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93 Cards in this Set
- Front
- Back
Female Reproductive System
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* Normal menstruation
* Common abnormalities in female reproductive system * Menopause * Cervical cancer * Breast cancer and self breast exam |
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Menarche
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* First menstrual period
* Average age of onset 12 to 13 years old * Can range from 9-17 years old and still be within normal limits * Often anovulatory |
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Menstruation (continued)
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* Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days) * Average duration of flow is 2-7 days * Average blood loss is 30-80cc * Requires intact hypothalamus, pituitary gland, ovaries, and uterus |
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Menstrual Disorders
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* Dysmenorrhea: painful menstruation
Can be primary or secondary |
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Dysmenorrhea
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* Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation
* Secondary: pelvic disease present. Common causes: endometriosis, cervical os stenosis, fibroids, cancer |
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Amenorrhea
* What is the most common cause???? |
Pregnancy
Breastfeeding Menopause |
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Other causes of amenorrhea?
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anxiety
fatigue chronic illness extreme dieting strenuous exercise |
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Menorrhagia
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abnormally heavy menstrual flow, greater than 80cc per menses
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Metorrhagia
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bleeding between menstrual periods
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Leukorrhea
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any vaginal discharge than blood- often a symptom of vaginal or cervical infection
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Endometriosis
Defined as |
abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Cause unknown * Occurs in 30s & 40s, rarely before 20 |
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There are three theories proposed to explain the cause endometriosis
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Implantation theory
Vascular, lymphatic theory Formation theory |
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Implantation theory
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Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow
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Vascular, lymphatic theory
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Endometrial glands are transported through vascular & lymphatic systems to other areas
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Formation theory
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Endometrial tissue forms spontaneously outside the uterus
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Endometriosis
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* Causes intense pain
* Can lead to infertility * Can lead to painful intercourse * Treatment can be medical or surgical Medical management: mild analgesics, NSAIDS, OCs Comfort measures: heating pads, relaxation, biofeedback |
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Premenstrual Syndrome
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* Symptoms occur during the LUTEAL phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels * Most common in 30-40 year olds * Severity increases with age until menopause * Risk factors: after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses |
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PMS symptoms occur during the _____
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LUTEAL
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PMS most common in what age group?
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30-40
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PMS risk factors
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after pregnancy
childbirth tubal ligation perimenopausal years during major life stresses |
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PMS emotional symptoms
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irritability
easily induced crying spells low self esteem anxiety depression |
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PMS physical symptoms
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breast tenderness
bloating fluid retention increased appetite and food cravings insomnia fatigue hot flashes headaches musculoskeletal discomfort |
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PMS cognitive symptoms
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short term memory problems
difficulty concentrating unclear thinking |
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PMS treatment - Diet & nutritional therapy
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* Eat small meals throughout the day
* Limit sugar, red meat, EtOH, coffee, tea & chocolate * Eliminating caffeine can help w/irritability * limit sodium intake if edema is a problem * Ca, MG, Vits A, B6, & C can be helpful |
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PMS treatment - Medications (most are controversial)
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* mild K+ sparing diuretics
* Progesterone * Parlodel * OCs * Gonadotropin-releasing hormone agonists * Antidepressants * Prostaglandin inhibitors (NSAIDS) Menopause * Refers to the end of menstrual periods - the actual date cannot be determined until one year passes without menses * FSH and LH levels increase * Decreased estrogen levels affect the reproductive system, CV system, and bone density * Ave age of onset 50-52 * Preceded by perimenopause |
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Average age of onset of menopause?
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50-52
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Effects of Menopause
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* Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis * During perimenopausal phase: hot flashes, emotional changes, and fatigue |
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Cervical Cancer
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* Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, multiple sex partners, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV |
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Pap smears test for?
