Study guide for this exam Flashcards
Know post-op care the precautions for testicular, bladder and prostate cancer and urinary diversions
Sure, here is a list of post-operative care precautions for testicular, bladder and prostate cancer, and urinary diversions:
Testicular Cancer:
Encourage the patient to perform testicular self-examinations regularly after the surgery.
Advise the patient to avoid heavy lifting or strenuous physical activities for a few weeks following surgery.
Monitor for signs of infection, such as fever or redness and swelling at the incision site.
Advise the patient to wear supportive underwear to help reduce swelling and discomfort.
Educate the patient on the potential side effects of surgery, such as pain and swelling, and provide appropriate pain management.
Bladder Cancer:
Monitor the patient for signs of infection, such as fever or pain in the lower abdomen.
Encourage the patient to drink plenty of fluids to help flush out the bladder and reduce the risk of infection.
Instruct the patient on how to care for the urinary catheter and ensure it remains clean and functioning properly.
Advise the patient to avoid strenuous activities, such as heavy lifting or exercise, until the urinary catheter is removed.
Monitor the patient for signs of urinary incontinence or retention and provide appropriate interventions as needed.
Prostate Cancer:
Educate the patient on the potential side effects of surgery, such as urinary incontinence and erectile dysfunction.
Monitor the patient for signs of infection, such as fever or pain in the surgical area.
Advise the patient to avoid heavy lifting or strenuous physical activities for a few weeks following surgery.
Instruct the patient on how to care for any surgical drains or catheters and ensure they remain clean and functioning properly.
Provide appropriate pain management as needed.
Urinary Diversions:
Monitor the patient for signs of infection, such as fever or pain at the site of the diversion.
Instruct the patient on how to care for the stoma, including how to clean and change the ostomy bag.
Educate the patient on how to maintain fluid and electrolyte balance and prevent dehydration.
Provide appropriate dietary recommendations to help prevent blockages and maintain bowel regularity.
Encourage the patient to report any changes in the color, consistency, or amount of urine output.
Review continuous bladder irrigation, peritoneal dialysis and the indications for and management of these interventions.
Review continuous bladder irrigation, peritoneal dialysis and the indications for and management of these interventions.
Sure, here is an overview of continuous bladder irrigation and peritoneal dialysis, including their indications and management:
Continuous Bladder Irrigation (CBI):
Continuous bladder irrigation is a procedure used to flush out the bladder continuously with sterile fluid, typically following surgery or in the treatment of conditions such as bladder cancer or clot retention. The procedure involves inserting a three-way Foley catheter into the bladder and connecting it to a closed system that infuses and drains sterile fluid. The goal is to prevent blood clots from forming and causing obstruction in the bladder.
Indications:
Treatment of clot retention
Treatment of hematuria
Treatment of bladder cancer
Postoperative bladder irrigation
Management:
Monitor the patient’s urine output, color, and clarity regularly
Assess the patient’s pain and comfort level and provide appropriate interventions as needed
Ensure the patency of the catheter and the drainage system
Monitor the patient’s fluid and electrolyte balance and adjust the irrigation rate and solution as necessary
Monitor for signs of infection, such as fever or increased pain, and provide appropriate interventions as needed.
Peritoneal Dialysis (PD):
Peritoneal dialysis is a treatment for kidney failure that involves using the patient’s peritoneal membrane as a dialysis membrane. The procedure involves instilling sterile dialysate solution into the peritoneal cavity through a catheter, which is left in place for several hours to allow for diffusion and ultrafiltration of waste products and excess fluid across the peritoneal membrane.
Indications:
Chronic kidney disease
End-stage renal disease
Acute renal failure
Drug overdose or poisoning
Management:
Monitor the patient’s vital signs and fluid and electrolyte balance regularly
Assess the patient’s pain and comfort level and provide appropriate interventions as needed
Monitor for signs of infection, such as fever or increased pain, and provide appropriate interventions as needed
Monitor the patient’s dialysate volume and composition and adjust as necessary based on the patient’s needs and laboratory results
Ensure proper catheter placement and function and provide appropriate care and maintenance to reduce the risk of infection and complications.
