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301 Cards in this Set
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- Back
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This hypothalmus controls the release of this hormone:
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Gonadotropic Releasing Hormone (GnRH)
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GnRH stimulates this to release FSH and LH.
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Anterior Pituitary gland
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In males, FSH is responsible for________ and LH is responsible for ________.
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Spermatogenesis, Testosterone production in the testes.
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In women, FSH is responsible for _______ which stimulates growth and maturity of ovarian foliicles.
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Estrogen
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In women, LH is responsible for _________ and ________ production.
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Development of ruptured follicle, Progesterone.
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These two hormones are produced by the ovaries in women.
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Estrogen and Progesterone
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This hormone develops female sex organs secondary characteristics, decrease bone resportions, and increased HDL and low LDL.
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Estrogen
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This hormone stimulates the growth of the uterine wall and maintains pregnancy, as well as prepares the breast for milk production.
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Progesterone
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True or False: gonadal hormones are controlled primarily by a positive feedback process.
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False. They are controlled by a negative feedback process.
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What is the first menstrual bleeding called?
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Menarche
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The first day of menustration is day ___ of the cycle.
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1 (one)
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The menstrual/ischemic phase occurs during days ___ to ___.
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1-5
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The proliferative/Follicular phase occurs during days ___ to ___.
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6-14
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The luteal/secretory phase occurs during days ___ to ___.
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14-28
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This phase is the week before ovulation:
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Proliferative/Follicular
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This phase occurs 2wks prior to menses; the woman may experience PMS and/or fibrocystic/tender breasts:
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Luteal/Secretory
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The occurence of mumps in young men can lead to:
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Sterility
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If a woman is infected with/exposed to Rubella during the first 3mths of pregnancy, it can lead to:
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Congenital anomalies
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How long must a woman wait to conceive once she receives a Rubella vaccination?
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3 months
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Normal findings in female breats:
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Symmetric w/o dimpling, nipples are soft w/o drainage/retraction/or lesions noted, no masses or tenderness, no lymphadenopathy.
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When performing a breast exam on a patient in the supine posistion, the patient is asked to:
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place her arm above and behind her head.
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When palpating the breast, the nurse should use:
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the distal finger pads
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What are the normal age related changes in women?
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decreased vaginal lubrication, thinning of pubic hair, atrophy of urinary/genital tracts (r/t loss of estrogen), decreased bone density, and an increase r/f atherosclerosis.
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What are the normal age related changes in men?
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enlarged prostate, small less firm testes, decreased penis size, decreased amount of ejaculate, longer time to attain an erection, and fewer erections.
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What test is routinely done to detect for cervical cancer?
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Pap test
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What are the ACS recommendations for pap smears?
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Do once q3yrs with the first test done within 3yrs after the first sexual encounter but no later than 21, high risk patients should be done qyr, if 65-70 and have had a negative result x 10years pap testing may stop.
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What is a Colposcopy?
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a test done to visualize the cervix, vagina, and vulva.
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What should the pt be told regarding colposcopy?
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it is similar to a speculum exam and is done outpatient or in the doctors office.
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What is Laparoscopy used for?
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it is a diagnostic and surgical procedure done to visualize the pelvic structures.
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What should the pt be told regarding Laparscopy?
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the pt is to rest 1-3 days following the procedure, there will be small abdominal incisions in the abdomen, pt may experience postop shoulder pain r/t CO2 used during surgery.
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What is a Hysteroscopy?
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test done to visualize the interior of the uterus and cervical canal.
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What is a Wet Mount?
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direct microscopic visualization of specimen of vaginal discharge performed immediately after collection.
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What does the wet mount test detect?
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Trichomoniasis (NS) and bacterial vaginosis (KOH)
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What does the gram stain detect?
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Gonorrhea & Chlamydia
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What is the Huhner test?
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a post-coital test done to examine the cervical mucus to see if it is "hostile" to sperm.
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For a patient undergoing the Huhner test, instructions should the nurse give the patient?
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have intercourse during estimated time of ovulation and be present for the test within 2-8 hours after intercourse.
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A 53 year old female patient has an FSH level of 75, what does this indicate?
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Menopause
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What is an Hysterosalpingogram?
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a test done to visualize the uterus and fallopian tubes. Used to assess fertility.
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What is involved in a Hysterosalpingogram?
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unstillation of contrast media through the cervix into uterine cavity to fallopian tubes. Spot xray's are taken to detect abnormalities.
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What should the nurse instruct the patient who is to undergo an Hysterosalpingogram?
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make sure there is no allergy to idodine, schedule 2-5 days after menses, explain the procedure is uncomfortable and she may experience discomfort.
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At what age does the ACS recommend women get a baseline mammogram?
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35-40
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At what age should women begin yearly mammograms?
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40
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During what phase are cervical biopsies taken?
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Proliferative phase (days 6-14)
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What instructions should the nurse give the patient undergoing a cervical biopsy?
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rest 3 days after procedure, instruct necessity for 3wk fu, explain requires anesthesia and therefore needs to be done at a surgical facility.
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What is the LEEP procedure?