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Cervical cancer
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Cervical CA Classic symptom
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painless vaginal bleeding (starts as spotting between menstrual periods or after sex as malignancy grows, the bleeding increases in frequency, duration, and amount)
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Other sx of cervical cancer
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* leg pain/unilateral swelling of the leg
* wt loss/pelvic pain * dysuria/hematuria, rectal bleeding |
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Cervical CA - Nonsurgical
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* Laser therapy
* cryosurgery * radiation therapy * chemotherapy |
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Cervical cancer - Sugical
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* Conization
* hysterectomy * pelvic exenteration |
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Is ovarian cancer often bilateral?
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yes
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Ovarian Cancer
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* Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates * Tumors grow and spread rapidly and are often bilateral |
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Ovarian cancer - Risk Factors
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* Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer * Nulliparity * Infertility |
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Ovarian cancer risk factors -
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* History of dysmenorrhea or heavy bleeding
* Diets high in animal fat * Age older than 40- peaks at age 50-55 |
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Ovarain Cancer Assessment - Sx to look for
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* abdominal pain or swelling
* dyspepsia * indigestion * gas * Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding |
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The only sign of ovarian cancer may be an abdominal mass- may not be identifiable until size reaches _____ inches
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6
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Ovarian Cancer Assessment
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* Pap only abnormal in 20-30%
* CA-125 may be elevated (not diagnostic- used to eval progress) * USG and CT can be diagnostic tools * Exploratory laparotomy used to dx and stage tumors |
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Ovarian cancer Treatment
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* Similar to cervical cancer
* Tx depends on stage of cancer * Chemotherapy * Radiation * Surgery |
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Breast Cancer
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* Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90% * When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25% * 2nd leading cause of cancer deaths in women * Leading cause of cancer deaths in women 35-54 yrs of age |
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Breast cancer types
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* Multiple pathologic types
* Most common: infiltrating ductal carcinoma * Noninvasive * invasive |
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Early detection methods - breast cancer
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* Self breast exam needs to be done monthly in women over 20
* Mammography- begin age 40, then annually * Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes |
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Breast Cancer Assessment
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* Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau d orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration * Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment |
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Breast Cancer Risk Factors
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* Female
* Hx of previous breast cancer * Age > 40 * Early menarche, late menopause or both * Nulliparity or 1st child after 30 * Family hx * Diet * Alcohol * Obesity * Ionizing radiation * Benign breast disease * OCs * Exogenous hormones |
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Breast cancer in men
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* 1% of all cases occur in men
* Ave age of onset 60 yrs * Common sx - Hard - nonpainful mass - nipple discharge - retraction - erosion - ulceration |
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Breast Cancer Surgical
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1. Lumpectomy: local excision and resection
2. Partial mastectomy: removal of portion of breast that contains the tumor 3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact) |
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Breast CA Nursing Dx
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* Anxiety
* Anticipatory grieving * Acute pain * Disturbed sleep pattern * Disturbed body image * Sexual dysfunction |
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Male Reproductive Disorders
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* Benign Prostatic Hypertrophy
* Prostate Cancer * Erectile Dysfunction * Testicular Cancer |
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Benign Prostatic Hypertrophy
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* Saw Palmetto
* Occurs in almost all men with aging * Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland * Leads to narrowing of prostatic urethral channel * Cause is unknown |
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BPH symptoms
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* Urinary frequency
* Nocturia * Urinary hesitancy * Hematuria * Diminished force of urinary stream * Post-void dribbling * Bladder distention * Possible renal insufficiency (edema, pallor, pruritis) * Uniform, elastic, nontender palpable prostate |
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BPH Assessment
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* Clinical manifestations
* Distended bladder * Digital rectal exam |
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BPH Laboratory assessment
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* CBC (infection or anemia)
* BUN & serum creatinine (eval renal function) * Prostate specific antigen (PSA) to rule out malignancy * Flowmetry- evaluates flow rate and residual urine |
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What is an important disticntion betwenn BPH and Proatate Cancer when assesseing?