Review the indications for renal replacement therapy, the assessment of an AV fistula and the care and precautions of the CVC dialysis access device.
Sure, here is an overview of the indications for renal replacement therapy, the assessment of an AV fistula, and the care and precautions of the CVC dialysis access device:
Indications for Renal Replacement Therapy (RRT):
Renal replacement therapy is used to manage patients with end-stage renal disease or acute kidney injury who are unable to maintain adequate fluid, electrolyte, and metabolic balance without intervention. Indications for RRT include:
Severe fluid overload or electrolyte imbalances
Uremic symptoms, such as nausea, vomiting, and lethargy
Hyperkalemia that is refractory to medical management
Decreased urine output or anuria
Signs of uremia or encephalopathy
Uncontrolled hypertension or heart failure
Assessment of an AV Fistula:
An arteriovenous (AV) fistula is a surgical connection between an artery and a vein used for hemodialysis access. Assessment of the AV fistula should be done regularly to ensure patency and identify any signs of complications, such as infection or stenosis.
Assessment should include:
Checking for a thrill or bruit over the fistula site, which indicates adequate blood flow
Monitoring the fistula for signs of infection, such as redness, swelling, or drainage
Assessing the patency of the fistula by measuring blood flow and pressure
Monitoring for signs of stenosis, such as decreased blood flow or aneurysm formation
Care and Precautions of the CVC Dialysis Access Device:
A central venous catheter (CVC) is a type of dialysis access device used for temporary access to the vascular system. Proper care and precautions are essential to reduce the risk of complications, such as infection and clotting.
Care and precautions for the CVC dialysis access device include:
Using sterile technique for insertion and dressing changes
Cleaning the insertion site with chlorhexidine or other appropriate antiseptics
Regularly flushing the catheter with saline or heparin to maintain patency
Avoiding the use of the catheter for non-dialysis related procedures
Monitoring for signs of infection or clotting, such as redness, swelling, or decreased blood flow
Educating the patient on proper hygiene and care of the catheter and surrounding skin
Monitoring the patient’s fluid and electrolyte balance and adjusting dialysate as necessary.
What is TURP? TURP post op care. A three-way foley cath is inserted after surgery. Continuous bladder irrigations are done to flush all the blood out of the bladder to prevent clots from developing.
TURP stands for transurethral resection of the prostate, which is a surgical procedure used to remove part or all of the prostate gland in men with benign prostatic hyperplasia (BPH) or prostate cancer.
Postoperative care after TURP typically includes:
Monitoring the patient’s vital signs, urine output, and fluid and electrolyte balance
Providing pain management and bladder spasms control as needed
Administering prophylactic antibiotics to prevent infection
Assessing the patient’s bladder function and catheter patency
Checking the urine for color, clarity, and presence of clots or bleeding
Encouraging early ambulation and deep breathing exercises to prevent complications such as blood clots in the legs or lungs
Educating the patient on proper catheter care and hygiene
Providing clear instructions on follow-up care and scheduling of postoperative appointments.
As mentioned, a three-way Foley catheter is inserted after TURP surgery. This catheter has three ports or channels. One port is used to inflate the balloon at the tip of the catheter to keep it in place. The second port is used to drain urine from the bladder, and the third port is used for continuous bladder irrigation (CBI).
CBI involves flushing the bladder with sterile saline solution to prevent blood clots from forming and to promote healing. The purpose of CBI is to keep the urine clear of blood or clots and to promote healing of the bladder lining. The rate and volume of the irrigation solution are determined by the surgeon or healthcare provider based on the patient’s individual needs.
Patients who undergo TURP surgery will typically have CBI for a specified period, typically up to 48-72 hours, depending on the patient’s condition and the surgeon’s preference. During this time, the patient’s urine output, color, and clarity will be closely monitored, and adjustments to the irrigation solution may be made as needed. Once the CBI is discontinued, the patient will continue to have a Foley catheter in place for several more days or until their urinary function has recovered sufficiently.
