CH-6 Urinary System – Medical Language for Modern Health Care : Chapter Notes

CHAPTER 6 – Urinary System The Language of Urology Chapter 6 Teaching Overview When teaching students the language of urology, be sure to address how the kidneys are the filter of blood and why this is so important. Also discuss the role the kidneys play in electrolyte and fluid balance and the regulation of blood pressure. Discuss the importance of “waste management” and why there must be an exit system for body waste. Review how efficient the body really is—how it keeps most everything it ingests to fuel the body. The various means of transport, filtration, and absorption/re- absorption are important concepts students must learn. These concepts can be difficult for students to grasp, so try to provide as many practical examples as possible to help students understand. In addition, it is important to spend some time on acute and chronic renal failure and end stage renal disease. These are important terms for health professionals of all types. As with all lessons in this Lesson Planning Guide, you can and should modify them to best meet the needs of your students, your schedule, and your curricula. Teacher to Teacher: • Students find kidney transplants fascinating. Review with them the story of the young girl at Duke University who received a kidney transplant, but the organ was not matched correctly. The patient rejected the organ and died. This can also tie back to the chapter on blood. Discuss how matching transplants is a very tricky thing to do and bring up the number of anti-rejection drugs patients who have received transplants must take for the rest of their lives. • Emphasize this study hint: There are two ureters—one tube from each kidney to the bladder (which is a reservoir)—and there are two “e’s” in ureter. There is one urethra—the tube that leads from the bladder to the outside—and there is one “e” in urethra. • Emphasize that certain prefixes added to the root “uria” generate all new terms that are symptoms (e.g., anuria, polyuria, oliguria, hematuria, etc.). Chapter 6: Learning Outcomes Upon successful completion of the lessons in this chapter, your students will . . . 6.1 Describe the structure and functions of the urinary system. 6.2 Relate the structure of the kidney to its functions. 6.3 Explain disorders of the kidney. 6.4 Discuss the structure and function of the ureters. 6.5 Explain the disorders of the ureters. 6.6 Relate the structure of the urinary bladder and urethra to their functions. 6.7 Describe disorders of the urinary bladder and urethra. 6.8 Explain the diagnostic procedures used for urinary system disorders. 6.9 Discuss the therapeutic procedures used for urinary system disorders. 6.10 Describe the pharmacologic agents used in the treatment of urinary system disorders. 6.A Use the medical terms of urology to communicate in writing and to document the terms of urology accurately and precisely in any health care setting. 6.B Use the medical terms of urology to communicate verbally with accuracy and precision in any health care setting. 6.C Using word elements, construct medical terms associated with urology. 6.D Deconstruct medical terms associated with urology into their word elements. 6.E Identify health professionals involved in the care of urologic patients. 6.F. Use approved abbreviations for urologic terms correctly. Note: These lessons are designed with ultimate flexibility in mind. When customizing the lessons for your own class, always choose activities that are most relevant to your curriculum, your students, and your teaching goals—especially if you do not have time to implement all the provided activities into your class period. Lesson 6.1: Urinary System and Kidneys Total Time: 50 Minutes Lesson 6.1 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 6.1.1 Detail the urinary system. 6.1.2 Identify the location and anatomic features of the kidney. 6.1.3 Describe the functions of the kidney. 6.1.4 Map the flow of fluid through the renal filtration process. 6.1.5 Explain how common disorders of the kidneys affect health. Prepare Your Materials: • Lesson 6.1 KWL Handout – You may wish to make extra copies of this handout in case students need additional room for their notes. Found on Page 6-6 of this Instructor Manual. • Lesson 6.1 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab of Connect, and then under “Instructor Resources.” • Lesson 6.1 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Smart devices with Internet access: computer, cell phone, tablet. Instructor Lesson Plan Date: _____________ Chapter 6—Lesson 6.1 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Introduction 15 min Activity Description: Introducing the urinary system, kidneys ureters, and bladder and determining prior knowledge. Step 1: Pass out Lesson 6.1 KWL Handout found on page 6-6. Step 2: Tell students that this type of chart can be used to help focus their learning; it can be used with any subject matter. Since the urinary system, and especially the kidneys, are topics students may know something about, this activity will help solidify current knowledge and uncover what they still need to learn. Step 3: Go through the “K” portion of the handout and ask all students to offer information and facts they know about the urinary system, kidneys, ureters, and bladder. Have students record what they know on the handout. Step 4: Go through the “W” portion of the handout and have students record what they want to learn about the urinary system. Encourage students to think about what diseases and disorders affect the urinary system, kidneys, and ureters, and bladder. Step 5: Have students keep the KWL handout