ) = (weight in pounds *
703 )
height in inches²
Metric BMI ( kg/m² ) = weight in kilograms
height in meters²

37. Enteral Nutrition
 provides liquefied feeding into the
gastrointestinal tract via a tube
 for patient who have a functioning GI tract but
cannot ingest food by MOUTH
 Feeding tubes:
- short-term: nasogastric tube
- long-term: esophagostomy, gastrostomy,
enterostomy tube

38. Enteral Nutrition
Nasogastric Route Nasoduodenal Route
Nasojejunal Route Esophagostomy Route
Gastrostomy Route Jejunostomy Route

39. Nasogastric Tube
 Insertion:
- NEX
- High Fowler’s position
- Sips of water and advance tube as client swallows
- Do not force the tube!
 Confirm placement of NGT
 Monitor and record residual volume q4h by aspirating stomach content
with a syringe. A residual volume of >100-150 ml indicates delayed
gastric emptying. Notify MD.
 During and after feeding keep HOB 30 degrees to prevent aspiration;
For continuous feedings, keep the patient in a semi-Fowler’s position
at all times
 Flush/Irrigate tube feeding with 30-60ml of water q4h during
continuous feeding, before and after each intermittent feeding, before
and after administering meds, after each time you check residual
volume
 Feeding set changed q24h.
 Bag rinsed q4h.
 Medications:
◦ Liquid medications should be diluted with water
◦ Mixing medications with the feeding should be avoided
◦ Avoid diluting capsules in water
◦ She should consult with the pharmacist to coordinate timing of
meds

42. Digital Rectal
Exam

43. Hodgkin’s Disease

44. Glasgow Coma Scale

49. Points for quick thinking…
Natremias
D
hypErnatremia
hydration
hypOnatremia
verload
I was taught that kalemias do the same as the prefix except for
heart rate and urine output.
EX: HYPERkalemia: bradycardia, oliguria, restlessness,diarrhea,
hyperglycemia,hyperreflexia, increased BP, peaked T waves
HYPOkalemia: tachycardia, polyuria, constipation, hypoglycemia
Calcemias do the opposite of the prefix
EX: HYPOcalcemia causes neuromuscular irritability

50. ……any question?