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PCM III Exam 2 > Urological procedures > Flashcards

Urological procedures Flashcards

1
Q

Take a moment to be amazed:

A

Each individual kidney consists of at least 1 million and up to 2 million nephrons.
If the nephrons in both kidneys are taken out and placed end to end horizontally, they will cover a distance of 16 kilometers (approx. 9 miles).

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2
Q

Urinalysis purpose and methods

A 
Purpose:
Routine screen
Assess systemic disorders
Metabolic
Endocrine
Evaluate renal or urinary tract disease
Prenatal  evaluation

Methods:
Physical appearance
Dipstick evaluation
Microscopic evaluation

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3
Q

Obtaining a Voided Sample

A

Male-Expose the glans and urethral meatus, cleanse with a sterilizing agent and dry with sterile cloth. Collect mid-stream urine in a sterile container.

Female-Separate labia to expose urethral meatus. Cleanse the meatus front to back with sterilizing agent. Keep the labia spread and collect mid-stream urine in a sterile container

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4
Q

Situations where a voided sample is not adequate

A

Vaginitis
Menses
Extremes in age
Morbid obesity

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5
Q

If the patient cannot void

A

urine can be obtained by catheterization.
Urethral, Suprapubic, Nephrostomy

Pediatrics usually obtained with a bag frequently called a “Puck” Pediatric Urine Collection Kit

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6
Q

Urinalysis Physical appearance

A

Color
Pink-usually blood
Orange-frequently medications
Blue/green-drugs or ingested dyes, Pseudomonas
Brown/black-myoglobin, bilirubin, rhubarb, medication

Clarity
Cloudy-excess protein or cellular material, infection

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7
Q

Dipstick evaluation

A

Specific gravity- State of hydration
Ketones- Diabetes or starvation
pH- Kidney disease or urinary tract infection
Protein- Kidney disease
Glucose- Diabetes (Threshold is > 180 mg/dL)
Blood- Kidney disease, clotting disorders, stones, cancer
Bilirubin- Liver damage
Leukocyte esterase- Urinary tract infection
Nitrites- Urinary tract infection

  • If leukocytes and nitrates are positive there is a 74% predictive value for UTI, and 97% predictive value if both are negative
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8
Q

urinalysis- microscopic evaluation

A

White blood cells - Infection
Red blood cells - Kidney disease, decreased coagulation, cancer
Epithelial cells - Usually contamination but may indicate cancer
Casts - Kidney disease
Crystals - Kidney stones
Bacteria or yeast - Infection

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9
Q

microscopic eval: test results

A 
Rare/trace	- under 2  
Occasional/1+		3-5
Frequent/2+		5-9
Many/3+		Large amt
TNTC/4+ 	      Packed field
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10
Q

Blood in the urine

A 
RBC’s:
Glomerulonephritis
Cancer
Clotting disorders
Exercise
Stones

WBC’s:
Infection
Inflammation
Injury

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11
Q

Casts

A

RBC casts are indicative of glomerulonephritis, with leakage of RBC’s from glomeruli, or severe tubular damage.

WBC casts are most typical for acute pyelonephritis

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12
Q

Crystal formation can be caused:

A

by an augmentation of concentration beyond the super saturation capacity. This is typically caused by dehydration.
by a decreased supersaturation capacity. This situation could be caused by a decrease in inhibitors of concentration, a neutralization of these inhibitors, by some electrolytes, or a by pH change.
by the presence of crystals with a promoter effect on the crystallization of another species. Crystallization of calcium oxalate promoted by amorphous urates is a good example of this phenomenon.

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13
Q

most common crystals and their causes

A

Calcium Oxalate are most common. The presence of these crystals is without any clinical meaning.

Uric Acid crystals are mainly due to a poor dilution volume at an acidic pH

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14
Q

Bacteria

A

Almost always caused by infection in the urinary tract. E. Coli is the most common organism.

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15
Q

24 hour urine collection

A

Total protein
Calcium, sodium, potassium
Creatinine (Cr)and creatinine clearance (CrCl)
Clearance = Urine Cr (x) Total volume/Plasma Cr (x) Time

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16
Q

Urine protein electrophoresis

A

Measures the levels of both major types of protein in the urine (albumins and globulins).

17
Q

Catheterization of the Bladder indications

A

Acute urinary retention
Obtain uncontaminated sample
Diagnostic studies (Urodynamics, cystourethrogram)
Monitor urine output – ICU, postoperatively
Measure residual volume
Surgery on adjacent structures
Urinary tract surgery

18
Q

Catheterization of the Bladder contraindication and complications

A

Contraindications
Known urinary tract obstruction (stricture)
Reconstructive surgery of urethra or bladder neck
Combative or uncooperative patient
Pelvic trauma – suspect urethra injury
Acute infection of the prostate and/or urethra (relative)

Complications
Infection
Hematuria
Urethral stricture

19
Q

Catheterization of the Bladder

A

Select catheter usually 16-18 French
Check balloon of the catheter
Sterile draping and gloving
Aseptic technique – the hand that cleans and holds the labia or penis should not touch the catheter
Retract foreskin or labia and cleanse the urethral meatus and surrounding area with antiseptic solution
2% lidocaine jelly into urethra
Introduce catheter into urethral meatus
Follow the anticipated course of the urethra and pass approximately 3 inches into the bladder
The balloon should only be inflated after urine is observed flowing through the catheter
Gently pull catheter outward until balloon resting against bladder neck

20
Q

When it is time to remove the Foley catheter, remember to

A

deflate the balloon first!!!

