Urologic Procedures

Question 0

Absolute contraindications to EWSL

Answer 0

Pregnancy

Bleeding Disorder

Question 1

What level of a spinal is needed for a ESWL

Answer 1

T4-T6

Question 2

Relative contraindications to ESWL

Answer 2

AICD
Pacemaker 
Morbid Obesity
Large calcification 
Renal Artery Aneurysms

Question 3

When are shock waves delivered on ESWL

Answer 3

Shock waves ware defined to discharged 20 ms after the R wave

Question 4

Immersion in heated bath causes physiologic alterations

CV effects

Answer 4

Increases central blood volume (CVP, blood pressure, and PA pressures increases)

Some patients can can have vasodilation resulting in hypotension

Question 5

Immersion in heated bath causes physiologic alterations

Resp. Effects

Answer 5

Decrease VC, FRC, VT ; increased RR because WOB is increased

Question 6

How do you put pt in the bath and with what monitors.

Answer 6

Hemodynamics, temperature, and O2

And gradual immersion in warm water

Question 7

What is turp syndrome

Answer 7

The inter-vascular absorption of irrigation fluid can have neurological and cardiopulmonary consequences

Question 8

When do the S/S occur

Answer 8

Intra op and post op

Question 9

Serum Na level of 120 S/S

Answer 9

Possible widening of the QRS

restlessness and confusion

Question 10

Serum Na level of 115

Answer 10

Widened QRS elevated ST

Nausea / Solmnolence

Question 11

Serum Na level of 110

Answer 11

V-tach
V-fib

Seizures
Coma

Question 12

Tx for TURP syndrome

Answer 12

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

Question 13

Estimated blood loss in a TURP

Answer 13

Usually 2-4 ml/min

Question 14

Increase bleeding with ___(2)_____ during a TURP

Answer 14

Larger prostate

Procedures lasting longer than 90 mins

Question 15

How much blood for a prostate < 30 grams

Answer 15

No cross match

Question 16

How much blood for a prostate 30-80 grams

Answer 16

Type and cross 2 UNITs

Question 17

How much blood for a prostate >80 grams

Answer 17

Type and cross 4 units

Question 18

Hydrostatic pressures of the irrigating pressures during a TURP

Answer 18

Height no >30 above the bed in the beginning

Height no >15 above the bed at the end. (Working on veins in the end)

Question 19

Absorption of irrigants can lead to what physiologic alterations

Answer 19

Increased myocardial work

Dilution of blood proteins and electrolytes

Rapid hyponateremia resulting in fluid overload, pulmonary edema, cerebral edema, cardiac dysrhymias

Question 20

The volume of irritant being absorbed is determined by (4 things)

Answer 20

of the venous sinuses

Duration obtuse resection (<1hr)

Hydrostatic pressure of the irrigation

The irritant and blood interface (keep the pt Blood pressure high)

Question 22

Advantages and disadvantages of distiller water

Answer 22

A: superior visibility and non el

D: hemolysis, hemoglobionemia, hyponateremia

Question 23

Advantages and disadvantages of glycine

most commonly used

Answer 23

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

Question 24

Advantages and disadvantages of cytal (sorbitol & mannitol)

Second most common

Answer 24

Decreased likelihood of TURP SYNDROME

Hyperglycemia

Question 25

Advantages and disadvantages of NS

Answer 25

Minimal effects with absorption Dispenses current during electro- caterty

Question 26

What is the most common urologic procedure

Answer 26

Cystoscopy

Question 27

what are some indications for cystoscopy?

Answer 27

``` Hematuria (Most Common) Recurrent urinary tract infections Renal calculi Urinary tract obstruction Bladder Biopsy Resection of Bladder tumors Placement of ureteral catheter stents ```

Question 28

Compare old scopes to new scopes

Answer 28

Old were ridged and now they are flexible Lubricate with viscus lidocaine

Question 29

when the surgeon goes into the urethra should the patient deep or light

Answer 29

deep

Question 30

Lithotomy has what effects on the pulmonary system

Answer 30

Decrease the FRC decrease the V/Q ratio can lead to hypoxia increased risk for atelectasis

Question 31

Cardiovascular system changes with lithotomy

Answer 31

increase in central blood volume leads to increase BP and CVP…. can lead to CHF

Question 32

How do you lower the legs of a patient? and what physiological symptom can you expect?

Answer 32

in Unison to prevent hip and back injury BP may drop after lowering

Question 33

Injury to the common perineal nerve?

Answer 33

injury to the lateral thigh on the strap can result in FOOT DROP

Question 34

Injury to the saphenous nerve

Answer 34

injury to the medial calf on the strap support resulting in calf numbness

Question 35

what happens in extreme flexion at thigh

Answer 35

injury to the sciatic nerve resulting in pain/numbess of pesterer leg.

Question 36

What is the most common nerve injury in the lithotomy position?

Answer 36

Brachial Plexus

Question 37

When should you use a Regional Block? and what level of block is required for a bladder surgery?

Answer 37

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

Question 38

What is the Obturator Reflex?

Answer 38

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

Question 39

What is a common risk for a bladder resection surgery?

Answer 39

Perforation

Question 40

What things can cause a bladder perforation?

Answer 40

Over distention of the bladder with irritants the tip of the resectoscope the energized wire loop

Question 41

what are the two types of bladder perforations?

Answer 41

Extraperitoneal (Most common) Intraperitoneal

Question 42

What is the s/s of extraperitoneal bladder rupture and how is it treated

Answer 42

Periumbilical, supapublic, or inguinal pain irregular return of the irrigation fluid TX= drains, antibiotics, no surgery needed

Question 43

Intraperitonial s/s and treatment

Answer 43

Generalized pain-- and., shoulder, chest Pallor sweating N/V Abdominal rigidity (MUST OPEN AND REPAIR) TX: surgery to open and repair the bladder.

Question 44

Why is continuous irrigation needed for a TURP?

Answer 44

distends the bladder, washes away any extra blood and tissue, and optimizes visibility.

Question 45

what weight must a prostate be under to be performed through a re-sectocope?

Answer 45

less than 60 gms

Question 46

What would be the properties of a perfect irrigation fluid?

Answer 46

- isotonic and non-hemolytic if absorbed - non-electrolytic - non-metabolized - non-toxic - rapidly excreted - inexpensive (because hospitals are cheap)