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164 Cards in this Set
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- Back
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assessment of urinay problems related to timing of urination
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-Frequency (going often)
-enuresis (bedwetting) -Hesitancy (unable to start urination) -urgency (desire to pee) -retention (feeling of needing to go after urination) -nocturia (urination at night) -Polyuria (urination often with large amounts) -anuria (no urine) -oliguria (small amounts of urine) -incontinence (unable to control bladder) -stress incontinence (pressure on bladder releasing urine) |
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assessment of discomfort urination include
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-Dysuria (painful urination)
-hematuria (bloody urination) -pain -burning while urination |
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The primary responsibility of the gonads (testes) are what?
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-secretion of hormones
-production of sperm |
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The 3 primary roles of the reproductive system is what?
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-produce and transport sperm
-deposit sperm into women -secretion of hormones |
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The male urethra is much ____ than a female's urethra
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longer
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So what should be used more of while placing a catheter?
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more KY should be used
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The prostate is situated where?
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under the bladder, around the urethra and closely to the rectum, and just over the penis
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how much space is there between the prostate, and these areas?
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very little...
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Benign Prostate Hyperplasia (BPH) is what?
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-enlargement of the prostate gland resulting from increased amounts of epithelial cells and stromal tissue
-thought to result from endocrine due to age |
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Possible causes of BPH include
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-over accumulation of testosterone
-stimulation by estrogen -local growth hormone action |
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where does BPH occur?
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in the INNER part of the prostate
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T/F
In BPH the prostate enlarges very rapidly so symptoms have a quick onset |
F
it's a gradual compression of the urethra |
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BPH can partial or completely obstruce the urethra
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both
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Compression leads to what?
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clinical symtoms (pain, decreased velocity)
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T/F
There is no relationship with size of prostate and obstruction |
true,
the prostate can grow outward and be huge with little obustruction, or it can "swell" and yet be small (pic. 55.2) |
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What determines the obstructive symptoms?
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the location of enlargement
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R/F for BPH are
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-family history (1st degree relatives)
-environment -obesity (increased waist circ) -diet (sat. fat)- * use DASH diet* |
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what are some foods high in Sat. fat?
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butter, beef, foods with high zink
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clinical manifestations of BPH
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-gradual onset
-early symptoms are minimal because bladder can compensate -become worse as urethral obstruction increases |
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obstructive symptoms include
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-decreased in caliber of force of urinary stream
-hesitancy -intermittency (stop-go-stop) -dribbling afterwards |
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What is used to check for urinary problems?
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bladder scan
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T/F
You shouldn't have the Pt void before doing a bladder scan |
T
your checking for residual |
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irritative symptoms are what?
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symptoms associated with inflammation or infection
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irritative symptoms include what?
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-frequent and urgency urination
-dysuria -bladder pain -nocturia -incontinence |
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urinary retention is an irriative problem why?
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due to stasis of urine which can lead to UTI and sepsis
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what other problem could occur from urinary stasis?
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urine becomes more basic which can lead to stone formation
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urinary retention can also lead to what?
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Hydoronephrosis (distention of kidney) which can lead to kidney failure
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What can a Pt do to help with urinary retenion?
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-self cath (poss. for rest of their life)
- take antibiotics |
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Diagnostic studies for BPH include
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-H&P
-DRE -urnialysis with culture -PSA level -serum creatinine -TRUS scan -uroflowmetry -cystocurethroscopy |
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DRE is what?
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Digital Rectal Exam (dr. will insert his finger in the rectum and feel the shape of prostate)
*should be inlarged, firm, smooth* |
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PSA level will show what?
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prostate specific antigen will show if it could be cancerous
*not difinitive answer if it is elevated* |
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Serum cratinine level is important why?
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shows function of the kidneys (hydronephrosis) or to rule out kidney failure, not BPH
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TRUS scan is what?
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Trans Rectal Ultra Sound (shows prostate up close and visual)
and biospy prostate *only diffinative way to see if it's cancerous* |
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Uroflowmetry shows what?
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velosity of urine flow per second, blockage (creek, or raging river)
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Cystourethroscopy does what?
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goes through the urthera and gives a visual look
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our goals for BPH are what?
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-restore bladder drainage
-relieve symptoms -prevent/treat complications |
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What is "watchful waiting"
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just allowing the Pt to rest and see if the problem resolves itself
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What are our dietary changes?
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Avoid:
-caffeine -spicy -acidic foods -*artifical sweetners* |
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what should our voiding schedule be?
