Shared Flashcard Set

Details

principles II, test 3, Renal slides 36-46
mahatma
23
Nursing
Graduate
11/22/2009

Additional Nursing Flashcards

 


 

Cards

Term
During a TURP, how much fluid is absorbed before you see symptoms of TURP syndrome?  What are those syndromes?
Definition

2 liters or more

 

headache, restlessness, confusion, cyanosis, dyspnea, arrhythmias, hypotension, seizures, death

Term
What are the symptoms of TURP syndrome due to?
Definition
Fluid overload, water intoxication, and occasionally from the solute in the irrigation fluid, which are absorbed into the venous sinuses of the prostate.
Term

What can happen when sodium levels are 120 meq/L?

115?

<100?

Definition

120 = neurological symptoms

115 = widening of QRS, ST segment elevation

<100 = VT/VF

Term
Why is regional a nice technique for TURP?  What level is needed?
Definition

Provides an ability to check neuro status

T10

Term
What should you do if you suspect your patient has TURP syndrome?
Definition

Draw lytes and serum osmolarity.

Supportive treatment includes intubation if needed to help maintain saturation, stopping the procedure, lasix 0.5 mg/kg, hypertonic saline

Term
What are the manifestations of TURP syndrome?
Definition

Hyponatremia

Hypoosmolarity

Fluid overload

Hemolysis

Hyperglycinemia

Hyperammonia (from glycine)

Hyperglycemia (from sorbitol)

Term
What are the factors that affect uptake of irrigation solution?  Which are most important?
Definition

Height of irrigation bag

Duration of resection

Size of gland resection

Congestion of the gland

Number of sinuses open

Experience of surgeon

Term
What is the average rate of absorption of irrigant during a TURP?
Definition
20 ml/min
Term
Bladder perforation is a complication of TURP.  If the TURP is done under general, how is bladder perf. detected?
Definition
Only the surgeon can detect if under general b/c he/she will see less bladder fluid returned.
Term
Symptoms of bladder perf. depend on whether the perforation is located where?  Which is harder to detect?
Definition

Intraperitoneal or extraperitoneal.

 

Extraperitoneal

Term
What are symptoms of intraperitoneal rupture?
Definition

Abdominal rigidity, distention, and pain (suprapubic)

Referred shoulder pain

Hiccups

Tachycardia

SOB

Hypo/hypertension

Diaphoresis

Vomiting

Term

What are symptoms of extraperitoneal rupture?

 

Definition

Periumbilical inguinal (pain, I'm assuming?)

 

or lower abdominal extension

Term
Hyperglycinemia is a complication of TURP.  What is glycine, and what happens with hyperglycinemia?
Definition

Glycine is the #2 inhibitory neurotransmitter.

Hyperglycinemia causes transient blindness.  Glycine is degraded to ammonia (which can also lead to CNS depression.)

Term

Lithotripsy (extracorporeal shock wave lithotripsy) uses high energy repetitive shocks (sound waves) focused on the stone that causes it to fragment.  Why is tissue not damaged in this procedure?

What areas are vulnerable to damage?

Definition

Tissue has the acoustic density of water and thus no damage is done.

Air filled tissue (lungs and guts) are vulnerable to destruction, thus, an inability to position to avoid these areas is a contraindication.

Term
What are contraindications to lithotripsy?
Definition

Pregnancy

Stone below the obstruction

Inability to position correctly

Bleeding diathesis

Untreated infection

(aortic aneurysm and orthopedic prosthetics are RELATIVE contraindications)

Term
Patients with a history of cardiac arrhythmias and those with pacers/ICDs may be at risk for arrhythmias produced by shock waves.  What should be done to help?
Definition
The lithotripsy should be synchronized with the R wave on the EKG to reduce the risk of arrhythmias.  The shock is times to 20 ms after the R wave occurs (to hopefully occur during absolute refractory)
Term
If a patient has no history of arrhythmias, does the lithotripsy machine need to be synched?
Definition
No, asynchronous delivery is usually safe.
Term
Run through the hemodynamic effects of water immersion for litho.
Definition
The patient is placed in a heated water bath, which can lead to vasodilation and hypotension.  The pressure of the water on the legs usually improves preload, however, and arterial BP will rise.  SVR increases, CO decreases.  The increased preload and afterload can potentiate CHF in pts with poor LV function.  Also, the increased intrathoracic blood volume decreases FRC, potentially leading to hypoxia.
Term
What type of anesthetic plan is often used for non-immersion litho?
Definition
MAC is often used (procedure can be painful).  If pt c/n lie still, general should be used.
Term
If using an epidural for water immersion litho, what level is needed, and what special considerations are needed?
Definition

T6 sensory level needed.

Little air should be used for loss of resistance because air can dissipate the shock waves.  Foam tape should not be used to secure the epidural because it dissipates the shock wave.  

 

Light sedation + oxygen works well.

Term
Although a spinal might work okay for water litho, what might need to be considered?
Definition
The patient is in a sitting position in the tank, which may increase the incidence of PDPH, and there is less control over the level of the block.
Term
A radical cystectomy is a big surgery, where bladder is removed, and the ureters are rerouted to a bowel segment.  The bowel segment is either used to form a pseudo bladder or attached to a cutaneous stoma.  Why might regional be a bad idea for this?
Definition
Regional technique may lead to a contracted bowel and hyperparastalis--making it more difficult for the surgeon to operate.
Term
What are the anesthetic implications of a radical cystectomy?
Definition

1.  Possible hypotensive technique

2.  Want them well hydrated, and they will have significant evaporative loss (huge incision)

3.  CVP is often used to manage fluids

4.  Consider A-line if limited cardiac reserve (or hypotensive technique)

5.  need to work to keep them warm!

6.  Type and cross

7.  Prolly gonna need muscle relaxation

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