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BPH = uniform, elastic, nontender palpaplbe prostate
Prostate cancer = hard, irregular prostate |
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BPH Interventions Pharmacologic
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1. finasteride (Proscar) shrinks prostate gland and improves urine flow by decreasing the level of dihydrotestosterone (DHT), which is responsible for prostate growth
2. alpha-adrenergic agonists (Cardura & Flomax) cause constriction of prostate gland, which reduces urethral pressure, improves urine flow, and decreases residual mass |
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BPH Interventions Nonsurgical
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* measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time * Avoid alcohol, caffeine, and diuretics * Void as soon as urge is felt ***Prevent overdistention of bladder, which leads to loss of tone ***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants |
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BPH Operative interventions
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* Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate
* Prostatectomy - Suprapubic - Transvesical - Retropubic - Perineal |
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Prostate Cancer
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* Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50 * If at risk (prostate CA in 1st degree relative or African American), need screening earlier * DRE yields hard, irregular prostate Prostate Cancer * One of the slowest growing malignancies & metastasizes in a fairly predictable manner * Most commonly metastasizes to the prostatic & perivesicular lymph nodes, pelvic lymph nodes, bone marrow, & bones of the pelvis, sacrum, & lumbar spine * Involvement of visceral organs occurs later in progression of disease, usu spreads to the lungs, liver, adrenals, & kidneys |
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Prostate Cancer Grading of the tumor is done with
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Gleason grading system
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____ pain is associated with prostete cancer...
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bone
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Prostate Cancer risk
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* Advancing age
* Incidence increases 75% in men > 65 yo * Heavy metal exposure * Hx of vasectomy or STD * Uncertain link between BPH & prostate cancer * Screening - Most effective procedures are DRE & PSA |
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Prostate Cancer - DRE
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* a hard, irregular mass is felt & presumed to be malignant
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PSA
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* Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL * Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis * PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA) * Normal PSA level is slightly higher in older adults & in African-American |
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Other Prostate screening
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* Transrectal USG
* If malignancy suspected, need biopsy * After dx made, need CT & MRI of pelvis & abdomen to assess nodes * Bone scan can determine metastasis * Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone |
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Prostate Cancer Interventions
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* Management includes surgery, radiation therapy, & drug therapy
* Surgery is the standard treatment * Surgical approaches similar to BPH * Advanced cases require pelvic lymphadenectomy * Radical Prostatectomy * Cryosurgical ablation * Newer, less invasive procedure * Chemotherapy * Radiation * Hormonal therapies |
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Radical Prostatectomy
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* removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes
* Patient is sterile, but ability to have erection and orgasm shouldnt be permanently impaired * May have erectile dysfunction if damage is done to pudendal nerve during surgery * Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley |
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Cryosurgical ablation
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* Newer, less invasive procedure
- A transrectal US probe is placed to determine the size of the prostate & the number of cryoprobes to be placed around the prostate gland - Liquid nitrogen freezes the gland & the dead cells are absorbed by the body * Advantages - Minimal blood loss - Minimal postoperative pain - Dec risk of incontinence after surgery A shorter hospital stay Procedure can be repeated as needed |
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Prostate Cancer Nonsurgical
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* Chemotherapy
* Radiation * Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, gonadotropin-releasing hormone agonist, or Depo-Provera * Estrogens, & GnRH agonists, & Depo inhibit the release of LH from the pituitary |
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Erectile Dysfunction
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* Inability to maintain an erection for sexual intercourse
* Can be organic or functional |
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Organic ED
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* Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; neurologic disorders; DM; thyroid dysfunction; priapism; smoking; ETOH; certain medications; poor overall health |
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Functional ED
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* Psychologic cause
* Have normal nocturnal and morning erections * Usually precipitated by stress Assessment * Medical, social, sexual history are needed * Complete PE, lab tests * Need to determine if ED is organic or functional in nature * If ED is functional the pt is referred to a certified sexual therapist |
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men taking _____ cannot take Viagra because of vasodilatation effects
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nitrates
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Testicular Cancer
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* Most common malignancy in men ages 15-35; peak incidence between 18-40 yo
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection * Occurs more often in caucasians, rarely African-Americans * Testicular CA rarely bilateral- if it is, usually metastatic * Early detection aided by self exam |
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Is testicular cancer usually bilateral?
