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Nursing II > Hernia & Prostate > Flashcards

Hernia & Prostate Flashcards

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1
Q

Hernia

A

protrusion of part of an organ, tissue, or structure thru the wall of the cavity in which it is normally located

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2
Q

Types of hernias

A

Sliding, reducible, irreducible/incarcerated & strangulated

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3
Q

Type of hernia: If a person is laying down, the hernia will slide back in and when standing up the hernia slides out

A

sliding hernia

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4
Q

Reducible

A

hernia can be pushed back in with gentle pressure, when you lie down it will naturally go back in

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5
Q

Irreducible/incarcerated

A

It can not be pushed back in. It is protruding out all the time so you’ll see a bump

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6
Q

Strangulated

A

Constriction of blood flow to trapped viscera can become gangrenous, its an emergency

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7
Q

s/s of a strangulated hernia

A

severe N/V, abdominal pain & distention, tachycardia, fever

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8
Q

Inguinal & femoral hernias are located where

A

groin

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9
Q

Ventral or incisional hernias are located where

A

abdomen

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10
Q

How can you acquire a hernia

A

from abdominal surgery, lifting

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11
Q

2 types of inguinal hernias

A

direct &indirect

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12
Q

direct hernia is located

A

at the inguinal wall

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13
Q

indirect hernia is located

A

at a pre-existing opening. Male: spermatic duct, Female: round ligament

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14
Q

Abdominal hernias

A

ventral or incisional

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15
Q

Groin hernias

A

inguinal & femoral

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16
Q

How can you acquire an umbilical hernia?

A

increased intra abdominal pressure, obesity, pregnancy, cirrhosis, ascites, chronic cough

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17
Q

Abdominal hernia-incisional/ventral risk factors

A

poor nutrition, anemic, malignancy, abdominal distension, increased intra abdominal pressure, steroid therapy

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18
Q

poor nutrition, anemic, malignancy, abdominal distension, increased intra abdominal pressure, steroid therapy are risk factors for?

A

Abdominal hernia-incisional/ventral

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19
Q

Contents of the sac can be replaced into the abdominal cavity

A

reducible

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20
Q

Muscle ring enlarges allowing peritoneum to slip thru

A

femoral

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21
Q

occurring in region of the naval

A

umbilical

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22
Q

Tissue follows spermatic cord, descending into scrotum

A

indirect inguinal

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23
Q

cannot be replaced back into abdominal cavity

A

incarcerated

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24
Q

blood supply to herniated bowel segment is cut off

A

strangulated

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25
Q

occurring at site of a prior surgical incision

A

ventral

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26
Q

what is the most common location for a hernia

A

inguinal

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27
Q

How to prevent hernias

A

proper lifting techniques, splint abdomen with increased intra-abdominal pressure, early recognition & diagnosis

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28
Q

Treatment goals for hernias

A

no strangulation/complications

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29
Q

What non-surgical methods could someone try before having surgery?

A

manual reduction, truss or firm pad

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30
Q

What is a truss or firm pad?

A

you put this on before you get out of bed. it keeps the hernia in place

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31
Q

herniorrhaphy

A

they sew muscles back together

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32
Q

hernioplasty

A

they put a mesh in there to keep organs in place

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33
Q

hernia surgery can be either open or laproscopic. Open is done with patients who have ____ hernias

A

large

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34
Q

encourage coughing or deep breathing post op hernia surgery?

A

no coughing! encourage deep breathing. If they HAVE to cough make sure they splint it and leave mouth open

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35
Q

post op duties for hernia surgery

A

prevent increased abdominal pressure by monitor voiding (because they could have a lot of swelling if hernia was located by bladder), stool softeners

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36
Q

extra duties for post op groin hernia surgery

A

they will have scrotal/labial edema so you want to put ice, support & elevate the groin by using a scrotal sling

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37
Q

duties for post op hernia surgery for children

A

put pressure dressings on children because they don’t understand that you cant run around etc after surgery

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38
Q

potential problems with hernia surgery post op

A

prolonged scrotal/labial swelling, urinary retention, paralytic ileus, infection, bowel complications

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39
Q

discharge instructions for hernia surgery patient

A

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

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40
Q

Why do you want patients who have had hernia surgery to increase their fluids and fiber in diet?

A

So they don’t become constipated

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41
Q

Four days after an elective herniorrhaphy, the patient starts coughing and sneezing. How can he avoid tension on his incision?

A

Splint incision when sneezing or coughing & sneeze with mouth open

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42
Q

Where is the prostate located?