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excision of cervical tissue via an electrosurgical instrument?
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What should the nurse inform the patient who is to have a LEEP procedure?
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that it is done in the office for further diagnostic testing.
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What is an endometrial biopsy?
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a test done by taking a sample of endometrial lining via a curette to assess changes common to progesterone secretion.
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When is endometrial biopsy performed?
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during the Luteal phase (days 21-22)
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What is a D&C?
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surgical procedure that allows for dialation of the cervix and curetting of endometrial lining.
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What is D&C used for?
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to assess abnormal bleeding patterns and cytologic evaluation of lining.
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What nursing assessment should be done for a patient who has had a D&C
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frequent pad checks x 24hrs
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What are the postop nursing considerations for patient's who have undergone breast biospy?
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perform wound care and instruct patient about SBE's.
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Test done to detect masses >3cm, ovarian cysts, and ectopic pregnancies:
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ultrasound
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Which ultrasound requires a full bladder, pelvic or transvaginal?
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Pelvic requires a full bladder for proper visualization
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Transillumination of the scrotum is used to detect what in males?
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hydrocele
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What are normal findings during male inspection?
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diamond shaped hair distribution, circumcised penis, symmetric scrotum, no masses/lesions/growths/discharge, no inguinal hernia, descended testes.
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What diagnostic tests are used for males?
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PSA, serum/ua testosterone levels, semen analysis, TRUS
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How are urine testosterone levels obtained?
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by doing a 24hr urine collection
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What is normal semen analysis?
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2-5ml of ejaculate with >20million sperm, with 60% mobility
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What instructions should the nurse give the patient who is to have a semen analysis?
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to bring the specimen in within 2hrs after ejaculation.
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What is known as a collection of emotional and physical signs and symptoms that appear during the luteal phase and are cyclic in nature?
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Premenstrual syndrome
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What are the manifestations of PMS?
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anxiety. irritability, depression, breast tenderness, feeling bloated, headache, salt/sweet cravings, peripheral edema
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What lifestyle modifications are taught to a patient experiencing PMS?
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avoid caffeine and alcohol, eat complex carbohydrates, take Vit B6, calcium and magnesium supplements, limit salt intake
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What medications are used to control PMS symptoms?
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Diuretics (aldosterone), Advil/Motrin, BuSpar, TCA's (Elavil), SSRI (zoloft), oral contraceptives
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What herbal medications are recommended for PMS?
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Primrose oil and Chaste Tree berry
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What is Dysmenorrhea?
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abdominal cramping pain or discomfort associated with menstrual flow.
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What are the two types of dysmenorrhea?
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Primary and secondary
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What is the cause of primary dysmenorrhea?
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increased prostoglandin or an increased sensitivity to it
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What is the cause of secondary dysmenorrhea?
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endometriosis, chronin PID, or uterine fibroids
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How is primary dysmenorrha treated?
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oral contraceptives, NSAIDS (prostoglandin inhibitors)
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What are the manifestations of primary dysmenorrhea?
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begins 12-24hrs prior to onset of menses, lower abdominal pain radiating to upper thighs and lower back, diarrhea, n/v, loose stools, fatigue, headache, and light-headedness.
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What are the manifestations of secondary dysmenorrhea?
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occurs between ages 30-40 after the women has not experienced any problems, dyspareunia, painful defecation, irregular bleeding between menses.
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How is primary dysmenorrhea treated?
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heat applications to lower back or abdomen, regular exercise, NSAID (naproxen) started at first sight of menses then q4-8hrs, oral contraceptives
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How is secondary dysmenorrhea treated?
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depends on the cause, may benefit from same treatments used to primary dysmenorrhea or may require surgical intervention
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How is primary amenorrhea characterized?
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failure of menstrual cycles to begin by age 16 or by age 14 if sex characteristics are present.
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How is secondary amenorrhea characterized?
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the cessation of menstrual cycles for at least 6mths once they have been already established.
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What is oligomenorrhea?
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long intervals between menses, generally greater than 35 days.
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What is menorrhagia?
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excessive (>80ml) or prolonged (>7days) menstrual bleeding.
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What is metorrhagia?
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irregular bleeding (spotting) or bleeding between menses (breakthrough). *usually r/t cervical polyps*
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What can post-menopausal bleeding indicate?
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endometrial/uterine cancer
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How is amenorrhea treated?
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with combined oral contraceptives to ensure regular shedding of the endometrium, if the women does not need BCP, then progesterone may be prescribed to ensure shedding.
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How is menorrhagia treated?
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with combo of Estrogen and Progesterone if d/t anovulatory cycle; balloon thermotherapy, D&C, endometrial ablation, hysterectomy
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What should the nurse monitor during a patiens menses?
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# of pads/tampons used, degree of saturation, fatigue level, BP, HR
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What is perimenopause?
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The first signs of change in menstrual cycles and ends after cessation of menses.
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What are the s/s of perimenopause?
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irregular menses, hot flashes, night sweats, vaginal atrophy, stress and urge incontinence, breast tenderness, and mood changes
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How is perimenopause diagnosed?
