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APA/Foundations 2 > Urologic Procedures - Rupp > Flashcards

Urologic Procedures - Rupp Flashcards

1
Q

5 conditions that can be diagnosed via urologic endoscopy procedures

A
  1. Hematuria
  2. Pyuria
  3. Calculi
  4. Trauma
  5. Cancer
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2
Q

5 nerves commonly injured r/t lithotomy position during urologic procedures

A
  1. Common perineal
  2. Saphenous
  3. Sciatic
  4. Obturator
  5. Femoral
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3
Q

Nerve injured by compression of fibular head on leg brace

A

Common peroneal nerve

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4
Q

Nerve injured by compression of the medial tibial condyle

A

Saphenous nerve

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5
Q

Nerve injured by excessive external rotation of legs or excessive extension of the knees

A

Sciatic Nerve

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6
Q

Nerves injured by flexion of the groin (surgeon leaning on leg)

A
  1. Obturator nerve

2. Femoral nerve

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7
Q

What is the obturator reflex?

A

electrocautery stimulates obturator nerve –> adductor muscle contracts –> bladder ruptures/is injured

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8
Q

What procedure has increased risk of obturator reflex? Why?

A

Resection of lateral wall tumors

Electrosurgical resection of these lesions is more likely to inadvertently stimulate the obturator nerve

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9
Q

Which procedure consists of a rigid scope passed through the urethra?

A

cystoscopy

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10
Q

If regional anesthesia is chosen for cystoscopy, what level of sensory block is required?

A

T9-T10

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11
Q

What spinal level should be blocked for a cystoscopy involving the ureters?

A

T8

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12
Q

4 reasons to perform cystoscopy for retrograde ureteral catheterization

A
  1. To visualize the ureter and kidney
  2. To place stents
  3. To drain obstructions
  4. To remove renal calculi
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13
Q

What is a TURBT?

A

Transurethral Resection of Bladder Tumor

Endoscopic resection and electrodessication used to treat superficial bladder tumors

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14
Q

Why is General anesthesia beneficial for a TURBT?

A

Coughing or straining may cause bladder perforation

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15
Q

What is the risk associated with regional anesthesia for a TURBT?

A

Increased risk of perforation

bladder becomes atonic and may become thinner when distended

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16
Q

S/S bladder perforation in an awake pt (who had regional anesthesia)

A
  1. Shoulder discomfort
  2. N/V
  3. Suprapubic fullness
  4. Abd spasm
  5. Pain
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17
Q

4 Risks associated with bladder perforation

A
  1. If high-grade malignancy present: risk of seeding it into the peritoneum
  2. Blood loss
  3. Hypothermia (cold fluid in peritoneal cavity)
  4. Bacteremia
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18
Q

How do decrease risk of vasoconstriction R/T bladder perforation?

A

Warm the irrigation fluid

Cool irrigation causes vasoconstriction and systemic cooling

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19
Q

What leads to DIC after bladder perforation?

A

release of prostatic thrombogenic substances, especially w prostate CA

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20
Q

Characteristics required for fluid with which the distend the bladder during a TURP

A
  1. Optically clear
  2. Nonconductive
  3. Nonhemolytic
  4. Nontoxic
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21
Q

Advantage to general anesthesia for a TURP

A

coughing must be avoided because it increases the risk of bleeding

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22
Q

Benefits of spinal anesthesia for a TURP

A

Bladder will be atonic with a large capacity therefore:

  • glycine infusion pressure can be low
  • emptying can be less frequent
  • facilitates the resection
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23
Q

Preferred type of anesthesia for a TURP

A

Spinal

b/c of benefits and away pt can supply early detection of complications

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24
Q

How to prevent post-op bladder spasm after TURP

A

allow for homeostasis

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25
Q

Complications of TURP

A
  1. Blood loss

2. Venous absorption of irrigation fluid

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26
Q

How does venous absorption of irrigation fluid occur during a TURP and on what does it depend?

A

open sinuses provide direct communication to the circulation

depends on pressure and time of exposure

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27
Q

Early signs of venous absorption during TURP

A

HTN

Tachycardia

28
Q

During venous absorption during TURP, CVP may rise as ___________ occurs

A

cardiac decompensation

29
Q

In the event of venous absorption during a TURP, and awake pt may complain of:

A
  1. Dyspnea/SOB

2. Nausea

30
Q

2 causes of TURP syndrome after venous absorption

A

Hypoxia and/or hyponatremia

31
Q

Late stages of TURP syndrome/water intoxication/glycine toxicity

A
  1. apprehension
  2. disorientation
  3. convulsions
  4. coma
32
Q

3 irrigating solutions used for TURP

A
  1. Glycine
  2. Sorbitol
  3. Mannitol
33
Q

Which irrigation solution for TURP can cause transient post-op visual impairment/blindness but carries a decreased likelihood of TURP syndrome?