A

below the neck of the bladder

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43
Q

Prostate function

A

produces secretions for semen, creates an alkaline environment & increases sperm motility, secretion contain acid phosphatase

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44
Q

an increase in acid phosphatase is associated with

A

cancer

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45
Q

BPH stands for

A

Benign Prostatic Hypertrophy/hyperplasia

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46
Q

BPH prevention

A

no prevention unless you want to be castrated

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47
Q

Who gets BPH

A

men over 50 who have testes

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48
Q

Symptoms of BPH

A

urgency, urge incontinence, dysurina, hematuria, nocturia, frequency, incomplete emptying

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49
Q

BPH assessment

A

urinary frequency, digital rectal exam, check out abdomen, any comorbidities?

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50
Q

an enlarged prostate could be because of what two things?

A

BPH or Cancer

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51
Q

What does it mean if the Dr does a Digital rectal exam and feels hard nodules

A

Prostate Cancer

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52
Q

Digital Rectal Exam

A

Dr. sticks finger up anus to feel how big prostate is and if there are any nodules which would indicate cancer

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53
Q

Complications of BPH

A

urinary retention & overstretching of the bladder

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54
Q

urinary retention in BPH is a problem because

A

it causes a back up in urine which will cause renal failure (hydroureter/hydronephrosis), it will also cause UTIs & kidney infections

55
Q

Overstretching of bladder in BPH is a problem because

A

it causes muscle weakness which will lead to incontinence

56
Q

Why will massage of the prostate & hot sitz baths help relieve some of the symptoms of BPH?

A

because it releases some of the prostate fluid which temporarily shrinks the prostate which reduces pressure on the urethra. Not a permanent fix

57
Q

Why should a man with BPH avoid excessive alcohol?

A

it may trigger acute urinary retention

58
Q

decongestants, antihistamines, triclyclic antidepresents, meds for Parkinson’s disease can cause what in a man with BPH?

A

acute urinary retention

59
Q

prolonged delay in emptying the bladder can cause what in a man with BPH

A

acute urinary retention

60
Q

BPH nursing diagnosis

A

risk for injury, risk for infection, pain, sexual dysfunction, anxiety, knowledge deficit

61
Q

Plan/Goal for BPH patient

A

patient will not experience any complication from the disease process or treatment

62
Q

If no obstruction, what conservative treatments are available for BPH

A

kegel exercises, warm bath, herbs

63
Q

If you have BPH what should you avoid

A

avoid diuretics, alcohol, large amount of fluid in a short amount of time

64
Q

What can the Dr if a man with BPH comes to the ER with urine retention?

A

He can straight cath him. This is not a permanent fix

65
Q

Why is urine retention so serious?

A

The patient can become septic

66
Q

anticholinergic effect

A

decongestants, antihistamines

67
Q

Medication for BPH

A

alpha-blockers; androgen inhibitor

68
Q

Alpha-blocker med used for BPH

A

Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin

69
Q

Alpha-blocker med used for BPH does what

A

reduces excessive smooth muscle contraction relieving obstruction increasing flow. “maximize urinary flow”

70
Q

Androgen inhibitor med used for BPH

A

Proscar finasteride, Avodart dutasteride

71
Q

Androgen inhibitor meds used for BPH does what

A

decreases the size of the prostate

72
Q

Proscar finasteride, Avodart dutasteride are what kinds of meds? and what are the side effects

A

Androgen inhibitor med used for BPH; reduced libido, erectile dysfunction, impotence

73
Q

Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin are what kinds of meds? and what are the side effects?

A

Alpha-blocker med used for BPH; hypotension, dizziness

74
Q

Hytrinterazosin, Cardura doxazosin, Flomax tamsulosin do what

A

maximize urinary flow, takes about 1-2 weeks to work

75
Q

Proscar finasteride, Avodart dutasteride do what?

A

decrease prostate size. takes about 6 months to see full effect

76
Q

phytoestrogens, pygeum, rye grass pollen extract & saw palmetto are examples of what

A

herbs used to treat BPH

77
Q

What to teach during pre-op?

A

what to expect post op, fears, misconceptions, anxiety

78
Q

what do you expect a patient to have post-op

A

catheter, CBI, bloody urine (because they have manipulated something in there, pain control

79
Q

when do you use closed methods for prostate

A

when prostate is between 30-80 grams

80
Q

when do you use open methods for prostate?

A

when prostate is greater than 80 grams

81
Q

closed method type of surgery example

A

Transurethral resection of the prostate (TURP)

82
Q

Transurethral resection of the prostate (TURP)

A

Dr drills away at prostate gland. Scope is injected thru urether. Prostate can grow back. They can use lasers which cause less bleeding

83
Q

what do you asses for after a Transurethral resection of the prostate (TURP)

A

bleeding (there will be blood in urine), 3 way catheter so I&O

84
Q

Suprapubic prostatectomy

A

Dr makes incision into abdomen and go down thru bladder to urethra & scrapes out prostate.

