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Nursing 2240: Patho > Reproductive: Male and Female > Flashcards

Reproductive: Male and Female Flashcards

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1
Q

What are important nursing considerations after breast biopsy (specific to type of biopsy done if possible)

A

Avoid NSAID’s afterwards (to prevent bleeding) except for fine-needle aspiration biopsy (FNAB)
Wear sports bra/tight bra 24hr for 2 weeks after biopsy
Continue with yearly mammograms after biopsy
Avoid strenuous activity/heavy lifting after biopsy for 2 weeks (ABBI and surgical biopsies)

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2
Q

3 main risk factors (non-modifiable) for prostate cancer

A

African-American
Family history
> 65 years

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3
Q

Modifiable risk factors for prostate cancer

A

diet high in red meat and low in fruits/vegetables
diet low in selenium, vitamin D, E. lycopene
exposure to cadmium

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4
Q

Differentiate between early and late signs and symptoms of prostate cancer

A

Early: asymptomatic because cancer usually in peripheral zone of prostate
As tumor grows, may have similar manifestations as BPH: urinary frequency, urgency, decreased strength of stream, incomplete emptying, straining to urinate, PLUS blood in urine or ejaculate, and pain in hips, back if mets

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5
Q

Screening for prostate cancer

A

DRE + PSA annually after 50 yrs old

both important because DRE may not find tumor and PSA levels may indicate more accurately

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6
Q

Normal PSA levels and levels of risk

A

Normal = 0-4 ng/mL
15% risk if under 4 ng/mL
25% risk if 4-10 ng/mL
50% risk if > 10 ng/mL

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7
Q

There is a positive link between BPH and prostate cancer: true or false?

A

False

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8
Q

High PSA level is always an indicator of prostate cancer

A

False: PSA level may be elevated with prostatitis or BPH

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9
Q

Explain the percent free PSA test and how it compares in patients with or without prostate cancer

A

Percent free PSA test compares free PSA (in blood) with total PSA
Men WITH prostate cancer will have lower percent of free PSA (because more is at prostate (?)

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10
Q

What is the only reliable/definitive diagnosis for prostate cancer

A

Biopsy with transrectal ultrasound

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11
Q

Explain the staging system for prostate cancer

A

1-4

1: microscopic
2: prostate only
3: spread beyond capsule of prostate
4: spread to local organs and possible distant mets

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12
Q

Explain the grading for prostate cancer

A

Gleason scale (1-5) taken twice –> total score 2-10
2 indicates well differentiated cells
10 indicates poorly/undifferentiated cells

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13
Q

What factors are considered when choosing treatment for a patient with prostate cancer?

A

life expectancy
presence of comorbidities
grade/stage of tumor

patients with >10 yrs life expectancy, no comorbidities, and low grade/stage of tumor will have more options: cryosurgery, TUPR, or prostatectomy

palliative patients may receive TUPR to relieve symptoms and chemotherapy for mets

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14
Q

Explain the difference between alkaline phosphatase and acid phosphatase in relation to diagnostics for prostate cancer

A

Alkaline Phosphatase is a serum enzyme that is elevated in advanced prostate cancer, due to metastasis to bone
Acid Phosphatase: is a serum enzyme that is another indication of prostate cancer, expecially if there is extracapsular spread

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15
Q

Explain the differences between radical prostatectomy that is done retropubic route vs. perineal route

A

Perineal prostatectomy incision is made between scrotum and anus - unable to remove regional lymph nodes
Retropubic prostatectomy: horizonal incision is made above pubic bone - able to remove lymph nodes

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16
Q

What is the purpose of androgen deprivation therapy in prostate cancer?

A

Prostate cancer growth is dependent on the presence of androgens; therefore, androgen deprivation helps to reduce tumor growth so that it can be surgically removed easily

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17
Q

What are the 2 major complications of radical prostatectomy?

A

Erectile dysfunction (ED)/impotence and incontinence

18
Q

Briefly describe the procedure and explain the rationale for cryosurgery in prostate cancer

A

Used as initial treatment and second-line treatment after radiation failures
TRUS probe to visualize prostate and probe inserted into prostate to freeze cancer cells with liquid nitrogen: no abdominal incision

19
Q

Briefly describe the procedure and explain the rationale for external beam radiation in prostate cancer

A

Most widely used method of delivery of radiation therapy
Outpatient basis 5d/wk for 6-8 weeks
Each treatment lasts a few minutes (because cumulative effects of radiation more effective and fewer side effects)

20
Q

Briefly describe the procedure and explain the rationale for brachytherapy in prostate cancer

A

Implantatin of radioactive seeds via TRUS - permanent or temporary and allows sparing of surrounding tissue
Used for patients that are not candidates for other apporaches, with localized disease, older patients, and those that refuse other treatments

21
Q

Briefly describe the procedure and explain the rationale for hormone therapy in prostate cancer

A

Includes androgen deprivation therapy, LHRH agonists, and orchiectomy
LHRH agonists suppress feedback with pituitary and testes to decrease testosterone
Orchiectomy removes both testes so testosterone suppressed
Decreased testosterone levels will help decrease size of prostate - hormone therapy is used in combination with radiation for locally advanced, advanced, or metastatic disease

22
Q

Briefly describe the procedure and explain the rationale for chemotherapy in prostate cancer

A

Chemotherapy is used palliatively for patients with metastases

23
Q

What are the clnical manifestations of BPH?

