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EMRG 1130 > Module 26- GU Injuries and Management > Flashcards

Module 26- GU Injuries and Management Flashcards

1
Q

Urinary tract infections

A
  • usually develop in the lower urinary tract (urethra and bladder)
  • Normal flora bacteria enter the urethra and grow
  • More common in women
    • Shorter urethra
    • Close proximity to the vagina and rectum
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2
Q

When do the upper urinary tracts (ureters and kidneys) get most infected?

A
  • Occur most often when the lower UTIs go untreated
  • Pyelonephritis: inflammation of the kidney linings
  • Abscesses: reduce kidney function
  • Severe cases can lead to sepsis
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3
Q

What are the symptoms of a UTI?

A
  • Painful urination
  • Frequent urges to urinate
  • Difficulty urinating
  • Bladder pain in women
  • Prostate pain in men
  • Urine may have a foul odour or appear cloudy
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4
Q

Where do kidney stones originate?

A
  • They originate in the renal pelvis
  • It’s a result of an excess of insoluble salts or uric acid crystallizes in the urine
  • Insufficient water intake
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5
Q

What are the different type of kidney stones?

A
  • Calcium stones
  • Struvite stones
  • Uric acid and cystine stones
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6
Q

Calcium stones

A
  • Most common
  • Occur frequently in men
  • Has hereditary component
  • Metabolic disorders (gout, hormonal disorder)
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7
Q

Struvites stones

A
  • Common in women
  • Associated with chronic UTI or frequent catheterization
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8
Q

Uric acid and cystine stones

A
  • Least common
  • Uric acid stones tend to run in families
  • Cystine stones are associated with a condition that causes large amounts of amino acids and proteins to accumulate in the urine
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9
Q

What is the pain for kidney stones?

A
  • Rate as 11 on a scale of 1 to 10
  • Usually starts as a vague discomfort in the flank
  • Becomes very intense within 30 to 60 mins
  • May migrate forward and toward the groin
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10
Q

What is the pain presentation of kidney stones?

A
  • Some will be agitated and restless (walk and move to relieve pain)
  • Others will attempt to remain motionless and guard the abdomen
  • Palpation of the abdomen difficult
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11
Q

What is acute renal failure?

A
  • Sudden decrease in filtration through the glomeruli
  • Accompanied b an increase of toxins in the blood
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12
Q

What is oliguria?

A

urine output drops to less than 500ml/day

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13
Q

What is anguria?

A

urine production stops completely

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14
Q

Acute Renal Failure is classified into 3 types based on the area where failure occurs, what are they?

A
  • Prerenal
  • Intrarenal
  • Postrenal
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15
Q

What is prerenal?

A

hypoperfusion of the kidneys (shock)

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16
Q

What is intrarenal?

A

damage to the kidney often caused by immune-mediated disease, toxins chronic inflammation or medications

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17
Q

What is postrenal?

A

obstruction of urine flow from kidneys, prostate enlargement, renal calculi or stricture

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18
Q

What are the s/s of acute renal failure?

A
  • hypertension
  • SOB and edema (volume overload)
  • Hyperventilation
  • Confusion
  • Lethargy (uremia)
  • Chest pain (pericarditis)
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19
Q

What are the s/s of prerenal acute renal failure?

A
  • Hypotension
  • Tachycardia
  • Dizziness
  • Thirst, oliguria
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20
Q

What are the s/s of intrarenal acute renal failure?

A
  • Rash
  • Purpura
  • Inflammatoryarthritis
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21
Q

What are the s/s of postrenal acute renal failure?

A
  • Suprapubic or flank pain
  • Distended bladder
  • Hematuria
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22
Q

What is chronic renal failure?

A
  • Progressive and irreversible inadequate kidney function due to permanent loss of nephrons
  • Develops over months or years
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23
Q

What can cause chronic renal failure?

A
  • More than half caused by systemic disease
  • Can also be caused by congenital disorders or prolonged pyelonephritis
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24
Q

During chronic renal failure, what happens to the nephrons?

A
  • Damaged and cease to function
  • Scarring in the kidneys
  • Tissue begins to shrink and waste away
  • Kidney function diminishes, fluid builds up in the blood
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25
Q

What is uremia?

A

increased urea and waste products in blood

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26
Q

What is azotemia?

A
  • increased nitrogenous wastes in blood
  • Leads to hypertension, anemia and electrolyte imbalances
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27
Q

What are the s/s of chronic renal failure?