85
Q

What do you asses for after a suprapubic prostatectomy

A

urine leakage, suprapubic catheter

86
Q

Retropubic surgery

A

Dr makes incision underneath bladder & scrapes prostate out without going thru bladder

87
Q

What do you want to assess for after a Retropubic

A

Infection or bleeding at incision

88
Q

Perineal surgery

A

Dr goes in thru perineal area (beneath testes) & scrapes out prostate. Patient in lithotomy position

89
Q

What do you want to assess for after a Perineal & what can patient use

A

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

90
Q

Which BPH surgery would you give your patient Colace & why

A

Perineal because you don’t want them straining

91
Q

A CBI is used to prevent

A

clot formation & help decrease bleeding

92
Q

If you have a CBI what is important to note

A

I & O

93
Q

CBI: If the urine is red what are you going to do with the solution?

A

youre going to have it wide open

94
Q

CBI: if the urine is pinkish what are you going to do with the solution?

A

You can slow it down

95
Q

How much is put into catheter balloon and why?

A

Usually about 30 cc in order make a little pressure

96
Q

CBI complications

A

hemorrhage (which could cause hypovolemia) , dilutional hyponatremia TURP syndrome, infection (which could cause shock), impotence

97
Q

CBI can cause bladder spasms which can be painful. What do you give for this?

A

B & O suppository (belladonna & opium). they relax the muscles so there are no spasms

98
Q

B & O suppository (belladonna & opium) are given to patients who have a CBI to control what?

A

bladder spasms

99
Q

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?

A

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)

100
Q

Normal post op TURP findings

A

pink tinged urine for several days post-op, some clots in urine, bright red blood initially then pink, clear amber urine

101
Q

dilutional hyponatremia TURP syndrome

A

fluid used to irrigate the bladder is absorbed causing hyponatremia with NA levels < 125

102
Q

If blood goes from Pink to Red what do you do?

A

Vital signs, increase flow, call Dr

103
Q

How can patient stop dribbling after TURP & catheter is out?

A

Kegal excersises

104
Q

How soon after the TURP surgery will the urine go back to its normal color

A

about 3 days

105
Q

How much time to heal after BPH surgery

A

4-8 weeks

106
Q

What cant a patient do after BPH surgery

A

no heavy lifting, not tub baths if they still have catheter

107
Q

Discharge instructions for patient with BPH surgery

A

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

108
Q

After a prostatectomy will erectile dysfunction happen

A

it can

109
Q

BPH is not an inflammation what is it

A

the prostate cells get bigger not inflamed

110
Q

Prostate tumor is androgen dependent which means that

A

testosterone will make it grown more

111
Q

inorder to get prostate cancer what does the patient have to be producing?

A

testosterone

112
Q

Prostate Cancer is more common with

A

advancing age, genetically, dietary fat, environmental carcinogens

113
Q

Most prostate cancers are found in the _____ portion of the prostate

A

posterior; Dr can feel it when he does a rectal exam

114
Q

What age do men start screening for prostate cancer

A

40, Annual Direct rectal exam

115
Q

Prostate Cancer causes what kind of symptoms?

A

BPH symptoms

116
Q

If PSA (which you do over 50 yrs old) or the Annual Direct rectal exam is positive then what is the next step

A

a transrectal ultrasound

117
Q

PSA higher than 20 =

A

good chance of cancer, not used as much

118
Q

prostate biopsy

A

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

119
Q

Why is a CT scan administered?

A

to see if cancer has metastasized

120
Q

Why is an IVP administered or a Bone scan

A

IVP to test renal function & a Bone scan to see if it metastasized

121
Q

A ____ sample is taken after a prostate biopsy to make sure there is no bladder damage

A

urine

122
Q

After prostate biopsy, a patient should avoid exercise for _____ days & intercourse for ____ days

A

3; 7

123
Q

what symptoms should a patient who had a Prostate biopsy call the DR for

A

bleeding or fever

124
Q

What does prostate cancer treatment depend on?

A

age, general health, patients preference

125
Q

Whats important to have between patient and Dr

A

open communication

126
Q

watchful waiting

A

dr keeps close watch over patient to determine what treatment to do.

127
Q

Prostate cancer treatment

A

watchful waiting, radiation (early stage), Hormonal (advanced stage)

128
Q

External beam therapy & brachytherapy are which kinds of treatment

A

Radiation treatment

129
Q

Brachytherapy

A

implant radioactive seeds into prostate

130
Q

Hormonal treat for prostate cancer

A

orchiectomy, estrogen therapy, luteinizing hormone, steroids & nonsteroidal antiandrogens

131
Q

orchiectomy

A

removal of testes which decreases testosterone

132
Q

when on estrogen therapy patient needs to know what?

A

immobility will cause blood clots

133
Q

Long term problems with prostatectomy

A

urinary incontinence & impotence (inability to achieve or maintain erection

Nursing II (16 decks)

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