DIAGNOSTIC PROCEDURE

1. Blood Chemistry
It is a test done to determine malfunctioning in the serum level of all elements or
aspect comprising the blood.

(December 18, 2009)

Test Normal Value Unit Found Value Analysis

Blood Urea Nitrogen 1.7 – 8.3 mmol/ L 6.63 Normal

Creatinine 44.2 – 150.3 umol/L 178.36 High
Sodium 136-150 mmol/ L 136.00 Normal
Potassium 3.4 – 5.3 mmol/ L 4.80 Normal
Chloride 96 -106 mmol/ L 97.00 Normal

Nursing Analysis:
An abnormal elevation of creatinine in the serum blood level means a
malfunction of the kidney – commonly related to some renal disorder like
Pyelonephritis. Also in Congestive heart Failure there is an increased serum creatinine
which is caused by a decrease in the volume of blood in the kidneys, which result in
decrease GFR. The creatinine cannot be excreted in normal amounts and the serum
level rises.

Nursing Responsibility Rationale

1. Check doctor’s order. To know the procedures to be done to
the patient.
2. Inform and explain the procedure to the To gain her cooperation and to increase
patient. her understanding about the procedure
to be done.
3. Patient is placed NPO post midnight Ingestion of foods and fluids may
before the procedure. influence test results.
4. Fill up laboratory request form properly To notify the medical technologist for
and be sure to forward it to the laboratory scheduling of the procedure.
as early as possible.
5. After the procedure, applying pressure or Venipuncture site for this procedure
dressing in the venipuncture site is needed. includes extraction of blood from large
Instruct client to avoid a forceful veins in the arm, a forceful or sudden
movement on the arm where the movement after the extraction, may
venipuncture had made. result a bleeding from the site.
6. Upon the arrival of the result, refer it to For the physician to determine
the physician and make sure that result appropriate management for the
form is attached properly to chart. condition of the patient.
2. Urinalysis
Is a useful urologic test which is an essential component of physical examinations
and hospital admission workups. Results may provide a tentative diagnosis, indicate
further studies, or monitor the progression of a diagnosed diseased.

PHYSICAL EXAMINATION

(December 19, 2009)

Urine Normal Value Found Value Analysis

Color Yellow Yellow Normal

Clarity Clear Turbid Abnormal
Specific gravity 1.003 – 1.035 1.025 Normal
pH 4.6 – 8 5.0 Normal

CHEMICAL EXAMINATION

(December 19, 2009)

Urine Normal Value Found Value Analysis

Protein Negative (+) 3 Abnormal

Glucose Negative (+) 1 Abnormal
Haemoglobin Negative (+) 4 Abnormal
Ketone Negative (+) 1 Abnormal
Nitrite Negative Negative Normal
Bilirubin Negative Negative Normal
Urobilinogen Negative Negative Normal
Leuko esterase Negative Negative Normal

MICROSCOPIC EXAMINATION

(December 19, 2009)

Urine Normal Value Found Value Analysis

WBC 0-5 8-10 High

RBC 0-3 18-20 High
Epithelial cells Few Moderate
Bacteria ----- Many
Mucus Threads ----- Many
Renal Cells ----- Many
Nursing Analysis:
Results shows on the physical examination, that the urine is turbid – Cloudy
urine is usually caused by the presence of pus, RBC’s or bacteria which is evidently seen
in the microscopic examination, wherein, WBC and RBC levels are high and many
bacteria’s were noted. Also that mucus threads and renal cells are also many which
indicate also irritation of urinary tract lining by certain bacterias.
On the chemical examination deviations were noted, certain chemical contents
that should not be notably excreted in the urine were seen. Our client is having:
Protenuria which is a sensitive indicator of kidney dysfunction. Normally protein is not
present in the urine, because the spaces in the normal glomerular filter membrane are
too small to allow its passage. In pyelonephritis, glomerular membranes were injured
thus the spaces becomes much larger and protein is allowed to seep out into the filtrate
and then the urine. Glycosuria happens when the blood glucose level exceeds it spill
over into the urine. As the blood glucose level increases further, the amount of glucose
in the urine also increases. Glycosuria is also triggered by the presence of infection –
pyelonephritis. Ketonuria is noted on the examination, like glycosuria if there is an
increase amount of ketone in the blood it spills over to the urine. Ketonuria is also seen
in clients with excessive aspirin ingestion – since our client is taking Aspirin as his
maintenance dose for her RHD since she was 13 years old, there is already excessive
amount of aspirin contents on her system, eventually resulting to ketonuria. Hematuria
is seen on conditions of pyelonephritis.

