ASSIGNMENT DNGE 4313

NAME: NURUL NAZIRAH BINTI MOHD NASIR

NO MATRIX: 3046

1) UROFLOWMETRY

DEFINITION

 The uroflowmetry is use to test the amount of urine voided during urination. It also measures
the speed of urination. The test is called a uroflow test. It can help your doctor identify the
causes of certain urinary difficulties

NURSING CARE

BEFORE OF UROFLOWMETRY

1. A physician should explain the procedure of conducting the Uroflowmetry test to the Patient.
2. Generally, no prior preparation, such as fasting or sedation, is required.
3. Tell to the doctor if you’re pregnant and also about all medicines, herbs, vitamins, and any
supplements you’re taking. Certain medications can interfere with bladder function.
4. The patient is instructed to drink about 3-4 glasses of water a couple of hours before the test is
performed to ensure that his bladder is full. In addition, he should not empty his bladder before
arriving for the Uroflowmetry test.
5. Based on the patient’s medical condition, the physician may request other specific preparation.

DURING OF UROFLOWMETRY

1. The nurse needs to urinate into a funnel-shaped device or a special toilet for the uroflow test.
It’s important that you don’t put any toilet tissue on or in the toilet or device.
2. It’s best to urinate as you normally would, without attempting to manipulate the speed or flow
in any way. An electronic uroflowmetry hooked up to the funnel or toilet measures the speed
and quantity of urination. You must not urinate until the machine is turned on.
3. The uroflowmetry calculates the amount of urine you pass, the flow rate in milliliters per
second, and the length of time it takes to empty your bladder completely. It will record this
information on a chart. During normal urination, your initial urine stream begins slowly, speeds
up, and then finally slows down again. The uroflowmetry can record any differences from the
norm to help your doctor make a diagnosis.

AFTER OF UROFLOWMETRY

1. When you’re finished urinating, the machine will report your results. Your doctor will then
discuss the findings with you. Depending on your specific case, you may need to perform the
urine test on several consecutive days.
2. Generally, there is no special type of care required following a Uroflowmetry Test. However, the
physician may give the patient additional or alternate instructions after the Uroflowmetry test,
depending on the situation.
2) CYSTOSCOPY

DEFINITION

 Uses a scope to view the inside of the bladder and urethra. Doctors use cystoscopy to diagnose
and treat urinary tract problems. These problems include bladder cancer, bladder control issues,
enlarged prostates and urinary tract infections.

NURSING CARE

BEFORE CYSTOSCOPY

1. Assess patient’s understanding of the procedure and answer any queries. The procedure is
usually performed in a urology clinic and it takes about 30-45 minutes. Inform the patient who
will perform the test, where it will take place, and other health team members involved in the
care.
2. Obtain informed consent. A written and informed consent is signed prior to the procedure and
before administration of medications.
3. Withhold blood thinning medications. Some examples are aspirin, warfarin (Coumadin),
enoxaparin (Lovenox), heparin
4. Provide instruction for fasting and non-fasting preparation. Unless a general anesthetic has
been ordered, inform the patient that he doesn’t need to restrict food and fluids. If a general
anesthetic will be administered, instruct the patient to fast for at least 6 to 8 hours prior to the
test.
5. Establish an IV line. To allow infusion of fluids, anesthetics, sedatives or emergency
6. Prepare the patient. 
7. Administer sedation and other medications as ordered. Preoperative medications are given 1
hour before the test. Sedative decreases the spasm of the bladder sphincter, reducing the
patient’s discomfort.

AFTER CYSTOSCOPY

1. Monitor and record vital signs. An increase in pulse (tachycardia) and a decrease in blood
pressure (hypotension) may indicate a sign of hemorrhage
2. Assess the patient’s ability to void at least 24 hours after the procedure. Urinary retention may
be secondary to edema as a result from instrumentation.
3. Observe the color of urine. Pink-tnged urine and burning or mild discomfort when urinating
may be experienced for a few voidings after the procedure. This usually resolves within two or
three days.
4. Encourage increased fluid intake as indicated. Fluids will help flush the bladder to decrease the
amount of bleeding and to reduce risk of infection
5. Encourage deep breathing exercises. These exercises may relieve the patient from bladder
spasms.
6. Provide warm sitz baths and administer mild analgesics as ordered. These may relieve urinary
discomfort and promote muscle relaxation.
7. Watch out for signs of serious complications (sepsis, bladder perforation,
hematuria). Persistent, severe flank pain, elevated temperature over 101° F, chills, bright red
blood or clots in the urine, painful urination, or urinary retention must be reported immediately
3) RETROGRADE PYELOGRAM

DEFINITION

 A retrograde pyelogram is an imaging test that uses X-rays to look at your bladder, ureters, and
kidneys. The ureters are the long tubes that connect your kidneys to your bladder.

