Kidney 7 Flashcards
Irrigation fluid for TURP is absorbed through
the open venous sinuses of the prostate
The height of the solution for TURP should be kept no more than
60 cm above the OR table
The ideal irrigation fluid
provides good surgical visibility (should be clear)
is isotonic
is absent of toxicity
0.9% NaCl or LR would be great choices for TURP, however
they’re highly ionized and good conductors of electricity- contraindicated when monopolar electrocautery is used
Free water absorption can lead to
decreased serum osmolality
dilutional hyponatremia
hemolysis
Which solutions have decreased risk of TURP syndrome?
glycine
sorbitol 3.3%
Cons of sorbitol include
hyperglycemia
osmotic diuresis
lactic acidosis
Mannitol 5% can lead to
osmotic diuresis
transient plasma expansion (risk of LV failure)
Serum Na+ of ________- increases the risk of complications with TURP syndrome
<120 mEq/L
Serum Na+ <110 mEq/L is associated with
seizure
coma
lethal ventricular dysrhythmias
Cardiopulmonary problems with TURP syndrome include
Circulatory overload
hypertension
reflex bradycardia
CHF
pulmonary edema
dysrhythmias
myocardial infarction
CNS problems with TURP syndrome include
restlessness
N/V
cerebral edema
seizures
coma
Additional problems with TURP syndrome include
hyponatremia
hemolysis
hypo-osmolality
Correcting Na+ too quickly increases the risk of
central pontine myelinolysis
Lab data for TURP syndrome should include
electrolytes
hematocrit
creatinine
glucose
12 lead EKG
If Na+ >120 mEq/L with turp syndrome, then
restrict fluids and give furosemide (loop diuretic)
If Na+ <120 mEq/L with TURp syndrome then give
3% NaCl at <100 mL/hr & discontinue once Na+ >120 mEq/L
Treatment of bladder perforation includes
supportive with IVF, vasopressers
serial assessment of H&H and transfuse as indicated
The patient with a perforated bladder will require
emergent suprapubic cystostomy or possible exploratory laparotomy
Inadvertent stimulation of _______________ through the bladder wall can cause lower extremity movement which may cause the resectoscope to puncture the bladder wall
the obturator nerve
What is a rough estimate of blood loss during a TURP procedure?
2-5mL of blood loss per minute of resection time
Which findings represents an absolute contraindication to extracorpeal shock wave lithotripsy?
a. pregnancy
b. pacemaker
c. morbid obesity
d. diabetes
a. pregnancy
Lithotripsy is a procedure that
breaks up stones in the kidney
ureter or bladder
Extracorpeal shock wave lithotripsy delivers
shock waves in rapid succession that are directed at the stone
Absolute contraindications to ESWL include
pregnancy
coagulopathy
the presence of ___________ is a relative contraindication for ESWL
pacemaker
the shock wave can produce
dysrhythmias
The pulse wave of ESWL is timed to the _______ on the EKG to minimize the risk of
R wave; R on T phenomenon
______________ is often been used when ESWL has been ineffetive
percutaneous nephrolithotomy
The anesthetic for percutaneous nephrolithotomy is
GETA and the patient in the prone position
_____________ uses a laser to break up the stone
laser lithotripsy
Laser lithotripsy considerations include
TURP syndrome/considerations
laser precautions
Nephrolithiasis is a
kidney stone
ureterolithiasis is a
ureter stone
Cystolithiasis is a
bladder stone
Relative contraindications to ESWL includes
pacemaker/ICD
morbid obesity (further distance from energy source to stone)
obstruction beyond the renal stone (can’t eliminate fragments)
UTI (untreated)
calcified aneurysm of the aorta or renal artery (problem of density)
Any internal organ in the path of the shock wave is at risk for
perforation
Common side effects of ESWL include
skin bruising
petechiae
hematuria
Possible complication of percutaneous nephrolithotripsy include
pneumothorax
The position for laser lithotripsy is typically
lithotomy
