Ultrasound, Bladder and Ureters

Bladder Sonography Definition: Bladder ultrasound evaluates disorders of the bladder, such as masses or lesions. Bladder position, structure, and size are examined with the use of high-frequency waves of various intensities delivered by a transducer, a flashlight-shaped device, pressed against the skin. Indications: Assess residual urine after voiding to diagnose urinary tract obstruction causing overdistention Detect tumor of the bladder wall or pelvis, as evidenced by distorted position or changes in bladder contour Determine end-stage malignancy of the bladder caused by extension of a primary tumor of the ovary or other pelvic organ Evaluate the cause of urinary tract infection, urine retention, and flank pain Evaluate hematuria, urinary frequency, dysuria, and suprapubic pain Measure urinary bladder volume by transurethral or transvaginal approach Contraindications: Patients with latex allergy; use of the vaginal probe requires the probe to be covered with a condom-like sac, usually made from latex Preparation: 1. Obtain a history of the patients complaints, including a list of known allergens (especially allergies or sensitivities to latex) and report immediately to the health practitioner. 2. Obtain a history of the patients genitourinary, reproductive, and gastrointestinal systems, as well as results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures. 3. Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hours between administration of barium and this test.

Fig 1. Small right-sided vesical diverticulum in the bladder

4. For the transvaginal approach, inform the patient that a latex or sterile sheath-covered probe will be inserted into the vagina. 5. Instruct the patient to remove jewelry (including watches), hairpins, credit cards, and other metallic objects in the area to be examined. 6. Abdominal ultrasound to drink five to six glasses of fluid 90 minutes before the procedure, and not to void before the procedure. Patients receiving transvaginal ultrasound only do not need to have a full bladder. Procedure: 1. Prior to performing the procedure, introduce self and verify the clients identity. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Discuss the purpose of the procedure. 2. Perform hand hygiene and observe other appropriate infection control procedures. 3. Provide for client privacy. 4. Place the patient in the supine position on an exam table; other positions may be used during the examination. The right- or left-side-up position allows gravity to reposition the liver, gas, and fluid to facilitate better organ visualization. 5. Expose the abdomen area and drape the patient. 6. Transabdominal approach: Conductive gel is applied to the skin, and a transducer is moved over the skin while the bladder is distended to obtain images of the area of interest. The sound wave images are projected on the screen and stored electronically or reproduced on film. 7. Transvaginal approach: A covered and lubricated probe is inserted into the vagina and moved to different levels. Images are obtained and recorded. 8. Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath. 9. The results are recorded manually, on film, or in a computerized system for recall and postprocedure interpretation by the appropriate health care practitioner. 10. A written report of the examination will be completed by a health care practitioner specializing in this branch of medicine. The report will be sent to the requesting health care practitioner, who will discuss the results with the Fig.2. Multiple calculi in the lower ureter patient. Aftercare: 1. When the study is completed, remove the gel from the skin. 2. If the patient is to be examined for residual urine volume, ask the patient to empty the bladder; repeat the procedure and calculate the volume.

Ultrasound, Kidney
Renal Sonography; Renal Ultrasound Definition: Renal ultrasound is used to evaluate renal system disorders. It is valuable for determining the internal components of renal masses (solid versus cystic) and for evaluating other renal diseases, renal parenchyma, perirenal tissues, and obstruction.
Fig 3. a normal kidney

Indications: Aid in the diagnosis of the effect of chronic glomerulonephritis and endstage chronic renal failure on the kidneys (e.g., decreasing size) Detect an accumulation of fluid in the kidney caused by backflow of urine, hemorrhage, or perirenal fluid Detect masses and differentiate between cysts or solid tumors, as evidenced by specific waveform patterns or absence of sound waves Determine the presence and location of renal or ureteral calculi and obstruction Determine the size, shape, and position of a nonfunctioning kidney to identify the cause Evaluate or plan therapy for renal tumors Evaluate renal transplantation for changes in kidney size Locate the site of and guide percutaneous renal biopsy, aspiration needle insertion, or nephrostomy tube insertion Monitor kidney development in children when renal disease has been diagnosed Provide the location and size of renal masses in patients who are unable to undergo IVP because of poor renal function or an allergy to iodinated contrast medium Preparation: 1. Obtain a history of the patients complaints, including a list of known allergens and report immediately to the health practitioner. 2. Obtain a history of the patients genitourinary system, as well as results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures.

3. Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hours between administration of barium and this test. 4. Instruct the patient to remove jewelry (including watches), hairpins, credit cards, and other metallic objects in the area to be examined.

Procedure: 1. Prior to performing the procedure, introduce self and verify the clients identity. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Discuss the purpose of the procedure. 2. Perform hand hygiene and observe other appropriate infection control procedures. 3. Provide for client privacy. 4. Place the patient in the supine position on an exam table; other positions may be used during the examination. The right- or left-side-up position allows gravity to reposition the liver, gas, and fluid to facilitate better organ visualization. 5. Expose the abdomen area and drape the patient. 6. Conductive gel is applied to the skin, and a transducer is moved over the skin while the bladder is distended to obtain images of the area of interest. The sound wave images are projected on the screen and stored electronically or reproduced on film. 7. Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath. 9. The results are recorded manually, on film, or in a computerized system for recall and postprocedure interpretation by the appropriate health care practitioner. 10. A written report of the examination will be completed by a health care practitioner specializing in this branch of medicine. The report will be sent to the requesting health care practitioner, who will discuss the results with the patient. Aftercare: 1. When the study is completed, remove the gel from the skin.

Ultrasound, Prostate
Prostate Sonography Definition: Prostate ultrasound is used for the evaluation of disorders of the prostate, especially in response to an elevated concentration of
Fig 4. Prostate Calcification

prostatespecific antigen on a blood test and as a complement to a digital rectal examination. It uses high-frequency waves of various intensities delivered by a transducer, a candle-shaped device, which is lubricated, sheathed with a condom, and inserted a few inches into the rectum. Indications: Aid in the diagnosis of micturition disorders Aid in prostate cancer diagnosis Assess prostatic calcifications Assist in guided needle biopsy of a suspected tumor Assist in radiation seed placement Determine prostatic cancer staging Detect prostatitis

Contraindications: Patients with latex allergy; use of the rectal probe requires the probe to be covered with a condom, usually made from latex. Preparation: 1. Obtain a history of the patients complaints, including a list of known allergens and report immediately to the health practitioner. 2. Obtain a history of the patients genitourinary system, as well as results of previously performed laboratory tests, surgical procedures, and other diagnostic procedures. 3. Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hours between administration of barium and this test. 4. Inform the patient that a latex or sterile sheath-covered probe will be inserted into the rectum. 5. Instruct the patient to remove jewelry (including watches), hairpins, credit cards, and other metallic objects in the area to be examined. 6. Patient should be instructed to void prior to the procedure. Procedure: 1. Prior to performing the procedure, introduce self and verify the clients identity. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate. Discuss the purpose of the procedure. 2. Perform hand hygiene and observe other appropriate infection control procedures. 3. Provide for client privacy.

4. Place the patient in the supine position on an exam table; other positions may be used during the examination. 5. Expose the abdomen area and drape the patient. 6. Cover the rectal probe with a lubricated condom and insert it into the rectum. Inform the patient that he may feel slight pressure as the transducer is inserted. Water may be introduced through the sheath surrounding the transducer. The scan is performed at several levels. 7. Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath. 9. The results are recorded manually, on film, or in a computerized system for recall and postprocedure interpretation by the appropriate health care practitioner. 10. A written report of the examination will be completed by a health care practitioner specializing in this branch of medicine. The report will be sent to the requesting health care practitioner, who will discuss the results with the patient. Aftercare: 1. When the study is completed, remove the gel from the skin. References: Kozier et. al. (2008). Kozier & Erbs Fundamentals of Nursing, 8th Edition. Jurong, Singapore: Pearson Education South Asia Pte Ltd. Leeuwen et. al. (2006). Daviss Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications, 2nd Edition. Philadelphia, USA: F.A Davis Company.