and ask them to fill in the “L” portion during each Chapter 6 lesson (they can begin with the Lesson 6.1 Lecture/ Discussion). Collect the KWL handouts at the end of the chapter, if desired. Textbook KWL Handout 6.1.1 Lecture 20 min Lesson 6.1 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 6.1 PowerPoint Presentation 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 Active Learning & Practice 15 min Activity Description: Students will write and role-play a situation related to the case reports in Lesson 6.1 of the textbook. Step 1: Divide the class into groups of four to six students. Step 2: Each group should discuss the patient used in Lesson 6.1 case report: • Nelson Hughes Step 3: Have each group begin by brainstorming a list of questions that the family of the patient might have about the patient’s condition and treatment. Step 4: Select at least five questions from the brainstormed list and then have the students write a skit that incorporates those five questions. Characters in the skit may include the patient, members of the patient’s family, and health care providers at Fulwood Medical Center. The five questions, as well as answers to the questions, should be a part of the dialogue of the skit. Note: Encourage students to use their textbooks, as well as other resources in the classroom (other books, Internet resources, etc.) to answer the questions in their skit. Textbook, Lesson 6.1 Smart devices with internet access (computer, cell phone, tablet) 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 Review 5 min Step 1: Have the students perform their skits for the rest of the class. Step 2: If there is time, begin Lesson 6.1 exercises in class. (The rest may be assigned as homework). Textbook 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 Homework Assignment 5 min • Students read Lesson 6.2 in the textbook and complete Lesson 6.2 exercises. • Finish Lesson 6.1 exercises. • Ask students to bring a profile of a person who has had a kidney transplant to the next class; newspaper and magazine databases, as well as the Internet, are great places to search for “human interest” type articles describing what life is like for people with illnesses. 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 KWL Handout: Chapter 6, Lesson 6.1 Medical Language for Modern Health Care: Lesson 6.1 – Urinary System, Kidneys, and Ureters Directions: Write what you know in the “K” column, what you want to know in the “W” column, and what you have learned about the digestive system in the “L” column. Lesson 6.2: Ureters and Associated Disorders Total Time: 50 Minutes Lesson 6.2 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 6.2.1 Identify the structure of the ureters. 6.2.2 Relate the functions of the ureters to their structure. 6.2.3 Describe disorders of the ureters. Prepare Your Materials: • Medical terms on index cards – Create by selecting around 20 terms from Lesson 6.1 and writing them on index cards (one term per card); you could also assign students to make these cards prior to this lesson. • Lesson 6.2 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources.” • Lesson 6.2 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Lesson 6.2 Case Report Handout – Found on Pages 6-11 and 6-12 of this Instructor Manual. • Lesson 6.2 Case Report Handout Answer Key- Found on Pages 6-13 and 6-14 of this Instructor Manual • Prizes – (optional) TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 10 min Activity Description: Review of the urinary system, kidneys, and ureters in the form of a game loosely based on the “Password” game show. Step 1: Divide students into two teams. Each team should select the first “clue giver” and “receiver.” Step 2: One team will go first. Give the clue giver a card with a medical term on it. The receiver should not be able to see what is on the card. To play the game, the clue giver tries to get the receiver to say the medical term but must use only one-word clues. You may want to impose a time limit of 1 to 3 minutes. Step 3: If the receiver correctly guesses the term, their team gets a point and a new clue giver and receiver from their team get to try a new word. If the receiver cannot guess the term, then the other team gets to try with the same word. Play continues in this manner Step 4: If desired, you can give the winning team some sort of prize. Note: It can be helpful to keep a list of the terms that stump everyone for future use. Medical terms from Lesson 6.1 on index cards (Review Lesson 6.1 concepts) Introduction 5 min Step 1: Read aloud (or ask a student) the Case Report for Lesson 6.2 concerning patient Justin Leandro. This can be read from the text or using the Lesson 6.2 Case Report Handout (page 6-11). Step 2: Ask students to point out significant parts of the case, if they are aware of any. Encourage students to share anything they may already know about this type of situation and how it relates to stones in the urinary system. Step 3: Remind students to listen for some of these terms during today’s lecture. Lesson 6.2 Case Report Handout Textbook 6.2.3 Lecture 20 min Lesson 6.2 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 6.2 PowerPoint Presentation 6.2.1 6.2.2 6.2.3 Active Learning & Practice 10 min Step 1: Distribute Lesson 6.2 Case Report Handout found on pages 6-11 and 6-12. Step 2: Arrange students into small groups or partners. Step 3: Instruct groups to re-read the Case Report, but this time, they should circle or underline (or highlight with a highlighter) any medical terms they recognize from the lecture/discussion (or previously assigned reading) as related to the urinary bladder and urethra. Step 4: Once each group has indicated