Exam 2 Flashcards
What is BPH?
BPH = Benign Prostatic Hyperplasia
It’s non-malignant enlargement of the prostate, which is common in aging men.
BPH Risk Factors
AGE:
Rare before age 40
>50% of men in 60s have symptoms
90% of men in 70s/80s have symptoms
RACE:
Black, hispanic develop symptoms earlier than whites
Asians develop later than whites
Clinical Manifestations of BPH
urinary retention
bladder distention
frequency
urgency
incontinence
nocturia
dysuria
bladder pain
increased time to void, straining to void
Reductase Inhibitors
(Finasteride, Dutasteride)
used to reduce the size of the prostate in BPH.
Inhibits the conversion of testosterone to drotesterone, shrinking the prostate.
Side effects: impotence, decreased libido, decreased ejaculate volume.
Adrenergic Receptor Blockers
(Tamsulosin, Alfuzosin, Silodosin, Prazosin)
Used for BPH
Relax the smooth muscles in the neck of the bladder, relieving the obstruction and improving ability to urinate.
Side effects: may cause orthostatic hypotension. Antihypertensives may worsen BPH symptoms.
BPH Surgeries
Balloon urethroplasty
Intraurethral stent = looks like a little cage, and it keeps the urethra open.
TURP = snips away some of the excess tissue to relieve pressure on the urethra. High risk of bleeding, hypovolemia. Report large blood clots / dark red urine, signs of hypovolemia to the doctor.
TUNA = trans-urethral needle ablation
burn away the excess prostate tissue by needles. This one doesn’t have as much post-op needs as TURP.
TUIP = Trans urethral Incision of the Prostate
similar to TURP but not as problematic post-op.
Laser surgery = most frequently conducted by the younger surgeries.
BPH Nursing Priorities
After surgical interventions,
* Pre/post op antibiotics
* Insert urinary catheter: Only try X2 at the most. Call Urologist or the PCP. If we can’t get it X2, don’t try X3 due to excessive trauma.
* Monitor vital signs, particularly post op for TURP. That one is a ‘nasty surgery’ with lots of bleeding.
* Monitor for if the patient is still having difficulty urinating post-op.
BPH Patient Education
Avoid irritants like caffeine, spicy food, artificial sweeteners
Avoid alcohol
2000-3000mL per day of fluid, but restrict before bed
Don’t suppress urge to urinate
Take meds as prescribed
Monitor symptoms & report if they worsen.
Urinary Tract Infection (UTI) upper vs. lower
Infection in the urinary tract
Upper: Kidneys (Pyelonephritis)
Upper: Ureters
Lower: Urinary bladder (Cystitis)
Lower: Urethra
UTI Patho
Inflammation of the bladder from bacteria, obstruction of the urethra, orother factors.
Commonly caused by bacteria, but may be caused by parasitic/ fungal infections (this is only seen in immunosuppressed patients)
More common in women.
UTI Risk Factors for Females
Females have a short urethra
Increases with increase in sex
spermicidal compounds
lack of normally protective mucosal enzyme
Personal hygiene
Voluntary urinary retention
Increased risk in 2nd trimester of pregnancy & PP
anal intercourse
UTI risk factors for males
Prostatic hypertrophy
circumcision
Personal hygiene
voluntary urinary retention
Anal intercourse
UTI Clinical Manifestations
not feeling well
high temp
elevated WBC
mental status changes in older adults
Foul odor
burning when urinating
Pyuria = puss in the urine
UTI Short course
3 day course
Reduces cost & increases compliance
lower rate of side effects
Oral antibiotics such as TMP-SMZ, Ciprofloxacin, or enoxacin (Penetrex)
UTI Long Course
for Pyelonephritis, abnormalities, stones, recurrent frequent UTIs
7-10 day course
May use the same antibiotics as 3 day course
May require IV antibiotics if severe: ciprofloxacin, gentamicin, ceftriazone (Rocephin), ampicillin
Severe illness may require hospitalization
UTI Patient education for Women
urinate after sex
wipe front to back
Wear cotton underwear and loose-fitting clothing
UTI general patient education
keep genital area clean
take the full course of antibiotics
Empty bladder at least every 3-4 hours
Adequate fluids (up to 3L/day)
Avoid coffee/cola
Eat foods that can maintain acidic urine (pH<5.5) like blueberries, prunes, cranberries.
Drinking cranberry juice daily decreases the risk of UTI.
