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A and E II > WEEK 6 Prostate Disorders > Flashcards

WEEK 6 Prostate Disorders Flashcards

1
Q

What is Benign Prostatic Hyperplasia (BPH)?

A

Glandular units in the prostate that undergo an increase in number of cells (HYPERPLASIA), resulting in enlargement of prostate gland - inflammation occurs!

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2
Q

What are the risk factors for BPH? (7)

A
  1. Aging
  2. Obesity (“apple”)
  3. Lack of physical activity
  4. Alcohol consumption
  5. Erectile dysfunction
  6. Smoking
  7. Diabetes
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3
Q

BPH is influenced by __

A

androgens !

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4
Q

What are symptoms of BPH? (11)

A
  1. Hyperirritable bladder
  2. Urgency and frequency
  3. Hypertrophied bladder wall muscles
  4. Cellules and diverticula
  5. Hydroureter
  6. Hydronephrosis
  7. Overflow urinary incontinence
  8. Urinary retention
  9. Nocturia
  10. they might have to strain
  11. stream itself might be very weak
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5
Q

In BPH, prostate grows __ causing narrowing of the __.

A

inward

urethra

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6
Q

The prostate should be __, __ __, and should not be __.

A

soft, freely movable

hard

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7
Q

In __, the patient has similar symptoms as an individual with BPH

A

prostatitis

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8
Q

For a patient with BPH, the ureter can become __, when urine is __ __ if outflow is completely obstructed from prostate enlargement. Stones can form from __ __ and __ __. When the urine backs up all the way to the __, hydronephrosis can occur.

A

irritable
backed up

urinary retention; urinary stasis

kidney

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9
Q

What are diagnostic studies for BPH? (6)

A
  1. Digital rectal exam
  2. Urine analysis and culture
  3. Serum creatinine and BUN
  4. PSA (Prostate Specific Antigen)
  5. Urodynamic flow studies
  6. Cystourethroscopy
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10
Q

What are treatment goals for BPH? (3)

A
  1. Restore bladder drainage
  2. Relieve symptoms
  3. Prevent/Treat complications
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11
Q

What drug therapies are used for individual with BPH? (4)

A
  1. Hormonal manipulation (androgen)
  2. Alpha-adrenergic blockers
  3. Conservative therapy
  4. Invasive therapy
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12
Q

What androgen is used in hormonal manipulation as a drug therapy method for BPH pts?

A

Proscar (finasteride)

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13
Q

What is Proscar (finasteride)? What is its mechanism of action?

A

A 5-alpha-reductase inhibitor. Mechanism of Action: inhibits enzymes that converts testosterone to a potent androgen dihydrotestosterone (DHT), which the prostate glad need for its development. “Shrinks” the prostate.

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14
Q

When administering Proscar (finasteride), what should you remember to do?

A

wear gloves! there’s some degree of androgens within it

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15
Q

One should check __ before conducting a __ __ __ b/c the __ can be ELEVATED if __ is done first

A

PSA
digital rectal exam
PSA
DRE

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16
Q

When can PSA levels be falsely elevated?

A
  1. when doing a digital rectal exam before getting PSA levels
  2. when foley catheter is inserted before getting PSA levels
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17
Q

If the PSA is greater than __, a __ is done because they may potentially have prostate cancer

A

4

biopsy

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18
Q

If PSA is less than __, a patient may still have __ __

A

4

prostate cancer

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19
Q

What are 3 examples of alpha-adrenergic blockers used in drug therapy for BPH pts?

A
  1. Minipress
  2. Cardura
  3. Hytrin
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20
Q

What do alpha-adrenergic blockers to help BPH pts?

A

they relax smooth muscle and increase urinary flow

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21
Q

What are side effects of alpha-adrenergic blockers?

A
  1. orthostatic hypotension

2. dizziness

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22
Q

When are alpha-adrenergic blockers normally given?

A

They are typically given at night

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23
Q

What two things are used in conservative therapy for the BPH pt?

A
  1. stents, prostatic balloon

2. foley catheters

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24
Q

What does the invasive therapy for the BPH pt consist of?

A

TURP

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25
Q

What are 4 indications for BPH surgery?

A
  1. Decrease in urine flow sufficient to cause discomfort
  2. Persistent residual in urine
  3. Acute urinary retention
  4. Hydronephrosis
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26
Q

What does TURP stand for?

A

Transurethral Resection of Prostate

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27
Q

TURP is the __ __ for BPH!

A

GOLD STANDARD

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28
Q

When would it be appropriate for a patient to receive a TURP?

A

for debilitating patient with moderate prostatic enlargement

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29
Q

Does TURP involve an incision?

A

NO, therefore it is less likely to cause ERECTILE DYSFUNCTION

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30
Q

Does TURP completely remove the prostate tissue?

