Kidney, Ureter, and Bladder Study

Synonym/Acronym:
Flat plate of the abdomen; kidney, urine, and bladder (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

Contraindications

Patients who are pregnant or suspected of being pregnant when the examination site involves the abdomen, pelvis, or area where the fetus would be in the field of view, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother. The facility’s imaging polices should always be followed.

Factors that may alter the results of the study

  • 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
  • Congenital renal anomaly
  • Foreign body
  • Hydronephrosis
  • Intestinal obstruction
  • Organomegaly
  • Renal calculi
  • Renal hematomas
  • Ruptured viscus
  • Soft tissue masses
  • Trauma to liver, spleen, kidneys, and bladder
  • Vascular calcification

Nursing Implications

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Inform the patient this procedure can assist in assessing the status of the abdomen.
  • Pregnancy is a general contraindication to procedures involving radiation; lower radiation emission technology allows for safe performance of many imaging procedures during pregnancy. In all cases, the benefits and risks should be discussed with the HCP before proceeding with the study.
  • Explain to the female patient that she may be asked the date of her last menstrual period. Pregnancy testing may be performed in accordance with the facility’s imaging policies.
  • Review the procedure with the patient.
  • Explain that little to no pain is expected during the test, but there may be moments of discomfort.
  • Explain that the procedure takes 5 to 15 minutes and is performed in the radiology department.
  • Facilitate removal of all metallic objects from the area to be examined.
  • Advise remaining still throughout the procedure as movement produces unreliable results.
  • Positioning for this procedure is on the table in a supine position with hands relaxed at the side.
  • Explain that the patient will be asked to inhale deeply, hold breath while the x-ray images are taken, and then to exhale after the images are taken.

After the Study: Potential Nursing Actions

Treatment Considerations

  • Pain is often associated with abdominal disease. Assess pain character, location, duration, intensity with an easily understood pain rating scale.
  • Facilitate placement in a position of comfort.
  • Administer ordered analgesics with consideration of alternative measures for pain management such as imagery, relaxation, music, etc. Evaluate response and readjust pain management strategies as needed.
  • Monitor and trend laboratory results; Hgb, Hct, electrolytes, uric acid, BUN, Cr.
  • Maintain ordered NPO status.
  • Insufficient fluid volume related to a specific disease process can be a concern.
  • Interventional strategies to address fluid volume concerns include monitor and trend vital signs, vigilant intake and output, observing urine output and color, encourage oral fluids, administer ordered parenteral fluids, and administer ordered antiemetics.

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.

Kidney, Ureter, and Bladder Study is a sample topic from the Davis's Lab & Diagnostic Tests.

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