CAUTI (Catheter Associated Urinary Tract Infection)
UTI diagnosis related to catheter if the catheter has been there at least 48 hours
Prevented by not using a catheter unless indicated! only use for strict I/O, neurological diagnosis preventing control of urine outflow, skin breakdown - skin injury/ select surgical proceudres.
Meticulous care of the catheter is paramount to prevent infections.
Treat with antibiotics post dx
Meticulous Catheter Care
Sterile insertion
Keep foley bag below the bladder
Peri care at least once/shift and as needed
Clean from insertion site down the catheter
Do not open the system.
Use stat lock to prevent movement of the tube while inserted.
Hang bag on lower bed frame, not side rail.
Keep bag empty.
Discontinue catheter as soon as possible.
Perfusion
Perfusion refers to the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells.
Perfusion is managed by cardiac output, which is the amount of blood pumped by the heart each minute.
What happens to organs if perfusion is altered?
Interference with tissue perfusion reduces blood flow through capillaries - which reduces O2, fluid, and nutrients to cells.
Occlusion, vasoconstriction, even dilation of arteries, atherosclerosis, thrombi
Ischemia is a reversible cellular injury that occurs when there isn’t enough O2 due to reduced perfusion.
Clinical Manifestations of poor perfusion
Muscles that hurt or feel weak when you walk.
A “pins and needles” sensation on your skin.
Pale or blue skin color.
Cold fingers or toes.
Numbness.
Chest pain.
Swelling.
Veins that bulge.
Nursing Assessment findings related to poor perfusion
Arrhythmias
Capillary refill >3 seconds
altered RR
Use of accessory muscles to breathe
Abnormal ABG
Chest pain, dyspnea, sense of impending doom
Change in BP (could be high or low)
Decreased urine output
Elevated BUN & Creatinine
Altered mental state, restlessness
Weak/absent peripheral pulse
Edema
Loss of hair to legs
Delayed wound healing
Normal blood path thru the heart
1) body
2) inferior/superior vena cava
3) right atrium
4) tricuspid valve
5) right ventricle
6) pulmonary arteries
7) lungs
8) pulmonary veins
9) left atrium
10) mitral or bicuspid valve
11) left ventricle
12) aortic valve
13) aorta
14) body.
Pre-hypertension
SBP: 120-129
AND
DBP: <80
treatment = lifestyle changes
Stage 1 HTN
SBP: 130-139
OR
DBP: 80-89
treatment = lifestyle changes and meds
Stage 2 HTN
SBP: 140-179
OR
DBP: 90-119
treatment = lifestyle changes and 2+ meds
Stage 3 HTN
SBP >=180
and/or
DBP> 120
treatment = IV meds
Thiazide Diuretic
Hydrochlorothiazide
Diuretic; used for HTN
Prevents tubular reabsorption of sodium, promoting sodium and water excretion and reducing blood volume.
Spironolactone may be used to treat ascites
Monitor for hypokalemia, vital signs for hypotension, dizziness, headache.
monitor fluid status for dehydration (daily weight)
Monitor electrolyte status
Beta Blockers
“LOLs”
Metoprolol/Lopressor
Atenolol/Tenormin
Labetalol / Trandate
Used for HTN and for post MI.
Used when HR/BP is too fast, like in hyperthyroidism/ Grave’s disease
Used to treat esophageal varices or gastric varices.
Contraindicated for COPD patients and patients with Printzmetal Angina.
Reduces BP by preventing beta receptor stimulation in the heart, resulting in decreased HR and CO
Monitor for hypotension. HR less than 60, BP less than 90/60 unless otherwise indicated in the orders.
Monitor for orthostatic hypotension, bronchospasm, fatigue, heart block, worsening HF.
ACE Inhibitors
Lisinopril/Zestril
Captopril/Capoten
Enalapril/Vasotec
Used for HTN
Blocks Angiotensin 1 from converting to Angiotensin 2. Prevents vasoconstriction and sodium/water retention.
Monitor for syncope, persistent cough
Monitor for angioedema.
Less effective for African Americans, who are also more likely to develop angioedema.
Calcium Channel Blockers
Nifedipine/Procardia
Verapamil/Calan
Used for HTN
Potentiates other meds, so there will be bigger side effects.
Don’t drink grapefruit juice.
Inhibits calcium transport into myocardial and vascular smooth muscle cells, resulting in
inhibition of excitation - contraction. Blocks calcium channels causing vasodilation.
Assess for headache, edema, hypotension.