all the appropriate terms, have them list the terms at the bottom of the handout and write a brief definition. Encourage students to discuss the terms within their groups to reinforce correct pronunciation. Step 5: After the terms have been defined, have students answer the questions on the handout. Step 6: Once groups are finished with the handout, bring everyone back together and share answers. Ask students questions about the importance of these terms to the Case Report and Mr. Leandro’s illness. Lesson 6.2 Case Report Handout 6.2.1 6.2.2 6.2.3 Review 5 min Step 1: Have students complete the Lesson 6.2 exercises in pairs. Step 2: When they are finished, go over the answers so students can ensure their understanding. Any exercises that are not completed in class may be assigned as homework. Textbook, Lesson 6.2 exercises 6.2.1 6.2.2 6.2.3 Homework Assignment • Complete remaining Lesson 6.2 exercises. • Read Lesson 6.3 in textbook • Instruct students to review the terms in the Word Analysis and Definition (WAD) Tables from Lessons 6.1 and 6.2 and practice pronouncing them correctly. Textbook, Lesson 6.2 exercises 6.2.1 6.2.2 6.2.3 Lesson 6.2 Masters • Lesson 6.2 Case Report Handout found on pages 6-11 and 6-12 Answers to Lesson 6.2 Masters • Lesson 6.2 Case Report Answer Key found on pages 6-13 and 6-14 Medical Language for Modern Health Care: Lesson 6.2 – Case Report: Medical Terms in Documentation Directions: (1) Read the Case Report below and underline or circle any medical terms related to the ureters. (2) List and briefly define the identified terms below (use additional paper if needed). (3) Then, answer the question at the bottom of the page. (1) Medical Terms in Patient Documentation YOU ARE An Emergency Medical Technician -Paramedic (EMT-P) working in the Emergency Department of Fulwood Medical Center. YOUR PATIENT IS Mr. Justin Leandro, a 37-year-old construction worker who is complaining to sudden onset of excruciating pain in his right abdomen and back an hour previously while at work. The pain is spasmodic and radiates down into his groin. He has vomited once and keeps having the urge to urinate but cannot. He has no previous medical history of significance. Vital signs (VS): T 99.4 o F, P 92, R 20, B/P 130/86. Abdomen slightly distended, with tenderness in the right upper and lower quadrants and flank. A dipstick test showed blood in his urine. Provisional diagnosis: stone in the right ureter. An IV line was inserted, and 2 mg morphine sulfate given by IV push at 1540. He is going to X-ray stat for KUB and IVP. (2) Medical Terms Identified: Medical Term Definition (3) Medical Terms Applied: List the signs and symptoms mentioned by Mr. Leandro that point toward a diagnosis of stone in the right ureter. (4) Discussion Questions: a. Does his job as a construction worker put him at increased risk for ureteral or kidney stones? b. What caused Mr. Leandro to vomit? c. Why is Mr. Leandro’s pain spasmodic? d. What is the medical term for blood in the urine? _______________________________________________________________________ e. What does the term stat mean? ________________________________________________________________________ Medical Language for Modern Health Care: Lesson 6.2 – Case Report: Medical Terms in Documentation Answer Key Directions: (1) Read the Case Report below and underline or circle any medical terms related to the ureter. (2) List and briefly define the identified terms below (use additional paper if needed). (3) Then, answer the question at the bottom of the page. 1. Medical Terms in Patient Documentation YOU ARE An Emergency Medical Technician -Paramedic (EMT-P) working in the Emergency Department of Fulwood Medical Center. YOUR PATIENT IS Mr. Justin Leandro, a 37-year-old construction worker who is complaining to sudden onset of excruciating pain in his right abdomen and back an hour previously while at work. The pain is spasmodic and radiates down into his groin. He has vomited once and keeps having the urge to urinate but cannot. He has no previous medical history of significance. Vital signs (VS): T 99.4 o F, P 92, R 20, B/P 130/86. Abdomen slightly distended, with tenderness in the right upper and lower quadrants and flank. A dipstick test showed blood in his urine. Provisional diagnosis: stone in the right ureter. An IV line was inserted, and 2 mg morphine sulfate given by IV push at 1540. He is going to X-ray stat for KUB and IVP. 2. Medical Terms Identified: Medical Term Definition Spasmodic Intermittent spasms or contractions Intermittent Alternately ceasing and beginning again IV intravenous Mg milligram KUB Kidneys, ureters, bladder IVP Intravenous pyelogram Stat immediately VS Vital signs EMT-P Emergency Medical Technician-Paramedic 3. Medical Terms Applied: List the signs and symptoms mentioned by Mr. Leandro that point toward a diagnosis of stone in the right ureter. Sudden onset of excruciating pain in his right abdomen and back the pain is spasmodic and radiates down into his groin has the urge to urinate but cannot slightly distended abdomen with tenderness in the RUQ and RLQ and flank urine dipstick showed hematuria 4. Discussion Questions: a. Does his job as a construction worker put him at increased risk for ureteral or kidney stones? It might if he works long hours in hot conditions and becomes dehydrated. His diet may contribute to the development of urinary stones as well as a family history. b. What caused Mr. Leandro to vomit? The excruciating pain caused him to vomit. c. Why is Mr. Leandro’s pain spasmodic? Because the stone is moving down the ureter from the kidney. The peristaltic waves in the ureter which are moving the stone down toward the bladder are causing the pain because the ureter is being stretched from the stone. d. What is the medical term for blood in the urine? ____Hematuria__________________________ e. What does the term stat mean? __immediately____________________________________ Lesson 6.3: Urinary Bladder and Urethra Total Time: 50 Minutes Lesson 6.3 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 6.3.1 Describe the structure and functions of the urinary bladder. 