Hernia & Prostate Flashcards
Hernia
protrusion of part of an organ, tissue, or structure thru the wall of the cavity in which it is normally located
Types of hernias
Sliding, reducible, irreducible/incarcerated & strangulated
Type of hernia: If a person is laying down, the hernia will slide back in and when standing up the hernia slides out
sliding hernia
Reducible
hernia can be pushed back in with gentle pressure, when you lie down it will naturally go back in
Irreducible/incarcerated
It can not be pushed back in. It is protruding out all the time so you’ll see a bump
Strangulated
Constriction of blood flow to trapped viscera can become gangrenous, its an emergency
s/s of a strangulated hernia
severe N/V, abdominal pain & distention, tachycardia, fever
Inguinal & femoral hernias are located where
groin
Ventral or incisional hernias are located where
abdomen
How can you acquire a hernia
from abdominal surgery, lifting
2 types of inguinal hernias
direct &indirect
direct hernia is located
at the inguinal wall
indirect hernia is located
at a pre-existing opening. Male: spermatic duct, Female: round ligament
Abdominal hernias
ventral or incisional
Groin hernias
inguinal & femoral
How can you acquire an umbilical hernia?
increased intra abdominal pressure, obesity, pregnancy, cirrhosis, ascites, chronic cough
Abdominal hernia-incisional/ventral risk factors
poor nutrition, anemic, malignancy, abdominal distension, increased intra abdominal pressure, steroid therapy
poor nutrition, anemic, malignancy, abdominal distension, increased intra abdominal pressure, steroid therapy are risk factors for?
Abdominal hernia-incisional/ventral
Contents of the sac can be replaced into the abdominal cavity
reducible
Muscle ring enlarges allowing peritoneum to slip thru
femoral
occurring in region of the naval
umbilical
Tissue follows spermatic cord, descending into scrotum
indirect inguinal
cannot be replaced back into abdominal cavity
incarcerated
blood supply to herniated bowel segment is cut off
strangulated
occurring at site of a prior surgical incision
ventral
what is the most common location for a hernia
inguinal
How to prevent hernias
proper lifting techniques, splint abdomen with increased intra-abdominal pressure, early recognition & diagnosis
Treatment goals for hernias
no strangulation/complications
What non-surgical methods could someone try before having surgery?
manual reduction, truss or firm pad
What is a truss or firm pad?
you put this on before you get out of bed. it keeps the hernia in place
herniorrhaphy
they sew muscles back together
hernioplasty
they put a mesh in there to keep organs in place
hernia surgery can be either open or laproscopic. Open is done with patients who have ____ hernias
large
encourage coughing or deep breathing post op hernia surgery?
no coughing! encourage deep breathing. If they HAVE to cough make sure they splint it and leave mouth open
post op duties for hernia surgery
prevent increased abdominal pressure by monitor voiding (because they could have a lot of swelling if hernia was located by bladder), stool softeners
extra duties for post op groin hernia surgery
they will have scrotal/labial edema so you want to put ice, support & elevate the groin by using a scrotal sling
duties for post op hernia surgery for children
put pressure dressings on children because they don’t understand that you cant run around etc after surgery
potential problems with hernia surgery post op
prolonged scrotal/labial swelling, urinary retention, paralytic ileus, infection, bowel complications
discharge instructions for hernia surgery patient
avoid lifting, strenuous activity until you get the ok from dr-usually about 2 weeks, teach about signs of infection, bleeding etc, increase fluid & fiber, any meds, wound care
Why do you want patients who have had hernia surgery to increase their fluids and fiber in diet?
So they don’t become constipated
Four days after an elective herniorrhaphy, the patient starts coughing and sneezing. How can he avoid tension on his incision?
Splint incision when sneezing or coughing & sneeze with mouth open
Where is the prostate located?
below the neck of the bladder
Prostate function
produces secretions for semen, creates an alkaline environment & increases sperm motility, secretion contain acid phosphatase
an increase in acid phosphatase is associated with
cancer
BPH stands for
Benign Prostatic Hypertrophy/hyperplasia
BPH prevention
no prevention unless you want to be castrated
Who gets BPH
men over 50 who have testes
Symptoms of BPH
urgency, urge incontinence, dysurina, hematuria, nocturia, frequency, incomplete emptying
BPH assessment
urinary frequency, digital rectal exam, check out abdomen, any comorbidities?
an enlarged prostate could be because of what two things?