A

NOPE

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31
Q

What is common for a patient undergoing a TURP?

After the procedure what medications should you take the patient off of?

A

BLEEDING

Anticoagulants like Plavix, Coumadin

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32
Q

What type of anesthesia is given to the patient during a TURP? What should you check for?

A

semi-conscious anesthesia

check for HYPOnatremia

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33
Q

After a TURP is done, the prostate can or cannot grow back?

A

CAN

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34
Q

Prior to a TURP, the bladder is irrigated for the first __ hours to prevent what?

A

24

mucous and blood clots

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35
Q

Complications of TURP include? (4)

A
  1. bleeding
  2. clot retention
  3. dilutional hyponatremia
  4. retrograde ejaculation (backwards ejaculation)
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36
Q

Patients must stop __ before surgery (TURP)

A

ANTICOAGULANTS

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37
Q

During the TURP procedure, the bladder is …

This person is going to have __ after procedure. Important to wash out bladder so __ aren’t retained.

A

irrigated with lots of fluid

hematuria

clots

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38
Q

What should be included in nursing care for continuous bladder irrigation (CBI)?

A
  1. Monitor I/O and drainage color
  2. Anchor catheter
  3. CAUTI Prevention
  4. Pain and spasm – nl to have bladder spasms but if severe, may have clots/obstruction
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39
Q

What type of catheter is used for continuous bladder irrigation (CBI)?

A

a 3 way catheter - one port connected to fluids, one port connected to drainage back, one port to inflate balloon

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40
Q

What is the goal of continuous bladder irrigation (CBI)?

A

To keep the urine as clear as possible!

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41
Q

Remember for continuous bladder irrigation: WHAT YOU’RE PUTTING IN IS…

A

WHAT YOU’RE PUTTING OUT AND THEN SOME

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42
Q

If you give a patient 3 L how much should come out?

A

3L should come PLUS urine that is made

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43
Q

What are pre-operative assessment/nursing diagnoses for pts undergoing TURP?

A
  1. Pain (? Anxiety)
  2. Fear related to sexual dysfunction
  3. Possible diagnosis of cancer
  4. Knowledge deficit (surgery)
  5. Risk of infection
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44
Q

What are post-operative assessment/nursing diagnoses for pts undergoing TURP?

A
  1. Pain related to bladder spasms
  2. Urge incontinence related to poor sphincter control
  3. Potential for hemorrhage
  4. Hyponatremia
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45
Q

What are preoperative nursing INTERVENTIONS for pts undergoing TURP?

A
  1. use catheters (3 types)
  2. treat urinary infection
  3. high fluid intake (2-3 L/day)
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46
Q

What are the 3 types of catheters than can be used for pt undergoing TURP?

A
  1. Urethral catheter – to restore urinary drainage
  2. Coude catheter (curved tip catheter)
    Much more rigid, harder, allows to push past prostate vs inserting TURP
  3. Filiform (rigid)
47
Q

What are postoperative nursing INTERVENTIONS for pt who has undergone TURP?

A
  1. CBI: Use of 3 way foley catheter; removes clots, urinary drainage
  2. Observe for hemorrhage
    24-36 hours, normal blood clots
  3. Avoid activities that increase intra-abdominal pressure – coughing, sneezing, straining (pt needs to be on stool softeners)
48
Q

For postoperative care of the pt who has undergone TURP, urinary catheter with __ __ is placed into bladder. Apply traction via taping to patient’s __ or __. Patient will feel uncomfortable urge to __ __. Tell patient not to force __. Once catheter is removed, might feel __ __ __ which is normal. Pt should increase __ __ as long as they don’t have __/__ conditions.

A

retention ballon

abdomen; thigh

void continuously

urination

urge to void

fluid intake

cardiac/kidney

49
Q

In caring for the client who has had a TURP, the nurse assess the client frequently for which of the following complications?

  1. HTN and bradycardia
  2. bright red blood and large clots in urine
  3. Large amounts of dilute, light pink urine
  4. Increased hgb and hct
A

2

50
Q

For postoperative nursing interventions for the pt with TURP done, make sure to relieve __ __. What can you use to relieve this?

A

bladder spasms

  1. Belladonna
  2. Opium
  3. Suppositories
  4. Antispasmodics
51
Q

For postoperative nursing interventions for the pt with TURP done, you should promote __ __. What can you teach the patient to achieve this?

A

sphincter tone

Kegel’s exercise

52
Q

The nurse should monitor for signs and symptoms of __ for the post op TURP patient.

A

infection

53
Q

How do you teach Kegel’s exercise?

A

Start urinating, hold for a couple of seconds, urinate again, and hold

54
Q

What should you include in your patient teaching for the post op TURP pt?

