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Summer 2020 - APA Foundations 2 - Other > Urological Procedures - Quiz 2 > Flashcards

Urological Procedures - Quiz 2 Flashcards

1
Q

What is the patient position for urological procedures?

A

Lithotomy

Risk for Common Peroneal, Saphenous, Sciatic, Obturator, and Femoral nerve injury

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2
Q

How does the Lithotomy cause Common Peroneal nerve injury?

A

Leg brace compresses Fibular Head

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3
Q

How is the Saphenous nerve injured in Lithotomy?

A

Compression of Medial Tibial Condyle

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4
Q

Excessive external rotation of legs & extension of knees in the Lithotomy position causes damage to which nerve?

A

Sciatic Nerve

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5
Q

In Lithotomy position, how is the Obturator and Femoral nerve injured?

A

Excessive Groin Flexion

Elevated legs can cause blood pooling

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6
Q

How could the Obturator Reflex potentially be harmful during Urological Procedures?

A

Accidental electrosurgical stimulation of Obturator nerve can cause adductor muscle contraction leading to Bladder Rupture.

Especially during Lateral Wall Tumor Resection

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7
Q

What is needed in Cystoscopy for a passing rigid scope?

A

Urethral stimulation, dilation, & bladder distension

Regional or General for pain

Regional @ T9-T10 (T8 for Ureters)

2% Lidocaine Jelly

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8
Q

When is Cystoscopy for Retrograde Ureteral Cath indicated?

A

Visualization of Upper Urinary Tract

Stent Placement

Drain Obstructions

Calculi Removal

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9
Q

What procedure is done to treat Superficial Bladder Tumors?

A

Transurethral Resection of the Bladder (TURBT)

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10
Q

What should be avoided during a TURBT?

A

Coughing/Straining - bladder perf

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11
Q

How does Regional Anesthesia affect the bladder?

A

Atonicity & thinning of bladder = more perf risk

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12
Q

What can happen due to a Bladder Perf?

A

Shoulder Pain

N/V

Spreading of Malignancy to Peritoneum

Blood Loss

Hypothermia

Bacteremia

Possible convert to Open Procedure

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13
Q

What should you suspect if a patient complains of Suprapubic Fullness, Abdominal spasms, and pain?

A

Bladder Perforation

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14
Q

What are the early signs of a Bladder perf?

A

HTN & Tachycardia, then, severe Hypotension

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15
Q

With a Bladder Perf, what can be triggered by release of Prostatic Thrombogenic Substances, especially w/ Prostate Cancer?

A

DIC

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16
Q

What does a TURP procedure entail?

A

Endoscopic electrosurgical resection of obstructive prostate tissue or tumor using a high frequency wire loop.

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17
Q

How is the bladder distended for a TURP procedure?

A

Distend bladder w/ nonconductive, nonhemolytic, nontoxic solution

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18
Q

How is homeostasis achieved during a TURP?

A

Coagulation current seals vessels

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19
Q

Why is Spinal Anesthesia preferred over General Anesthesia for a TURP?

A

Avoids Cough & Bleed

Atonic Bladder w/ Large Capacity

Less Post-Op Bladder Spasms

Awake patients can voice complications

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20
Q

What are the main complications of a TURP?

A

Blood Loss

Venous Absorption of Irrigation Fluid

TURP Syndrome

21
Q

What are the signs and symptoms of Venous Absorption of Irrigation fluid?

A

Early: HTN & Tachycardia

↑CVP

Dyspnea

Nausea

Hypoxia

Hyponatremia

22
Q

What is TURP Syndrome?

A

Water Intoxication Or Glycine Toxicity

Apprehension

Disorientation

Convulsions

Coma

23
Q

What are the Irrigation Solutions used for TURPs?

A

Glycine (1.5%)

Sorbitol (3.3%)

Mannitol (5%)

24
Q

What are the Disadvantages of using the TURP Irrigation Fluids?

A
  • Glycine = Post-Op Vision Problems
  • Sorbitol = Hyperglycemia & Lactic Acidosis
  • Mannitol = Osmotic Diruesis & Hypervolemia
25
How should TURP Syndrome be managed?
Tell MD to control Bleeding & Finish Draw Sodium Level Fluid Restriction Lasix Hypertonic Solutions
26
50% of Radical Prostatectomy cases result in what?
Impotence
27
What are the positions used for a Radical Prostatectomy?
**Supine, Trendelenburge, Flex Table** for Supra/Retropubic approach & **Extreme Lithotomy** for Perineal approach | (Hemmorrhage Risk)
28
During which period of a Radical Prostatectomy would you be most concern for Blood Loss?
During Control of Dorsal Venous Complex
29
During a Radical Prostatectomy, what can be used to Identify Ureters?
* **Methylene Blue 1%** - Hypotension * **Indigo Carmine 0.8%** - Pressor Effect * Both can cause a lower O2 Sat Reading to 65% for 2 min, but more so for Methylene
30
When is a Nephrectomy indicated?
Chronic Infections Trauma Cystic/Calculus Disease Neoplasms
31
What is invovled in a Nephrectomy?
Lateral-Flex Table Kidney Bar Lateral Retroperitoneal Incision Anterior Abdominal Incision
32
What is a concern when using a Kidney Bar during a Nephrectomy?
Vena Cava Compression & Hypotension
33
How should the patient be positioned for a Renal Transplant?
Supine w/ Role under hip
34
Which NMBs should not be used for Renal Transplants?
Sux & Atracurium
35
How is a Renal Transplant done?
Kidney connected to External Illac Arteries or Prior Nephrectomy & Ureteral Anastomosis
36
\_\_\_\_\_\_\_\_\_ Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants
**Regional** Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants
37
Which fluids should **_not_** be used for hydration during Renal Transplants?
LR & Fluids containing Potassium
38
Which drugs can help w/ Renal Transplant rejection & Diuresis?
Methylprednisone & Diuretics
39
If the patient is oliguric once the new kidney is transplanted, what can be given?
Low dose dopamine
40
What are Renal Transplant complications?
Graft Failure Hyperkalemia Delayed Renal Fxn
41
What can be used to preserve the Kidney for transplant and how long would the kidney last?
**POPS** - Portable Organ Preservation System **72 hrs** w/ renal perfusion @ 40-60 mmHg **48 hrs** w/ cold storage @ 4° C
42
When is a Radical Cystectomy indicated?
Invasive Bladder Tumors Pelvic Cancer Neurogenic Bladder Chronic Lower Urinary Tract Obstruction Post Radiation Bladder Problems
43
What is the end result of a Radical Cystectomy?
Uretero-Ileal Anastomosis & Ileostomy
44
What are the Anesthetic Considerations for a Radical Cystectomy?
Supine Position A-Line CVP Diuretics Dyes
45
What are the Complications of a Radical Cystectomy?
Hypothermia Inadequate Fluids Post-Op Ventilation
46
When are Orchidopexy or Orchiectomy Indicated?
Congenital Malformations Neoplasms Impotence Testicle Torsion
47
What kind of anesthesia is needed for an Orchidopexy or Orchiectomy?
General or Regional T9 Sensory Block Supine/Lithotomy Position
48
How does Extracorporal Shock Wave Lithotripsy (ESWL) work?
* Shocks upper urinary tract stones while patient is in water * Triggered by QRS on R-WAVE * Lithotomy, then Supine * Fluids & Diuretics to flush stone fragments

Summer 2020 - APA Foundations 2 - Other (10 decks)

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