Kidney/Pudenda - Unit 4 - Care of Male Patients with Reproductive Problems Flashcards
What happens in benign prostatic hyperplasia?
Glandular units in the prostate that undergo an increase in the number of cells —-> enlargement of the prostate gland.
What happens in benign prostatic hyperplasia?
Glandular units in the prostate that undergo an increase in the number of cells —-> enlargement of the prostate gland.
What are some risk factors for BPH?
Age & Family History
What are some signs and symptoms of BPH?
Increased frequency, nocturia, urinary urgency, hesitancy in starting urination, decreased volume and force of urinary stream, feeling of bladder fullness, recurrent UTI’s
What are some diagnostic procedures for BPH?
Urinalysis with culture, PSA, renal function tests, digital rectal exam, biopsy of prostate, KUB, etc.
What is the normal Prostate Specific Antigen (PSA) level?
Should a patient have their PSA drawn before a digital rectal exam?
Yes - don’t want the DRE to be increasing the PSA
What’s a TRUS?
Transrectal ultrasound and needle biopsy - performed to rule out prostate cancer.
What are two types of drugs taken for BPH?
5-alpha reductaste inhibitors (5-ARI) and Alpha blocking agents.
How long will someone be on a 5-ARI before they might feel better?
6 months
How long will someone be on a 5-ARI before they might
blah blah blah
What are some risk factors for BPH?
Age & Family History
What are some signs and symptoms of BPH?
Increased frequency, nocturia, urinary urgency, hesitancy in starting urination, decreased volume and force of urinary stream, feeling of bladder fullness, recurrent UTI’s
What are some diagnostic procedures for BPH?
Urinalysis with culture, PSA, renal function tests, digital rectal exam, biopsy of prostate, KUB, etc.
What is the normal Prostate Specific Antigen (PSA) level?
Should a patient have their PSA drawn before a digital rectal exam?
Yes - don’t want the DRE to be increasing the PSA
What’s a TRUS?
Transrectal ultrasound and needle biopsy - performed to rule out prostate cancer.
What are some complications of TURP? Nursing actions to prevent them?
Urethral trauma, urinary retention, bleeding, infection
NA = monitor urine, force fluids, avoid caffeine, stool softeners can help, etc.
What are some 5-Ari’s - what do they do? SE?
Proscar, avodart - they reduce the size of the prostate gland.
Side effects include gynocomastia, ED, flushing -
How long will someone be on a 5-ARI before they might
blah blah blah
If you’re pregnant, you can touch a 5-ARI - T/F?
FALSE - DO NOT touch it.
What do alpha-blocking agents do for BPH? What do they do?
cardura, hytrin, flomax, uroxatral (ER), smooth muscle relaxation of prostate.
What’s TURP?
Transurethral Resection of the prostate - 23 hour hold, small glands - poor surgical risk - may need to be repeated.
What are some pre-operative nursing actions for a TURP?
are they healthy? general anesthetic? Flush fluids for irritated urethra, etc.
What are some post operative nursing actions for a TURP?
PCA, pain, monitor urine, Monitor VS, etc.
What’s continuous bladder irrigation?
Three-way urinary catheter with a 30-40ml retention balloon through the urethra into the bladder.
What continuous bladder irrigation, what do patients feel?
An uncomfortable urge to void continuously.
What are some complications of TURP?
Urethral trauma, urinary retention, bleeding, infection
What does arterial bleeding look like in continuous bladder irrigation? Venous?
Art = bright red and clots more.
Venous = darker.
What are some potential complications of BPH?
Hydronephrosis, hydroureter, hyperirritable bladder, urinary retention and reflux, UTI’s
Prostate cancer - what are the first symptoms related to?
Bladder neck obstruction
What questions should you ask when taking a genitourinary history in a man older than 50?
?’s related to lower urinary symptoms, does prostate cancer run in the family, BRCA 2 (high in men with prostate issues)
What are symptoms of prostate cancer?
Lower urinary tract symptoms, frequent bladder infections, urinary retention, HEMATURIA, NOCTURIA, pain with intercourse
In terms of placement, what’s a different with BPD and Prostate cancer?
BPH - swollen prostate, blocks urethra.
