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Nursing Semester 3 > Cyndi - Week 8 - Exam 4 > Flashcards

Cyndi - Week 8 - Exam 4 Flashcards

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1
Q

what is benign prostatic hypertrophy?

A

enlargement of prostate gland d/t overgrowth of tissue; hormonal changes during aging process

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2
Q

what are the 6 characteristics of BPH?

A
  • ↑ % estrogen/↓ testosterone
  • ↑ accumulation of DHT? (prostatic androgen made from testes)
  • result = hyperplasia - more cells
  • enlargement compresses urethra
  • compression not r/t size but location
  • lack of cellular apoptosis
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3
Q

what are the 4 complications of BPH?

A
  • urinary retention
  • UTI
  • bladder or kidney damage
  • hydronephrosis (fluid backup in kidney)
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4
Q

what are the 8 risk factors for BPH?

A
  • obesity
  • sedentary lifestyle
  • alcohol use
  • age (> 50 years = 50%; >80years = 90%)
  • erectile dysfunction
  • smoking
  • diabetes
  • family hx
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5
Q

T/F: BPH does predispose to prostate cancer

A

FALSE; it does NOT predispose to cancer

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6
Q

how is BPH diagnosed? (8)

A 
History + Physical
DRE – digital rectal exam done by 50 y/o to r/o cancer
Urinalysis  (UA) with culture
PSA – Prostate‐specific antigen
Serum creatinine
TRUS: Trans Rectal UltraSound
Uroflowmetry/Post Void Residual
Cystoscopy (risk for infection; 5-10 min; anesth; bleeding normal for 24hrs; clot; irrigation)
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7
Q

what are the two main clinical manifestations of BPH?

A
  • obstruction (d/t obstruction or retention)

- irritation (d/t inflammation or infection)

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8
Q

what are the sxs of obstruction for BPH?

A
  • Decreased force (weaker stream)
  • Difficulty initiating
  • Intermittency (stopping and starting)
  • Dribbling - bladder full → still have some → go a little
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9
Q

what are the sxs of irritation for BPH?

A
  • Frequency, urgency
  • Pain
  • Nocturia
  • Incontinence
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10
Q

what are the 3 different tx for BPH?

A
  • watchful waiting
  • medications
  • invasive
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11
Q

what does watchful waiting consist of for BPH tx?

A
  • Dietary (no artificial sweetners, no coffee)
  • Timed voiding schedule (q2hr to try to urinate)
  • Pt education
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12
Q

what meds are used for BPH tx?

A
  • 5 alpha reductase inhibitors - Proscar
  • Alpha adrenergic receptor blocker - Hytrin
  • Erectogenic drugs - Cialis,Viagra
  • Herbal therapy - Saw Palmetto
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13
Q

what invasive tx is used for BPH?

A
  • Coude catheter – special catheter
  • Prostate stent
  • Surgery – TURP
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14
Q

what is the post op care for transurethral resection of the prostate (TURP)?

A
  • Ambulate
  • Monitor for hemorrhage
  • Bladder spasms
    •Treat with Belladonna (B&O suppository)
  • Urinary incontinence
  • Monitor for S/S infection:
    •Assess urine character and amounts; enc hydration
  • Continuous bladder irrigation (CBI)
    •To manage blood clots and prevent obstruction
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15
Q

what is continuous bladder irrigation used for in BPH?

A

NS irrigation used to remove blood clots

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16
Q

what are the NI for bladder irrigation?

A
  • Clots may occur for 24‐36 h
  • Removed 24‐48 H post‐op
  • Irrigation may be used intermittently
  • Pt may experience bladder spasms
  • Strict I&O
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17
Q

what is important to remember about the catheter used for continuous bladder irrigation?

A

has a large balloon (30 mL)

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18
Q

what is prostate cancer? and three characteristics of prostate cancer?

A

Malignant tumor of the prostate gland
• One in 6 men
• Generally good long‐term survival – but depends
• Androgen‐dependent tumor

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19
Q

what are the risk factors for prostate cancer?

A
  • Ethnicity (African American) *test
  • Age
  • Familial history
  • Other
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20
Q

what are the diagnostics used for prostate cancer?

A
  • Labs
  • Digital Rectal Exam ‐ hard, nodular, asymmetrical area felt for
  • Ultrasound used to locate tumor sites
  • TRUS
  • Biopsy
  • CT, MRI, bone scan to look for metastases
21
Q

what labs are used to help diagnose prostate cancer?

A
  • PSA – initial and monitoring
  • PAP‐prostatic iso‐enzyme of acid phosphates
  • Alkaline phosphatase - met. into bone - elevated
22
Q

what grading system is used for biopsies for prostate cancer?