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by having a serum FSH >30
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What is menopause?
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the physiologic cessation of menses associated with declining ovarian function and is considered complete after 1yr of amenorrhea.
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At what age does menopause usually occur?
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42-58, avg age of 51
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Women who have undergone menopause are at risk for what conditions?
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Coronary Artery Disease & Osteoporosis
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What is the FSH level of a menopausal women?
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>35
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What is the recommended calcium intake for menopausal women?
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if not on supplemental estrogen 1500mg, if on estrogen replacement 1000mg
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What non-hormonal therapies can the nurse recommend to a menopausal patient?
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keep a cool environment, reduce alcohol/caffeine intake, apply cool cloths/take Vit E 800iu/day to help hot flashes, use lotion for dry skin, use lubricant for dyspareunia, weight bearing exercises, reduce CAD risk factors (wt, stress,HTN), soy or black cohosh
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What hormonal therapies are used for menopausal women?
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Estrogen only therapy (ERT), estrogen and progesterone therapy (HRT), SERM's (Evista)
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Estrogen only therapy is indicated for what type of patient?
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for those who do not have a uterus (r/f endometrial cancer)
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If a patient is undergoing menopause, and still has her uterus, what medication should be prescribed?
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Estrogen/progesterone therapy (HRT)
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What information should the nurse give the patient taking Evista?
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DO NOT take med x 1wk prior to flying
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A downward placement of the uterus is known as what?
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Uterine prolapse
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What are the s/s of uterine prolapse?
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pelvic pressure, dysapareunia, backache
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What is a first degree prolapse?
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the cervix rests in the lower part of the vagina
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What is a second degree prolapse?
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the cervix is at the vaginal opening
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What is a third degree prolapse?
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the uterus protrudes through the introitus
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What treatments are used for uterine prolapse?
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Pessaries (1st degree), Kegel exercises, or surgical repair
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When support between the vagina and bladder is weakened, this is know as:
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Cystocele
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When support between the vagina and rectum is weakened, this is know as:
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Rectocele
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What are the s/s of cystocele?
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Vaginal pressure, urinary retention, UTI, stress incontinence
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What are the s/s of rectocele?
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Constipation, incomplete evacuation, fecal incontinence
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What are the postop nursing considerations for a patient who had vaginal surgery?
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prevent wound infection and pressure on the suture line, perineal care 2x/day, locally applied ice packs (made from gloves or cloths), assure the patient loss of vaginal sensation is normal and temporary
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What are the postop nursing condiderations for a patient who had an anterior colporrhaphy?
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Catheter care with anitseptic 2x/day- the pt will have an indwelling cath x 4days postop to prevent suture strain
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What are the postop nursing considerations following a posterior colporrhaphy?
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provide low residue diet and stool softener to prevent constipation
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When urine leaks into the vagina, this is known as:
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vesicovaginal fistula
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When flatus/feces leaks into the vagina, this is known as:
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rectovaginal fistula
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How are fistulas diagnosed?
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with an instillation of methylene blue dye, fistulogram
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What are the nursing considerations for a patient with a fistula?
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perineal cleansing q4hrs, warm sitz baths 3x/day, change perineal pads frequently, encourage adequate fluid intake, postop the pt will have an indwelling cath x7-10days, use strict asepsis with cath irrigation
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What are the s/s of ovarian cysts?
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constipation, irregular menses, urinary frequency, full feeling in abdomen, anorexia, peripheral edema, increase in abdominal girth, pain
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How are cysts diagnosed?
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by ultrasound
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What is the treatment for ovarian cysts?
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if >8cm or is solid laparoscopic, if <8cm then f/u in 4-6wks. Immediate surgery is neccessary for ovarian torsion
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Which ethnic group has the highest mortality rate from cervical cancer?
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African-americans
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What are the risk factors for ovarian cancer?
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family hx of ovarian cancer, nulliparity, infertility, BRCA-1 gene mutation
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Late manifestations of cervical cancer are:
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pain, wt loss, anemia, cachexia
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What screening tests are done to eval for cervical cancer?
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pap test, colposcopy w/ biopsy
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What are the s/s of cervical cancer?
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EARLY- no s/s, LATE-leukorrhea, intermenstrual bleeding, thin/watery discharge that becomes dark and foul smelling, spotting
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What is a late manifestation of ovarian cancer?
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ascites
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What factors can help lower the risk of ovarian cancer?
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breastfeeding, multiple pregnancies, oral contraceptive use >5yrs, and early age at first birth
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What is the treatment for ovarian cancer?
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treatment depends on the stage of cancer, all will have TAH-BSO, stage I-chemo, intraperitoneal radioisotopes, stage II-radiation/chemo, stage III/IV-chemo, Hexalen (palliative tx), Taxol & Hycamtin for metastastic ovarian ca.
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The presence of normal endometrial tissue in sites outside the endometrial cavity is known as:
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Endometriosis
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The typical endometriosis patient is:
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in late 20's or 30's, white, and never had a full term pregnancy
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What are the s/s of endometriosis
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Severe dysmenorrhea, dysfuntional bleeding, back pain, rectal pressure, dyspareunia, infertility r/t scar formation
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What meds are used to treat endometriosis?