What is Priapism? Treatment: Sedatives; Injection of smooth muscle relaxants into penis; Aspiration & irrigation of corpora cavernosa with large bore needle; Surgical creation of a shunt (drain corpora cavernosa). Complications: penile tissue necrosis; Hydronephrosis from bladder distention; inability to achieve a normal erection after priapism subsides.
Priapism is a medical condition in which a persistent and prolonged erection of the penis occurs, often in the absence of sexual stimulation. There are two types of priapism: ischemic priapism, which is caused by insufficient blood flow to the penis, and non-ischemic priapism, which is caused by excessive blood flow to the penis.
Treatment for priapism depends on the type and underlying cause of the condition. For ischemic priapism, initial treatment typically involves conservative measures such as sedatives and pain relief medications to help relax the smooth muscle tissue in the penis and promote blood flow. If conservative measures fail, more invasive treatments such as injection of smooth muscle relaxants directly into the penis or aspiration and irrigation of the corpora cavernosa (the spongy tissue in the penis) with a large bore needle may be necessary to remove the blood clot and relieve the prolonged erection.
In severe cases of priapism, surgical creation of a shunt or bypass may be required to drain the blood from the corpora cavernosa and restore normal blood flow to the penis. This procedure involves creating a small opening or channel between the corpora cavernosa and the spongy tissue in the penis, allowing the blood to flow out and prevent further tissue damage.
Complications of priapism can include penile tissue necrosis (death of penile tissue), hydronephrosis (swelling of the kidneys due to bladder distension), and the inability to achieve a normal erection after priapism subsides. It is important to seek medical attention promptly if priapism is suspected to prevent long-term complications and preserve normal erectile function.
Transillumination is used to identify solid tumors/cancer versus fluid in the scrotum. Most men detect scrotal/testicular problems while bathing or performing their monthly testicular exam. Epididymitis is unilateral, caused by infection, trauma, urinary reflux down the vas deferens. Most common cause of infertility is varicocele. Testicular torsion common in young boys and is a surgical emergency to untangle the blood supply that is twisted around the vas deferens. Monthly men’s testicular exam is performed in the shower or when the scrotum is warm. Vasectomy is performed in the MD office. Should use contraception for 6 weeks or 10 ejaculations to evacuate sperm distal to surgical site.
Transillumination is a medical technique used to differentiate between solid tumors/cancer versus fluid in the scrotum. It involves shining a light through the scrotum to examine the contents of the scrotal sac. Solid masses, such as tumors, will not allow light to pass through, while fluid will allow light to pass through.
Men should perform a monthly testicular exam to detect any scrotal/testicular problems early. This can be done while bathing or in the shower when the scrotum is warm. During the exam, men should feel for any lumps, changes in size or shape, or pain in the scrotum.
Epididymitis is a medical condition that causes inflammation of the epididymis, a tube located at the back of the testicle that stores and carries sperm. It is usually unilateral, meaning it affects only one testicle, and can be caused by infection, trauma, or urinary reflux down the vas deferens.
Varicocele is a medical condition that causes swelling and enlargement of the veins in the scrotum. It is the most common cause of infertility in men and can affect the production and quality of sperm.
Testicular torsion is a medical emergency that occurs when the testicle twists around the spermatic cord, which carries blood to the testicle. It is most common in young boys and can lead to a loss of blood supply to the testicle, which can result in permanent damage or loss of the testicle. Surgery is required to untangle the twisted blood supply.
Vasectomy is a surgical procedure that involves cutting or blocking the vas deferens, the tube that carries sperm from the testicles to the urethra, in order to prevent pregnancy. It is usually performed in a doctor’s office and is a highly effective form of contraception. However, men should use additional contraception for at least 6 weeks or 10 ejaculations after the procedure to evacuate any remaining sperm distal to the surgical site.
Testicular cancer diagnostic tests: palpate scrotal contents, ultrasound, CXR, CT scan abd & pelvis, α-fetoprotein, LDH, human chorionic gonadotropin.