6.3.2 Contrast the differences in structure of the male and female urethras. 6.3.3 Explain the greater incidence of urinary tract infections in the female. 6.3.4 Discuss common disorders of the bladder and urethra. Prepare Your Materials: • Lesson 6.3 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources.” • Lesson 6.3 Student Note-taking Handout – Create by selecting the “Handouts” option when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Lesson 6.3 Case Report Handout – Found on Pages 6-18 and 6-19 of this Instructor Manual. • Lesson 6.3 Case Report Handout Answer Key- Found on pages 6-20 and 6-21 of this Instructor Manual Instructor Lesson Plan Date: ____________ Chapter 6—Lesson 6.3 TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 10 min Activity Description: Step 1: Review answers to Lesson 6.2 exercises in a round robin manner. Step 2: As the students are reading the answers out loud, pay attention to their pronunciation and reinforce the correct pronunciation. Step 4: If desired, you can give the winning team some sort of prize. Note: It can be helpful to keep a list of the terms that stump everyone for future use. Textbook, Lesson 6.2 exercises 6.2.1 6.2.2 6.2.3 Introduction 5 min Step 1: Read out loud (or ask a student) the Case Report for Lesson 6.3 concerning patient Caroline Dobson. This can be read from the text or using Lesson 6.3 Case Report Handout. Step 2: Ask students to point out significant parts of the case, if they are aware of any. Encourage students to share anything they may already know about this type of situation and how it relates to the urinary bladder and urethra. Step 3: Remind students to listen for some of these terms during today’s lecture. Lesson 6.3 Case Report Handout Textbook 6.3.1 6.3.2 6.3.3 6.3.4 Lecture 20 min Lesson 6.3 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 6.3 PowerPoint Presentation 6.3.1 6.3.2 6.3.3 6.3.4 Active Learning & Practice 10 min Step 1: Distribute Lesson 6.3 Case Report Handout. Step 2: Arrange students into small groups or partners. Step 3: Instruct groups to re-read the Case Report, but this time, they should circle or underline (or highlight with a highlighter) any medical terms they recognize from the lecture/discussion (or previously assigned reading) as related to the urinary bladder and urethra. Step 4: Once each group has indicated all the appropriate terms, have them list the terms at the bottom of the handout and write a brief definition. Encourage students to discuss the terms within their groups to reinforce correct pronunciation. Step 5: After the terms have been defined, have students answer the questions on the handout. Step 6: Once groups are finished with the handout, bring everyone back together and share answers. Ask students questions about the importance of these terms to the Case Report and Mrs. Dobson’s illness. Lesson 6.3 Case Report Handout Textbook 6.3.1 6.3.2 6.3.3 6.3.4 Review 5 min Step 1: Have students complete Lesson 6.3 exercises in pairs. Step 2: When they are finished, go over the answers so students can ensure their understanding. Any exercises that are not completed in class may be assigned as homework. Textbook, Lesson 6.3 exercises 6.3.1 6.3.2 6.3.3 6.3.4 Homework Assignment • Read Lesson 6.4 in the textbook and complete Lesson 6.4 exercises. • Instruct students to review the terms in the Word Analysis and Definition (WAD) Tables from Lessons 6.1, 6.2, and 6.3 and practice pronouncing them correctly. 6.1.1-6.1.6 6.2.1-6.2.3 6.3.1-6.3.4 Medical Language for Modern Health Care: Lesson 6.3 – Case Report: Medical Terms in Documentation Directions: Read the Case Report below and underline or circle any medical terms related to the urinary bladder and urethra. List and briefly define the identified terms below (use additional paper if needed). Then, answer the question at the bottom of the page. Medical Terms in Patient Documentation YOU ARE A medical assistant working in the office of Dr. Susan Lee, a primary care physician, at Fulwood Medical Center YOUR PATIENT IS Mrs. Caroline Dobson, a 32-year-old housewife Your task is to document her care: Mrs. Dobson: Since yesterday afternoon I’ve had a lot of pain low down in my belly and in my lower back. I keep having to go to the bathroom every hour or so to pee. It’s often difficult to start and it burns as it comes out. I’ve had this problem twice before when I was pregnant with my two kids, so I’ve started drinking cranberry juice. I’ve been shivering since I woke up this morning and the last urine I passed was pink. Was that due to the cranberry juice? Mrs. Dobson described many of the symptoms of cystitis. She had suprapubic and low back pain. She had increased frequency of micturition with dysuria, difficulty in, and burning on, micturition. Her pink urine is probably hematuria. 1. Medical Terms Identified: Medical Term Definition 2. Medical Terms Applied: List the signs and symptoms mentioned by Mrs. Dobson that point toward a diagnosis of cystitis. 