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Lupron/Synarel (GnRH analog) & Danocrine (an androgen)
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What are the side effects of danazol (Danocrine)?
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weight gain, acne, hot flashes, and hirsutism
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What is the only cure for endometriosis?
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surgical removal of endometrial implants
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Surgical removal of endometrial implants involves:
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laparoscopic surgery to lyse/excise impants
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Benign smooth-muscle tumors that occur within the uterus are known as:
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uterine fibroids (leiomyomas)
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What are the s/s of uterine fibroids?
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*menorrhagia*, pelvic pressure, pain, rectal/bladder/lower abd discomfort
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How are uterine fibroids diagnosed?
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by pelvic findings of an enlarged uterus with nodular masses, ultrasound
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What is the treatment for fibroids?
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hysterectomy if the pt does not want any more children, if so, then myomectomy is done. Lupron may also be used to shrink tumor preoperatively
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What are the risk factors for endometrial cancer?
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*unopposed estrogen*, increasing age, late menopause, nulliparity, obesity, smoking, DM, personal or family hx of nonpolyposis colorectal ca.
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What is the chief sign of endometrial cancer?
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post menopausal bleedingq
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How is endometrial cancer diagnosed?
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via endometrial biopsy done outpatient
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How is endometrial cancer treated?
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radical TAH-BSO, radiation, Progesterone hormone therapy (Megace), chemo (palliative)
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What type of patient is a candidate for a vaginal hysterectomy?
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one who has a history of vaginal births, has a normal uterus *this type removes uterus and involves vaginal repair
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What type of patient is a candidate for abdominal hysterectomy?
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one who needs ovaries and fallopian tubes removed, or when there are large tumors present
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What is the nursing care for a patient who has undergone a hysterectomy?
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Monitor incision site-abd will have abd dressing, vaginal will have sterile pad, observe s/o bleeding first 8hrs, moderate amount of serosanguinous drainage is normal, pt may have foley-monitor output-report asap to md if c/o backache or decreased urine output = ureter ligation, pt may require rectal tube to help with abd distention, frequent posistion changes, AVOID high fowlers (increase r/f DVT), encourage leg exercises
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What postop instructions should the nurse give the patient who has had a hysterectomy?
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Advise she will no longer menstruate, avoid intercourse x4-6wks, adivse a temporary loss of sensation is normal and will return in few weeks, avoid heavy lifting x2mths, avoid dancing, walking swiftly-swimming is ok, ok to wear girdle for comfort
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Cervical polyps are seen in what patient?
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multiparous women, >40yrs old
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What are the s/s of cervical polyp?
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intermenstrual bleeding, bleeding after BM or coitus, chronic irritation, discharge, spotting during pregnancy
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What is the treatment for cervical polyps?
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Polypectomy, can be either outpatient or if it is not accessible via cautery, removal is done in OR
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What post op instructions should be given to the patient who had a polypectomy?
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Do not use tampons, do not douche, do not have coitus x 1wk, vaginal packing will be needed first 24hrs
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What are the risk factors for cervical cancer?
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early frequent coitus, multiple sex partners, exposure to viral infection (HPV, HSV), low SES, smoking, immunosuppression
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What are the surgical options for cervical cancer?
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Laser surgery, conization, cryotherapy, LEEP, hysterctomy, pelvic exenteration, radiation (4-6wks)
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What 4 procedures for cervical cancer allow fertility to be maintained?
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Conization, Laser treatment, cautery, cryosurgery
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What are the nursing considerations for a patient who has undergone internal radiation for cervical cancer?
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pt must remain still during treatment, pt will be on bedrest, foley will be inserted, limit visits to <3hrs/day and visitors must remain at least 6ft from bed, give pain rx for cramping, pt will be on low-residue diet, nurse should not attend the patient for longer than 30min
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What is a subtotal hysterctomy?
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removal of uterus without cervix (rare)
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What is a total hysterectomy?
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removal of uterus and cervix
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What is a total abdominal hysterctomy and bilateral salpingo-oopherectomy?
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removal of uterus, cervix, fallopian tubes, and ovaries
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What is a radical hysterectomy?
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panhysterectomy, partial vaginectomy, and dissection of lymph nodes in pelvis
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What is a pelvic exentration?
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radical hysterectomy, vaginectomy, + urinary/bowel diversions
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What side effects should the nurse tell the patient recieving radiation to expect?
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skin irritation, enteritis, cystitis. Explain to pt to empty bladder prior to treatment to minimize radiation exposure to the bladder
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What causes vaginitis?
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occurs when acid vaginal secretions and presence of lactobacillus are disrupted. Can be from aging, poor nutrition, use of rx's (hormone, abx)
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What are the s/s of candidiasis?
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pruritis, thick white curd-like discharge. Vaginal pH 4.0-4.7
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How is candidiasis treated?
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with antifungal meds (monistat, Diflucan 150mg x1)
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What are the s/s of trichomoniasis?