A

Glycine

34
Q

Which irrigation solution for TURP can cause hyperglycemia and lactic acidosis but is is less likely to cause TURP syndrome?

A

Sorbitol

35
Q

Which irrigation solution for TURP is non metabolized and causes osmotic diuresis?

A

Mannitol

36
Q

Does the osmotic diuresis from Mannitol cause hyper- or hypo-volemia? Why?

A

Hypervolemia

It draws fluid into the vascular spaces

37
Q

How to treat TURP Syndrome

A
  1. Ask surgeon to control bleeding and finish surgery
  2. Send a blood sample
  3. Fluid restrictions and diuretics (10-20 mg Lasix) to correct hypervolemia and hyponatremia
  4. Hypertonic solutions to correct HypoNa
  5. Give NS or LR if Na >125 (don’t give if Na <125)
38
Q

Below what Na should a TURP be postponed?

A

125

39
Q

Which approach to open radical prostatectomy carries increased risk for hemorrhage?

A

Retropubic Approach

supine, flex table, and trendelenberg

40
Q

From where does most of the blood loss during open prostatectomy come from?

A

Dorsal venous complex

41
Q

Although regional and general anesthesia are both appropriate for open radical prostatectomy, what is a MUST in either case?

A

Large IV

42
Q

Which position for open radical prostatectomy poses a very high risk for post-op blindness? How can this be prevented?

A

Perineal approach
(extreme lithotomy position)

Keep BP up and don’t let pt get HoTN

43
Q

Which procedure cares a 50/50 chance that the pt will never have another erection?

A

Radical Open Prostatectomy

44
Q

What are the effects of Methylene blue dye?

A

HoTN and sat falsely down to 65% for 1-2 min

45
Q

What are the effects of indigo carmine dye 0.8%?

A

alpha sympathomimetic effect - increases BP

46
Q

Which dye used for open radical prostatectomies has a greater effect, Methylene blue or indigo?

A

Methylene blue

47
Q

Indications for nephrectomy

A
  1. Chronic infection
  2. Trauma
  3. Cystic or calculus dz
  4. Neoplasm
48
Q

What may result from the lateral-flex table and kidney bar used for nephrectomy positioning?

A

vena cava compression and HoTN

49
Q

2 lab values that should be optimized prior to renal transplant

A

serum K should be normal

metabolic acidosis should be corrected

50
Q

common disorder present in renal transplant its

A

anemia

51
Q

Best NMB to use for renal transplant pts

A

atracurium
(or cisatracurium for any renal pt)

definitely not succs

52
Q

contraindications to regional anesthesia for renal transplant

A
  1. preexisting coagulopathy

2. immunosuppression

53
Q

Adequate hydration is critical in a renal transplant pt. what types of fluid should be used for revascularization of the kidney? What should not be used?

A
  1. Crystalloid (NS)
  2. Colloid
  3. Blood

avoid LR

54
Q

What drugs help discourage rejection and diuresis during renal transplant?

A

methylprednisone

diuretics

55
Q

What should be used if a renal transplant pt becomes oliguric?

A

low dose dopamine

56
Q

complications of renal transplant

A
  1. hyper K
  2. delayed renal fx
  3. graft failure
57
Q

how long can a donor kidney be considered viable if preserved with the POPS (portable organ preservation system)?

A

72 hrs

58
Q

how long can a donor kidney be considered viable if preserved by cold storage?

A

48 hrs

past that point, necrosis will jeopardize graft survival

59
Q

What monitoring devices should be used during a radical cystectomy?

A

Arterial line

CVP

60
Q

Why is CVP important during a radical cystectomy?

A

Fluid shifting can be extensive and UOP cannot be monitored

61
Q

Complications of radical cystectomy

A
  1. hypothermia
  2. inadequate fluid replacement
  3. need for post-op ventilation
62
Q

If a regional is used for orchidopexy, orchiectomy, or urogenital plastic procedure, up to what sensory level should be blocked?

A

T9

63
Q

What procedure will likely make a child infertile?

A

Orchiectomy

64
Q

Common co-existing medical problems in patients receiving AV shunts or fistulas?

A

Anemia
CAD
DM

65
Q

procedure that breaks upper urinary tract stones with external shock waves; includes a cushion interface with skin or pt is submersed in a tank of water

A

ESWL - Extracorporal Shock Wave Lithotripsy

66
Q

What triggers the shock delivered during ESWL?

A

QRS

67
Q

What is important to help pt pass stone fragments after ESWL?

A

very adequate hydration and diuretics

APA/Foundations 2 (6 decks)

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