A

Decresed force of urine stream, abdominal straining, increased frequency, urgency, urinary retention, feeling of incomplete emptying of bladder

24
Q

What diagnostic tests indicate BPH?

A

DRE + symptoms of urethral obstruction

PSA and biopsy to rule out prostate cancer

25
Q

What drug therapy is commonly used to treat BPH?

A

Finasteride - may reduce PSA levels by 50%

Alpha 1 adrenergic receptor blockers (doxazosin, prazosin, terazosin) may decrease symptoms

26
Q

What are the most common surgical procedures to treat BPH?

A

Transurethral Prostate Resection

Abdominal approach to resection if extent of prostate enlargement is too much to treat trans-urethrally

27
Q

What are some risk factors for breast cancer?

A

Female, 50 years and older (especially post-menopausal)
Family history
Genetics especially with BRCA1 and BRCA2 gene mutations
Personal hx of breast, colon, endometrial, ovarian cancers
Early menarche and late menopause (55 yrs)
First full-term pregnancy after age 30; nullparity
Benign breast disorder
Weight gain and obesity after menopause (because fat cells store estrogen)
Exposure to radiation

28
Q

What is the gold standard for breast cancer treatment?

A

Surgical removal (lumpectomy/mastectomy), radiation, chemotherapy

29
Q

How is breast cancer diagnosed?

A

SBE or medical practitioner exam
Mammography
BIRADS (breast imaging reporting and data system):
0-2 benign
3-5 score must have follow-up: low, moderate, or high probability of being malignant
6 is know biopsy proven malignancy - done to assure treatment has been effective
Biopsy

30
Q

What are some clinical manifestations of breast cancer?

A

Unilateral lump - often occurs in upper outer quadrant (high amounts of glandular tissue)
Palpable lump is hard, irregularly shaped, poorly delineated, nonmobile, nontender
May be nipple discharge or retraction

31
Q

Possible complications of cryotherapy for prostate cancer?

A 
damage to the urethra
urethrorectal fistula (urethra to rectum) - rare
urethrocutaneous fistula (urethra to skin) - rare
32
Q

Side effects and complications of external beam radiation for prostate cancer?

A 
Skin irritation (dryness, redness, pain), GIT disurbances (diarrhea**, abdominal cramping, bleeding) and genitourinary tract dysfunction (dysuria, frequency, hesitancy, urgency, nocturia, ED, sexual fatigue), and bone marrow suppression
Risk for infection from skin breakdown; therefore teach patient to recognize s/s
Low-residue diet to manage diarrhea
Avoid alcohol, caffeine, spices, and smoking because it can irritate the bladder mucosa and aggravate urinary tract symptoms
33
Q

Explain the phrase “watchful waiting”

A

Frequent periodic monitoring of the patient (DRE and PSA) and not starting treatment unless symptoms progress or changes
Suitable “treatment” for prostate cancer or BPH if short life expectancy, multiple medical problems, or clinically insignificant disease

34
Q

Possible complications of brachy therapy for prostate cancer

A

must adhere to radiation precautions, including restricting sexual activity for 2 weeks + condom use following those 2 weeks to catch lost seeds
Perineal care because of discomfort from procedure
Hematuria and semen that may be red, brown, or black from blood
Rectal bleeding or irritation, gassy bowel movements or diarrhea –> contact physician immediately

35
Q

What are some complications of hormone therapy for prostate cancer?

A 
Gynecomastia
Breast tenderness
Impotence
Osteoporosis
Hot flashes
Fatigue
Hepatic dysfunction
Anemia (when LHRH agonists given with radiation therapy))
36
Q

What are some common complications of chemotherapy for prostate cancer?

A 
Bone marrow depression
Fatigue
Nausea and vomiting
Hair loss
Renal, liver, cardiac toxicity
37
Q

Describe and explain the rationale for radical prostatectomy

A

Candidates whuld be 70 or younger, without mets, and 10-20 years life expectancy
Involves abdominal or perineal incision and complete removal of prostate, (regional lymph nodes - retropubic only), seminal vesicles, and part of the bladder neck

38
Q

Common complications of radical prostatectomy

A 
Incontinence
Impotence
Urethral strictures
Bladder neck contractures
Post-op complications: DVT, PE, infection, bleeding, UTE, paralytic ileus
39
Q

Common complications of BPH?

A

Diverticula
Urinary stasis
Calculus development
Thickening of bladder wall that may compress ureters –> backing up urine flow and causing kidney distention –> renal insufficiency

40
Q

What are the different mastectomies for breast cancer?

A

Lumpectomy (breast conservation sx): remove tumor + margin of normal tissue + radiation and/or chemo
Modified radical mastectomy: removal of breast + axillary lymph nodes with preservation of pectoralis major muscle
Radical mastectomy: remove breast + axillary lymph nodes, pectoralis muscles

Nursing 2240: Patho (12 decks)

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