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*STD*, pruritus, frothy green/grey discharge with foul odor, hemorrhagic spots on cervix, pH >4.5
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How is trichomoniasis treated?
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with Flagyl 2gm po single dose, or 500mg po bid x 7days for patient and partner
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What are the s/s of bacterial vaginosis?
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watery discharge with fishy odor
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How is bacterial vaginosis treated?
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Flagyl 500mg or Cleocin 300mg po bid x 7days to Clindesse vag cream in single dose, treat partner as well
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What are the s/s of atrophic vaginitis?
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odorless discharge with pruritus
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How is atrophic vaginitis treated?
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with estrogen cream
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What are the s/s of cervicitis?
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*STD*, mucopurulent discharge with post-coital spotting, pelvic pain, dysuria
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How is cervicitis treated?
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do culture for gonorrhea/chlamydia, Zithromax 1gm po single dose or doxycycline 100mg po bid x 7days, treat partner with same meds
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What is Pelvic Inflammatory Disease (PID)?
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an infectious condition of the pelvic cavity that may involve infection of the fallopian tubes, ovaries, pelvic peritoneum
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What are the most common causes of PID?
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Chlamydia and Gonorrhea
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What are the s/s of PID?
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moderate to severe pelvic pain, pain with walking, spotting after intercourse, purulent cervical/vaginal discharge, increased cramping with menses, lower abdominal tenderness, adnexal tenderness, positive cervical motion tenderness, fever, chills
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How is PID diagnosed?
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by s/s presented, +Gram stain/culture/ultrasound, Pregnancy test need to be done to rule out ectopic pregnancy
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What is the treatment for PID?
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Mefoxin (cefoxitin) and Vibramycin (doxycycline)
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What instructions should the nurse give the patient being treated with PID?
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refrain from intercourse x 3wks, encourage rest and PO fluids, re-eval in 48-72hrsl apply heat to lower abd or warm sitz baths to decrease pain
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What are the nursing considerations for a patient with PID?
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bed rest in Semi-Fowler's posistion, maintain IV fluids, monitor VS, assess character, amount, color and odor of discharge, assess degree of abdominal pain, provide analgesics as needed
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What is the cause of Toxic Shock Synrome (TSS)?
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a toxin of Staph aureus
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What are the s/s of TSS?
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high fever, vomiting, diarrhea, weakness, myalgia, sunburn-like rash
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What are the acute manifestations of TSS?
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abrupt onset of flu-like symptoms, hypotensive shock, sunburn like rash on face, arms, or trunk
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How is TSS treated?
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Admin of plasma volume expanders, o2, and beta lactamase resistant Abx
|
|
|
When is infertility diagnosed?
|
when there is a failure to acheive a pregnancy after 1yr of unprotective sex
|
|
|
What are the causes of female infertility?
|
anovulation, inadequate corpus luteum, tubal obstruction/dysfunction, uterine or cervical factors (fibroids, structural abnormalities)
|
|
|
What are the risk factors for infertility?
|
tobacco and illicit drug use, infection of the reproductive tract, occupational/environmental exposures
|
|
|
How is infertility treated in women?
|
Ovarian-Clomid (for anovulation), Tubal-balloon catheter (for blocked tubes), Cervical-Premarin (for inadequate cervical mucous), Uterine-Lupron (for endometriosis)
|
|
|
What is an enlargement of the prostate gland resulting from an increasein the number of epithelial cells and stromal tissue know as?
|
Benign Prostatic Hyperplasia (BPH)
|
|
|
What are the risk factors for BPH?
|
family hx (first degree relatives), obesity (increased waist circumference), diet high in saturated fat
|
|
|
What are the s/s of BPH?
|
Hesitency and decreased force of urine stream, post-void dribbling, nocturia, sensation of incomplete voiding or retention, frequency and urgency
|
|
|
What are the complications of BPH?
|
acute urinary retention, UTI, poss sepsis, bladder calculi, hydronephrosis, postrenal ARF
|
|
|
How is BPH diagnosed?
|
by DRE (enlarged, firm and smooth prostate is noted), PSA(may be slightly elevated)
|
|
|
Proscar and Advodart are what types of meds? What are the side effects?
|
5a-reductase Inhibitor, *S/E-decreased libido, decreased ejaculate volume, ED
|
|
|
What medications are considered alpha-anderenergic receptor blockers? What are the side effects?
|
Hytrin, Cardura, & Flomax, *S/E-orthostatic hypotension, dizziness, retrograde ejaculation, nasal congestion
|
|
|
What herbal meds are recommended for BPH treatment? What are side effects?
|
Saw Palmetto *S/E-GI symptoms
|
|
|
When is surgical intervention for BPH indicated?
|
if the patient has ARF, persistent residual urine, acute urinary retention, or hydronephrosis
|
|
|
What is a TURP?
|
removal of the prostate via a rectoscope inserted through the urethra
|
|
|
What is the preop nursing care for BPH?