3. Discussion Questions: a. What effect does pregnancy have on the urinary system? b. In this case report, why did Mrs. Dobson think cranberry juice would help? c. In this case report, what does shivering indicate? d. Is it normal for blood to appear in urine? Medical Language for Modern Health Care: Lesson 6.3 – Case Report: Medical Terms in Documentation Answer Key Directions: Read the Case Report below and underline or circle any medical terms related to the urinary bladder and urethra. List and briefly define the identified terms below (use additional paper if needed). Then, answer the question at the bottom of the page. Medical Terms in Patient Documentation YOU ARE A medical assistant working in the office of Dr. Susan Lee, a primary care physician, at Fulwood Medical Center YOUR PATIENT IS Mrs. Caroline Dobson, a 32-year-old housewife Your task is to document her care: Mrs. Dobson: Since yesterday afternoon I’ve had a lot of pain low down in my belly and in my lower back. I keep having to go to the bathroom every hour or so to pee. It’s often difficult to start and it burns as it comes out. I’ve had this problem twice before when I was pregnant with my two kids, so I’ve started drinking cranberry juice. I’ve been shivering since I woke up this morning and the last urine I passed was pink. Was that due to the cranberry juice? Mrs. Dobson described many of the symptoms of cystitis. She had suprapubic and low back pain. She had increased frequency of micturition with dysuria, difficulty in, and burning on, micturition. Her pink urine is probably hematuria. 1. Medical Terms Identified: Medical Term Definition cystitis Inflammation of the bladder suprapubic Pertaining to above the pubis frequency Many times micturition Act of passing urine dysuria Condition of painful urination hematuria Condition of blood in the urine 2. Medical Terms Applied: List the signs and symptoms mentioned by Mrs. Dobson that point toward a diagnosis of cystitis. Belly pain Low back pain Frequency of urination Burning on urination Shivering/chills Pink urine 3. Discussion Questions: a. What effect does pregnancy have on the urinary system? • Growing fetus presses against the bladder • Extra weight of pregnancy overloads the urinary system b. In this case report, why did Mrs. Dobson think cranberry juice would help? • Cranberry is supposed to have a beneficial effect on the urinary system c. In this case report, what does shivering indicate? • Shivering indicates chills, and a possible infection d. Is it normal for blood to appear in urine? • No, blood should never appear in urine Lesson 6.4: Diagnostic Procedures and Pharmacology Total Time: 50 Minutes Lesson 6.4 Lesson Objectives: Your teaching objective for this lesson is to help your students accomplish these learning objectives: 6.4.1 Describe the diagnostic procedures used for disorders of the urinary system. 6.4.2 Explain therapeutic procedures used for disorders of the urinary system. 6.4.3 Define the pharmacologic agents used for disorders of the urinary system. Prepare Your Materials: • Lesson 6.4 PowerPoint® presentation – Found with the Instructor Resources that can be accessed through the “Library” tab on Connect, and then under “Instructor Resources.” • Lesson 6.4 Student Note-taking Handout – Create by selecting the “Handouts” option • when printing the PowerPoint presentation; select 3 slides per page to print slides with blank lines to the right where students can take notes. • Lesson 6.4 Diagnostic Procedures Handout -found on Pages 6-25 – 6-31 of this Instructor Manual • Lesson 6.4 Diagnostic Procedures Answer Key- found on Pages 6-32 -- 6-39 of this Instructor Manual. • Smart device with Internet access: computer, cell phone, tablet TIME ACTIVITY & INSTRUCTIONS MATERIALS LESSON OBJECTIVES Warm-up & Review 5 min Step 1: Review Lesson 6.3 exercises in a round robin manner. Step 2: Explain incorrect answers to ensure student’s understanding. Listen for pronunciation errors and correct. Textbook, Lesson 6.3 exercises 6.3.1 6.3.2 6.3.3 6.3.4 Introduction 5 min Tell students that several of the diagnostic procedures listed in Lesson 6.4 are universal to many body systems, but the majority are specific to diagnosing urologic conditions. The functions of the kidneys are to remove waste products from the blood stream, balance water and electrolytes, release hormones, and degrade and eliminate hormones from the body. Therefore, any condition that affects the kidney will harm other body organs because these functions are not properly carried out. Many medications are filtered by the kidney; a problem with the kidney can cause toxic buildup of medications in the bloodstream which can harm other organs. It is important to correctly identify and treat kidney conditions through appropriate diagnostic testing. 6.4.1 6.4.2 6.4.3 Lecture 20 min Lesson 6.4 Lecture/Discussion Reference the Speaker Notes for each slide to assist you in discussing the talking points. You can view or print “Notes Pages” to use during the lecture for easy reference (in PowerPoint, select “View,” then “Notes Page”). Lesson 6.4 PowerPoint Presentation 6.4.1 6.4.2 6.4.3 6.4.4 Active Learning & Practice 15 min Step 1: Place students in pairs. Step 2: Distribute Chapter 6, Lesson 6.4 Diagnostic Procedures Handout. Step 3: Assign each pair to one diagnostic procedure. Step 4: Ask each pair to report on their assigned topic. It would help to have a picture or a short video clip of the various procedures to show classmates. Step 5: Assign each pair of students to research the following pharmacologic agents on their smart devices: agents for: overactive bladder; renal transplants; urinary tract infections; erectile dysfunction; swelling (diuretics); nephrotic syndrome, kidney/ureteral stones, chlamydia; gonorrhea, syphilis, Human papilloma virus, trichomoniasis, and genital herpes infection. Step 6: Each pair of students reports their research findings to their classmates. Chapter 6, Lesson 6.4 Diagnostic Procedures Handout found on pages 6-25 to 6-31 Smart device with internet access (computer, cell phone, tablet) Review 5 min Step 1: Complete Lesson 6.4 exercises in pairs. Step 2: When they are finished, go over the answers so students can ensure their understanding. Textbook, Lesson 6.4 exercises 6.4.1 6.4.2 6.4.3 6.4.4 Homework Assignment • Complete Chapter 6 Review exercises • Students read Chapter 7, Lesson 7.1 • Instruct students to review the terms in the word Analysis and Definition tables from Lessons 6.1 through 6.4 and practice pronouncing them correctly. 