Adults 2 Exam 4

Question 1

prostatitis S/S:

Answer 1

resemble a UTI: fever, dysuria, peripneal prostatic pain, severe lower symptoms

Question 2

Goal of prostatitis treatment: (viral and bacterial)

Answer 2

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

Question 3

if a patient has prostatitis and presents with UA but no fever..

Answer 3

treat with anti-inflammatory agents or alpha adrenergic blockers

Question 4

when should a person with prostatitis seek a follow up appointment

Answer 4

6 months to 1 year

Question 5

Acute prostatitis

Answer 5

patient should be hospitalized and on IV antibiotic therapy. Comfort measures such as analgesics and sitz bath

Question 6

Chronic prostatitis

Answer 6

treated on outpatient basis, needs to be educated on antibiotic therapy and recognizing S/S

Question 7

BPH (what it is an pathophys, risk factors)

Answer 7

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

Question 8

clinical manifestations of BPH

Answer 8

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

Question 9

Azotemia

Answer 9

excess of nitrogen waste in bladder from urine being held onto in the bladder

Question 10

Assessment and Diagnoses of BPH

Answer 10

assess PSA levels for cancer and post residual urine, UA

voiding diary should be useful in determining BPH, focus on health history

Question 11

medical management for BPH

Answer 11

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,

Question 12

stylet catheter

Answer 12

emergency situation usage

Question 13

Coude catheter

Answer 13

normal BPH usage

Question 14

ONLY surgeons/doctors can cath patients with inflamamtion

Answer 14

TRUE

Question 15

Pharmacological therapy for BPH

Answer 15

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

Question 16

TURP

Answer 16

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

Question 17

what should be assessed before TURP procedure is done

Answer 17

kidney and bladder function. Need to flush and make sure that it is functioning. BUN and Cr levels are assessed.

Question 18

nursing process diagnoses pre-op

Answer 18

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

Question 19

nursing process diagnoses post-op

Answer 19

imbalanced fluid volume related to fluid overload .

acute pain postop- analgesics

deficient knowledge

Question 20

3 way cath

Answer 20

• count the number of ml going in and out
• flush with 30-50ml
• hypervolemia at risk
• always read note before taking out foley

Question 21

postop nursing interventions

Answer 21

maintain fluid balance with IV fluids, monitor electrolyte imbalances such as hyponatremia (increased BP, confusion, resp distress)

REPORT TO SURGEON and DOCUMENT FIRST

Question 22

in order to relieve pain after TURPs procedure.. patient is instructed to

Answer 22

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)

Question 23

Potential complications after TURPS

Answer 23

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

Question 24

Arterial blood

Answer 24

bright red- call doctor if seen. SEND to surgery

Question 25

Venous blood

Answer 25

darker in color
might be controlled by prescribed traction to the catheter so that the balloon holding the catheter in place applies pressure

Question 26

Rehab and home care after surgery

Answer 26

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

Question 27

orchitis

Answer 27

acute inflammatory response of one or both testes can happen from UTI

Question 28

S/S of orchitis

Answer 28

fever, pain, tenderness in one or both testes, swelling bilaterally or unilaterally, penile discharge, blood in semen, leukocytosis

Question 29

epididymitis

Answer 29

infection of epididymis, spread from infected urethra, bladder or prostate, greatest in men 19-35

Question 30

S/S in early epididymitis

Answer 30

develops slowly over 1-2 days

low grade fever, chills, heaviness in affected testicle

Question 31

S/S in late epididymitis

Answer 31

increasing tenderness to pressure and traction, unilateral pain, severe pain in lower abdomen, pain aggravated by bowel movement

Question 32

Assesment and diagnostics for epididymitis

Answer 32

UA, CBC, gram stain, HIV testing

Question 33

Nursing management for epididymitis

Answer 33

bed rest, scrotal bridge, antimicrobial agents, intermittent cold compress, local heat or sitz bath, analgesics, activity restrictions

Question 34

testicular torsion S/S

Answer 34

nausea, vomiting, pain occuring wtihin 1-2 hours, lightheadedness