03 urology

Dutchess Community College EMS

Urology


Sections

Anatomy and Physiology

General Mechanisms of Nontraumatic Tissue Problems

General Pathophysiology, Assessment, and Management

Renal and Urologic Emergencies


Anatomy & Physiology

The Urinary System Female Male

Urology & Nephrology

The Kidneys


The Kidneys


Nephrons



Functions of the Kidneys Forming and Eliminating Urine

Maintaining blood volume with proper balance of water, electrolytes, and pH.

Retaining key compounds such as glucose, while excreting wastes such as urea.

Controlling Arterial Blood Pressure Regulating Erythrocyte Development



Formation of Urine Glomerular Filtration

GFR Reabsorption & Secretion

Simple diffusion and osmosis Facilitated diffusion

Active transport



Tubular Handling of Water and Electrolytes Diuresis and Antidiuresis

Tubular Handling of Glucose and Urea BUN and Creatnine

Control of Arterial Blood Pressure The Renin-Angiotensin System

Control of Erythrocyte Production Erythropoietin



Inflammatory or Immune-Mediated Disease

Infectious Disease

Physical Obstruction

Hemorrhage



Differentiating GI and Urologic Complaints

Pathophysiologic Basis of Pain Causes of Pain Types of Pain

Visceral pain Referred pain

General Pathophysiology, Assessment and Management


Scene Size-upInitial AssessmentFocused History OPQRST History Prior History of Similar Event History of Nausea, Vomiting, and Weight Loss Change in Bowel Habits and Stool Last Oral Intake Presence of Chest Pain

Assessment and Management


Physical Exam Appearance

Uncomfortable appearance. Posture

Lying with knees drawn up. Relief with walking.

Level of Consciousness Determine if changes are acute or chronic.



Physical Exam Apparent State of Health Skin Color Examination of the Abdomen

Inspection for distention, ecchymosis, or scarring Pain associated with percussion of abdomen Palpation

Normal or ectopic pregnancy Masses

Assessment Tools Vital Signs



Management Airway, Breathing Circulation Pharmacologic Interventions

IV access and analgesics. Nonpharmacological Interventions

Nothing by mouth (NPO). Maintain position of comfort. Reassess mental status and vital signs frequently.

Transport Considerations



Risk Factors Older Patients History of Diabetes History of Hypertension Multiple Risk Factors

Renal and Urologic Emergencies Acute Renal Failure Chronic Renal Failure Renal Calculi Urinary Tract Infection



Acute Renal Failure

Pathophysiology Prerenal Acute Renal Failure

Dysfunction before the level of kidneys Most common and most easily reversible

Renal Acute Renal Failure Dysfunction within the kidneys themselves

Postrenal Acute Renal Failure Dysfunction distal to the kidneys


Acute Renal Failure


Acute Renal Failure

Assessment Focused History

Change in urine output Swelling in face, hands, feet, or torso Presence of heart palpitations or irregularity Changes in mental function


Acute Renal Failure Physical Assessment

Altered mental status Hypertension Tachycardia ECG indicative of hyperkalemia Pale, cool, moist skin


Acute Renal Failure

Physical Assessment Edema of face, hands, or feet Abdominal findings

dependent on the cause of ARF


Acute Renal Failure

Management Airway, Breathing, Circulation IV Access

Protect fluid volume. Positioning and Transport


Chronic Renal Failure

Chronic Renal Failure Permanent Loss of Nephrons End-Stage Renal Failure (ESRF)

Pathophysiology Similar to Renal ARF

Microangiopathy, glomerular injury Tubular cell injury Insterstitial injury





Impairment of Kidney Functions Maintenance of blood volume with proper balance

of water, electrolytes, and pH Increased sodium, water, and potassium retention

Retention of key compounds such as glucose with excretion of wastes such as urea

Loss of glucose and buildup of urea within the blood Control of arterial blood pressure

Disruption of the renin-angiotensin loop resulting in HTN Regulation of erythrocyte development

Development of chronic anemia



Assessment Differentiate chronic and acute problems. Focused history and physical exam.

Gastrointestinal complaints Changes in mental status Marked abnormalities during physical exam Uremic frost





Immediate Management Monitor and support ABCs. Establish IV access.

Regulate fluid volume. Monitor vital signs and cardiac rhythm. Expedite transport to an appropriate facility.



Long-Term Management Renal Dialysis

Hemodialysis Common complications


Hemodialysis



Long-Term Management Renal Dialysis

Peritoneal dialysisCommon complications


Peritoneal Dialysis


Renal Calculi

Pathophysiology Results when “too much insoluble stuff”

accumulates in the kidneys. Stone types

Calcium salts Struvite stones Uric acid Cystine


Renal Calculi


Renal Calculi


Severe pain in one flank that increases in intensity and migrates from the flank to the groin

Painful, frequent urination with visible hematuria Prior history of calculi

Physical Exam Difficult due to patient discomfort Tachycardia with pale, cool, and moist skin


Renal Calculi

Management Maintain ABCs. Maintain position of comfort. Establish IV access.

Fluid bolus may promote stone movement and urine formation.

Consider medication administration. Parenteral narcotic analgesics may be indicated.


Urinary Tract Infection

Pathophysiology Risk Factors

Increased risk in female or catheterized patients Sexual activity

Lower and Upper UTIs Urethritis Cystitis Prostatitis Pyelonephritis Community-acquired vs. nosocomial infections




Abdominal painFrequent, painful urinationA “burning sensation” associated with

urinationDifficulty beginning and continuing to voidStrong or foul-smelling urineSimilar past episodes



Physical Exam Restless, uncomfortable appearance. Presence of a fever. Vital signs vary with degree of pain.

Management Maintain ABCs. Establish IV access. Consider analgesics. Transport to appropriate facility.


Urology and Nephrology Review

Anatomy and Physiology


General Pathophysiology, Assessment, and Management


Education

03 urology