6.1.1 – 6.1.6 6.2.1 – 6.2.3 6.3.1 – 6.3.4 6.4.1 – 6.4.3 CHAPTER 6, LESSON 6.4 DIAGNOSTIC PROCEDURES HANDOUT NAME OF TEST ABBREVIATION WHAT IT IS USED FOR PATIENT EDUCATION Urinalysis Kidneys, Ureters, Bladder X-ray Intravenous Pyelogram Retrograde Pyelogram Voiding Cystourethrogram Renal Angiogram Cystoscopy Magnetic Resonance Imaging Computed Tomography Extracorporeal Shock Wave Lithotripsy Hemodialysis Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis Continuous Cycling Peritoneal Dialysis CHAPTER 6, LESSON 6.4 DIAGNOSTIC PROCEDURES HANDOUT – ANSWERS NAME OF TEST ABBREVIATION WHAT IT IS USED FOR PATIENT EDUCATION Urinalysis UA It is an examination of urine to determine the presence of any abnormal elements (such as sugar, ketones, blood, protein, white cells) that can indicate pathological conditions. The patient may first be given towelettes to wipe their genital area. The patient is then given a clean container and asked to catch the urine stream without touching the container to the skin. Kidneys, Ureters, Bladder X-ray KUB An x-ray examination of the kidneys, ureters, and bladder without the use of contrast. It is used to show the size and location of those structures in relation to other abdominopelvic organs. There is no patient preparation. The patient will be taken to the radiology department and placed in a supine position on the x-ray table while the x-ray is taken. Intravenous Pyelogram IVP The test is used in patients with hematuria, pain in the urinary system, suspected kidney tumor, urinary outlet obstruction, and trauma to the urinary system. Patient must sign a consent form. Patient is given a laxative the night before the procedure. Patient has clear liquids for breakfast the morning of the test. Since the test uses a contrast material, the patient should be asked about allergies to shellfish or iodinated dye. An IV is inserted (unless one is already present) and the radiologist injects contrast dye through the IV catheter. The patient may feel a flushing sensation, salty or metallic taste in the mouth, nausea or vomiting, or headache when the dye is injected. X-rays are taken at specific intervals to follow the course of the dye through the urinary system. After the test, the patient is asked to urinate, and a post-void film is taken to visualize the empty bladder. Retrograde Pyelogram It is an x-ray image of the renal pelvis and ureters after a contrast medium is injected through a urinary catheter inserted through the bladder and into the ureters. It is used to locate urinary stones and obstructions. Patient must sign a consent form. The patient may be given an enema prior to the procedure. If a local anesthetic is used, the patient can have clear liquids for breakfast the morning of the test. Since the test uses a contrast material, the patient should be asked about allergies to shellfish or iodinated dye. Ureteral catheters are placed inside the ureters by means of a cystoscopy. The radiologist injects radiopaque dye through the ureteral catheters and x-ray films are taken. As the catheters are removed, more dye is injected, and more films are taken to visualize the complete outline of the ureters. Voiding Cystourethrogram VCUG It is used in patients with hematuria, recurrent urinary tract infections, or suspected bladder trauma. It can be used to diagnose vesicoureteral reflux. Patient must sign a consent form. Patient has clear liquids for breakfast the morning of the test. Since the test uses a contrast material, the patient should be asked about allergies to shellfish or iodinated dye. A Foley catheter is inserted into the bladder. The radiologist injects approximately 300 ml of radiopaque dye through the catheter into the bladder and then the catheter is clamped. X-rays films are taken. The catheter is removed, and the patient is asked to void while x-rays are taken of the bladder and urethra. The patient is encouraged to drink fluids afterward to eliminate the dye. Renal Angiogram This is an x-ray of the blood vessels of the kidney using contrast material. This test is used to see how well blood is flowing to the kidneys and to diagnose obstruction (occlusion) or constriction (stenosis) of blood vessels, or ballooning of a blood vessel (aneurysm). Patient must sign a consent form. Patient must be NPO for 2 – 8 hours before the test. If taking a blood thinner, may need to stop taking it before the test. Since the test uses a contrast material, the patient should be asked about allergies to shellfish or iodinated dye. The radiologist injects the dye through a catheter that is inserted into the femoral artery. Patient may feel a flushing sensation, salty or metallic taste in the mouth, nausea or vomiting, or headache when the dye is injected. Using fluoroscopy, the radiologist takes pictures of the blood flowing through the kidneys. After the test, the catheter is removed, and a pressure dressing is applied to the groin. The patient’s distal circulation is monitored. Cystoscopy Cysto This test is used to evaluate patients with suspected pathologic conditions that involve the urethra, bladder