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-voiding every 2 hrs, or as soon as they feel the urge to go
-decrease nighttime fluid |
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What OTC should they avoid?
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-cough medicine
-anticholinergic |
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What are our 2 drugs that we are going to use to Tx BPH?
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-5 A-Reducatse inhibitors
-a-Adrenergic blockers |
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the purpose of 5 A-Reducatase inhibitor is what?
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decrease the size of the prostate by decreasing testosterone
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What are 2 types of 5-A's?
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-Proscar
-Avodar (ends with "eride") |
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who shouldn't touch 5-A's?
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pregnant nurses
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How often and how long does it take "eride's" to work?
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taken daily for 3-6 months
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S/E for 5-a drugs are?
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-decrease libido
-decrased vol of ejaculation -ED |
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Alpha blockers do what?
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-promotes smooth muscle relaxation in the prostate which allows more urine to flow
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two types of Alpha blockers are?
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-flomax
-cardura |
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how long does it take for Alpha blockers to work?
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2-3 weeks
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what are some S/E of them?
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-ortho HTN
-retrograde ejactulation (goes into the bladder and urine looks cloudy) -nasal conjestion -dizziness |
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what herbal therapy is there?
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saw palmetto
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Saw Palmetto is helpful for what?
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-nocturia
-improve flow -reduce bladder volume |
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problems with using Saw Palmetto is?
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-increase BP
-increase risk for bleeding (think saw to cut) |
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invasive therapy is used when?
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-decreased urine is causing discomfort
-persistent residual urine -acute urinary retention -bypass obstruction -hydronephrosis (ARF) |
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AFR is what?
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acute renal failure
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what catheter is used for BPH?
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caude catheter
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what is urinary bypass?
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urine is leaking around the catheter because the catheter is irritating the bladder (most RN's will increase the size of the catheter, this is wrong)
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what is given to help with urinary bypass?
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Ditropan (antispasmodic)
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collabrative care involves what?
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-no long-term catheters (increase risk of infection
-tx depends on size, loc, age, and surgical risk |
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TURP stands for what?
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Transurethral resection
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How and why is a TURP used?
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-removal of obstructive tissue using a resectoscope inserted in the urethra
-low risk -done under spinal or general -requires hospital stay |
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what will be needed following at TURP?
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CBI (continous bladder irrigation)
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bladder is irrigated for how long?
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24 hours to prevent mucus and blood clots
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complications from TURP include
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-bleeding
-clot retention -dilutional hyponatremia -retrograde ejaculation |
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Pt's must stop what before a TURP is done
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-anticoagulants
-ASA 7-10 days prior |
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a TUMP is what?
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transurethral microwave therapy
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it's done where?
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Out Pt
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what does it do?
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sends microwaves directly to prostate through a transurtheral probe
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TUNA is what?
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transurthral needle ablation
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what does it do?
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increases the temp of the prostate tissue and it becomes necrosed
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what does the TUNA allow for?
what will the Pt be on afterwards? |
-greatest precision of tissue removed
-short term catheter |
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laser prostatectomy does what?
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a laser beam goes transurethrally and cuts or destroys parts of the prostate
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VLAP is what?
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visual laser ablation of the prostate
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VLAP takes how long to heal?
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several weeks
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what is the risk?
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small risk
minimal bleeding, fast recovery |
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what should the RN assess for before surgery?
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-medication (estrogen, testosterone suppliments)
-surgery or previous tx's for BPH -vol. fluid restrictions -nocturia |
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what type of bladder may we see?
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-distended on palpation
-smooth, firm -enlargement of prostate on rectal exam |
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what will the UA show?
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-enlargement on ultrasound
-residual urine -creatinine levels -residual urine on bladder scan |
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What else should we be asking for during assessment?
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-urinary urgency
-diminution of caliber and force of urination -hesitancy in voiding -post dribbling -incontinence -dysuria -sensation of incomplete voiding -anxiety of sexual dysfunction |
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RN implementation is focused on what?
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-early dection and tx
-yearly H&P and DRE for men 50 -educate on avoiding ETOH, Caffeine, cold & cough meds |
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RN teaching includes
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-telling Pt to void Q2-3 hrs.
-adequate fluid intake -time to express feelings of sexual dysfunction -possible complications of procedures |
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RN Post Op
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-CBI
-admin antispasmodics B&O suppositories -kegal exercise -stool softners |
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what are B&O suppositories?
