Module 26- GU Injuries and Management Flashcards
Urinary tract infections
- 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
When do the upper urinary tracts (ureters and kidneys) get most infected?
- 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
What are the symptoms of a UTI?
- 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
Where do kidney stones originate?
- 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
What are the different type of kidney stones?
- Calcium stones
- Struvite stones
- Uric acid and cystine stones
Calcium stones
- Most common
- Occur frequently in men
- Has hereditary component
- Metabolic disorders (gout, hormonal disorder)
Struvites stones
- Common in women
- Associated with chronic UTI or frequent catheterization
Uric acid and cystine stones
- 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
What is the pain for kidney stones?
- 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
What is the pain presentation of kidney stones?
- 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
What is acute renal failure?
- Sudden decrease in filtration through the glomeruli
- Accompanied b an increase of toxins in the blood
What is oliguria?
urine output drops to less than 500ml/day
What is anguria?
urine production stops completely
Acute Renal Failure is classified into 3 types based on the area where failure occurs, what are they?
- Prerenal
- Intrarenal
- Postrenal
What is prerenal?
hypoperfusion of the kidneys (shock)
What is intrarenal?
damage to the kidney often caused by immune-mediated disease, toxins chronic inflammation or medications
What is postrenal?
obstruction of urine flow from kidneys, prostate enlargement, renal calculi or stricture
What are the s/s of acute renal failure?
- hypertension
- SOB and edema (volume overload)
- Hyperventilation
- Confusion
- Lethargy (uremia)
- Chest pain (pericarditis)
What are the s/s of prerenal acute renal failure?
- Hypotension
- Tachycardia
- Dizziness
- Thirst, oliguria
What are the s/s of intrarenal acute renal failure?
- Rash
- Purpura
- Inflammatoryarthritis
What are the s/s of postrenal acute renal failure?
- Suprapubic or flank pain
- Distended bladder
- Hematuria
What is chronic renal failure?
- Progressive and irreversible inadequate kidney function due to permanent loss of nephrons
- Develops over months or years
What can cause chronic renal failure?
- More than half caused by systemic disease
- Can also be caused by congenital disorders or prolonged pyelonephritis
During chronic renal failure, what happens to the nephrons?
- 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
What is uremia?
increased urea and waste products in blood
What is azotemia?
- increased nitrogenous wastes in blood
- Leads to hypertension, anemia and electrolyte imbalances
What are the s/s of chronic renal failure?
- 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
What is renal dialysis
- Technique for “filtering” toxic wastes from the blood, removing excess fluid, and restoring the normal balance of electrolytes
What are the two types of renal dialysis?
- Peritoneal dialysis
- Hemodialysis
What is peritoneal dialysis?
Large amounts of specifically formulated dialysis fluid are infused into the abdominal cavity
What is hemodialysis?
Patient’s blood circulates through a dialysis machine (functions as a normal kidney)
What is a internal shunt?
- Artificial connection between a vein and an artery
- Usually located in the forearm or upper arm
- Beware- no BP on arm with fistula
What is a fistula?
- 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
What is chronic dialysis?
“On the machine” every 2 or 3 days for 3 to 5 hours
What are chronic dialysis patient vulnerable too?
- 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
Renal Dialysis, hypotension and shock
- 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
Potassium imbalance
- Inability to excrete ingested potassium
- Prone to developing hyperkalemia
What is hyperkalemia?
can occur with over aggressive dialysis
How do you tell if a patient has developed hyperkalemia?
- May present with profound muscular weakness
- On the ECG, peaked T waves, a prolonged QRS complex, and sometimes disappearance of the P waves
Disequilibrium Syndrome
- Concentration of urea in the blood is lowered rapidly during dialysis
- Solute of CSF remains high (Water shifts into the CSF increasing ICP)
What are the symptoms of disequilibrium syndrome?
- Nausea
- Vomiting
- Headaches
- Confusion
How does a air embolism occur with dialysis pt’s?
Loose fittings and connections in the dialysis system
What are symptoms of an air embolism?
- Sudden dyspnea
- Hypotension
- Cyanosis
What is the prehospital treatment for air embolism
- Transport patient in left lateral position with a slight head down tilt
- This will trap embolism in right atrium
Tumour of the adrenal gland- Pheochromocytoma
- Usually in the medulla
- Causes excess release of the hormones epinephrine and norepinephrine
- Less than 10% malignant
- May occur at any age
What are the s/s of pheochromocytoma?
- Hypertension
- Anxiety
- Chest pain
- Abdominal pain
- Fatigue
- Weight loss
- Vision problems
- Potentially seizures
Genitourinary trauma- kidney
- Generally involve large forces
- Blunt renal trauma
- Contact sports, “kidney punch”
- Presentation is flank and hematuria
- Penetrating renal trauma
Genitourinary Trauma- Ureter
- Difficult, if not impossible, to identify in the prehospital setting
- Rarely leads to an immediate life-threatening condition
Genitourinary Trauma- bladder and urethra
- 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
What is testicular torsion?
Is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum
What can cause testicular torsion?
- 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
What are the s/s of testicular torsion?
- 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
What are the functions of the penis?
Vital for both proper urination and sexual function
What are injuries to the penis?
- Blunt or penetrating trauma
- Also from sexual behaviour and self-mutilation
- Becomes erect when blood fills the corpus cavernosa:
- Priapism
- Fractured penis
Where is the uterus located?
- Behind the bladder
- Well-protected within the pelvis
Vaginal trauma
- Blunt or penetrating trauma or self-inflicted
- Do not attempt to remove any objects, immediately transport to ED
- Sexual assault
What are the s/s of vaginal trauma?
- Hematomas
- Ecchymosis in the lower pelvic area and on the external female genitalia
- Bleeding and tenderness upon palpation of pelvis
What is the assessment of GU injuries?
- 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
Scene assessment for GU injuries
- Routine precautions, consider mechanism of injury, assess for hazards and the need for additional help
- General impression
Initial assessment of GU injuries
- General impression and life-threatening conditions
- Mental status and ABCs
- Extremes of activity (kidney stone dance)
Focused History and Physical Examination/ Detailed Physical Examination for GU injuries
- 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
Initial Impression and Treatment Plan GU Injuries
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
What is the ongoing assessment for GU injuries?
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
What is the management of a UTI or Renal Calculi?
- 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
What is the management for acute renal failure and chronic renal failure?
- 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
What are the symptoms of a UTI?
- Painful urination
- Frequency of urination
- Difficulty of urination
- Restless and uncomfortable
Skin:
Pale, cool, and moist (lower UTI)
Warm and dry (Upper UTI)
What is the prehospital management of a UTI?
- 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
What is the prehospital management for kidney stones?
- Centers on pain relief
- Analgesia
- Breathing techniques
- Establish an IV line and administer fluids at a rate sufficient to deliver pain medication
- Transport
Acute renal failure- toxic buildup
- Nitrogenous waste and salts
- Skin will be pale, cool, and moist
- Edema
- Abdomen
- Look for scars, ecchymosis, or distension
- Palpate for any pulsing masses
Acute renal failure- metabolic changes
- Can be life-threatening
- Support the ABCs
- Medication can nephrotoxic
What is the management of acute renal failure?
- Talk with your patient
- Inform him or her of what you are doing and what is occurring
- Be confident and calm
What is the assessment of chronic renal failure?
- 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