NURSING CARE BEFORE OF RETROGRADE PYELOGRAM

1. lie flat on a table with your legs up.

2. Then, an intravenous (IV) tube will be inserted in a vein in patient arm to give anesthesia.
3. Fast for a few hours before the procedure. Many doctors will tell you to stop eating and drinking
after midnight on the day of the procedure. You may not be able to eat or drink from 4 to 12
hours before the procedure.
4. Take a laxative. You may be given an oral laxative or an enema to make sure your digestive
system is cleaned out.
5. Take some time off work. This is an outpatient procedure, meaning it only takes a few hours.
However, your doctor will likely give the patient general anesthesia to keep you asleep during
the procedure. The patient probably won’t be able to go to work and will need someone to drive
you home.
6. Stop taking certain medications. Your doctor may tell the patient to stop taking blood thinners
or certain herbal supplements before the test.
7. Make sure to tell your doctor if you’re taking any medications or herbal supplements, if
pregnant or allergic to certain medications, metals, or materials that may be used in the
procedure, such as latex or anesthesia.

NURSING CARE DURING OF RETROGRADE PYELOGRAM

1. Insert an endoscope into your urethra

2. Push the endoscope slowly and carefully through the patient urethra until it reaches into the
bladder, at this point, doctor may also insert a catheter into your bladder
3. Use a process called dynamic fluoroscopy to take X-rays that can be viewed in real time
4. Remove the endoscope (and catheter, if used) from your body

NURSING CARE AFTER OF RETROGRADE PYELOGRAM

1. After the procedure, you’ll stay in a recovery room until you wake up and your breathing, heart
rate, and blood pressure return to normal. Your doctor will monitor your urine for any blood or
signs of complications.
2. The patient either go to a hospital room or be cleared to go home. The doctor may prescribe
pain medication, such as acetaminophen (Tylenol) to manage any pain or discomfort you might
feel when urinating. Don’t take certain pain medications, such as aspirin, that can increase your
risk of bleeding.
3. The doctor may ask you to watch your urine for blood or other abnormalities for a few days to
make sure there are no complications.
4. Call your doctor right away if you notice any of these symptoms:
 high fever (101°F or higher), bleeding or swelling around your urethral opening, unbearable
pain when urinating, blood in your urine and trouble urinating
4) CT (computed tomographic) SCAN

DEFINITION

 Computed tomography (CT) scan is a useful diagnostic tool for detecting diseases and injuries. It
uses a series of X-rays and a computer to produce a 3D image of soft tissues and bones.
NURSING CARE

BEFORE OF CT (computed tomographic) SCAN

1. Informed Consent. Obtain an informed consent properly signed.

2. Look for allergies. Assess for any history of allergies to iodinated dye or shellfish if contrast
media is to be used.
3. Get health history. Ask the patient about any recent illnesses or other medical conditions and
current medications being taken. The specific type of CT scan determines the need for an oral or
I.V. contrast medium
4. Check for NPO status. Instruct the patient to not to eat or drink for a period amount of time
especially if a contrast material will be used.
5. Get dressed up. Instruct the patient to wear comfortable, loose-fitting clothing during the exam.
6. Provide information about the contrast medium. Tell the patient that a mild transient pain from
the needle puncture and a flushed sensation from an I.V. contrast medium will be experienced.
7. Instruct the patient to remain still. During the examination, tell the patient to remain still and to
immediately report symptoms of itching, difficulty breathing or swallowing, nausea, vomiting,
dizziness, and headache.
8. Inform about the duration of the procedure. Inform the patient that the procedure takes from
five minutes to one hour depending on the type of CT scan and his ability to relax
DURING OF CT (computed tomographic) SCAN

1. The patient will lie on your back on a table (like a bed). If the patient test requires it, a
healthcare provider may inject the contrast dye intravenously (into your vein). This dye can
make you feel flushed or have a metallic taste in your mouth.
2. When the scan begins, the bed slowly moves into the doughnut-shaped scanner. At this point,
the patient will need to stay as still as possible because movement can create blurry images.
3. The scanner takes pictures of the area the healthcare provider needs to see. Unlike an MRI scan,
a CT scan is silent.
4. When the exam is over, the table moves back out of the scanner.