Cancer - in one spot, affects different spaces but doesn’t necessarily block the urethra.
What are some diagnostic tests for prostate cancer?
DRE, PSA, biopsy, CT, MRI, ultrasound
What does the prostate normally feel like?
An erase
What are some benefits of the Da Vinci Prostatectomy?
Less nerve damage and preserves sexual function
What’s the second most common surgery for prostate cancer?
Retropubic Approach …then perineal approach.
What are some post-op complications for prostate cancer surgery?
Hemorrhage, infection, DVT, catheter obstruction, sexual dysfunction
What are some ways to non-surgically manage prostate cancer?
Radiation therapy, hormonal therapy (SE = osteoporosis and decreased libido), chemo (ketaconazole, which stops androgen production), cryotherapy (freezes it), complementary and alternative therapies
What are some complications for non-surgical treatment of prostate cancer?
Urinary incontinence, erectile dysfunction
Testicular cancer - most common men ages __ to __
15-34
Germinal vs. non-germinal testicular cancer.
Serminomas vs. nomseminomas
Germinal = come from sperm - most cancer is this.
Non-germinal - comes from testosterone producing cells.
Seminomas - best outcomes, it’s local.
Nonseminomas - metastasize quickly.
What are some risk factors for testicular cancer?
Age, ethnicity, history of undescended testicle, HIV infection
What are some symptoms of testicular cancer?
Painless lumps or swelling of testes, heaviness, swelling of lymph nodes in groin.
What are some lab assessments for testicular cancer?
Alpha-fetoprotein (AFP), beta human chorionic gonadotropin (hCG), ultrasound, computed tomography, MRI
What should we do pre-op for a radical unilateral orchiectomy (ball removal) ?
Talk to patient about sperm bank stuff!
What should we do post-op for a radical unilateral orchiectomy (ball removal) ?
Assess I/O, assess for infection, monitor pain, counseling, avoid heavy lifting
What’s some non-surgical management stuff for testicular cancer?
Lymph node dissection, radiation, chemo (used in advanced stages)
What’s the difference between oligospermia and azoospermia?
Oli = low sperm count.
Azoo = no sperm.
Hydrocele - def
Fluid around testicle
Spermatocele - def
Self-contained cystic mass on epidydmis (sperm filled)
Varicocele - def
filated veins
Torsion - def
twisted spermatic cord and blood vessels
Can a varicocele cause infertility?
Yes
What is cancer of the penis?
When epidermoid carcinomas develop from squamous cells- painless, wartlike growth or ulcer
What is epididymitis?
Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma. Usually from an STD
What are some risk factors for penile cancer?
HPV infection, Smoking, smegma (oily secretions from the skin), phimosis (foreskin can’t be pulled back), previous treatment of psoriasis, >55 years old, AIDS
What are some treatment options for penile cancer?
Excision biopsy (entire lesion is removed), incisional biopsy (part of the abnormal tissue is removed), penectomy (your penis go bye-bye)
What is phimosis?
Constricted prepuce that cannot be retracted - it’s an emergency requiring immediate treatment.
What is priapism? What causes it?
Uncontrolled and long-maintained erection without sexual desire - causes the penis to become large and painful. Can occur from thrombosis of veins of corpora cavernosa, leukemia, sickle cell disease, DM, malignancies, abnormal reflex, some drugs, recreational drugs, prolonged sexual activity, etc.
Is priapism a medical emergency?
YES
How do we treat priapism?
Demerol, warm enemas, catheterization, large-bore needle or surgical intervention
What is prostatitis?
Inflammation of the prostate gland
What causes prostatitis?
UTI, chronic bacterial prostatitis, nonbacterial/chronic pelvic pain syndrome, asymptomatic inflammatory prostatitis, STD’s, etc.
What are symptoms of prostatitis?
Back pain, dysuria, enlarged prostate
How do we treat epididymitis?
Bedrest with scrotum elevated on a towel, scrotal support when ambulating, comfort measures, epididymectomy
What is orchitis?
Acute testicular inflammation resulting from trauma or infection. Mumps can cause this.
How do we treat orchitis?
Bedrest with scrotal elevation, application of ice, analgesics and antibiotics.