|
make sure urinary drainage is restored prior to surgery, pt may have Coude catheter placed with 10ml of sterile 2%lidocaine, admin antibiotics, enocurage high fluid intake (2-3L if allowed)
|
|
|
What is the postop nursing care for BPH?
|
assess for s/s of hemorrhage, bladder spasms, urinary incontinence, and infection. Pt will had CBI going with a triple lumen catheter (30cc balloon), measure I&O after first bag is emptied, give antispasmotic meds as needed
|
|
|
How many ml's of irrigating solution should be used with a manual bladder irrigation?
|
50ml
|
|
|
What meds are used for bladder spams?
|
Belladonna, Ditropan
|
|
|
What are the normal urine findings during CBI/after BPH surgery?
|
urine should be light pink, clots are expected during the first 24-36 hours, large amounts of bright red blood indicate hemorrhage
|
|
|
To help improve bladder sphincter tone, what can the nurse recommend to the patient?
|
perform Kegel exercises 10-20 times per hour while awake
|
|
|
What postop instructions should the nurse give the patient who has undergone TURP procedure?
|
cath care/empty bag q 3-4hrs, maintain fluid intake of 2-3L/day, observe for s/s of UTI, avoid constipation, no heavy lifting (more than 10lbs), avoid intercourse x 6wks, no strenuous activities, urinate q2-3hrs to flush urinary tract
|
|
|
What is the most common cancer in males?
|
Prostate cancer
|
|
|
Prostate cancer is dependent on what hormone?
|
Androgen
|
|
|
What ethnic group has the highest incidence of prostate cancer?
|
African-Americans
|
|
|
What are the risk factors for prostate cancer?
|
Age (risk increases after age 50), race, family hx
|
|
|
What are the s/s of Prostate cancer?
|
Early stage-no symptoms, Late stage-dysuria, hesitency, dribbling, frequency, urgency, hematuria, nocturia, retention, interrupted urinary stream, inability to urinate
|
|
|
What are the metastatic symptoms of prostate cancer?
|
pain in the lumbosacral area radiating down to hips or legs along with urinary symptoms
|
|
|
What is the treatment for stage I & II prostate cancer?
|
radical prostatectomy with radiation
|
|
|
What is the treatment for stage III prostate cancer?
|
rad. prostatectomy, radiation and hormone therapy
|
|
|
What is the treatment for stage IV prostate cancer?
|
rad prostatectomy, radiation, hormone therapy, and orchiectomy
|
|
|
What is involved with a radical prostatectomy?
|
removal of prostate gland, prostate capsule, cuff at bladder neck, seminal vesicles, and regional lymph nodes
|
|
|
What are the two major complications following a radical prostatectomy?
|
Erectile dysfunction and urinary incontinence
|
|
|
Lupron is what type of class of medication?
|
LH-RH agonists, it reduces secretion of LH and FSH, decreasing testosterone production
|
|
|
What medication is an anti-androgen?
|
Eulexin, it blocks action of testosterone by competing with receptor sites
|
|
|
What is the Gleason scale?
|
Grading of the tumor based on tumor histology. Score ranges from 2-10, a high number is not good, should be less than 7
|
|
|
What are the s/s of acute bacterial prostatitis?
|
fever, chills, back pain, perineal pain, dysuria, frequency, cloudy urine. Prostate will be very swollen and tender and firm on DRE
|
|
|
What are the s/s of chronic non-bacterial prostatitis?
|
frequency, urgency, dysuria, backache, perineal/pelvic pain, ejaculatory pain, on DRE prostate feels enlarged and firm ("boggy")
|
|
|
The most common type of prostatitis is:
|
Chronic non-bacterial
|
|
|
What diagnostics tests are done for prostatitis?
|
UA w/ C&S (will show WBC's and bacteria), serum CBC, blood cultures, PSA, culture of prostate secretions
|
|
|
How is acute bacterial prostatitis treated?
|
with Levaquin, Bactrim, Cipro, or Floxin for up to 4wks, if pt has high fever, then meds given IV
|
|
|
How is chronic prostatitis treated?
|
po anitbiotic therapy x4-16wks, NSAIDS for pain control, sitz baths, regular ejaculation
|
|
|
What is the most common cancer in males age 15-35?
|
Testicular cancer
|
|
|
What is a major risk factor in testicular cancer?
|
Cryptorchidism (undecended testes)
|
|
|
What are the s/s of testicular cancer?
|
painless hard nodule on testis, scrotal swelling, feeling of heaviness
|
|
|
What is the recommended screening for testicular cancer?
|
monthly self testicular exams beginning at age 13
|
|
|
How is testicular cancer diagnosed?
|
palpation of scrotum, cancerous masses are firm and do not illuminate, ultrasound, serum AFP, LDH, hCG, cxr and Ct are done to eval for mets
|
|
|
Why should a testicular biopsy not be performed?
|
because it can spread the cancer
|
|
|
How is testicular cancer treated?
|
by a radical orchiectomy followed by radical lymph node disection, chemo (chief reason for survival in men), radiation
|
|
|
Twisting of the spermatic cord and testis r/t sudden pull on the cremasteric muscle is known as:
|
Testicular torsion, commonly seen in males <20yrs old
|
|
|
What are the s/s of testicular torsion?