A
  • Altered level of consciousness
  • Late stages: seizures and coma are possible
  • Lethargy, nausea, headaches, cramps, and signs of anemia
  • Skin: pale, cool, and moist
  • Jaundice
  • Uremic frost: powdery accumulation of uric acid around the face
  • Edema: due to fluid imbalances
  • Hypotension and tachycardia
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28
Q

What is renal dialysis

A
  • Technique for “filtering” toxic wastes from the blood, removing excess fluid, and restoring the normal balance of electrolytes
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29
Q

What are the two types of renal dialysis?

A
  • Peritoneal dialysis
  • Hemodialysis
30
Q

What is peritoneal dialysis?

A

Large amounts of specifically formulated dialysis fluid are infused into the abdominal cavity

31
Q

What is hemodialysis?

A

Patient’s blood circulates through a dialysis machine (functions as a normal kidney)

32
Q

What is a internal shunt?

A
  • Artificial connection between a vein and an artery
  • Usually located in the forearm or upper arm
  • Beware- no BP on arm with fistula
33
Q

What is a fistula?

A
  • A fistula is made by connecting a vein to an artery
  • The vein becomes bigger allowing for increased blood flow
  • Created from natural parts of the body and can be repeatedly “stuck” to perform hemodialysis treatments
34
Q

What is chronic dialysis?

A

“On the machine” every 2 or 3 days for 3 to 5 hours

35
Q

What are chronic dialysis patient vulnerable too?

A
  • Accidental disconnection from the machine, malfunction of the machine, or rapid shifts in fluids and electrolytes
  • If on home dialysis patient is usually very educated and can help with any problems that may occur
36
Q

Renal Dialysis, hypotension and shock

A
  • Sudden drop in blood pressure
  • Patient may feel lightheaded or become confused
  • Shock secondary to bleeding is also possible
  • Leaking shunt- reconnect or clamp off shunt
  • Patients can exsanguinate if left open
37
Q

Potassium imbalance

A
  • Inability to excrete ingested potassium
  • Prone to developing hyperkalemia
38
Q

What is hyperkalemia?

A

can occur with over aggressive dialysis

39
Q

How do you tell if a patient has developed hyperkalemia?

A
  • May present with profound muscular weakness
  • On the ECG, peaked T waves, a prolonged QRS complex, and sometimes disappearance of the P waves
40
Q

Disequilibrium Syndrome

A
  • Concentration of urea in the blood is lowered rapidly during dialysis
  • Solute of CSF remains high (Water shifts into the CSF increasing ICP)
41
Q

What are the symptoms of disequilibrium syndrome?

A
  • Nausea
  • Vomiting
  • Headaches
  • Confusion
42
Q

How does a air embolism occur with dialysis pt’s?

A

Loose fittings and connections in the dialysis system

43
Q

What are symptoms of an air embolism?

A
  • Sudden dyspnea
  • Hypotension
  • Cyanosis
44
Q

What is the prehospital treatment for air embolism

A
  • Transport patient in left lateral position with a slight head down tilt
  • This will trap embolism in right atrium
45
Q

Tumour of the adrenal gland- Pheochromocytoma

A
  • Usually in the medulla
  • Causes excess release of the hormones epinephrine and norepinephrine
  • Less than 10% malignant
  • May occur at any age
46
Q

What are the s/s of pheochromocytoma?

A
  • Hypertension
  • Anxiety
  • Chest pain
  • Abdominal pain
  • Fatigue
  • Weight loss
  • Vision problems
  • Potentially seizures
47
Q

Genitourinary trauma- kidney

A
  • Generally involve large forces
  • Blunt renal trauma
    • Contact sports, “kidney punch”
    • Presentation is flank and hematuria
  • Penetrating renal trauma
48
Q

Genitourinary Trauma- Ureter

A
  • Difficult, if not impossible, to identify in the prehospital setting
  • Rarely leads to an immediate life-threatening condition
49
Q

Genitourinary Trauma- bladder and urethra

A
  • Blunt or penetrating trauma may result in bladder rupture or laceration
  • Bladder rupture
    • Inability to urinate
    • Blood noted in the penile opening
    • Tenderness upon palpation of the suprapubic region
50
Q

What is testicular torsion?

A

Is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum

51
Q

What can cause testicular torsion?

A
  • Some men may be predisposed to testicular torsion as a result of inadequate connective tissue within the scrotum
  • Can result from trauma to the scrotum, particularly if significant swelling occurs
  • After strenuous exercise or may not have an obvious cause
52
Q

What are the s/s of testicular torsion?

