Kidney, Ureter, and Bladder Study

General

Synonym/Acronym:
flat plate of the abdomen, KUB, plain film of the abdomen.

Rationale
To visualize and assess the abdominal organs for obstruction or abnormality related to mass, trauma, bleeding, stones, or congenital anomaly.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

  • Normal size and shape of kidneys
  • Normal bladder, absence of masses and renal calculi, and no abnormal accumulation of air or fluid.

Critical Findings and Potential Interventions

  • Bowel obstruction
  • Ischemic bowel
  • Visceral injury

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Overview

(Study type: X-ray, plain; related body system: Digestive and urinary systems.)

A KUB x-ray examination provides information regarding the structure, size, and position of the abdominal organs; it also indicates whether there is any obstruction or abnormality of the abdomen caused by disease or congenital malformation. Calcifications of the renal calyces, renal pelvis, and any radiopaque calculi present in the urinary tract or surrounding organs may be visualized in addition to normal air and gas patterns within the intestinal tract. Perforation of the intestinal tract or an intestinal obstruction can be visualized on erect KUB images. KUB x-rays are among the first examinations done to diagnose intra-abdominal diseases such as intestinal obstruction, masses, tumors, ruptured organs, abnormal gas accumulation, and ascites.

Indications

  • Determine the cause of acute abdominal pain or palpable mass.
  • Evaluate the effects of lower abdominal trauma, such as internal hemorrhage.
  • Evaluate known or suspected intestinal obstructions.
  • Evaluate the presence of renal, ureter, or other organ calculi.
  • Evaluate the size, shape, and position of the liver, kidneys, and spleen.
  • Evaluate suspected abnormal fluid, air, or metallic objects in the abdomen.

Interfering Factors

  • Retained barium from a previous radiological procedure.
  • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
  • Inability of the patient to cooperate or remain still during the procedure, because movement can produce blurred or otherwise unclear images.

Potential Medical Diagnosis: Clinical Significance of Results

Abnormal Findings In:

  • Abnormal accumulation of bowel gas
  • Ascites
  • Bladder distention
  • Bowel obstruction
  • Congenital renal anomaly
  • Foreign body
  • Hydronephrosis
  • Intestinal obstruction
  • Ischemic bowel
  • Organomegaly
  • Renal calculi
  • Renal hematomas
  • Ruptured viscus
  • Soft tissue masses
  • Trauma to liver, spleen, kidneys, and bladder
  • Vascular calcification

Nursing Implications, Nursing Process, Clinical Judgement

Before the Study: Planning and Implementation


Teaching the Patient What to Expect

  • Review the procedure with the patient.
  • Discuss how this procedure can assist in assessing the status of the abdomen.
  • Explain that the procedure takes 5 to 15 min and is performed in the radiology department. Pregnancy testing may be required.
  • Advise remaining still throughout the procedure as movement produces unreliable results. Little to no pain is expected during the test, but there may be moments of discomfort.

Procedural Information

  • Positioning for this procedure is on the table in a supine position with hands relaxed at the side. Instructions are given to inhale deeply, hold breath while the x-ray images are taken, and then to exhale after the images are taken.

After the Study: Implementation & Evaluation Potential Nursing Actions


Treatment Considerations

  • Pain is often associated with abdominal disease.
  • Interventions/actions related to pain management include the following: Assess pain character, location, duration, and intensity. Use a culturally appropriate, easily understood pain rating scale. Facilitate placement in a position of comfort. Maintain ordered NPO status. Monitor and trend laboratory results: Hgb, Hct, electrolytes, uric acid, BUN, Cr.
  • Fluid volume deficit related to a specific disease process can be a concern.
  • Interventions/actions related to fluid volume deficit include the following: Monitor and trend vital signs. Document vigilant intake and output observing urine color. Encourage oral fluids. Administer ordered parenteral fluids. Administer ordered antiemetics.

Clinical Judgement

  • Consider all pain management strategies, such as analgesics, alternative therapies, and cultural choices.

Followup Evaluation and Desired Outcomes

  • Understands that additional testing may be necessary to monitor disease progression and determine the need for a change in therapy.
  • Communicate the importance of adjusting pain management as needed to provide relief.