A
  1. Catheter care
  2. Managing incontinence
  3. Maintain adequate oral intake (2-3 L/day)
  4. Sexual counseling
    like Erectile dysfunction and Retrograde ejaculation
55
Q

An older male is being evaluated for hydronephrosis . What priority health history question may provide info about cause of disorder?

  1. Do have have HTN?
  2. Do you have difficulty starting and continuing urinating?
  3. Do you have family h/o kidney disease ?
  4. Do you have UTI?
A

2

56
Q

Prostate cancer consists of a __ __ of the prostate gland

A

malignant tumor

57
Q

What is the most common form of cancer in MEN?

What is the ratio? What is the lifetime risk percentage?

A

prostate cancer

1 in 5 men
15.9%

58
Q

Prostate cancer is the __ leading cause of cancer DEATH in men after __ cancer.

A

2nd

lung

59
Q

Prostate cancer has a higher incidence in men greater than __ years and majority of deaths occur after age __.

A

65

75

60
Q

Which racial group has a higher risk for prostate cancer?

A

African American men

61
Q

Prostate cancer can spread locally to nearby __ __ and can eventually affect: (5)

A

lymph nodes

bone
hips 
lumbar spine 
liver 
lungs
62
Q

According to research, risk factors and causes for prostate cancer may be linked to __-__ __ and __ factors

A

high-fat diet; environmental

63
Q

What are genetic risk factors for prostate cancer?

A
  1. 3 or more 1st-degree relatives with prostate cancer
  2. Prostate cancer in 3 generations on the same side of the family
  3. 2 or more close relatives on the same side of the family diagnosed with prostate cancer before age 55 (Father, brother, son, grandfather, uncle, nephew)
64
Q

What type of adenocarcinoma is a risk factor for prostate cancer?

A

Androgen-dependent adenocarcinoma

65
Q

Androgen-dependent adenocarcinoma is __ growing and usually begins in the __ or __ portions of the __. Can be spread to: (6)

A

slow
posterior; lateral ; prostate

  1. pelvic bones
  2. femur (bones)
  3. lymph
  4. lower spine
  5. liver
  6. lungs
66
Q

In the early stage of prostate cancer, patient is __.

A

asymptomatic

67
Q

Prostate cancer clinical manifestations are similar to that of __.

A

BPH

68
Q

What are some symptoms of prostate cancer? (6)

A
  1. Dysuria
  2. dribbling
  3. frequency
  4. hematuria
  5. nocturia
  6. retention
69
Q

For a pt with prostate cancer, prostate feels…

A

hard, enlarged, and fixed on rectal exam

70
Q

Where is pain felt for a pt with prostate cancer? And what is this indicative of?

A

pain in the lumbosacral area with radiation down the hips and legs are indicative of metastasis (renal calculi symptoms?)

patient may also feel pain of lymph nodes and groin area

71
Q

Is hematuria an early or late sign of prostate cancer?

A

LATE sign

72
Q

Prostate cancer pt may have pain during __ especially when __.

A

intercourse

ejaculating

73
Q

Another sign of prostate cancer is sudden, unexplained __ __

A

weight loss

74
Q

What are NON-DEFINITIVE diagnostic studies for prostate cancer? (2)

A
  1. digital rectal exam (DRE)

2. (+) elevated PSA

75
Q

What are abnormal findings of DRE for a prostate cancer patient?

A
  1. areas of firmness
  2. localized (nodules) or generalized
  3. bogginess and asymmetry
76
Q

What is the normal range for PSA (prostate-specific antigen) ?

A

0.2-4 ng/ml

77
Q

When can there be mild elevation of PSA?

A

BPH

UTI

78
Q

the higher the PSA the larger the __ __

A

tumor mass

79
Q

Since PSA and DRE are __ __ diagnoses, we need a __.

A

NOT definitive

BIOPSY

80
Q

Does the U.S. Preventive Services Task Force (USPSTF) recommend prostate-specific antigen (PSA)-based screening for prostate cancer?

A

NO

81
Q

Management strategies for localized prostate cancer include: (4)

A
  1. watchful waiting
  2. active surveillance
  3. surgery
  4. radiation therapy
82
Q

Is there a consensus regarding optimal treatment for PSA testing?

A

NOPE

83
Q

What are the harms of screening for PSA testing?

A
  1. pain
  2. fever
  3. bleeding
  4. infection
  5. transient urinary difficulties associated with prostate biopsy
84
Q

There can be __ harm of false-positive test results for prostate cancer screening and __.

A

psychological

overdiagnosis

85
Q

The time between actual diagnosis of prostate cancer and treatment can be __ years because it is __ growing cancer. Initially, may just keep watchful observation by doing __ and __.

A

10

slow

DREs, PSAs

86
Q

What are the definitive diagnostic studies for prostate cancer and metastasis?

