Kidney, Ureter, and Bladder Study
Flat plate of the abdomen, kidney, urine, and bladder (KUB), plain film of the abdomen.
To visualize and assess the abdominal organs for obstruction or abnormality related to mass, trauma, bleeding, stones, or congenital anomaly.
Area Of Application:
Kidneys, ureters, bladder, and abdomen.
DescriptionA 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.
This procedure is contraindicated for
Patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother.
- 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.
Normal Findings In:
- Normal size and shape of kidneys
- Normal bladder, absence of masses and renal calculi, and no abnormal accumulation of air or fluid
Abnormal Findings In:
- Abnormal accumulation of bowel gas
- Bladder distention
- Congenital renal anomaly
- Foreign body
- Intestinal obstruction
- Renal calculi
- Renal hematomas
- Ruptured viscus
- Soft tissue masses
- Trauma to liver, spleen, kidneys, and bladder
- Vascular calcification
- Bowel obstruction
- Ischemic bowel
- Visceral injury
Note and immediately report to the requesting health-care provider (HCP) any critical findings and related symptoms. A listing of these findings varies among facilities. Timely notification of a critical finding for laboratory or diagnostic studies is a role expectation of the professional nurse. The notification processes vary among facilities. Upon receipt of the critical finding, the information should be read back to the caller to verify accuracy.
Factors that may alter the results of the study
- Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
- Improper adjustment of the radiographic equipment to accommodate obese or thin patients, which can cause overexposure or underexposure and a poor-quality study.
- Incorrect positioning of the patient, which may produce poor visualization of the area to be examined, for images done by portable equipment.
- Retained barium from a previous radiological procedure.
Nursing Implications Procedure
- Related tests include angiography kidneys, calculus kidney stone panel, CT abdomen, CT kidneys, CT pelvis, IVP, and MRI abdomen, retrograde ureteropyelography, US abdomen, US kidney, US pelvis, and UA.
- Refer to the Gastrointestinal System Table for related test by body system.
Refer to the Genitourinary System Table for related test by body system.
Potential Nursing Problems
|Problem||Signs & Symptoms||Interventions|
|Pain (related to obstruction; gas; fluid; stones; hematoma; mass; trauma)||Self-report of pain in abdomen; facial grimace; moaning; crying; abdominal guarding; intermittent or constant pain; cramping; abdominal distention; visible abdominal bruising||Assess pain character, location, duration, intensity; use an easily understood pain rating scale; place in a position of comfort; administer ordered analgesics; consider alternative measures for pain management (imagery, relaxation, music, etc.); administer ordered parenteral fluids; monitor and trend laboratory results (hemoglobin, hematocrit, electrolytes); maintain NPO status as appropriate; evaluate response and readjust pain management strategies|
|Insufficient fluid volume (related to vomiting; decreased oral intake)||Dry mucous membranes; low blood pressure; increased heart rate; slow capillary refill; diminished skin turgor; diminished urine output||Monitor and trend vital signs; administer ordered parenteral fluids; strict intake and output; monitor color of urine; encourage the intake of oral fluids as appropriate; administer ordered antiemetics; monitor and trend laboratory studies (uric acid, blood urea nitrogen, creatinine, electrolytes)|
|Anxiety (related to pain; diagnosis; fear of unknown)||Stated anxiety; restlessness; increased heart rate; appears apprehensive; may be confused or distracted; sleeplessness; fatigue||Discuss use of alternative measures to decrease anxiety (relaxation techniques, imagery, music, etc.); explain the purpose of all diagnostic studies in easy-to-understand, age- and culturally appropriate terms; stay with the patient during critical moments to decrease anxiety|
- Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures are performed.
- Patient Teaching: Inform the patient this procedure can assist in assessing the status of the abdomen.
- Obtain a history of the patient’s health concerns, symptoms, surgical procedures, and results of previously performed laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex.
- Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
- Obtain a list of the patient’s current medications, including over-the-counter medications and dietary supplements (see Effects of Dietary Supplements online at DavisPlus).
- Review the procedure with the patient. Address concerns about pain and explain that little to no pain is expected during the test, but there may be moments of discomfort. Inform the patient that the procedure is performed in the radiology department or at the bedside by a registered radiologic technologist and takes approximately 5 to 15 min to complete.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Instruct the patient to remove all metallic objects from the area to be examined.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection online at DavisPlus. Positively identify the patient.
- Ensure the patient has removed all metallic objects from the area to be examined prior to the procedure.
- Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
- Instruct the patient to cooperate fully and follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Place the patient on the table in a supine position with hands relaxed at the side.
- Instruct the patient to inhale deeply and hold his or her breath while the x-ray images are taken, and then to exhale after the images are taken.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Teach the patient to call for pain relief medication as soon as it is needed.
- Teach the patient how to measure intake and output.
Expected Patient Outcomes:
- The patient describes pain management strategies that work and those that do not work.
- The patient describes the meaning of pain relief in relation to his or her personal health.
- The patient can anticipate pain needs and request medication in a timely manner.
- The patient demonstrates how to accurately measure urinary output and intake.
- The patient describes the meaning of pain within the context of his or her personal health.
- The patient agrees to discuss concerns with identified support (family, friends, group, spiritual advisor).
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