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164 Cards in this Set
- Front
- Back
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assessment of urinay problems related to timing of urination |
-Frequency (going often) |
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assessment of discomfort urination include |
-Dysuria (painful urination) |
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The primary responsibility of the gonads (testes) are what? |
-secretion of hormones |
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The 3 primary roles of the reproductive system is what? |
-produce and transport sperm |
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The male urethra is much ____ than a female's urethra |
longer |
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So what should be used more of while placing a catheter? |
more KY should be used |
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The prostate is situated where? |
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? |
very little... |
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Benign Prostate Hyperplasia (BPH) is what? |
-enlargement of the prostate gland resulting from increased amounts of epithelial cells and stromal tissue |
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Possible causes of BPH include |
-over accumulation of testosterone |
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where does BPH occur? |
in the INNER part of the prostate |
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T/F |
F |
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BPH can partial or completely obstruce the urethra |
both |
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Compression leads to what? |
clinical symtoms (pain, decreased velocity) |
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T/F |
true, |
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What determines the obstructive symptoms? |
the location of enlargement |
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R/F for BPH are |
-family history (1st degree relatives) |
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what are some foods high in Sat. fat? |
butter, beef, foods with high zink |
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clinical manifestations of BPH |
-gradual onset |
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obstructive symptoms include |
-decreased in caliber of force of urinary stream |
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What is used to check for urinary problems? |
bladder scan |
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T/F |
T |
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irritative symptoms are what? |
symptoms associated with inflammation or infection |
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irritative symptoms include what? |
-frequent and urgency urination |
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urinary retention is an irriative problem why? |
due to stasis of urine which can lead to UTI and sepsis |
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what other problem could occur from urinary stasis? |
urine becomes more basic which can lead to stone formation |
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urinary retention can also lead to what? |
Hydoronephrosis (distention of kidney) which can lead to kidney failure |
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What can a Pt do to help with urinary retenion? |
-self cath (poss. for rest of their life) |
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Diagnostic studies for BPH include |
-H&P |
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DRE is what? |
Digital Rectal Exam (dr. will insert his finger in the rectum and feel the shape of prostate) |
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PSA level will show what? |
prostate specific antigen will show if it could be cancerous |
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Serum cratinine level is important why? |
shows function of the kidneys (hydronephrosis) or to rule out kidney failure, not BPH |
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TRUS scan is what? |
Trans Rectal Ultra Sound (shows prostate up close and visual) |
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Uroflowmetry shows what? |
velosity of urine flow per second, blockage (creek, or raging river) |
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Cystourethroscopy does what? |
goes through the urthera and gives a visual look |
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our goals for BPH are what? |
-restore bladder drainage |
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What is "watchful waiting" |
just allowing the Pt to rest and see if the problem resolves itself |
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What are our dietary changes? |
Avoid: |
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what should our voiding schedule be? |
-voiding every 2 hrs, or as soon as they feel the urge to go |
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What OTC should they avoid? |
-cough medicine |
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What are our 2 drugs that we are going to use to Tx BPH? |
-5 A-Reducatse inhibitors |
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the purpose of 5 A-Reducatase inhibitor is what? |
decrease the size of the prostate by decreasing testosterone |
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What are 2 types of 5-A's? |
-Proscar |
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who shouldn't touch 5-A's? |
pregnant nurses |
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How often and how long does it take "eride's" to work? |
taken daily for 3-6 months |
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S/E for 5-a drugs are? |
-decrease libido |
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Alpha blockers do what? |
-promotes smooth muscle relaxation in the prostate which allows more urine to flow |
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two types of Alpha blockers are? |
-flomax |
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how long does it take for Alpha blockers to work? |
2-3 weeks |
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what are some S/E of them? |
-ortho HTN |
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what herbal therapy is there? |
saw palmetto |
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Saw Palmetto is helpful for what? |
-nocturia |
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problems with using Saw Palmetto is? |
-increase BP |
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invasive therapy is used when? |
-decreased urine is causing discomfort |
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AFR is what? |
acute renal failure |
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what catheter is used for BPH? |
caude catheter |
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what is urinary bypass? |
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? |
Ditropan (antispasmodic) |
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collabrative care involves what? |
-no long-term catheters (increase risk of infection |
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TURP stands for what? |
Transurethral resection |
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How and why is a TURP used? |
-removal of obstructive tissue using a resectoscope inserted in the urethra |
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what will be needed following at TURP? |
CBI (continous bladder irrigation) |
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bladder is irrigated for how long? |
24 hours to prevent mucus and blood clots |
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complications from TURP include |
-bleeding |
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Pt's must stop what before a TURP is done |
