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ASSIGNMENT OF MEDICAL SURGICAL ( Diagnostic Evaluation )

1. URINE STUDIES
Urinalysis
(Immunology form) Urinalysis are the process used to examine urine using chemical and physical means. It is a useful screening tool for diseases such as urinary tract infactions, renal disease, and other diseases of the body which result in the formation of compounds that can be detected in the urien at abnormal level. This is used as atool to assess patient for early signs of disease, not only concerning the genitourinary tract but also diseases of other organs. A dipstick examination of the urine is the standard screening test for haematuria. To get the accurate result, the patient must inform the doctor about the drug that they are taking, since some of these can effect result. The clean catch means that the sample shoulde be taken without contamination from the external genitals, and the mid stream urine means that only the middle part of the urine stream is collected. Therefore it is important to clean the external genitalia in both males and females before urinating to prevent contamination. It is important the urine sample is analysed within 30-60 mins of collection.

Urine Culture
(Bacterial and Microbiology form) To determine the presence of microorganism, the type of organisms and the antibiotics to which the organisms are sensitive. Assess the colour, odor, and consistency of the urine and the presence of clinical signs of urinary tract infection. Wash the perineal area with soap and water, rinse and dry. Assist the client onto a clean commode or bedpan. If using a bedpan or urinal, position the client as upright allowed or tolerated. Instruct the client to start voiding. Place the specimen container into the midstream of urine and collect the speciment, taking care not to touch the container to the perineum or panis. Collect urine in the container. Cap the container tightly, touching only the outside of the container and the cap. NORMAL VALUE OF THE URINE Specific gravity Urine pH Osmolality 1.010 1.025 Acid ( 6pH ) 500 800 mOsm/kg

2. BLOOD INVESTIGATION
( Borang Pathology Kimia : Kecemasan / Ujian am: Pathology Kimia Am) Serum electrolytes are often routinely ordered for any client addmitted to a hospital as a screening test for electrolyte and acid-base imbalances. Serum electrolytes also are routinely assessed for clients at risk in the community, for example, clients who are being treated with a diuretic for hypertension or heart failure. The most commonly ordered serum tests are for sodium, potassium, chloride, and bicarbonate ions. Blood levels of two metabolically produced substances, urea and creatinine, are routinely used to evaluate renal function. Urea, the end product of protein metabolism, is measured as blood urea nitrogen ( BUN ). Creatinine is produced in relatively constant quantities by the muscle and is excreted by the kidneys. Thus, the amount of cretinine in the blood relates to renal excretory function. Renal function is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate(GFR) describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr or CrCl) is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the GFR. Creatinine clearance exceeds GFR due to creatinine secretion, which can be blocked by cimetidine. In alternative fashion, over estimation by older serum creatinine methods resulted in an underestimation of creatinine clearance, which provided a less biased estimate of GFR Both GFR and CCr may be accurately calculated by comparative measurements of substances in the blood and urine, or estimated by formulas using just a blood test result (eGFR and eCCr). The results of these tests are important in assessing the excretory function of the kidneys. For example, grading of chronic renalinsufficiency and dosage of drugs that are excreted primarily via urine are based on GFR (or creatinine clearance). It is commonly believed to be the amount of liquid filtered out of the blood that gets processed by the kidneys. In physiological terms, these quantities (volumetric blood flow and mass removal) are related only loosely. NORMAL VALUE OF THE BLOOD INVESTIGATION Sodium Potassium Chloride Calcium Magnesium Phosphate Serum osmolality 135 145 mEq/L 3.5 5.0 mEq/L 95-105 mEq/L 4.5-5.5 mEq/L @ 8.5-10.5 mEq/dL 1.5-2.5 mEq/L@ 1.6-2.5 mg/dL 1.8-2.6 mEq/L 280-300 mOsm/kg water

3. NON INVASIVE
KUB x-ray
KUB is typically used to investigate gastrointestinal conditions such as a bowel obstruction and gallstones, and can detect the presence of kidney stones. The KUB is often used to diagnose constipation as stool can be seen readily. The KUB is also used to assess positioning of indwelling devices such as ureteric stents and nasogastric tubes. KUB is also done as a scout film for other procedures such as barium enemas.

Ultra sound
An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer receives these reflected waves and uses them to create a picture. Unlike with an x-ray or CT scan, there is no ionizing radiation exposure with this test. The test is done in the ultrasound or radiology department. The patient will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. A handheld probe called a transducer is moved over the area being examined. The patient may be asked to change position so that other areas can be examined. The patient should wear comfortable, loose-fitting clothing for the ultrasound exam. The patient needs to remove all clothing and jewelry in the area to be examined. . Other preparation depends on the type of examination the patient will have. For some scans the doctor may instruct the patient not to eat or drink for as many as 12 hours before the appointment. For others the patient need to drink up to six glasses of water two hours prior to your exam and avoid urinating so that the patient bladder is full when the scan begins.

MRI
Magnetic resonance imaging (MRI) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD. MRI does not use ionizing radiation (x-rays). Detailed MR images allow physicians to better evaluate various parts of the body and determine the presence of certain diseases that may not be assessed adequately with other imaging methods such as x-ray and ultrasound .