BPH or Cancer
What does it mean if the Dr does a Digital rectal exam and feels hard nodules
Prostate Cancer
Digital Rectal Exam
Dr. sticks finger up anus to feel how big prostate is and if there are any nodules which would indicate cancer
Complications of BPH
urinary retention & overstretching of the bladder
urinary retention in BPH is a problem because
it causes a back up in urine which will cause renal failure (hydroureter/hydronephrosis), it will also cause UTIs & kidney infections
Overstretching of bladder in BPH is a problem because
it causes muscle weakness which will lead to incontinence
Why will massage of the prostate & hot sitz baths help relieve some of the symptoms of BPH?
because it releases some of the prostate fluid which temporarily shrinks the prostate which reduces pressure on the urethra. Not a permanent fix
Why should a man with BPH avoid excessive alcohol?
it may trigger acute urinary retention
decongestants, antihistamines, triclyclic antidepresents, meds for Parkinson’s disease can cause what in a man with BPH?
acute urinary retention
prolonged delay in emptying the bladder can cause what in a man with BPH
acute urinary retention
BPH nursing diagnosis
risk for injury, risk for infection, pain, sexual dysfunction, anxiety, knowledge deficit
Plan/Goal for BPH patient
patient will not experience any complication from the disease process or treatment
If no obstruction, what conservative treatments are available for BPH
kegel exercises, warm bath, herbs
If you have BPH what should you avoid
avoid diuretics, alcohol, large amount of fluid in a short amount of time
What can the Dr if a man with BPH comes to the ER with urine retention?
He can straight cath him. This is not a permanent fix
Why is urine retention so serious?
The patient can become septic
anticholinergic effect
decongestants, antihistamines
Medication for BPH
alpha-blockers; androgen inhibitor
Alpha-blocker med used for BPH
Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin
Alpha-blocker med used for BPH does what
reduces excessive smooth muscle contraction relieving obstruction increasing flow. “maximize urinary flow”
Androgen inhibitor med used for BPH
Proscar finasteride, Avodart dutasteride
Androgen inhibitor meds used for BPH does what
decreases the size of the prostate
Proscar finasteride, Avodart dutasteride are what kinds of meds? and what are the side effects
Androgen inhibitor med used for BPH; reduced libido, erectile dysfunction, impotence
Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin are what kinds of meds? and what are the side effects?
Alpha-blocker med used for BPH; hypotension, dizziness
Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin do what
maximize urinary flow, takes about 1-2 weeks to work
Proscar finasteride, Avodart dutasteride do what?
decrease prostate size. takes about 6 months to see full effect
phytoestrogens, pygeum, rye grass pollen extract & saw palmetto are examples of what
herbs used to treat BPH
What to teach during pre-op?
what to expect post op, fears, misconceptions, anxiety
what do you expect a patient to have post-op
catheter, CBI, bloody urine (because they have manipulated something in there, pain control
when do you use closed methods for prostate
when prostate is between 30-80 grams
when do you use open methods for prostate?
when prostate is greater than 80 grams
closed method type of surgery example
Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP)
Dr drills away at prostate gland. Scope is injected thru urether. Prostate can grow back. They can use lasers which cause less bleeding
what do you asses for after a Transurethral resection of the prostate (TURP)
bleeding (there will be blood in urine), 3 way catheter so I&O
Suprapubic prostatectomy
Dr makes incision into abdomen and go down thru bladder to urethra & scrapes out prostate.
What do you asses for after a suprapubic prostatectomy
urine leakage, suprapubic catheter
Retropubic surgery
Dr makes incision underneath bladder & scrapes prostate out without going thru bladder
What do you want to assess for after a Retropubic
Infection or bleeding at incision
Perineal surgery
Dr goes in thru perineal area (beneath testes) & scrapes out prostate. Patient in lithotomy position
What do you want to assess for after a Perineal & what can patient use
infection. They can do a perineal irrigation after a bowel movement. Can do a sitz bath or heat lamp. Can use a t-binder or scrotal support for dressing
Which BPH surgery would you give your patient Colace & why
Perineal because you don’t want them straining
A CBI is used to prevent
clot formation & help decrease bleeding
If you have a CBI what is important to note
I & O
CBI: If the urine is red what are you going to do with the solution?
youre going to have it wide open
CBI: if the urine is pinkish what are you going to do with the solution?