AFTER OF CT (computed tomographic) SCAN

1. Monitor patient
2. Diet as usual. Instruct the patient to resume the usual diet and activities unless otherwise
ordered.
3. Encourage the patient to increase fluid intake (if a contrast is given). This is so to promote
excretion of the dye.
5) RENAL BIOPSY

DEFINITION

 A kidney biopsy is a procedure to remove a small piece of kidney tissue that can be examined
under a microscope for signs of damage or disease.
 The doctor may recommend a kidney biopsy — also called renal biopsy — to diagnose a
suspected kidney problem. It may also be used to see how serious a kidney condition is, or to
monitor treatment for kidney disease.

NURSING CARE

BEFORE OF RENAL BIOPSY

1. Tell the doctor about any prescription drugs, over-the-counter medications, and herbal
supplements that patient taking. The patient should discuss with them whether you should stop
taking them before and during the test, or if you should change the dosage.
2. The doctor may provide special instructions if the patient taking medications that could affect
the results of the renal biopsy. These medications include:
 anticoagulants (blood thinners)
 nonsteroidal anti-inflammatory drugs, including aspirin or ibuprofen
 any medications that affect blood clotting
 herbal or dietary supplements
3. Tell the doctor if you’re pregnant or think you might be pregnant. Also,
4. Before the patient do renal biopsy, the patient have to take a blood test and provide a urine
sample. This ensures that you don’t have any preexisting infections.
5. The patient need to fast from food and drink for at least eight hours prior to your kidney biopsy.
6. If the patient will given a sedative to take at home before the biopsy, the patient won’t be able
to drive yourself to the procedure and need to arrange for transportation.

DURING OF RENAL BIOPSY

1. Remove the clothing and put on a hospital gown.

2. An IV (intravenous) line may be started in your arm or hand.
3. The patient will lie on your stomach so that the healthcare provider can easily reach the kidney.
A pillow may be used to hold you in the right position. If you have a transplanted kidney, you
will lie on your back.
4. The skin over the biopsy site will be cleaned with an antiseptic solution.
5. The patient will feel a needle stick when the local anesthetic is injected. This may cause a brief
stinging feeling.
6. The patient will need to lie still during the procedure.
7. Ultrasound or X-ray may be used to guide the needle into the kidney.
8. The patient will be asked to breathe in and hold your breath while the healthcare provider
inserts the biopsy needle into the kidney. This prevents movement of the diaphragm, which may
interfere with the placement of the biopsy needle.
9. The patient may feel mild pain or pressure when the healthcare provider takes the sample.
 10. There may be more than one puncture if the healthcare provider needs more than one tissue
sample. If so, the same puncture process will be repeated
11. When the needle is removed, firm pressure will be applied to the biopsy site to stop bleeding.
12. A sterile bandage or dressing will be applied.
13. The kidney tissue sample will be sent to the lab for testing.

AFTER OF RENAL BIOPSY

1. may be taken to the recovery room and watched closely as the anesthesia wears off. Once your
blood pressure, pulse, and breathing are stable and the patient are alert, you may be taken to a
hospital room or discharged to home
2. The nurse will encourage the patient to lie on your back for several hours. A nurse will check
your urine for signs of bleeding. The patient may have blood tests to check for internal bleeding.
The patient may be discharged later the same day or the next day. If patient had a sedative or
anesthetic, plan to have someone drive patient home.
3. The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for
soreness as advised by healthcare team. The doctor may be told to not take aspirin or certain
other pain medicines that may raise the chance of bleeding. Be sure to take only advised
medicines.
4. Tell your healthcare team to report any of the following:
 Blood in your urine after the first 24 hours
 Inability to urinate
 Fever or chills
 Redness, swelling, or bleeding or other drainage from the biopsy site
 Increased pain around the biopsy site or elsewhere
 Feeling faint
5. May get back to your normal diet unless told otherwise.
6. Healthcare team may ask patient to rest for a day or two. Don't do strenuous physical activity
for several days. Don't do any type of “bouncing" activities, such as jogging, aerobics, playing
tennis, or horseback riding for a couple of weeks to prevent bleeding of the biopsy site.