and lower ureters, including hematuria, urinary frequency, retention or incontinence. It can be used in suspected BPH to take a Bx or perform a TURP. Patient must sign a consent form. Patient may be given an enema prior to the procedure to clean out the bowel. If a local anesthetic is used, the patient can have clear liquids for breakfast the morning of the test. If a general anesthetic is used, the patient will be NPO before the test. The patient is positioned in a lithotomy position. A local anesthetic gel is instilled into the urethra before the cystoscope is inserted. If a biopsy is taken, the patient may experience some hematuria after the procedure. Magnetic Resonance Imaging MRI This is a noninvasive diagnostic procedure that can provide precise accuracy in detecting structural abnormalities of the body, specifically the urinary system. A checklist must be completed prior to the procedure. Patients with any type of implanted metal objects in the body may not be eligible for the test. Patients who cannot lie still or are claustrophobic may need to be sedated prior to the test. The patient must remain motionless for long periods of time, so images are not distorted. The machine makes loud, repetitive clicking and “thumping” noises – usually headphones with music are given to the patient. A contrast dye may be injected via an IV catheter (one will be inserted if not already present). There are no food or fluid restrictions prior to the test. The test can last ½ - 1 ½ hrs. Computed Tomography CT or CAT This is a special non-invasive x-ray test that produces cross-sectional images of the body using x-rays and a computer. CT scans allow doctors to look inside the body as one would look at the inside of a loaf of bread by slicing it. CT scans take pictures of slices of the body, so a physician can look at the area of interest (location, size, extension into surrounding tissue). This test can be used to located tumors in the kidney or bladder, and obstructions within the urinary system. Ask the patient about any allergies to contrast dye (if it will be used during the scan). If a dye will be used, it will be injected through the IV catheter (one will be inserted if not already present). The patient should not have anything to eat or drink for several hours before the scan – the contrast dye can cause stomach upset. Patients may be given an oral contrast agent, containing dilute barium, to drink 1 – 2 hours prior to the scan. This is done so the radiologist can identify the GI tract and separate those organs from others in the abdomen. The patient lies motionless in a supine position for the length of the study which takes just a few minutes. The patient may be asked to hold their breath for up to 20 seconds. If a dye is used, the patient is advised to drink plenty of fluids to flush the dye from the system. Extracorporeal Shock Wave Lithotripsy ESWL This procedure uses shock waves to break a kidney stone up into small pieces so that it can travel through the urinary system and be excreted. The patient lies on a water-filled cushion. The kidney stone is located through x-rays or an ultrasound. High energy sound waves pass through the body without injuring it, striking the stone and breaking it into small pieces. The process takes about an hour. The patient may be given sedation or local anesthesia. The patient may be asked to strain their urine for several days to check for passage of the stones (calculi). Hemodialysis Dialysis is used for patients that are in renal failure – those whose kidneys no longer filter blood. Because the kidneys aren’t working, waste products and extra fluid accumulate in the bloodstream and must be removed. In hemodialysis, a dialysis machine and special filter called an artificial kidney, or dialyzer, are used to clean the patient’s blood. The dialyzer, or filter has two parts: one for the blood and one for the washing fluid called dialysate. A thin membrane separates these two parts. Proteins, blood cells and other important things remain in the blood stream because they are too large to filter through the membrane. Waste products such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away. Before the first hemodialysis treatment, the physician makes an arteriovenous (AV) fistula (communication between an artery and a vein) in the arm to provide access for hemodialysis. Treatments are generally done 3 times/week for about 4 hours at a time. Treatments can be done in a dialysis center, hospital, or the patient’s home. Peritoneal Dialysis Dialysis is used for patients that are in renal failure – those whose kidneys no longer filter blood. Because the kidneys aren’t working, waste products and extra fluid accumulate in the bloodstream and must be removed. This type of dialysis, unlike hemodialysis which uses a machine, uses the lining of the patient’s abdomen to filter the blood. A catheter that has been inserted into the abdomen is connected to a bag of dialysis solution that flows into the abdomen. Waste materials such as urea and creatinine, found in the capillaries of the peritoneum, pass out of the blood stream and into the fluid. After a specified period, the fluid is drained out of the abdomen, into the empty dialysis solution bag. Prior to the first treatment, the surgeon places a permanent catheter into the abdomen. Since this is a surgical procedure, a consent form must be signed, and the patient must be NPO for a specific period before surgery. This procedure may need to be done several times per day. Continuous Ambulatory Peritoneal Dialysis CAPD A catheter that has been inserted into the abdomen is connected to a bag of dialysis solution that flows into the abdomen. Waste