Testicular cancer is usually diagnosed through a combination of physical examination, imaging tests, and blood tests. The following are some of the diagnostic tests used to detect testicular cancer:
Palpation: The first step in the diagnosis of testicular cancer is a physical examination to feel for any abnormalities or lumps in the scrotum. The doctor will gently palpate (feel) the testicles to check for any hard or lumpy areas that might indicate the presence of a tumor.
Ultrasound: An ultrasound is a painless and non-invasive imaging test that uses high-frequency sound waves to create images of the scrotum. Ultrasound is a highly effective tool for detecting tumors in the testicles.
Chest X-ray (CXR): A chest X-ray is often performed to check for any signs of cancer that may have spread to the lungs. This is important because testicular cancer can sometimes spread to other parts of the body, including the lungs.
CT scan of the abdomen and pelvis: A CT scan is a type of imaging test that uses X-rays to create detailed images of the body. This test is used to check for any signs of cancer that may have spread to the lymph nodes or other parts of the abdomen or pelvis.
Blood tests: Blood tests are used to measure the levels of certain substances in the blood that may be elevated in cases of testicular cancer. These include alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and human chorionic gonadotropin (HCG). These tests can help confirm the diagnosis of testicular cancer and determine the extent of the disease.
It is important to note that not all of these tests may be necessary for every case of suspected testicular cancer, and the specific diagnostic tests used will depend on the individual case and the doctor’s clinical judgment.
Treatments for prostate cancer: Surgery, Radiation therapy, Drug therapy. Drug therapy is called Hormonal therapy (androgen deprivation therapy – ADT). Goal: reduce the androgen level. Androgen promotes the tumor growth. Causing a castration effect will prevent the release of any androgen. Hence, the cancer will stop growing and begin to shrink in size. ADT is used as adjunct therapy before surgery or radiation. Complication of ADT is osteoporosis. Bisphonate drugs are given to prevent osteoporosis.
Prostate cancer is a cancer that starts in the prostate gland and affects only men. Treatment for prostate cancer depends on several factors such as the stage of cancer, the patient’s overall health, and the patient’s age. There are three main treatments for prostate cancer:
Surgery: Surgery involves the removal of the prostate gland, also known as radical prostatectomy. This is a common treatment for localized prostate cancer, meaning that it has not spread outside of the prostate gland. The surgery may be performed as an open procedure or as a minimally invasive laparoscopic or robot-assisted surgery.
Radiation therapy: Radiation therapy uses high-energy X-rays to kill cancer cells. There are two types of radiation therapy: external beam radiation therapy and brachytherapy. In external beam radiation therapy, radiation is delivered from outside the body. In brachytherapy, radioactive seeds are implanted into the prostate gland.
Drug therapy: Hormonal therapy, also known as androgen deprivation therapy (ADT), is a drug therapy used to treat prostate cancer. Androgens are male hormones that can promote the growth of prostate cancer cells. Hormonal therapy aims to reduce the level of androgens in the body, thereby depriving the cancer cells of the hormones they need to grow. This can be achieved by either removing the testicles surgically (bilateral orchiectomy) or by using medications that block the production of androgens (e.g., luteinizing hormone-releasing hormone agonists). Hormonal therapy is used as an adjunct therapy before surgery or radiation to shrink the tumor and make it easier to remove or destroy.
Complications of hormonal therapy include osteoporosis, hot flashes, loss of libido, fatigue, and weight gain. Bisphosphonate drugs are given to prevent osteoporosis. These drugs help to strengthen bones and reduce the risk of fractures. Patients on hormonal therapy should also have regular bone density scans to monitor their bone health.
Acute pyelonephritis manifestations and treatments.
Acute pyelonephritis is a bacterial infection that affects the kidneys and can cause serious complications if left untreated. The manifestations of acute pyelonephritis may include:
Fever and chills
Flank pain or pain in the lower back, usually on one side
Nausea and vomiting
Painful or frequent urination
Cloudy or foul-smelling urine
Blood in the urine
If you suspect you have acute pyelonephritis, it is important to seek medical attention as soon as possible. Your healthcare provider may perform diagnostic tests such as a urine culture, blood tests, or imaging studies to confirm the diagnosis.