6) RENAL ANGIOGRAM

DEFINITION

 A renal angiogram is an imaging test to look at the blood vessels in your kidneys. Your
healthcare provider can use it to look at the ballooning of a blood vessel (aneurysm), narrowing
of a blood vessel (stenosis), or blockages in a blood vessel. He or she can also see how well
blood is flowing to your kidneys.

NURSING CARE

BEFORE OF RENAL ANGIOGRAM

1. Healthcare provider will explain the procedure to the patient.

2. The patient may be asked to sign a consent form that gives permission to do the procedure.
Read the form carefully and ask questions if anything is not clear.
 3. The patient asked to not eat or drink liquids (fast) before the procedure. Your healthcare
provider will tell you how long to fast. It might be several hours or overnight.
4. Tell to the provider if you are pregnant or think you may be.
5. Tell to the healthcare provider if you are allergic to contrast dye or iodine.
6. Tell the healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, or
anesthetic drugs (local and general).
7. Tell the provider about all medicines you are taking. This includes prescriptions, over-the-
counter medicines, and herbal supplements.
8. Tell to the healthcare provider if you have had a bleeding disorder. Also tell your provider if you
are taking blood-thinning medicine (anticoagulant), aspirin, or other medicines or herbal
supplements that affect blood clotting. You may need to stop these medications before the test.
9. The patient may get medicine to help you relax (sedative) before the test.
10. Depending on the site used for injection of the contrast dye, the recovery period may last up to
12 to 24 hours. You may need to spend the night.
11. The patient may need a blood test before the procedure to see how long it takes your blood to
clot. You may also need other blood tests.
12. Follow any other instructions from provider gives the patient to get ready.

DURING OF RENAL ANGIOGRAM

1. The patient will be asked to remove any clothing, jewelry, or other objects that might get in the
way of the test.
2. The patient will be given a gown to wear.
3. The patient will be asked to empty your bladder before the test.
4. The patient will lie on the X-ray table.
5. An intravenous (IV) line will be started in the patient arm or hand.
6. The patient will be connected to an EKG monitor. It will record the electrical activity of your
heart during the test. Medical staff will watch your heart rate, blood pressure, and breathing
rate during the test.
7. The radiologist will check your pulses below the injection site for the contrast dye. He or she will
use a marker to note them. This is so that staff can check the circulation to the limb below the
site after the test.
8. The nurse or technician will shave the skin in an area of your groin. He or she will clean the skin
and inject local pain medicine. The radiologist will put a needle into an artery in your groin.
Sometimes an artery in the elbow area may be used instead. If the elbow site is used, a blood
pressure cuff will be put on your arm below the IV site. It will be inflated to keep the contrast
dye from going into your lower arm.
9. The radiologist will put a long thin tube (catheter) into the artery. He or she will move the
catheter into the aorta near the renal arteries. The radiologist will use fluoroscopy to see where
the catheter is.
10. The radiologist will inject the contrast dye. The patient may feel a flushing sensation, a salty or
metallic taste in the mouth, a brief headache, or nausea or vomiting. These effects usually last
for a few moments.
11. Tell the radiologist if you have trouble breathing, or if you have sweating, numbness, or heart
palpitations.
12. The radiologist will take several sets of X-rays pictures. The first set shows the arteries. The
second set shows the blood flow in the capillaries and veins.
 13. Depending on the study being done, you may need more injections of contrast dye.
14. Once the test is done, the radiologist will remove the catheter. He or she will put pressure on
the site to keep the artery from bleeding.
15. After the bleeding stops, he or she will put a dressing on the site. The radiologist may put
something heavy on the site for a period of time. This will help stop bleeding and keep blood
from collecting (hematoma) at the site.

AFTER OF RENAL ANGIOGRAM

1. The patient will be taken to the recovery room. A nurse will watch your vital signs and the
injection site. He or she will check the circulation and sensation in the leg where the catheter
was used.
2. The patient will need to lie flat in bed for several hours after the test. The leg or arm used for
the injection site will be kept straight for up to 12 hours.
3. The patient may be given pain medicine to ease pain or discomfort from the injection site or
from having to lie flat and still.
4. The patient be told to drink water and other fluids to help flush the contrast dye from your body
5. When patient leave the recovery room, the patient may go to a hospital room or be sent home.
If you had the test done as an outpatient, the patient will need to have someone drive you
home.
6. You may go back to your usual diet and activities after the test, unless your healthcare provider
tells you otherwise.