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rarely, if it is usually metastatic
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Testicular Cancer Assessment
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* Testes, lymph nodes, and abdomen are thoroughly examined
* Palpate for lumps or swelling * Psychosocial assessment is done to determine pts feelings about disease/outcomes |
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Testicular cancer Diagnostic Assessment
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* Primary tumor markers are alpha-fetoprotein and hCG
* Also used to evaluate responses to therapy * Continued elevated levels after orchiectomy is evidence of metastatic disease * Reappearance of elevated levels shows recurrence * Benign testicular tumors NEVER cause an increase in these markers |
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Primary tumor markers of testicular cancer are
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* alpha-fetoprotein
* hCG |
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Diagnostic Assessment Testicular Cancer
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After dx a pt should have:
CT scan of the abdomen & chest MRI CXR & bones scans if metastasis is suspected |
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Hydrocele
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* A cystic mass that forms around the testis
* Disorder in the lymphatic draining of the scrotum * No treatment is needed unless swelling becomes severe * Treatment Aspiration or removal |
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Spermatocele
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* Sperm-containing cystic mass that develops on the epididymis by the tesicle
* No treatment needed if remains small & assymptomatic * Can be removed if becomes uncomfortable |
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Variocele
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* Cluster of dilated veins posterior to and above the testis
* Dx by palpation, the scrotum feels wormlike * Most unilateral & on L side of scrotum * Not treatment necessary unless painful and then they are surgically removed * May cause infertility |
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Scrotal trauma
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* Rare because of mobility of the scrotum
* Torsion - Twisting of the spermatic cord - Occurs most often during puberty - Occurs after strenuous exercise, trauma, or spontaneously - A medical emergency cuts off blood supply and can cause irreparable testicular damage |
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Scrotal trauma - Torsion
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- Pt c/o pain (sudden onset,extreme), n/v, erythema, & edema
- Surgery straightens and fixates the affected testicle and fixates the other testicle as well - If necrotic the testicle is removed - Keep ice on scrotum for 72 hrs, elevate - Avoid heavy lifting for 4-6 wks - No strenuous activity for 1 mo - Wear scrotal support for at least 3 wks |
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Cryptochidism
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* Undescended testis
* Mainly a pediatric problem * 3% full-term & 20% pre-term * 80% descend spontaneously in 1st year * In an adult the testicle can be surgically placed into the scrotum (ochidopexy) |
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Cancer of the penis
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* Rare, < 1% of all malignancies in men
* Presents as a painless, wart-like growth or ulcer on the glans under the forskin * May appear as a reddened lesion w/plaque * If lesion only involves skin it will be removed * If not curable w/excision or radiation a penectomy will be done * Circumcision as an infant almost eliminates the risk of penile cancer |
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Epididymitis
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* Infection of the epididymis
* May result from infection of the prostate * Can be associated w/long-term use of indwelling foley catheter, prostatic surgery, or cystoscopic exam * < 35 yo the major cause is chlamydia |
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Epididymitis
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* c/o pain along the inguinal canal & along the vas deferens, followed by pain & swelling of the scrotum & groin
* If untreated can progress to point where testicles need to be removed * Pt should remain in bed w/scrotum elevated on a towel * May be given antibiotics until inflammation is gone |
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Epididymitis
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* Cold compresses, sitz baths will help w/comfort
* Avoid lifting, straining, or sexual activity until infection is under control * Testicular tumor should be r/o * If chronic the epididymis can be removed from the testicle |
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Orchitis
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* Acute testicular inflammation
* Can result from infection or trauma * Can be unilateral or bilateral * c/o scrotal pain & edema, n/v, & pain that radiates to the inguinal canal * Tx similar to epididymitis - Bedrest w/scrotal elevation - Application of ice - Pain meds, antibiotics |
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Bacterial Vaginoses
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pH >4.5
Thin, white discharge Fishy odor c/o discharge, bad smells, itchy |
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Trichamonas
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pH >4.5
yellow-green forthy discharge may have fishy odor c/o frothy discharge, bad odor, itchy |
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Candidas
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pH < 4.5
white cottage cheese-like discarhge no odr c/o dischrging discharging, itchy, burning |