Purpose of MRI :
MR imaging of the body is performed to evaluate: organs of the chest and abdomenincluding the heart, liver, biliary tract, kidneys, spleen, bowel,pancreas and adrenal glands. pelvic organs including the reproductive organs in the male (prostate and testicles) and the female (uterus, cervix and ovaries). blood vessels (MR Angiography). breasts. Physicians use the MR examination to help diagnose or monitor treatment for conditions such as: tumors of the chest, abdomen or pelvis. certain types of heart problems. blockages, enlargements or anatomical variants of blood vessels, including the aorta, renal arteries, and arteries in the legs. diseases of the liver, such as cirrhosis and tumors, and that of other abdominal organs, including the bile ducts, gallbladder, and pancreatic ducts. diseases of the small intestine, colon, rectum and anus. cysts and solid tumors in the kidneys and other parts of the urinary tract. tumors and other abnormalities of the reproductive organs (e.g., uterus, ovaries, testicles, prostate). causes of pelvic pain in women, such as fibroids, endometriosis and adenomyosis. suspected uterine congenital abnormalities in women undergoing evaluation for infertility. breast cancer and implants. fetal assessment in pregnant women.

PREPARATION:
The patient must wear a gown during the exam or the patients cloth if it is loosefitting and has no metal fasteners. The patient needs to remove all clothing and jewelry in the area to be examined. Assess the history taking such as health history or if the patient has the allergic with any drug such as allergy to iodine or x-ray contrast material, drugs, food, the environment, or asthma. Asses if the patient is pregnant or not. Pregnant women should not have this exam unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of contrast material. In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area unless explicitly instructed to do so by a radiologist or technologist who is aware of the presence of any of the following: internal (implanted) defibrillator or pacemaker cochlear (ear) implant some types of clips used on brain aneurysms some types of metal coils placed within blood vessels

BIOPSY
A biopsy is the removal of a small piece of tissue for laboratory examination to detact any disease, such as cancer, but it depends on the biopsy test. An abnormal biopsy means that the tissue or cells have an unusual structure, shape, size, or condition.

PROCEDURE :
A needle (percutaneous) biopsy removes tissue using a hollow tube called a syringe. A needle is passed several times through the tissue being examined. The surgeon uses the needle to remove the tissue sample. Needle biopsies are often done using x-rays (usually CT scan or ultrasound), which guide the surgeon to the right area. An open biopsy is a surgical procedure that uses local or general anesthesia. This means the patient are relaxed (sedated) or asleep and pain-free during the procedure. The procedure is done in a hospital operating room. The surgeon makes a cut into the affected area, and the tissue is removed. Closed biopsy uses a much smaller surgical cut than open biopsy. A small cut is made so that a camera-like instrument can be inserted. This instrument helps guide the surgeon to the right place to take the sample.

PREPARATION :
Determine the psychologist. Give the education and information to the patient regarding the procedure. Collect and document the patients past history. Sing the informed consent from the patient. Ask the patient to stop taking the anti-platelet drug such as asparin and heparin before make the biopsy test. Make sure the laboratory investigation that needed.

RISK :
Bleeding Infection

CYTOSCOPY
A cystoscopy is an examination of the inside of the bladder and urethra, the tube that carries urine from the bladder to the outside of the body.

In men, the urethra is the tube that runs through the penis. The doctor performing the examination uses a cystoscope-a long, thin instrument with an eyepiece on the external end and a tiny lens and a light on the end that is inserted into the bladder.

The doctor inserts the cystoscope into the patients urethra, and the small lens magnifies the inner lining of the urethra and bladder, allowing the doctor to see inside the hollow bladder. Many cystoscopes have extra channels within the sheath to insert other small instruments that can be used to treat or diagnose urinary problems.

PURPOSES :-

Blood in the urine (hematuria) Inability to control urination (incontinence) Urinary tract infection Signs of congenital abnormalities in the urinary tract Suspected tumors in the bladder Bladder or kidney stones Signs or symptoms of an enlarged prostate Pain or difficulty urinating (dysuria) Disorders of or injuries to the urinary tract Symptoms of interstitial cystitis

BEFORE PROSEDURE :

Talk with the doctor to ask questions and receive instructions Sign a consent form Urine sample before cytoscopy to check for infection and to avoid urinating for an hour before this part of the procedure.
Wear a hospital gown during the procedure and the lower part of the body is

covered with a sterile drape The region of the urethra is cleansed and a local anesthetic is applied

A sedative may be given about one hour prior to the operation to help the patient relax

URING PROSEDURE : After a local anesthetic is used to take away sensation in the ureter, the doctor gently inserts the tip of the cystoscope into the urethra and slowly glides it up into the bladder. A sterile liquid-water or salt water, called saline-flows through the scope to slowly fill the bladder and stretch it so the doctor has a better view of the bladder wall. As the bladder is filled with liquid, patients feel some discomfort and the urge to urinate. The doctor may then release some of the fluid, or the patient may empty the bladder as soon as the examination is over. The time from insertion of the scope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to treat it. Taking a biopsy-a small tissue sample for examination with a microscope-will also make the procedure last longer. In most cases, the entire examination, including preparation, takes 15 to 30 minutes.

AFTER PROSEDURE : Patients may have a mild burning feeling when they urinate, and the patients may see small amounts of blood in their urine. These problems should not last more than 24 hours. Patients should tell their doctor if bleeding or pain is severe or if problems last more than a day. Drink two 8-ounce glasses of water each hour for 2 hours. Taking a bath or using a warm, damp washcloth to relieve the burning feeling. Report any problems, such as : o bloody urine that lasts more than 24 hours after the test o severe pain o chills o fever Rest and refrain from driving for several days, especially if general anesthesia was used. Expect any blood in the urine to clear up in one to two days. Avoid strenuous exercise during recovery. Postpone sexual relations until the urologist determines that healing is complete.

RISK :
Bleeding Damaged urethra Perforated bladder Urinary tract infection Injured penis.