Nursing Responsibilities Rationale

1. Explain to the client the procedure to Obtaining the urine and putting it to desired
be done – on the importance of taking receptacle to avoid contamination. To have
the midstream urine. Provide the better/ accurate results.
specimen bottle.
2. Inform the client to collect the Urine is usually concentrated and more likely
specimen during her first urination on to reveal any abnormalities and formed
the morning. substances in the morning.
3. Instruct the client to observe aseptic To avoid contamination of the specimen.
technique upon urine collection.
4. Cover and label the specimen bottle Urine usually expires when validity time is
properly and sent it to the laboratory exceeded. Expired urines may bring about
immediately. false results.
5. Notify the physician as soon the For the physician to determine appropriate
result is received. medical intervention for the patient.
3. Fasting Blood Sugar Test
Is a carbohydrate metabolism test which measures plasma, or blood, glucose
levels after a fast. The body will produce and process insulin to counteract the rise in
glucose levels.
This procedure was ordered because our client has a glycosuria, which is
commonly seen on diabetic patients. FBS Test is usually used on testing diabetic clients,
thus, our client is suspected to have DM because of the presence of glucose in the urine.

(December 20, 2009)

Chemistry Normal Values Found Value Analysis

Glucose, FBS 4.20 – 6.40 6.19 Normal

Nursing Analysis:
The result was normal

Nursing Responsibilities Rationale

1. Explain the procedure to the client. To gain cooperation from the client.
2. Placed the client at NPO post Since, it is FBS Test the patient is required to
midnight. fast. Ingestion of foods and fluids may
influence test results.
3. FBS monitoring should be done on The patient is on NPO. Postponed schedules
time. (morning) may bring negative effect to the patient.
5. Notify the physician as soon the For the physician to determine appropriate
result is received. medical intervention for the patient.

4. KUB – UTZ (Kidney, Ureters and Bladder Ultrasound)

It is a safe, non-invasive diagnostic technique that enables visualization of the
structure and function of organs within the body (kidney, ureters and bladder). It is one
way of diagnosing or ruling out suspected disease and as confirmatory test of suspected
disease as well.

Findings:

The right kidney measures 10.2 x 4.40 cm. The left kidney measures 11.0
x 4.9 cm. Both kidneys are normal in size, contour and location. The renal critical
thickness is adequate. Parenchymal echopattern is slightly echogenic but still
with delineable corticomedullary junctions. Both central echocomplexes are
undilated no nephrolithiasis of focal lesion observed. Perinephric regions are
unremarkable.
The urinary bladder is adequately filled. No intravesical echoes detected.
Minimal ascites is detected in the pelvic region.
 Impressions:

Mild renoparenchymal change

Minimal pelvic ascites

Nursing Analysis:

Nursing Responsibilities Rationale

1. Check doctor’s order. To know what procedure to be done.
2. Explain the procedure to the patient. To gain her cooperation.
3. Instruct client to have light meals No food or fluid restriction on this
(dinner and breakfast). procedure.
4. Client is given 60 cc castor oil an hour To evacuate contents that may interfere
before sleep and 2 dulcolax with the procedure. To get accurate results.
suppositories early AM.
5. Instruct client to drink plenty of Full bladder is needed for the procedure.
water and ignore the urge to void.
6. Instruct client to go to the X-ray/ Procedure should be done at the exact time.
Ultrasound Room few minutes before
the scheduled procedure.

5. Urine Gram Staining/ Culture and Sensitivity Test

Bacteriology Result Form Specimen: Urine

Date Required: December 19, 2009 Date Reported: December 21, 2009
Gram Stain:
Gram (-) bacilli Many
Epithelial cells Many
WBC Many
Culture: X
Aerobic: X
Results: No growth after 48 hours of incubation
Susceptibility Test Results: (Disk Diffusion): ____________

Nursing Analysis:
Pyelonephritis –as shown by the result above is caused by gram (-) bacilli.
As a result, an increased in epithelial cells and WBC happens to respond on the
infection pocess.
 Nursing Responsibilities Rationale
1. Check doctor’s order. To know responsibilities to be done.
2. Prepare request form. For the laboratory personnel can schedule
the test.
3. Explain to the client the procedure to To have a better result.
be done – on the importance of taking
the midstream urine.
4. Inform the client to collect the Urine is usually concentrated and more likely
specimen during her first urination on to reveal any abnormalities and formed
the morning. substances in the morning.
5. Instruct the client to observe aseptic To avoid contamination of the specimen.
technique upon urine collection.
6. Cover and label the specimen bottle Urine usually expires when validity time is
properly and sent it to the laboratory exceeded. Expired urines may bring about
immediately. false results.
7. Notify the physician as soon the For the physician to determine appropriate
result is received. medical intervention for the patient.