The main treatments for acute pyelonephritis are antibiotics and supportive care. Antibiotics may be given orally or intravenously depending on the severity of the infection. It is important to complete the full course of antibiotics as prescribed, even if symptoms improve, to ensure the infection is completely cleared.
Supportive care may include:
Drinking plenty of fluids to help flush out the bacteria
Pain relief medication such as acetaminophen or ibuprofen
Resting and avoiding strenuous activities until symptoms improve
Warm compresses or a heating pad to relieve pain and discomfort
In severe cases of acute pyelonephritis, hospitalization may be required for intravenous antibiotics and close monitoring of vital signs. Complications of untreated or severe acute pyelonephritis can include sepsis, kidney damage, and renal failure.
Glomerulonephritis is a condition characterized by inflammation and injury to the glomeruli, the tiny blood vessels in the kidneys that filter waste products and excess fluid from the blood. This inflammation is often caused by antibodies that mistakenly attack the glomerular basement membrane, which can result in damage to the kidneys.
There are two main types of glomerulonephritis: primary and secondary. Primary glomerulonephritis is caused by an autoimmune reaction, where the immune system mistakenly attacks the glomeruli. Secondary glomerulonephritis is caused by an underlying condition, such as an infection or a systemic autoimmune disease.
The symptoms of glomerulonephritis may include generalized body edema, starting with periorbital edema (swelling around the eyes) and progressing to peripheral edema (swelling in the extremities) or ascites (fluid accumulation in the abdomen). Hypertension (high blood pressure) and decreased urine output (oliguria) may also occur.
Treatment for glomerulonephritis is based on the underlying cause and the specific manifestations of the condition. Medications may be prescribed to control blood pressure and reduce inflammation, and diuretics may be used to help reduce edema. In cases where the kidneys are severely damaged, dialysis or kidney transplantation may be necessary.
It is important for individuals with glomerulonephritis to work closely with their healthcare provider to manage the condition and prevent complications. This may include managing underlying conditions such as infections or autoimmune diseases, maintaining a healthy lifestyle, and following a specialized diet to help manage symptoms.
The treatment for glomerulonephritis will depend on the underlying cause of the condition and the specific symptoms that the individual is experiencing. Some common treatments include:
Medications: Depending on the type and severity of glomerulonephritis, medications may be prescribed to control blood pressure, reduce inflammation, or suppress the immune system. Examples of medications that may be used include corticosteroids, immunosuppressants, and angiotensin-converting enzyme (ACE) inhibitors.
Diuretics: These medications help to reduce excess fluid in the body and can be used to treat edema (swelling) associated with glomerulonephritis.
Dietary changes: Individuals with glomerulonephritis may need to make dietary changes to manage their symptoms. This may include reducing salt intake to help control blood pressure, limiting protein intake to reduce the workload on the kidneys, and avoiding foods that may exacerbate inflammation.
Dialysis or kidney transplant: In severe cases of glomerulonephritis where the kidneys are severely damaged, dialysis or kidney transplant may be necessary.
AKI Nursing Management: Meticulous aseptic technique: reduce infection (leading cause of death in AKI); Check skin for redness, cellulitis, pain; Monitor vitals, daily weights, I&O; Check for distended neck veins, skin color, edema, bruises, LOC, lungs, heart sounds; Dehydration: oral mucosa dry, poor skin tugor, pale. May see signs of dehydration in the oliguric phase; JVD, LE edema, lung congestion: CHF due to over hydrations with IVF for treatment during oliguric phase; Bruises occur when renal not producing erythropoietin. Pt becomes anemic. Any Vas cath or AV fistula (bruit?). explain thsese points
Acute Kidney Injury (AKI) is a sudden onset of kidney damage that can lead to multiple complications. Nursing management is vital for patients with AKI to prevent complications and promote recovery. Here are some explanations for the nursing management points you listed:
Meticulous aseptic technique: This means maintaining a sterile environment during procedures such as catheterization or dressing changes to prevent infection, which is the leading cause of death in AKI patients. Infection can worsen kidney function and cause sepsis, which can be life-threatening.