A

TNM system for grading tissue pathology (1‐4)

23
Q

what are the initial symptoms of prostate cancer?

A 
same as BPH
• Frequency, urgency
• Pain
• Nocturia
• Incontinence
• Decreased force (weaker stream)
• Difficulty initiating
• Intermittency (stopping and starting)
• Dribbling - bladder full → still have some → go a little
24
Q

what are the later symptoms of prostate cancer?

A
  • Pain, back pain
  • Urinary retention
  • Bilateral lower extremities weakness, bowel or bladder dysfunction
  • Weight loss and fatigue
25
Q

T/F: prostate cancer may be asymptomatic

A

TRUE

26
Q

what is the tx of prostate cancer?

A
  • Watchful waiting/active surveillance
  • Surgical approach
  • Radiation ‐ implanted seeds, external beam
  • Medications ‐ hormone therapies
  • Orchiectomy- removal of testes
27
Q

what are the surgical tx for prostate cancer?

A
  1. Radical prostatectomy
    - Retropubic
    - Perineal
    - Nerve sparing to maintain sexual function
  2. Cryotherapy-
28
Q

TEST: what are the considerations for perineal radical prostatectomy?

A

concerned about infection, clean frequently, constipation, care with wound

29
Q

what is post op care for prostatectomy for prostate cancer?

A
  • Retropubic versus perineal
  • Treat pain
  • Accurate I&O
  • Encourage po as tolerated
  • Ambulate
  • Encourage to verbalize feelings
  • Assess the urinary catheter for patency ‐ blood clots may impede drainage – monitor urine output!!
  • Minimize catheter manipulation - sticker the way they go1
  • Care of drain, dressing changes
30
Q

what are the complications of prostate cancer?

A 
Metastases
Surgery complications:
- Infection
- Incontinence
- Erectile dysfunction
- Hemorrhage
- Urinary retention
- DVT
- PE
31
Q

what is testicular cancer and what are the characteristics?

A

Rare cancer of young men developed from embryonic germ cells
• Seminoma (not as aggressive/common)
• Nonseminoma (rare/aggressive)
• Others 10%

32
Q

whata are the risk factors for testicular cancer?

A
  • History of cryptorchidism
  • A family history of testicular cancer
  • Others: orchitis, HIV, maternal exposure to exogenous estrogen, testicular cancer in other testes
33
Q

what are the diagnostic tests for testicular cancer?

A 
• Self exam *test**
- Perform in warm area
• Physical exam 
- Firm non‐tender lump
- Testicular swelling 
- Although testicles may not be same size normally
• Flashlight exam
• Ultrasound of testes
• Labs – tumor markers
• CT‐Abdominal and pelvis
34
Q

T/F testicular cancer may be asymptomatic

A

TRUE

35
Q

what are the possible early sxs of testicular cancer?

A
  • Painless lump
  • Scrotal swelling
  • Feeling of scrotal heaviness
  • Non‐tender, firm mass
  • Pain or ache
36
Q

what are the possible late sxs of testicular cancer?

A

back or chest pain
cough
dyspnea

37
Q

what are the different tx for testicular cancer?

A

Surgery – radical orchiectomy
Radiation
Chemotherapy

38
Q

T/F: 95% have complete remission if detected and treated in early stages

A

TRUE

39
Q

why aren’t meds routinely used for testicular cancer and what might a man want to consider?

A
  • Medications used can cause infertility, as well as other serious complications.
  • Patients may save sperm before treatment
40
Q

what is erectile dysfunction?

A

Inability to obtain or maintain an erection

41
Q

how is ED diagnosed?

A
  • self‐report of problem – age can affect causes
  • Sexual and psychosocial history questionnaire
  • Physical exam
  • Labs
42
Q

what are the possible reasons for ED for a younger man?

A

Stress, depression, substance abuse

43
Q

what are the possible reasons for ED for an older man?

A

Atherosclerosis, medications, diabetes

44
Q

what are the clinical manifestations of ED?

A
  • Gradual vs sudden
  • Intermittent vs continuous
  • Psychological or life changes
  • Distress
45
Q

what types of drugs are known to cause ED?

A
  • ARBs, ACE, CCB
46
Q

what is the treatment for ED?

A
  • Diet and lifestyle changes
  • Erectogenic drugs
  • Penile implants
  • Sexual counseling
  • Emotional support
47
Q

what is the primary goal for someone with ED?

A

restore satisfactory sexual function

48
Q

what is incontinence?

A

The involuntary leaking of urine

• 80% of incontinence can be improved

49
Q

how can incontinence be managed?

A 
Causative factors
Kegel exercises to strengthen pelvic muscles
Timed voiding schedule
Medications
Surgery

Nursing Semester 3 (29 decks)

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