materials such as urea and creatinine, found in the capillaries of the of the peritoneum, pass out of the blood stream and into the fluid. After several hours (dwell time), the fluid is drained out of the abdomen, into the empty dialysis solution bag. Prior to the first treatment, the surgeon places a permanent catheter into the abdomen. Since this is a surgical procedure, a consent form must be signed, and the patient must be NPO for a specific period before surgery. The dwell time is 4-6 hours; draining the fluid out of the abdomen can take 30-40 minutes. Once all the fluid has drained out, the process is repeated. Patients leave the solution in the abdomen all night. Continuous Cycling Peritoneal Dialysis CCPD Instead of manually filling and draining the abdomen through a catheter, this procedure uses a machine called a cycler to fill and empty the abdomen 3 – 5 times during the night while the patient sleeps. Prior to the first treatment, the surgeon places a permanent catheter into the abdomen. Since this is a surgical procedure, a consent form must be signed, and the patient must be NPO for a specific period before surgery. The patient may need to do an exchange with a dwell time that lasts the entire day. If needed, an additional exchange can be done in the afternoon. End of Chapter Answer Exercises Page 157 A. Ans 1: nephr/o/logist Ans 2: nephr/o/logist Ans 3: ren/al B. Ans 1: D: bladder Ans 2: A: kidney Ans 3: B: ureter Ans 4: C: urethra Exercises Page 159 A. Ans 1: filtr/ation Ans 2: ren/in Ans 3: peri/tubul/ar Ans 4: re/ab/sorpt/ion B. Ans 1: cortex Ans 2: medulla Ans 3: pelvis Exercises Page 161 A. Ans 1: blood Ans 2: B: lower back Ans 3: B: symptom Ans 4: B: No B. Ans 1: D: benign and usually asymptomatic Ans 2: A: condition only diagnosed in children Ans 3: E: condition that causes leakage of proteins into the urine; edema of the ankles and legs is a common sign Ans 4: B: malignant condition of the kidney; develops in the cells of the renal tubules Ans 5: C: can develop as a result of strep throat infection Exercises Page 163 A. Ans 1: ARF Ans 2: CRF Ans 3: PKD B. Ans 1: C: excessive Ans 2: B: scanty Ans 3: B: condition Ans 4: A: nitrogen Ans 5: D: many Exercises Page 165 A. Ans 1: acute Ans 2: hematuria Ans 3: D: intermittent Ans 4: nephrolithiasis Exercises Page 167 A. Ans 1: False Ans 2: True Ans 3: True Ans 4: True Ans 5: True Ans 6: False Exercises Page 169 A. Ans 1: A: urethra Ans 2: B: cystitis Ans 3: D: urinalysis Ans 4: C: loss of bladder control Ans 5: C: blood in the urine B. Ans 1: B: urine leaks because the bladder is always full Ans 2: D: urine leaks due to sudden pressure, like a cough Ans 3: C: urine leaks because another condition prevents the person from reaching the toilet in time to void Ans 4: A: urine leaks because the need to urinate comes on too fast to make it to the toilet in time to void Exercises Page 171 A. Ans 1: D: cystourethrogram Ans 2: C: glycosuria Ans 3: B: retrograde Ans 4: B: ketoacidosis Ans 5: A: urinalysis Exercises Page 173 A. Ans 1: ESWL Ans 2: BPH Ans 3: CCPD Ans 4: TURP Ans 5: CAPD B. Ans 1: ambulat/ory Ans 2: cysto/pexy Ans 3: nephro/scopy Ans 4: per/cutaneo/us Ans 5: nephro/litho/tomy Ans 6: hemo/dia/lysis Exercises Page 175 A. Ans 1: diuretic Ans 2: analgesia Ans 3: analgesic Ans 4: diuresis B. Ans 1: B: culture Ans 2: A: hypokalemia Ans 3: D: antibiotics Ans 4: C: phenazopyridine Exercises Page 177 A. Ans 1: A: it has two prefixes Ans 2: B: female Ans 3: A: Cipro B. Ans 1: C: IM penicillin Ans 2: D: no known treatment Ans 3: A: antibiotic combination to two drugs Ans 4: E. Flagyl Ans 5: B: HAART Exercises Page 179 A. Ans 1: D: radiation therapy Ans 2: E: sildenafil, tadalafil Ans 3: B: Bactrim, Cipro Ans 4: C: alpha blockers or alfuzosin Ans 5: A: solifenacin B. Ans 1: inhibbitors; impotance Ans 2: inhibitors; impotence Ans 3: prostatitis Chapter 6 Review A. Ans 1: C: the hilum Ans 2: A: reflux Ans 3: C: hypertension Ans 4: A: ammonia Ans 5: A: infection Ans 6: C: clenched fist Ans 7: D: cortex Ans 8: A: meatus Ans 9: D: the glomerular capsule Ans 10: A: protein Ans 11: A: ureter Ans 12: B: calculus Ans 13: C: resorption B. Ans 1: IV Ans 2: PKD Ans 3: ESWL Ans 4: TNM Ans 5: UTI C. Ans 1: spasmod/ic Ans 2: nephro/tomy Ans 3: ren/al Ans 4: nephr/ectomy Ans 5: ren/in Ans 6: nephr/itis Ans 7: nephro/logy Ans 8: nephro/logist D. Ans 1: D: extracorporeal Ans 2: B: idiopathic Ans 3: G: transplant Ans 4: E: retrograde Ans 5: C: catheter Ans 6: H: incontinence Ans 7: A: uremia Ans 8: F: dialyzer E. Ans 1: urethra Ans 2: bladder Ans 3: kidney Ans 4: ureter F. Ans 1: D: retrograde pyelogram Ans 2: H: needle aspiration Ans 3: F: nephrolithotomy Ans 4: J: lithotripsy Ans 5: I: renal angiogram Ans 6: B: transplant Ans 7: G: nephrectomy Ans 8: C: KUB Ans 9: E: cystoscopy Ans 10: A: dialysis G. Ans 1: C: hematuria and D: pain Ans 2: A: KUB Ans 3: A: kidneys; B: ureters; C: bladder Ans 4: C: procedure to view the inside of the abdomen Ans 5: C: renal calculi H. Ans 1: without, lack of Ans 2: urine Ans 3: condition Ans 4: absence of urine production Ans 5: bad, difficult Ans 6: urine Ans 7: condition Ans 8: difficulty or pain with urination Ans 9: n/a Ans 10: pass urine Ans 11: process Ans 12: act of passing urine Ans 13: n/a Ans 14: urine Ans 15: blood condition Ans 16: a condition caused by excess urea and other nitrogenous wastes in the blood Ans 17: scanty Ans 18: urine Ans 19: condition Ans 20: scanty production of urine Ans 21: between Ans 22: space Ans 23: pertaining to Ans 24: pertaining to the space between cells in a tissue or organ Instructor Manual for Medical Language for Modern Health Care David M. Allan, Rachel C. Basco 9780077820725, 9781260084931