|
severe scrotal pain, tenderness, swelling, N/V. Urinalysis will be negative for WBC, bacteria, fever will not be present
|
|
|
How do you test for testicular torsion?
|
with ultrasound, testicular scan or via the Cremasteric reflex-lightly stroking the inner aspect of the thigh downward, normal is contraction of cremaster muscle pulling up the scrotum/testes on side stroked. With torsion, the reflex is absent
|
|
|
How is testicular torsion treated?
|
with either a orchipexy or orchidectomy
|
|
|
Fluid in the testicle is known as:
|
hydrocele
|
|
|
A sperm containing cyst in the epididymis is known as:
|
Spermatocele
|
|
|
Dilation of the veins in the scrotum is known as:
|
Varicocele, **can lead to infertility**
|
|
|
How do you assess for a hydrocele? Treat?
|
by shining a light through the scrotum, not treated unless becomes large and uncomfortable then aspiration of fluid is done
|
|
|
How is spermatocele assessed?Treated?
|
it will be visible on transillumination and a firm, painless cyst, treated by surgical removal
|
|
|
How is varicocele assessed? Treated?
|
the scrotum will feel wormlike when palpated, usually located on the left side of the scrotum, it's treated with surgery or through injection a sclerosing agent or surgical ligation
|
|
|
An acute painful inflammatory process of the epidiymis is known as:
|
Epididymitis
|
|
|
S/s of Epididymitis:
|
scrotal swelling and pain
|
|
|
The most common infectious cause of orchitis is:
|
Mumps
|
|
|
Epididymitis is associated with:
|
STD's (gonorrhea, chlamydia), prostatitis, UTI, trauma, instrumentation
|
|
|
What are the manifestations of orchitis?
|
painful tender swollen testis
|
|
|
How is orchitis treated?
|
with abx, pain meds, bedrest with scrotum elevated on ice pack, gammaglobulin is given to prevent if needed
|
|
|
A painful persistent (<6hrs)erection not associated with sexual arousal is known as:
|
Priapism
|
|
|
What are the causes of priapism?
|
thrombosis of corpus cavernosal veins, leukemia, sickle cell anemia, DM, degenerative lesions of the spine, spinal cord/brain neoplasms, cocaine use, injection of vasoactive meds into corpus cavernosa, prolonged foreplay
|
|
|
How is priapism treated?
|
sedatives, injection of smooth muscle relaxants, aspiration of blood, shunting procedure
|
|
|
What are the risk factors for penile cancer?
|
uncircumcised penis, phimosis, >50, multiple sex partners, HPV, poor hygiene, radiation
|
|
|
A painless lesion on the tip of the penis is indicative of:
|
Penile cancer
|
|
|
How is penile cancer treated?
|
with laser removal of growth in early stages, later stages a radical resection of the penis is done along with chemo and radiation
|
|
|
A constriction of the uncircumcised foreskin around the head of the penis that makes retraction difficult is known as:
|
Phimosis
|
|
|
Edema of the retracted uncircumcised foreskin that prevents a normal return over the glans is known as:
|
Paraphimosis
|
|
|
A build up of plaques in the penis that causes it to curve when erect is known as:
|
Peyronie's disease
|
|
|
What is the treatment for Peyronie's disease?
|
there is no cure!! Vit E, paraaminobenzoic acid, tamoxifen, and colchicine, surgery
|
|
|
How is erectile dysfunction diagnosed?
|
via Nocturnal penile tumescence and rigidiy testing, penile blood flow study, penile doppler, Hormone levels (testosterone, LH, prolactin, and thyroid)
|
|
|
A firm, movable nontender and well delineated mass that is usually in one breast is known as:
|
Fibroadenoma
|
|
|
True or False: Fibroadenomas are not visible on mammograms.
|
False, they are visible on mammography and ultrasound
|
|
|
How are fibroadenomas treated?
|
by surgical excision
|
|
|
Mastalgia, nodularity and breast enlargement during the luteal phase is known as:
|
Fibrocystic changes
|
|
|
Fibrocystic changes most frequently occur in women:
|
with premenstrual abnormalities, nulliparous women, women with hx of spontaneous abortion, no OC use, women with early menarche or late menopause
|
|
|
How are fibrocystic changes diagnosed?
|
with either ultrasound (most useful) or mammo
|
|
|
What fibrocystic management can the nurse recommend to the patient with fibrocystic changes?
|
avoid caffeine/ETOH, use a good support bra, follow low salt diet, Vit E, Danocrine (danazol), diuretics, hormone therapy or antiestrogen therapy
|
|
|
What is a benign breast disease of perimenopausal women involving the ducts in the subareolar area know as:
|
Ductal ectasia
|
|
|
What are the s/s of ductal ectasia?
|
Non colored sticky nipple discharge (primary symptom), palpable lump behind areola, inflammatory signs, nipple may retract
|
|
|
How is ductal ectasia treated?
