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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
Q

How should TURP Syndrome be managed?

A

Tell MD to control Bleeding & Finish

Draw Sodium Level

Fluid Restriction

Lasix

Hypertonic Solutions

26
Q

50% of Radical Prostatectomy cases result in what?

A

Impotence

27
Q

What are the positions used for a Radical Prostatectomy?

A

Supine, Trendelenburge, Flex Table for Supra/Retropubic approach

&

Extreme Lithotomy for Perineal approach

(Hemmorrhage Risk)

28
Q

During which period of a Radical Prostatectomy would you be most concern for Blood Loss?

A

During Control of Dorsal Venous Complex

29
Q

During a Radical Prostatectomy, what can be used to Identify Ureters?

A
  • 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
Q

When is a Nephrectomy indicated?

A

Chronic Infections

Trauma

Cystic/Calculus Disease

Neoplasms

31
Q

What is invovled in a Nephrectomy?

A

Lateral-Flex Table

Kidney Bar

Lateral Retroperitoneal Incision

Anterior Abdominal Incision

32
Q

What is a concern when using a Kidney Bar during a Nephrectomy?

A

Vena Cava Compression & Hypotension

33
Q

How should the patient be positioned for a Renal Transplant?

A

Supine w/ Role under hip

34
Q

Which NMBs should not be used for Renal Transplants?

A

Sux & Atracurium

35
Q

How is a Renal Transplant done?

A

Kidney connected to External Illac Arteries or Prior Nephrectomy

&

Ureteral Anastomosis

36
Q

_________ Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants

A

Regional Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants

37
Q

Which fluids should not be used for hydration during Renal Transplants?

A

LR & Fluids containing Potassium

38
Q

Which drugs can help w/ Renal Transplant rejection & Diuresis?

A

Methylprednisone & Diuretics

39
Q

If the patient is oliguric once the new kidney is transplanted, what can be given?

A

Low dose dopamine

40
Q

What are Renal Transplant complications?

A

Graft Failure

Hyperkalemia

Delayed Renal Fxn

41
Q

What can be used to preserve the Kidney for transplant and how long would the kidney last?

A

POPS - Portable Organ Preservation System

72 hrs w/ renal perfusion @ 40-60 mmHg

48 hrs w/ cold storage @ 4° C

42
Q

When is a Radical Cystectomy indicated?

A

Invasive Bladder Tumors

Pelvic Cancer

Neurogenic Bladder

Chronic Lower Urinary Tract Obstruction

Post Radiation Bladder Problems

43
Q

What is the end result of a Radical Cystectomy?

A

Uretero-Ileal Anastomosis & Ileostomy

44
Q

What are the Anesthetic Considerations for a Radical Cystectomy?

A

Supine Position

A-Line

CVP

Diuretics

Dyes

45
Q

What are the Complications of a Radical Cystectomy?

A

Hypothermia

Inadequate Fluids

Post-Op Ventilation

46
Q

When are Orchidopexy or Orchiectomy Indicated?

A

Congenital Malformations

Neoplasms

Impotence

Testicle Torsion

47
Q

What kind of anesthesia is needed for an Orchidopexy or Orchiectomy?

A

General or Regional

T9 Sensory Block

Supine/Lithotomy Position

48
Q

How does Extracorporal Shock Wave Lithotripsy (ESWL) work?

A
  • 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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