A
  1. Trans-rectal ultrasound
  2. Prostate biopsy – confirms diagnosis
  3. CT or MRI to assess metastasis
  4. Elevated alkaline phosphatase indicates bone metastasis
  5. Grading & Staging (TNM classification)
87
Q

In suprapubic prostatectomy, patient has __-__ problems

A

co-existing

88
Q

In suprapubic prostatectomy, what two catheters are inserted?

A

Suprapubic catheter & Foley catheter

89
Q

In suprapubic prostatectomy, the foley catheter is removed __-__ __ day

A

2-4th

postoperative day

90
Q

In suprapubic prostatectomy, the __ tube has a greater risk for bladder spasms

A

suprapubic

91
Q

For a patient who had a suprapubic prostatectomy, monitor frequently for __ on __

A

urine; dressing

92
Q

For post-op CBI, watch for __ and __ in the patient who had a suprapubic prostatectomy.

A

hyponatremia

seizures

93
Q

In the suprapubic catheter, catheter goes through the __

A

bladder

94
Q

For a suprapubic prostatectomy, it can be done __ therefore the patient can go home more __

A

microscopically

quickly

95
Q

There is less risk for __ __ for a suprapubic prostatectomy because this procedure does not cut __ __

A

erectile dysfunction

perineal nerves

96
Q

In retropubic prostatectomy, is there a bladder incision?

A

No

97
Q

How do you perform catheter care for retropubic prostatectomy?

A

clean urethral meatus with soap and water

secure catheter

98
Q

In retropubic prostatectomy, wound is serosanguinous for __-__ days

A

4-5

99
Q

In retropubic prostatectomy, discharge with catheter for __-__ days

A

3-5

100
Q

In retropubic prostatectomy, how do you help with urinary incontinence?

A

Kegel’s exercises

101
Q

What are discharge teaching instructions for retropubic prostatectomy?

A
  1. No lifting heavy objects
  2. no driving
  3. no sex
  4. drink 2-3 liters/day
  5. stool softeners
  6. high fiber in diet
  7. walk
  8. question about impotence
102
Q

Can retropubic prostatectomy cause erectile dysfunction?

A

yes

103
Q

Can retropubic prostatectomy including the removal of lymph nodes?

A

yes

104
Q

Can patients go home with a catheter after a retropubic prostatectomy?

A

yes

105
Q

What is Erectile Dysfunction?

A

it is an inability to achieve or maintain erection for sexual intercourse

106
Q

what is organic vs. functional ED?

A

physiologic vs. psychosocial

107
Q

how does a nurse assess for ED?(3)

A
  1. medical, social, sexual history
  2. complete physical examination
  3. duplex doppler ultrasonography test
108
Q

What are some Organic (Physiologic)

Causes of ED? (10)

A
  1. Inflammation of prostate, urethra or seminal vesicle
  2. Surgery, e.g., prostatectomy
  3. Pelvic fractures
  4. Lumbosacral injuries
  5. Vascular disease, e.g., HTN – may have impairment of blood flow
  6. Chronic neuro conditions, e.g., Parkinson’s or MS
  7. Endocrine disorders, e.g., DM or thyroid
  8. Smoking & alcohol
  9. Drugs, e.g., antihypertensives
  10. Poor overall health
109
Q

how can DM affect ED?

A

DM can interfere with blood flow, microscopic changes in vessels

110
Q

What are some Collaborative Care for ED?

A
  • Phosphodiesterase-5 (PDE-5) inhibitors, e.g., sildenafil (Viagra), Levitra, Cialis
  • –1st line oral drugs
  • –Relax corpora cavernosa to ↑ penile blood flow
  • –Compress exit veins, limiting outward blood flow → penile tumescence (swelling)
  • –Teach to take 30 minutes to an hr before intercourse
  • –> natural → preferred by most men & partners
    • basically to relax smooth muscle to let blood flow in.
111
Q

What are other Collaborative Care of ED?

A
  1. Instruct pts to abstain from alcohol before intercourse
  2. Educate re: common side effects of PDE-5 inhibitors
    - –Dyspepsia, H/A, facial flushing, stuffy nose
    - –If > 1 pill: leg & back cramps, n/v may also occur
    - –If taking nitrates, do NOT take PDE-5 inhibitors!
    - —-Profound ↓ BP & ↓ blood flow to vital organs
  3. If can’t take PDE-5 inhibitors or ineffective, use other methods
112
Q

What is one caution about a pt taking PDE-5 inhibitors?

A

Don’t want patient on NTG – avoid 24-48 hours between NTG and PDE-5 inhibitors – if taken together, will have severe hypotension

113
Q

What is Priapism?

A

erection that won’t go away for 4 hours that can be life threatening = medical emergency

114
Q

What is one way to remove erection?

A

Aspirate blood, use injection of medications like phenoephrine (but you worry about hypotension?) to remove erection, other vasodilators

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