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.
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
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
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
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)
22.
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)
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
28.
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.
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.
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
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
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