21
Q

Catheterization of the Bladder- long term use

A 
Chronic retention
Neurogenic bladder with retention
Unable to self cath
Incontinent  with complicated skin breakdown or infection
Comfort measure for terminally ill
22
Q

Suprapubic Catheterization indications

A

Bladder neck stricture, contracture or obstruction
Inability to pass urethral catheter
Urethral trauma
Recent urethra or bladder neck surgery
Inability to tolerate or unwilling to self cath
Presence of urethral or prostate infection
Severe phimosis
Collect urine sample - analyze, culture
Relief of urinary retention

23
Q

Suprapubic Catheterization contraindications and complications

A

Contraindications
Uncooperative patient
Blood dyscrasia or anti coagulation treatment
Infection or cellulitis of the suprapubic area

Complications
Peri-vesicular bleeding
Gross hematuria
Infection-skin, subcutaneous, intra-abdominal, bladder
Intestinal perforation
24
Q

Bladder Scan

A

Portable 3-D ultrasound device which provides quick and non-invasive measurements of the bladder volume and post void residual volume

only gives volumes, not evaluation of bladder structure itself

25
Q

Flow Cystometry

A

Two catheters are inserted into the bladder. One fills the bladder while the other measures pressures.

Used for evaluation of urinary incontinence, an overactive bladder and urinary retention

26
Q

Cystoscopy indications and contraindications

A 
Indications
Urinary incontinence
Known or suspected malignancy  
Recurrent UTI’s
Pelvic pain symptoms
Pelvic trauma
Intra-operative assessment of bladder or urethral trauma

Contraindications:
Relative -UTI or pyelonephritis-Can cause sepsis so patient is usually treated with antibiotics before procedure

27
Q

Intravenous Pyelogram(IVP)

A

An x-ray of the kidneys, ureters, and bladder which uses contrast material (usually iodine based) injected into the vein

To detect problems in these areas including kidney stones, cancer, enlarged prostate

Can be done using plain films or a CT scan
Size of stones and tumors are difficult to measure

28
Q

Computed Tomography

A

Non-contrast helical CT scan is the gold standard for the radiologic diagnosis of renal stone disease.
***

29
Q

Extracorporeal Lithotripsy

A

Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract.

Ultrasonic waves are passed through the body focused to strike the stones. Pulses of the waves pulverize them into smaller fragments, which are easier to pass through the ureter and into the bladder.

30
Q

Intracorporeal Lithotripsy

A

Patient undergoes cystoscopy

Laser is introduced through the cystoscope into the ureter and stones are broken into small pieces that will pass

Procedure works well on stones in the ureter.

31
Q

Infant Circumcision- Indications

A

Parental desire based on religious, ethnic, and cultural preferences
May decrease UTI’s and STI’s
May decrease penile cancer rate

AAP recently stated that the benefits outweigh the risks

32
Q

Infant Circumcision- contraindications

A 
Hypospadius or epispadius
Atypical genitalia
Undetermined phenotype (ambiguous genitalia)
Less than 12 hours postpartum
Illness
Prematurity (Relative)
Familial bleeding disorder  
Maternal thrombocytopenia
33
Q

Infant Circumcision- Risks/complications

A 
Bleeding
Infection
Trauma to glans or urethra
Poor cosmetic result 
Paraphimosis
Degloving of the penile shaft
Meatal stenosis - rare
34
Q

Infant Circumcision procedure

A

Generally less complications than adult
Usually done before the newborn goes home
Frequently done without anesthesia- that’s not very nice!!!

Three Methods : GOMCO, MOGEN, PLASTIBELL

35
Q

circumcision procedures

A

foreskin clamped at 12 o’clock, doral slit created

GOMCO- with bell, some oozing
Mogen- very quick
plastibell-

36
Q

Adult Circumcision indications

A 
Phimosis
Paraphimosis
Penile hygiene  
Recurrent balantitis
Neoplastic foreskin 
Excessive foreskin redundancy
Frenular tears
Patient or spouse preference
37
Q

Adult Circumcision - Contraindications

and complications

A 
Contraindications
Acute inflammation
Infection
Psychiatric disorder 
Bleeding disorder
Complications
Bleeding
Hematoma
Infection
Pain with erection
Stricture or scarring
Wound disruption usually due to erection
38
Q

Vasectomy indications, contraindications

A

Indications
Undesired fertility

Contraindications:
Infection
Coagulation disorder
Inability to palpate or elevate vas deferens
Stress – divorce, financial
Inappropriate reasons for wanting procedure
Concern about ability to perform sexually after the procedure

PCM III Exam 2 (9 decks)

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