Adults 2 Exam 4 Flashcards
prostatitis S/S:
resemble a UTI: fever, dysuria, peripneal prostatic pain, severe lower symptoms
Goal of prostatitis treatment: (viral and bacterial)
viral- palliative, no antibiotics, sitz bath for 10-20 min, fluids but not an over abundant amount, foods to avoid such as tea, coffee, spices, chocolate
bacterial- antibiotics given at low and continuous doses
if a patient has prostatitis and presents with UA but no fever..
treat with anti-inflammatory agents or alpha adrenergic blockers
when should a person with prostatitis seek a follow up appointment
6 months to 1 year
Acute prostatitis
patient should be hospitalized and on IV antibiotic therapy. Comfort measures such as analgesics and sitz bath
Chronic prostatitis
treated on outpatient basis, needs to be educated on antibiotic therapy and recognizing S/S
BPH (what it is an pathophys, risk factors)
excessive growth of tissues and is not necessarily cancerous. It can press on the urethra and occur slowly overtime
pathophys-
- can be caused from DHT (dihydrotestosterone)- a metabolite of testosterone is a critical mediator or prostatic growth.
- Estrogen increase can cause increase in prostate tissue
Risk factors: Western diet- high in fat, smoking, alcohol consumption, HTM, heart disease, obesity, reduced activity levels
clinical manifestations of BPH
dribbling urine after peeing, more than 50cc left in bladder on a bladder scan, frequent urination, hesitancy in starting urine, sensation of incomplete bladder emptying, UTIs, decreased force of stream
Azotemia
excess of nitrogen waste in bladder from urine being held onto in the bladder
Assessment and Diagnoses of BPH
assess PSA levels for cancer and post residual urine, UA
voiding diary should be useful in determining BPH, focus on health history
medical management for BPH
improve quality of life by comfort measures.
Prevent progression by reducing inflammation.
prevent disease progression
Emergency situations will be when the patient hasnt urinated in 24 hours and will need a cath,
stylet catheter
emergency situation usage
Coude catheter
normal BPH usage
ONLY surgeons/doctors can cath patients with inflamamtion
TRUE
Pharmacological therapy for BPH
alpha adrenergic blockers to relax smooth muscles, (side effects: pt may have headaches, hypotension)
Hormonal manipulation- blocks testosterone but can result in womanly effects (breasts on men) as well as ejaculation issues NOT erection issues
TURP
transurethral resection of prostate
endoscopy
prostate gland is removed in small chips
doesn’t cause erectile dysfunction but may cause retrograde ejaculation
repeated procedures might be necessary
pt has to be put to sleep so it is not for all candidates
no incision
goes through the urethra
what should be assessed before TURP procedure is done
kidney and bladder function. Need to flush and make sure that it is functioning. BUN and Cr levels are assessed.
nursing process diagnoses pre-op
anxixety related to surgery or outcomes–should be sensitive to patient
deficit knowledge- why is occured or about procedure- explain anatomy, diagnostic tests, surgery, etc.
Acute pain preop- give analgesics- best rest
nursing process diagnoses post-op
imbalanced fluid volume related to fluid overload .
acute pain postop- analgesics
deficient knowledge
3 way cath
- count the number of ml going in and out
- flush with 30-50ml
- hypervolemia at risk
- always read note before taking out foley
postop nursing interventions
maintain fluid balance with IV fluids, monitor electrolyte imbalances such as hyponatremia (increased BP, confusion, resp distress)
REPORT TO SURGEON and DOCUMENT FIRST
in order to relieve pain after TURPs procedure.. patient is instructed to
dangle feet at the bedside the day of surgery and the ext morning is assisted to ambulate
pain can be related to: flank pain, bladder spasm (urgent to void, feeling of pressure, fullness, bleeding around cath, exoriation of skin)
Potential complications after TURPS
hemorrhagic shock- discontinue NSAIDs or platelet inhibitors 10-14 days before procedure.
Urinary drainage should be reddish pink!!!
Infection- initial dressing change is performed by –surgeon
VTE- day of surgery dangle at bedside, put TED hose on
Cath obstruction- watch for abdominal distention in the lower abdomen, no output.
urinary incontinence may be present for up to 1-2 years
Arterial blood
bright red- call doctor if seen. SEND to surgery
Venous blood
darker in color
might be controlled by prescribed traction to the catheter so that the balloon holding the catheter in place applies pressure
Rehab and home care after surgery
dressing changes, no alcohol, tea or irritants, avoid sex for 6-8 weeks, foley cath wil be in place for 2 weeks so it is important to teach how to empty (leg bag during the day instead of big bag at night)
Empty bag every 8 hours
orchitis
acute inflammatory response of one or both testes can happen from UTI
S/S of orchitis
fever, pain, tenderness in one or both testes, swelling bilaterally or unilaterally, penile discharge, blood in semen, leukocytosis
epididymitis
infection of epididymis, spread from infected urethra, bladder or prostate, greatest in men 19-35
S/S in early epididymitis
develops slowly over 1-2 days
low grade fever, chills, heaviness in affected testicle
S/S in late epididymitis
increasing tenderness to pressure and traction, unilateral pain, severe pain in lower abdomen, pain aggravated by bowel movement
Assesment and diagnostics for epididymitis
UA, CBC, gram stain, HIV testing
Nursing management for epididymitis
bed rest, scrotal bridge, antimicrobial agents, intermittent cold compress, local heat or sitz bath, analgesics, activity restrictions
testicular torsion S/S
nausea, vomiting, pain occuring wtihin 1-2 hours, lightheadedness
