Urologic Procedures Flashcards
Absolute contraindications to EWSL
Pregnancy
Bleeding Disorder
What level of a spinal is needed for a ESWL
T4-T6
Relative contraindications to ESWL
AICD Pacemaker Morbid Obesity Large calcification Renal Artery Aneurysms
When are shock waves delivered on ESWL
Shock waves ware defined to discharged 20 ms after the R wave
Immersion in heated bath causes physiologic alterations
CV effects
Increases central blood volume (CVP, blood pressure, and PA pressures increases)
Some patients can can have vasodilation resulting in hypotension
Immersion in heated bath causes physiologic alterations
Resp. Effects
Decrease VC, FRC, VT ; increased RR because WOB is increased
How do you put pt in the bath and with what monitors.
Hemodynamics, temperature, and O2
And gradual immersion in warm water
What is turp syndrome
The inter-vascular absorption of irrigation fluid can have neurological and cardiopulmonary consequences
When do the S/S occur
Intra op and post op
Serum Na level of 120 S/S
Possible widening of the QRS
restlessness and confusion
Serum Na level of 115
Widened QRS elevated ST
Nausea / Solmnolence
Serum Na level of 110
V-tach
V-fib
Seizures
Coma
Tx for TURP syndrome
Notify the surgeon to stop procedure
Send blood to lab
Insert invasive monitors
> 120 are mild and give pt fluid for BP support and lasix
< 120 give 3% Na and no IV greater than 100 ml/hr
Estimated blood loss in a TURP
Usually 2-4 ml/min
Increase bleeding with ___(2)_____ during a TURP
Larger prostate
Procedures lasting longer than 90 mins
How much blood for a prostate < 30 grams
No cross match
How much blood for a prostate 30-80 grams
Type and cross 2 UNITs
How much blood for a prostate >80 grams
Type and cross 4 units
Hydrostatic pressures of the irrigating pressures during a TURP
Height no >30 above the bed in the beginning
Height no >15 above the bed at the end. (Working on veins in the end)
Absorption of irrigants can lead to what physiologic alterations
Increased myocardial work
Dilution of blood proteins and electrolytes
Rapid hyponateremia resulting in fluid overload, pulmonary edema, cerebral edema, cardiac dysrhymias
The volume of irritant being absorbed is determined by (4 things)
of the venous sinuses
Duration obtuse resection (<1hr)
Hydrostatic pressure of the irrigation
The irritant and blood interface (keep the pt Blood pressure high)
Advantages and disadvantages of distiller water
A: superior visibility and non el
D: hemolysis, hemoglobionemia, hyponateremia
Advantages and disadvantages of glycine
most commonly used
Decreases likelihood of TURP Syndrome because it is isotonic.
Glycineis a non-essential amino metabolized into ammonia that crosses the BBB
Transient Blindness
Hyperglycemia
Coma
Inhibitory neurotransmitter that inhibits the release of NE and dopamine resulting in hypotension
Advantages and disadvantages of cytal (sorbitol & mannitol)
Second most common
Decreased likelihood of TURP SYNDROME
Hyperglycemia
Advantages and disadvantages of NS
Minimal effects with absorption
Dispenses current during electro- caterty
What is the most common urologic procedure
Cystoscopy
what are some indications for cystoscopy?
Hematuria (Most Common) Recurrent urinary tract infections Renal calculi Urinary tract obstruction Bladder Biopsy Resection of Bladder tumors Placement of ureteral catheter stents
Compare old scopes to new scopes
Old were ridged and now they are flexible
Lubricate with viscus lidocaine
when the surgeon goes into the urethra should the patient deep or light
deep
Lithotomy has what effects on the pulmonary system
Decrease the FRC
decrease the V/Q ratio
can lead to hypoxia
increased risk for atelectasis
Cardiovascular system changes with lithotomy
increase in central blood volume leads to increase BP and CVP…. can lead to CHF
How do you lower the legs of a patient? and what physiological symptom can you expect?
in Unison to prevent hip and back injury
BP may drop after lowering
Injury to the common perineal nerve?
injury to the lateral thigh on the strap can result in FOOT DROP
Injury to the saphenous nerve
injury to the medial calf on the strap support resulting in calf numbness
what happens in extreme flexion at thigh
injury to the sciatic nerve resulting in pain/numbess of pesterer leg.
What is the most common nerve injury in the lithotomy position?
Brachial Plexus
When should you use a Regional Block? and what level of block is required for a bladder surgery?
if the surgery is greater than 30 min. T10
Remember the hypotension from the sympathectomy and the hypotension from lower legs.
May want to give someone a IV fluid to increase their preload prior to surgery
What is the Obturator Reflex?
External rotation and adduction of the thigh due to cautery current thru the lateral bladder wall.
Still present if someone has a spinal. Respose is obliterated with MRs
What is a common risk for a bladder resection surgery?
Perforation
What things can cause a bladder perforation?
Over distention of the bladder with irritants
the tip of the resectoscope
the energized wire loop
what are the two types of bladder perforations?
Extraperitoneal (Most common)
Intraperitoneal
What is the s/s of extraperitoneal bladder rupture and how is it treated
Periumbilical, supapublic, or inguinal pain
irregular return of the irrigation fluid
TX= drains, antibiotics, no surgery needed
Intraperitonial s/s and treatment
Generalized pain– and., shoulder, chest
Pallor sweating
N/V
Abdominal rigidity (MUST OPEN AND REPAIR)
TX: surgery to open and repair the bladder.
Why is continuous irrigation needed for a TURP?
distends the bladder, washes away any extra blood and tissue, and optimizes visibility.
what weight must a prostate be under to be performed through a re-sectocope?
less than 60 gms
What would be the properties of a perfect irrigation fluid?
- isotonic and non-hemolytic if absorbed
- non-electrolytic
- non-metabolized
- non-toxic
- rapidly excreted
- inexpensive (because hospitals are cheap)
