Prostate

Question 1

Rectal Exam

Answer 1

Make sure pts void before rectal exam. They’ll feel like they have to urinate even if they don’t have to.

Question 2

Prostate Carcinoma

Answer 2

• Stone hard, regular fixed nodules. As prostate gland grows, it obstructs the urethra so they have trouble urinating.
• Normal prostate is moveable

Question 3

Bladder stones

Answer 3

Bladder stones can develop when urine sits in the bladder. Overflow incontinence occurs. It causes dribbling of urine. The inability to void is an emergency.

Question 4

You do which test to determine which organ and what antibiotics to use, and if the antibiotic is working?

Answer 4

Culture and sensitivity

Question 5

PSA: prostate specific antigen

Answer 5

P-rostate-specific antigen (PSA) is a protein produced by the prostate and found in the blood.
-If the PSA level is high for your age or is steadily increasing (with or without an abnormal physical exam), a biopsy may be recommended.

Question 6

What tests kidney function?

Answer 6

BUN and Creatinine

Question 7

Why do a C&S of prostatic fluid?

Answer 7

To check for prostatitis

Question 8

First line therapy for BPH and why

Answer 8

5-alpha reductase inhibitor (5-ARI), because high DHT levels cause prostate to enlarge. These drugs block the conversion of testosterone to DHT, so levels fall and the prostate shrinks. It takes a long time for a pt to feel effects. Maybe 6 months>leads to noncompliance. Tell them not to stop. SE: erectile dysfunction, decreased libido, dizziness, orthostatic hypotension
-Dutasteride (Avodart), Finasteride (Proscar)

Question 9

Alpha-1 selective blocking agents for BPH

Answer 9

Alpha 1s are in smooth muscle of prostate glands, also in peripheral muscle vessels. Causes smooth muscle relaxation and vasoconstriction. Take pill at bedtime to sleep through bad
SE: Don’t take viagra bc it also vasoconstricts, it could be nonreversible.
-Tamulosin (Flomax), Doxazosin (Cardura), Terazosin (Hytrin

Question 10

CAM therapy for BPH

Answer 10

Saw palmetto extract: studies haven’t shown effectiveness. Make sure pt knows that if they take that it may not work. Warn them about drug interactions.

Question 11

Thermotherapy for BPH

Answer 11

Outpatient technique using heat to destroy tissue, temporary fix. .p. 1635

Question 12

Hydronephrosis

Answer 12

Swelling of fluid backing up in kidneys

Question 13

TURP

Answer 13

Transurethral Resection of the Prostate

• Surgeon inserts a resectoscope through the urethra and into the bladder and removes pieces of tissue from the prostate gland.
• Not a permanent fix. It could grow again and have to be removed again.
• Turps don’t cause sexual dysfunction, neither does prostatectomy

Question 14

Preop for TURP

Answer 14

• Correct misconceptions
• Assess anxiety
• Anesthesia – usually epidural and spinal anesthesia
• Prepare pt for postop indwelling uretheral catheter and urge to void

Question 15

2 misconceptions with prostate surgery

Answer 15

Erectile dysfunction (nerves) and incontinence (sphincters)

Question 16

Post op for TURP

Answer 16

see p. 1636 Chart 75-1

Critical Rescue – monitor urine output, VS, pain

Question 17

Arterial bleed

Answer 17

Bright red urine, not good, may have clots in it. Admin more fluid to flush it out, call surgeon if it doesn’t stop. Venous blood would be brown.

Question 18

Where can prostate cancer spread?

Answer 18

Lymph nodes, lungs, pelvis, and liver.

Question 19

What increases the risk for prostate cancer?

Answer 19

Family history in first degree relatives

Question 20

Assessment of Prostate Cancer

Answer 20

Bladder outlet obstruction symptoms
Hematuria
Nocturia
Pain during intercourse
Other pain (bone pain – pelvis, spine, hips)
Unexpected weight loss
Swollen lymph nodes in groin
Digital Rectal Exam
Psychosocial assessment
PSA
Transrectal ultrasound

Question 21

Early stage Prostate Cancer

Answer 21

“Watchful waiting”

• TURP if obstruction
• Surgery for cure

Question 22

Home care and management for Prostate Cancer

Answer 22

• Collaborate with case manager, home care nurse, and other care providers
• Urinary catheter care p. 1641
• Activity
• Shower, don’t bathe
• Refer to health care resources
  
  • American Cancer Society’s Man to Man program
  • Us TOO International (www.ustoo.com)
• Prostate Cancer and Support Network
  
  • Prostate Cancer Foundation
  • National Prostate Cancer Coalition

Question 23

Advanced dz Prostate Cancer

Answer 23

Palliative surgery: bilateral orchiectomy

Question 24

Nonsurgical management for Prostate Cancer

Answer 24

• Radiation Therapy
• Drug Therapy
  
  • Hormone Therapy
  • Chemotherapy