|
with warm compresses and antibiotics, excision of duct
|
|
|
What is a benign wart like growth found in the mammary glands or ducts usually near the nipple called?
|
Intraductal papilloma
|
|
|
Intraductal papilloma usually affects women ages:
|
40-60yrs
|
|
|
What are the s/s of intraductal papilloma?
|
bloody nipple discharge, non-palpable unilateral mass
|
|
|
How is intraductal papilloma treated?
|
by excision of the papilloma and the involved duct or duct system
|
|
|
Mastitis is characterized by:
|
breast tenderness, erythema, and swelling, pain, and tender to palpate
|
|
|
How is mastitis treated?
|
with antibiotics (for staph), I&D
|
|
|
What recommendations can the nurse give the breastfeeding patient who develops mastitis?
|
continue breastfeeding unless purulent drainage is noted, may use nipple sheild or hand express milk until pain subsides
|
|
|
A transient noninflammatory enlargement of one or both of the male breasts is known as:
|
Gynecomastia
|
|
|
The common cause of gynecomastia is:
|
a disturbance of the normal ratio of active androgen to estrogen in plasma or with the breast itself
|
|
|
What is pubertal gynecomastia?
|
gynecomastia caused by increased estrogen in 13-17 year old males, requires no treatment and usually disappears on its own
|
|
|
What is senescent gynecomastia?
|
gynecomastia r/t the elevated estrogen in older men-the result of increased conversion of androgens to estrogens in peripheral circulation
|
|
|
How is gynecomastia treated?
|
by reduction mammoplasty or anti-estrogen meds (danocrine or tamoxifen)
|
|
|
What is the most common type of breast cancer?
|
Infiltrating ductal carcinoma
|
|
|
What are the manifestations of breast cancer?
|
non tender lump (most often in the UOQ!!!), abnormal nipple discharge, recent nipple retraction, dimpling of the skin, orange peel appearance
|
|
|
What are the risk factors for breast cancer?
|
female, age 50 or older, family hx, personal history of breast/colon/endometrial/ cervical/ovarian cancer, early menarche (<12) or late menopause (>55), first full term pregancy after 33, nulliparity, wt gain/obesity after menopause, exposure to ionizing radiation, BRCA1/2 mutations
|
|
|
How is breast cancer treated?
|
with lumpectomy, mastectomy, radiation, chemo, tamoxifen 10mg bid or 20mg qd x5yrs
|
|
|
What is a lumpectomy?
|
removal of the entire tumor with a margin of normal tissue (AKA breast conservation surgery)
|
|
|
What is a modified radical mastectomy?
|
removal of breast and axillary lymph nodes, but preserves pectoralis major muscle
|
|
|
Preop teaching for the brease cancer patient includes:
|
TCDB exercises, review of postop exercises, pain managment plan, teach how to manage drains, no abduction allowed until drains are removed
|
|
|
What is the nursing management after breast cancer surgery?
|
place in semi-fowler's posistion with arm elevated on pillow, begin with flexion/extension of fingers in recovery room, admin analgesics 30min prior to exercises
|
|
|
How can lymphadema be prevented?
|
never leave arm in dependent posistion even when sleeping, BP checks, venipuncutres and injections should not be done on the affected arm, no elastic bandages should be used, if trauma occurs, wash with soap and water, apply abx ointment and notify surgeon
|
|
|
Treponema pallidium causes:
|
Syphilis
|
|
|
Chancres are noticed during what stage of syphilis?
|
Primary stage
|
|
|
Skin rashes, fever, hair loss, wt loss, and sore throat appear during what syphilis stage?
|
Secondary
|
|
|
Gummas, tumors of skin/bone/liver, cardiovascular and neurologic changes are noted in what syphilis stage?
|
Tertiary/Third
|
|
|
How is syphilis diagnosed?
|
non-treponemal antigen tests (VDRL & RPR), treponemal test (FTAS-ABS)-most specific and sensitive
|
|
|
How is syphilis treat?
|
with Penicillin G IM, IV pcn for congenital or neurosensory syphilis
|
|
|
Neisseria gonorrheoeae causes:
|
Gonorrhea
|
|
|
Manifestations of gonorrhea are:
|
dysuria, penile/vaginal discharge (greenish yellow), anal itching, irritation, rectal bleeding, diarrhea, sore throat, lymphadenopathy
|
|
|
How is gonorrhea diagnosed?
|
by gram stain, culture, DNA amplification
|
|
|
How is gonorrhea treated?
|
Rocephin 125mg IM x 1 along with 7 days of chlamydia treatment
|
|
|
What are the complications of gonorrhea?
|
PID, infertility, sterility, urethral strictures
|
|
|
What organism causes Chlamydia?
|
Chlamydia trachomatis
|
|
|
Chlamydia is responsible for:
|
non-gonococcal urethritis and sterility (males), mucopurulent cervicitis and PID (females)
|
|
|
How is chlamydia diagnosed?
|
Gram stain, culture, DNA amplification
|
|
|
How is chlamydia treated?
|
Vibramycin or Zithromax
|
|
|
What test is used to diagnose herpes?
|
Tzanck smear
|