You can slow it down
How much is put into catheter balloon and why?
Usually about 30 cc in order make a little pressure
CBI complications
hemorrhage (which could cause hypovolemia) , dilutional hyponatremia TURP syndrome, infection (which could cause shock), impotence
CBI can cause bladder spasms which can be painful. What do you give for this?
B & O suppository (belladonna & opium). they relax the muscles so there are no spasms
B & O suppository (belladonna & opium) are given to patients who have a CBI to control what?
bladder spasms
If a patient had a TURP 6 hrs ago and you notice a decrease in urinary flow in the foley catheter what do you do?
check the tubing for kinks, if tubing ok then check the flow of irrigation solution if ok then irrigate catheter with 30 cc of NaCL using aseptic tech (you need an order for this)
Normal post op TURP findings
pink tinged urine for several days post-op, some clots in urine, bright red blood initially then pink, clear amber urine
dilutional hyponatremia TURP syndrome
fluid used to irrigate the bladder is absorbed causing hyponatremia with NA levels < 125
If blood goes from Pink to Red what do you do?
Vital signs, increase flow, call Dr
How can patient stop dribbling after TURP & catheter is out?
Kegal excersises
How soon after the TURP surgery will the urine go back to its normal color
about 3 days
How much time to heal after BPH surgery
4-8 weeks
What cant a patient do after BPH surgery
no heavy lifting, not tub baths if they still have catheter
Discharge instructions for patient with BPH surgery
increase fluids/rest, no Aspirin or NSAIDs, bleeding may occur temporarily after a bowl movement, cough or exercise, take stool softeners, no sex for 6 weeks & notify Dr. if fluids & rest do not stop bleeding
After a prostatectomy will erectile dysfunction happen
it can
BPH is not an inflammation what is it
the prostate cells get bigger not inflamed
Prostate tumor is androgen dependent which means that
testosterone will make it grown more
inorder to get prostate cancer what does the patient have to be producing?
testosterone
Prostate Cancer is more common with
advancing age, genetically, dietary fat, environmental carcinogens
Most prostate cancers are found in the _____ portion of the prostate
posterior; Dr can feel it when he does a rectal exam
What age do men start screening for prostate cancer
40, Annual Direct rectal exam
Prostate Cancer causes what kind of symptoms?
BPH symptoms
If PSA (which you do over 50 yrs old) or the Annual Direct rectal exam is positive then what is the next step
a transrectal ultrasound
PSA higher than 20 =
good chance of cancer, not used as much
prostate biopsy
they go in with this thing that has a bunch of little needles that shoot at the prostate to get samples. Bleeding can occur after this. It doesn’t hurt-there are no nerves on prostate
Why is a CT scan administered?
to see if cancer has metastasized
Why is an IVP administered or a Bone scan
IVP to test renal function & a Bone scan to see if it metastasized
A ____ sample is taken after a prostate biopsy to make sure there is no bladder damage
urine
After prostate biopsy, a patient should avoid exercise for _____ days & intercourse for ____ days
3; 7
what symptoms should a patient who had a Prostate biopsy call the DR for
bleeding or fever
What does prostate cancer treatment depend on?
age, general health, patients preference
Whats important to have between patient and Dr
open communication
watchful waiting
dr keeps close watch over patient to determine what treatment to do.
Prostate cancer treatment
watchful waiting, radiation (early stage), Hormonal (advanced stage)
External beam therapy & brachytherapy are which kinds of treatment
Radiation treatment
Brachytherapy
implant radioactive seeds into prostate
Hormonal treat for prostate cancer
orchiectomy, estrogen therapy, luteinizing hormone, steroids & nonsteroidal antiandrogens
orchiectomy
removal of testes which decreases testosterone
when on estrogen therapy patient needs to know what?
immobility will cause blood clots
Long term problems with prostatectomy
urinary incontinence & impotence (inability to achieve or maintain erection
