Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Urology
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Objectives
Label a diagram of the urinary system
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Objectives
Discuss prehospital management for patients with
genitourinary disorders
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Scenario
Your patient is 64 years old and complains of
weakness, dyspnea, and fatigue. She has a
history of renal failure but missed dialysis this
week. Her face, hands, and feet are swollen.
Her blood pressure is 190/110 mm Hg, pulse
is irregular; there are moist crackles in the
bases of the lungs; and her ECG shows
peaked T waves.
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Discussion
What is the most likely explanation for this patients
symptoms?
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary System
Functions
Removes waste products
from blood
Helps to maintain constant
body fluid volume and
composition
Components
Kidneys
Ureters
Urinary bladder
Urethra
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
GU Disorders that Cause Pain
Urinary retention
UTI
Pyelonephritis
Urinary calculus
Epididymitis
Testicular torsion
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Retention
Inability to urinate
Causes
Urethral stricture
Enlarged prostate
CNS dysfunction
Foreign body obstruction
Drugs
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Retention
Signs and symptoms
Abdominal pain
Urge to urinate
Distended bladder
Management
Transport for urinary catheterization
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Tract Infection (UTI)
Upper urinary tract infections
Pyelonephritis
Intrarenal and perinephric abscesses
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Tract Infection (UTI)
UTIs in men
Urethritis
Prostatitis
Cystitis
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Tract Infections
Signs and symptoms
Dysuria
Frequency
Hematuria
Abdominal pain
Fever, chills
Management
Hospital diagnosis, antibiotics
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Pyelonephritis
Inflammation of kidney parenchyma
Therapeutic intervention
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Calculus (Kidney Stones)
Pathological concretions originate in renal
pelvis
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary Calculus
Risk factors
Dehydration
CNS disorders
Drug use
Surgery
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Urinary CalculusS/S
Pain may radiate Low-grade fever
Restlessness Hematuria
Diaphoresis
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Epididymitis
Bacterial infection
Management
Elevate scrotum
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Testicular Torsion
True emergency
Usually spontaneous
May result from blunt trauma
Two peaks
<1 y/o
Puberty
Range 5 mos to 41 yrs of
age
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Testicular Torsion
Signs and symptoms
Tender epididymis
Painful swelling of the scrotal sac
Sudden
Often preceded by physical activity
Severe (sometimes radiates to left quadrant)
Unrelieved by position
Nausea and vomiting
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Testicular Torsion
Must diagnose and treat <6 hrs
To prevent loss of testis from ischemic infarction
Therapeutic intervention
Ice packs
Pain management
Physician reduction
Surgery
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
History
Focused history
OPQRST
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History
Recent illness Weight loss
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
History
Women
Menstrual activity
Possibility of pregnancy
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Physical Examination
Protect privacy
If possible, same-gender paramedic should
examine patient
Chaperone
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Physical Examination
Initial assessment
Physical examination
Appearance
Posture
Level of consciousness
Apparent state of health
Skin color
Vital signs
Abdominal examination
Genitalia examination (if indicated)
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Management and Treatment Plan
Airway, ventilatory, and circulatory support
Oxygen if indicated
Pain management
Transport
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Management and Treatment Plan
Do not permit patient to eat or drink
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Renal Failure
Kidneys maintain homeostasis by:
Controlling extracellular fluid volume
Maintaining proper electrolyte composition
Regulating blood pH
Eliminating wastes
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Renal Failure
Uremia
Encephalopathy
Pericarditis
Hyperkalemia
Acidosis
Hypertension
Volume overload
CHF
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Acute Renal Failure
Sudden decrease in glomerular filtration
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Acute Renal Failure
Onset may be within hours
Oliguric
<500 mL/day urine
Nonoliguric
>500 mL/day urine
Anuria
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Acute Renal Failure
Edema
Acidosis
Uremia
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Prerenal ARF
Inadequate kidney perfusion
Causes
Hypovolemia
Decreased cardiac output
Renal artery obstruction
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Prerenal ARF
Signs and symptoms
Dry mouth, thirst
Hypotension
Tachycardia
Management
Treat underlying condition
IV fluids
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Intrarenal ARF
Damage to both kidneys
Interstitial diseases
Drugs
NSAIDs, antibiotics, anticancer drugs, dyes, alcohol, cocaine
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Intrarenal ARFS/S
Fever Hypertension
Headache Oliguria
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Intrarenal ARF
Treat underlying cause
Renal dialysis
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Postrenal ARF
Obstruction of urine flow in both kidneys
Bilateral calculi
Prostatic enlargement
Urethral strictures
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Postrenal ARF
Urine retention
Distended bladder
Hematuria
Low back pain
Pain in groin, genitalia
Edema
Treat obstruction to reverse
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Chronic Renal Failure
Develops over months to years
Congenital disorders
Prolonged pyelonephritis
Diabetes
Hypertension
Autoimmune disorders
Causes scarring of kidneys
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Chronic Renal Failure
Progressive abnormality in blood counts and
blood chemistry levels
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Chronic Renal Failure
Gastrointestinal
Anorexia
Nausea
Vomiting
Cardiopulmonary
Hypertension
Pericarditis
Pulmonary edema
Peripheral, sacral, and periorbital edema
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Chronic Renal Failure
Nervous system
Anxiety
Delirium
Progressive obtundation
Hallucinations
Muscle twitching
Seizures
Metabolic or endocrine
Glucose intolerance
Electrolyte disturbances
Anemia
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Chronic Renal Failure
Personality changes
Fatigue
Mental dullness
Uremia
Yellow skin
Thin extremities
Uremic frost
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Renal Dialysis
Technique to normalize blood chemistry
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Renal Dialysis
Amount that transfers during dialysis depends
on:
Concentration difference
Molecular size of substance
Time
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Hemodialysis
Heparinized blood is pumped through:
Arteriovenous fistula
OR
Arteriovenous graft
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Peritoneal Dialysis
Dialysis membrane is peritoneum
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Dialysis Emergencies
Vascular access problems
Hemorrhage
Hypotension
Chest pain
Severe hyperkalemia
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Dialysis Emergencies
Disequilibrium syndrome
Group of neurological findings
Occurs during or immediately after dialysis
Symptoms are usually mild but may be severe
If seizures, diazepam may be indicated
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Air Embolism
Negative pressure on venous side of dialysis tubing
Malfunction in dialysis machine
Air embolism enters patient's bloodstream
Oxygen
Rapid transport
Position on left side
Modified Trendelenburg position
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Dialysis EmergenciesManagement
Support airway and ventilation
Oxygen administration
ECG
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Questions?
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.