Check skin for redness, cellulitis, pain: Skin changes may indicate infection or poor perfusion, which can lead to skin breakdown and pressure ulcers. Pain may be a sign of underlying conditions such as kidney stones or urinary tract infections.
Monitor vitals, daily weights, I&O: Vital signs such as blood pressure, heart rate, and respiratory rate can indicate complications such as fluid overload or electrolyte imbalances. Daily weights can indicate changes in fluid balance, and I&O monitoring can help determine if the patient is adequately hydrated.
Check for distended neck veins, skin color, edema, bruises, LOC, lungs, heart sounds: These assessments can indicate fluid overload, heart failure, or respiratory distress. Bruising may be a sign of anemia due to reduced production of erythropoietin, a hormone produced by the kidneys that stimulates red blood cell production.
Dehydration: Oral mucosa dry, poor skin turgor, pale. May see signs of dehydration in the oliguric phase: Dehydration can occur in AKI patients due to decreased fluid intake or increased fluid losses. Oliguria is a condition where the patient produces less urine than usual, and signs of dehydration may be seen during this phase.
JVD, LE edema, lung congestion: CHF due to over hydration with IVF for treatment during oliguric phase: In some cases, fluid overload can occur during the oliguric phase, leading to congestive heart failure (CHF). Signs of CHF include distended neck veins, leg edema, and lung congestion.
Any Vas cath or AV fistula (bruit?): A vas cath or AV fistula is a type of access used for hemodialysis. Checking for a bruit, a sound made by blood flowing through the fistula, can indicate patency and proper blood flow. Properly functioning access is essential for successful hemodialysis.
what are all the diagnostic exams for testicular cancer ?
There are several diagnostic exams that can be used to evaluate testicular cancer. These include:
Physical exam: A healthcare provider will examine the testicles and scrotum for any lumps, swelling, or changes in size or shape.
Ultrasound: This imaging test uses sound waves to create detailed images of the testicles and scrotum. It can help determine the size and location of a tumor.
Blood tests: These tests can measure levels of certain proteins that are often elevated in men with testicular cancer, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
Biopsy: In some cases, a small sample of testicular tissue may be removed and examined under a microscope to confirm the diagnosis of testicular cancer.
CT scan: This imaging test uses X-rays and computer technology to create detailed images of the abdomen, pelvis, and chest. It can help determine if the cancer has spread to other parts of the body.
MRI: This imaging test uses a magnetic field and radio waves to create detailed images of the body. It can be helpful in evaluating the extent of the cancer and determining if it has spread.
PET scan: This imaging test uses a radioactive tracer to detect areas of the body where cancer cells are growing. It can help determine if the cancer has spread beyond the testicles.
The specific tests ordered may vary depending on the individual’s symptoms, medical history, and other factors.
nephrotic syndrome vs Glomerulonephritis
Nephrotic syndrome and glomerulonephritis are both kidney diseases that affect the glomeruli, the tiny filters in the kidneys that remove waste products from the blood and produce urine. However, they have different causes, clinical features, and treatment options.
Nephrotic syndrome is a condition characterized by damage to the glomeruli, resulting in excessive protein loss in the urine (proteinuria), hypoalbuminemia (low blood albumin levels), edema or anasarca, and high blood cholesterol levels. The most common cause of nephrotic syndrome in adults is membranous nephropathy, whereas minimal change disease is the most common cause in children. The treatment of nephrotic syndrome involves medications to reduce proteinuria, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), corticosteroids, and diuretics, as well as dietary modifications.
Glomerulonephritis, on the other hand, is a group of kidney diseases characterized by inflammation of the glomeruli, which can lead to proteinuria, hematuria (blood in the urine), and decreased kidney function. Glomerulonephritis can be caused by various factors, including infections, autoimmune disorders, and hereditary conditions. Treatment options for glomerulonephritis depend on the underlying cause and may include antibiotics, immunosuppressive medications, and plasma exchange therapy.
In summary, nephrotic syndrome is a specific kidney disease that involves excessive protein loss and edema, whereas glomerulonephritis is a broader term that encompasses various kidney diseases characterized by glomerular inflammation and dysfunction.