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Belladonna Opium, helps prevent bladder spasms
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what are some other Post Op care?
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-incontinence
-dysuria -sensation of incomplete voiding -ansiety of secual dysfunction |
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Discharge instructions are what?
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-they will be discharged with an indwelling catheter
-manage incontinence -2-3L of fluid per day -S/S of UTI and wound infection |
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what things do we not want them to do?
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-prevent constipation
-avoid lifting 10lbs or more -driving -no sex for 4-6 wks -avoid bladder irritants |
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What should follow up care include?
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-sexual counseling if ED is a problem
-Yrly DRE |
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calculating a CBI
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Foley Output - CBI infused = True urine output
800ml - 300ml = 500 urine output |
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Prostate cancer is what?
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-androgen-dependent adenocarcinoma
-growth occurs on the OUTER aspect of gland -usually slow growing |
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R/F for prostate cancer are what?
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-high-fat diet
-exposure to chemicals -primary family history (father, brother) |
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T/F
BPH is NOT a risk factor for prostate cancer |
True
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Prostate cancer is what in the early stages?
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asymptomatic
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S/S of prostate cancer are similar to what other condition?
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BPH
-dysuria -Hesitancy -dribbling -frequency |
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Pain from Prostate cancer can be where?
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lumbosacral area that radiates to hips or legs
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Once cancer has spread what is a major problem in controlling?
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Pain, (remember the prostate sits so close to other organs, that once it spreads it goes fast)
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2 diagnostic tools used for prostate cancer are what?
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-PSA
-DRE |
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elevated PSA shows what?
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-prostate pathology (not ness. cancer)
-maker of tumor vol when cancer exists -also used to monitor success of tx |
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normal PSA range is what?
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0-4
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DRE shows what?
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-abnormal prostate size
(harness, nodular and asymmetric) |
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PAP is what?
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Prostate acid phosphatase
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what does it prove?
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if elevated it also indicates prostate cancer since PO4 is in bones, it shows cancer has spread to bones
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if there is an elevated DRE and PSA what does that say?
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"need for further testing' biopsy is the only definitive way (TRUS is used)
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Watchful waiting is used when?
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-life expectancy is less than 10 yrs
-significant comorbid disease -presence of low-grade, low-stage tumor |
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Radical prostatectomy involves what?
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removal of
-entire gland -seminal vesicles -part of the bladder neck -retroperineal lymph node dissection -most effective for long term survival -robotic procedures -nerve sparing procedure |
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what age range would this include?
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age 70 and in good health
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how long will Pt be cathetered for?
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1-2 weeks
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what are the major complications of Radical?
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-ED
-incontinence -hemorrhage -urinary retention -infection due to incision loc |
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what must be done after each BM?
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-perineal care
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surgery can be done in what 3 ways?
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-Retropubic (horizontal cut over pubic bone)
-perineal (through rectum) -uprapubic (vertical cut between belly button and penis) |
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lymph node dissection can't be done with which incision
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rectal
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Post Op care for the Pt is what?
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-no lifting 6 weeks
-no sex or driving until dr. order |
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What are 2 other ways to tx prostate cancer?
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-Cryosurgery
-radiation therapy |
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how is Cryosurgery helpful?
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destroying tissue cells by freezing the tissue
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what are 2 types of radiation?
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-direct
-brachytherapy (implantation of radioactive seeds into the prostate) |
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What type of drug therapy is used primarily?
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hormonal (Androgen Depervation)
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how does it work?
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slows the progression of growth
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When can Androgen Depervation be used?
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-before surgery or radiation to shrink the size
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Lupron is what?
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a drug that decreases the amount of Testerone in men and Estrogen in women
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orchiectomy is what?
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removal of testes for advanced prostate cancer
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T/F
orchiectomy can be done alone |
true
may also be done with a prostatecomy |
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what is the purpuse of a orchiectomy?
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to reduce the circulating hormone of testosterone
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S/E of orchiectomy are?
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-hot flashes
-ED -loss libido -irritability -wt gain -loss of muscle mass -osteoporosis |
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Chemo is used when?
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used to tx hormone resistant prostate cancer
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what is the goal of Chemo?
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at this point its palliative (prostate cancer responds poorly to chemo)
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RN implications are
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-DRE/PSA screenings (50 yrs and older)
-sensitive, caring support to Pt and family (don't be a ball buster) -encourage joining a support group and seek information |
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Since they will be discharged on a catheter what are some teachings?