A
  • Sudden onset of severe pain in one testicle, with or without a previous predisposing event
  • Swelling within one side of the scrotum
  • Nausea or vomiting
  • Lightheadedness
53
Q

What are the functions of the penis?

A

Vital for both proper urination and sexual function

54
Q

What are injuries to the penis?

A
  • Blunt or penetrating trauma
  • Also from sexual behaviour and self-mutilation
  • Becomes erect when blood fills the corpus cavernosa:
    • Priapism
    • Fractured penis
55
Q

Where is the uterus located?

A
  • Behind the bladder
  • Well-protected within the pelvis
56
Q

Vaginal trauma

A
  • Blunt or penetrating trauma or self-inflicted
  • Do not attempt to remove any objects, immediately transport to ED
  • Sexual assault
57
Q

What are the s/s of vaginal trauma?

A
  • Hematomas
  • Ecchymosis in the lower pelvic area and on the external female genitalia
  • Bleeding and tenderness upon palpation of pelvis
58
Q

What is the assessment of GU injuries?

A
  • Same as with any other medical patient
  • Pain
    • Often difficult to determine the source of the pain
    • Don’t waste valuable time trying to determine the exact cause of pain
    • Visceral pain- common with urologic problems
    • Crampy, achy deep pain within the body
      Referred pain
59
Q

Scene assessment for GU injuries

A
  • Routine precautions, consider mechanism of injury, assess for hazards and the need for additional help
  • General impression
60
Q

Initial assessment of GU injuries

A
  • General impression and life-threatening conditions
  • Mental status and ABCs
  • Extremes of activity (kidney stone dance)
61
Q

Focused History and Physical Examination/ Detailed Physical Examination for GU injuries

A
  • 80% of all medical diagnoses are based on the patient’s history
  • Determining the origin of the pain
  • SAMPLE & OPQRST

Physical examination
- Monitor vital signs
- ECG b/c of possible electrolyte imbalances

62
Q

Initial Impression and Treatment Plan GU Injuries

A

Once you have completed the history and physical examination
- Could be as simple as monitoring ABCs
- Or as complex as adjusting medications and support in patients with renal failure
- Includes transport decision

63
Q

What is the ongoing assessment for GU injuries?

A

Electrolyte imbalances
- Caused by the buildup of toxins
- Can cause major, rapid changes in the functioning of the body’s organs
- The heart is particularly susceptible to electrolyte changes; cardiac monitoring is essential

64
Q

What is the management of a UTI or Renal Calculi?

A
  • Centers on comfort and support
  • Allow the patient to assume a position of comfort
  • Analgesia
  • Establish an IV line
  • UTI: administer a bolus of fluid
  • Renal calculi: IV fluids at a rate sufficient to deliver pain medication
65
Q

What is the management for acute renal failure and chronic renal failure?

A
  • Can lead to life-threatening emergencies
  • Support of the ABCs is imperative
  • Medications to regulate acidosis and electrolyte imbalance as well as fluids for volume regulation
66
Q

What are the symptoms of a UTI?

A
  • Painful urination
  • Frequency of urination
  • Difficulty of urination
  • Restless and uncomfortable

Skin:
Pale, cool, and moist (lower UTI)
Warm and dry (Upper UTI)

67
Q

What is the prehospital management of a UTI?

A
  • Supportive prehospital care of the ABCs
  • Allow the patient to ride in a position of comfort
  • Be prepared for nausea and vomiting
  • Nonpharmacologic pain
  • Establish an IV
  • Transport to the nearest appropriate facility for evaluation
68
Q

What is the prehospital management for kidney stones?

A
  • Centers on pain relief
  • Analgesia
  • Breathing techniques
  • Establish an IV line and administer fluids at a rate sufficient to deliver pain medication
  • Transport
69
Q

Acute renal failure- toxic buildup

A
  • Nitrogenous waste and salts
  • Skin will be pale, cool, and moist
    • Edema
  • Abdomen
    • Look for scars, ecchymosis, or distension
    • Palpate for any pulsing masses
70
Q

Acute renal failure- metabolic changes

A
  • Can be life-threatening
  • Support the ABCs
  • Medication can nephrotoxic
71
Q

What is the management of acute renal failure?

A
  • Talk with your patient
  • Inform him or her of what you are doing and what is occurring
  • Be confident and calm
72
Q

What is the assessment of chronic renal failure?

A
  • Altered level of consciousness
  • In the late stages, seizures and coma
  • Lethargy, nausea, headaches, craps, and signs of anemia
  • Skin
  • Hypotensive and tachycardic
  • ECG monitor will sow increasing PR and QT intervals

EMRG 1130 (13 decks)

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