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Apex Review > Kidney 7 > Flashcards

Kidney 7 Flashcards

1
Q

Irrigation fluid for TURP is absorbed through

A

the open venous sinuses of the prostate

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2
Q

The height of the solution for TURP should be kept no more than

A

60 cm above the OR table

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3
Q

The ideal irrigation fluid

A

provides good surgical visibility (should be clear)
is isotonic
is absent of toxicity

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4
Q

0.9% NaCl or LR would be great choices for TURP, however

A

they’re highly ionized and good conductors of electricity- contraindicated when monopolar electrocautery is used

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5
Q

Free water absorption can lead to

A

decreased serum osmolality
dilutional hyponatremia
hemolysis

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6
Q

Which solutions have decreased risk of TURP syndrome?

A

glycine
sorbitol 3.3%

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7
Q

Cons of sorbitol include

A

hyperglycemia
osmotic diuresis
lactic acidosis

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8
Q

Mannitol 5% can lead to

A

osmotic diuresis
transient plasma expansion (risk of LV failure)

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9
Q

Serum Na+ of ________- increases the risk of complications with TURP syndrome

A

<120 mEq/L

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10
Q

Serum Na+ <110 mEq/L is associated with

A

seizure
coma
lethal ventricular dysrhythmias

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11
Q

Cardiopulmonary problems with TURP syndrome include

A

Circulatory overload
hypertension
reflex bradycardia
CHF
pulmonary edema
dysrhythmias
myocardial infarction

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12
Q

CNS problems with TURP syndrome include

A

restlessness
N/V
cerebral edema
seizures
coma

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13
Q

Additional problems with TURP syndrome include

A

hyponatremia
hemolysis
hypo-osmolality

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14
Q

Correcting Na+ too quickly increases the risk of

A

central pontine myelinolysis

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15
Q

Lab data for TURP syndrome should include

A

electrolytes
hematocrit
creatinine
glucose
12 lead EKG

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16
Q

If Na+ >120 mEq/L with turp syndrome, then

A

restrict fluids and give furosemide (loop diuretic)

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17
Q

If Na+ <120 mEq/L with TURp syndrome then give

A

3% NaCl at <100 mL/hr & discontinue once Na+ >120 mEq/L

18
Q

Treatment of bladder perforation includes

A

supportive with IVF, vasopressers
serial assessment of H&H and transfuse as indicated

19
Q

The patient with a perforated bladder will require

A

emergent suprapubic cystostomy or possible exploratory laparotomy

20
Q

Inadvertent stimulation of _______________ through the bladder wall can cause lower extremity movement which may cause the resectoscope to puncture the bladder wall

A

the obturator nerve

21
Q

What is a rough estimate of blood loss during a TURP procedure?

A

2-5mL of blood loss per minute of resection time

22
Q

Which findings represents an absolute contraindication to extracorpeal shock wave lithotripsy?
a. pregnancy
b. pacemaker
c. morbid obesity
d. diabetes

A

a. pregnancy

23
Q

Lithotripsy is a procedure that

A

breaks up stones in the kidney
ureter or bladder

24
Q

Extracorpeal shock wave lithotripsy delivers

A

shock waves in rapid succession that are directed at the stone

25
Q

Absolute contraindications to ESWL include

A

pregnancy
coagulopathy

26
Q

the presence of ___________ is a relative contraindication for ESWL

A

pacemaker

27
Q

the shock wave can produce

A

dysrhythmias

28
Q

The pulse wave of ESWL is timed to the _______ on the EKG to minimize the risk of

A

R wave; R on T phenomenon

29
Q

______________ is often been used when ESWL has been ineffetive

A

percutaneous nephrolithotomy

30
Q

The anesthetic for percutaneous nephrolithotomy is

A

GETA and the patient in the prone position

31
Q

_____________ uses a laser to break up the stone

A

laser lithotripsy

32
Q

Laser lithotripsy considerations include

A

TURP syndrome/considerations
laser precautions

33
Q

Nephrolithiasis is a

A

kidney stone

34
Q

ureterolithiasis is a

A

ureter stone

35
Q

Cystolithiasis is a

A

bladder stone

36
Q

Relative contraindications to ESWL includes

A

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)

37
Q

Any internal organ in the path of the shock wave is at risk for

A

perforation

38
Q

Common side effects of ESWL include

A

skin bruising
petechiae
hematuria

39
Q

Possible complication of percutaneous nephrolithotripsy include

A

pneumothorax

40
Q

The position for laser lithotripsy is typically

A

lithotomy

Apex Review (224 decks)

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