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-use soap and water to clean area daily
-keep bag lower than the bladder -kegal exercise after each urination -pain medication |
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Prostatitis is what?
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-grp of inflammatory conditions affecting the prostate gland
-occurs under 50 |
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manifestations can be what?
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acute or chronic
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acute causes are what?
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-E. coli
-klebsiella -chlamydia |
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acute S/S are what?
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-fever
-chills -back pain -dysuria -cloudy urine |
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acute tx is what?
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antibiotics <4 wks
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chronic causes are what?
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same as acute but more recurrent episodes of infection
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chronic S/S are what?
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same as acute only milder
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chronic tx is what?
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-opioids
-antibiotics 4-12 wks |
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Dx studies used are?
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-U/A (increased WBC, bacteria, urine culture)
-expressed prostate secretions (EPS) -TRUS -Transabdominal ultra sound -MRI |
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EPS is what, how is it done?
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manually stimulates the prostate to produce sections (painful)
-void, dr stimulates prostate, void |
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management includes what?
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-antibiotics
-pain management -anti-inflammatory agents -super pubic catheter -fluids -repetive prostate massage (to relieve prostate, only chronic) -ejaculation (reduces inflammation) -warm bath |
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Testicular cancer manifestations are what?
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-slow OR rapid onset
-lump in scrotum (swelling) -dull ache or heavy sensation in lower abd. |
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when are self exams done?
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during a shower, or bad
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what is specifically done during exam?
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-testis is rolled inbetween thumb and first 3 fingers (one at a time)
-should feel round and smooth, like a hard-boiled egg -choose the same day of the month to exam -one testi may be larger than the other |
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Diagnosis of testicular cancer is done how?
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-Alpha-feoprotein (blood test)
-Beta subunit of hCG (tumor marker) -CT -MRI -Lymphangiograms |
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there is a coincidence between testicular cancer and what?
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sports injury
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hCG stands for what?
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Human chorionic gonadotropin
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there is a higher level of hCG in what other condition?
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gynecomastia
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tx for testicular cancer risk for sexual dysfunction include
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-oligosermia (decrease sperm count)
-azoospermia (absent sperm count) -health teaching about fertility and sexuality -sperm banks -other reproductive options |
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interventions to prevent mets is what?
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-surgerical management
-preop care -radical retroperitoneal lymp node dissection -orchiectomy |
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Post op care and expected problems include
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-pain from surgical incisions
-immobility -injuries related to invasive cath/ or tubes |
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what 3 nonsurgical things can be done?
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-chemo
-radiation -stem cell |
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what is done after surgery and discharge?
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METICULOUS FOLLOW UP to see if it's spread to other testical
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Erectile dysfunction (ED) is what?
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-inability to achieve or maintain erection for sex
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Erectile dysfunction (ED) can occur how?
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-organic Phsyiologic
--functional ED with age |
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what should our assessment include?
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-medical, social, sex hx
-complete PE -duplex doppler ultrasound test |
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Functional dysfunction can result how?
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(psychological)
-anxiety -depression -fatigue -guilt -stress -martial discord -excessive ETOH |
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Physiologic dysfunction can result how?
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-cardiovascular
-DM -surgery on colon, bladder -Neuro (MS, CVA) -Priapism (erection longer than 6 hrs) -hormonal deficiency |
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tx options include
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-erectogenic meds
-urethral suppositories (MUSE) -injections -Vaccum constriction device -Surgery- Penile prosthesis -sex therapy |
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erectogenic meds are what?
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-Viagra
-Cialis -Levitra |
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injection meds are what?
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-Caverject
-Trimix -Bimix |
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What to avoid when taking erectogenic meds
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-Nitrates
-avoid ETOH S/S headache, facial flushing, diarrhea |
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Vaccum works how?
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-vaccum is created and blood flows into the penis to maintain an erection
-a rubber ring is then placed to maintain the erection and cylinder is removed |
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Intraurethral suppository is done how?
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-placed in urethra
-erection occurs in 10 min and lasts from 30-60 min. -burning occurs after application |
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a prosthesis is used how?
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-a bag is filled and implanted in the stomach lining or superpubic area
-a reservoir is placed in the scrotum -implants are placed in the penis |
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how does it work?
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the Pt "pumps" the scrotum which pulls fluid from the bag and it flows in the penis filling the prosthesis
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major disadvantage of it is...
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failure and infection
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Why would we need to know about a Pt who has a prosthesis?
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the use of SQ injections
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