ARBs “Sartans”
(Angiotensin 2 Receptor Blocker)
Losartan
Candesartan
Eprosartan
Used for HTN
Blocking vasoconstriction and aldosterone-secretion effects, lowering BP
Monitor closely if the client is on a diuretic. May cause additive hypotension.
Assess renal function and potassium level.
Monitor apical pulse and BP regularly.
Atherosclerosis
Hardening of arteries
Arteriosclerosis
Calcification of arterial walls
Peripheral Vascular Disease
Peripheral blood supply is impaired in the lower extremities due to atherosclerosis or arteriosclerosis
PVD Risk Factors
Age: 60-70 years old
African American men
Smoking
HTN
High cholesterol
Family history of PVD
Overweight
Physical Inactivity
PVD Priority Nursing Interventions
CHECK PULSES –> if you can’t find it, use the doppler, then call the provider.
Assess and evaluate cardiovascular risk status, family history, lifestyle
Encourage and teach healthy lifestyle changes
Encourage patient to take prescribed meds
Assess pulses for strength
Assess for pain, discoloration
Assess to detect changes and report changes to the provider
Position to avoid constriction - don’t bend knees
Change position hourly
HTN Emergency Clinical Manifestations
Severe headaches, especially to the back of the head
Confusion
Motor or sensory deficits
PVD Education
Stop smoking
Lose weight, low fat diet
Do not cross legs while sitting
Elevate feet at rest
Avoid sitting or standing for long periods of time
Avoid walking barefoot
Notify provider of any changes in color, sensation, temperature, or pulses
Aspirin (ASA)
Used for PVD
Antiplatelet
Prevents clot formation
Monitor for bleeding
Clopidogrel / Plavix
Used for PVD
Antiplatelet
Prevents clot formation
Monitor for bleeding
May take with ASA following revascularization
Cilostazol/Pletal
Pentoxifyline/Trental
Used for PVD
Antiplatelet and Vasodilator
Inhibit platelet aggregation, but mostly thins out the blood. Increases blood flow to the extremity, improving claudication
Decreases blood viscosity and increases RBC flexibility
PVD Surgical & Nonsurgical Treatment
Revascularization
Angioplasty – a stent in the vein to increase perfusion to the lower extremity.
Chronic Venous Insufficiency (CVI)
Insufficient venous return - O2 and nutrients don’t really get to the extremity so the cells begin to die
Vein blockage or valve leakage
Blood pools in the vein, causing stasis - discoloration, ulcers around the ankle
DVT linked to a higher risk for CVI
Little to no oxygen and nutrients
Risk factors for CVI
Obesity
Occupations with no movement or lots of standing in place
Thrombophlebitis
Priority Nursing Interventions for CVI
Assess discomfort
Assess long periods of sitting/standing
Assess edema of lower legs
Assess skin for ulcers, especially around the ankle area.
Bedrest with legs elevated above the heart level
Elastic support or compression hose
Do not wear tight, restrictive pants/socks/boots. Avoid girdles and garters that restrict circulation in upper leg.
Arterial Ulcer Signs
Intermittent claudication causes throbbing pain, usually in the calf area - then travels to the thighs and the buttocks. Predictable pain linked to activity.
Resting pain can occur, feels like burning
Legs might be cool to touch due to lack of blood flow
Sensation loss
Peripheral pulses absent/decreased –> LET PROVIDER KNOW!!
Bruit
Skin is thin, shiny, hairless, discolored
Toenails/nails are really thick
Venous Ulcer Signs
Aching pain
Mild compared to arterial ulcer; it increases with standing due to insufficient venous return.
Normal temp to the touch
Edema
Brown discoloration
Legs may be thin/shiny – it’s a bit like atrophied skin. Hard to move or spread for an IM shot.
Lower extremity skin becomes thicker, harder.
May experience recurrent ulcerations, especially in the medial or anterior ankle.
CVI diagnostic tests
Doppler ultrasound studies to look for vesicles
Angiography = a balloon is inserted to push the constricting plaque or thickened inner tissue back. Can place a stent in the lower extremity.
CVI treatment
garlic supplements
encourage regular exercise, which improves circulation and perfusion to the lower extremies
Blood thinning meds like clopidogrel/Plavix, Cilastozal/Pletal (both inhibits platelet aggregation and improves claudication), Pentoxifyline/Trental (decreases blood viscosity and RBC flexibility)
CVI Surgical/non-surgical treatment
Revascularization - put in a good vein bridge
Endarterectomy - go in and clean the vessel out
Bypass graft - reroutes blood flow around occlusion
Angioplasty is a non-surgical procedure to place a stent in a lower extremity