-anticoagulants |
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a TUMP is what? |
transurethral microwave therapy |
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it's done where? |
Out Pt |
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what does it do? |
sends microwaves directly to prostate through a transurtheral probe |
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TUNA is what? |
transurthral needle ablation |
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what does it do? |
increases the temp of the prostate tissue and it becomes necrosed |
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what does the TUNA allow for? |
-greatest precision of tissue removed |
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laser prostatectomy does what? |
a laser beam goes transurethrally and cuts or destroys parts of the prostate |
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VLAP is what? |
visual laser ablation of the prostate |
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VLAP takes how long to heal? |
several weeks |
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what is the risk? |
small risk |
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what should the RN assess for before surgery? |
-medication (estrogen, testosterone suppliments) |
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what type of bladder may we see? |
-distended on palpation |
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what will the UA show? |
-enlargement on ultrasound |
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What else should we be asking for during assessment? |
-urinary urgency |
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RN implementation is focused on what? |
-early dection and tx |
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RN teaching includes |
-telling Pt to void Q2-3 hrs. |
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RN Post Op |
-CBI |
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what are B&O suppositories? |
Belladonna Opium, helps prevent bladder spasms |
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what are some other Post Op care? |
-incontinence |
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Discharge instructions are what? |
-they will be discharged with an indwelling catheter |
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what things do we not want them to do? |
-prevent constipation |
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What should follow up care include? |
-sexual counseling if ED is a problem |
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calculating a CBI |
Foley Output - CBI infused = True urine output |
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Prostate cancer is what? |
-androgen-dependent adenocarcinoma |
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R/F for prostate cancer are what? |
-high-fat diet |
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T/F |
True |
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Prostate cancer is what in the early stages? |
asymptomatic |
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S/S of prostate cancer are similar to what other condition? |
BPH |
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Pain from Prostate cancer can be where? |
lumbosacral area that radiates to hips or legs |
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Once cancer has spread what is a major problem in controlling? |
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? |
-PSA |
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elevated PSA shows what? |
-prostate pathology (not ness. cancer) |
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normal PSA range is what? |
0-4 |
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DRE shows what? |
-abnormal prostate size |
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PAP is what? |
Prostate acid phosphatase |
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what does it prove? |
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? |
"need for further testing' biopsy is the only definitive way (TRUS is used) |
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Watchful waiting is used when? |
-life expectancy is less than 10 yrs |
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Radical prostatectomy involves what? |
removal of |
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what age range would this include? |
age 70 and in good health |
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how long will Pt be cathetered for? |
1-2 weeks |
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what are the major complications of Radical? |
-ED |
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what must be done after each BM? |
-perineal care |
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surgery can be done in what 3 ways? |
-Retropubic (horizontal cut over pubic bone) |
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lymph node dissection can't be done with which incision |
rectal |
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Post Op care for the Pt is what? |
-no lifting 6 weeks |
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What are 2 other ways to tx prostate cancer? |
-Cryosurgery |
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how is Cryosurgery helpful? |
destroying tissue cells by freezing the tissue |
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what are 2 types of radiation? |
-direct |
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What type of drug therapy is used primarily? |
hormonal (Androgen Depervation) |
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how does it work? |
slows the progression of growth |
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When can Androgen Depervation be used? |
-before surgery or radiation to shrink the size |
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Lupron is what? |
a drug that decreases the amount of Testerone in men and Estrogen in women |
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orchiectomy is what? |
removal of testes for advanced prostate cancer |
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T/F |
true |
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what is the purpuse of a orchiectomy? |
to reduce the circulating hormone of testosterone |
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S/E of orchiectomy are? |
-hot flashes |
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Chemo is used when? |
used to tx hormone resistant prostate cancer |
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what is the goal of Chemo? |
at this point its palliative (prostate cancer responds poorly to chemo) |
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RN implications are |
-DRE/PSA screenings (50 yrs and older) |
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Since they will be discharged on a catheter what are some teachings? |
-use soap and water to clean area daily |
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Prostatitis is what? |
-grp of inflammatory conditions affecting the prostate gland |
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manifestations can be what? |
acute or chronic |
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acute causes are what? |
-E. coli |
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acute S/S are what? |
-fever |
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acute tx is what? |
antibiotics <4 wks |
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chronic causes are what? |
same as acute but more recurrent episodes of infection |
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chronic S/S are what? |
same as acute only milder |
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chronic tx is what? |
-opioids |
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Dx studies used are? |
-U/A (increased WBC, bacteria, urine culture) |
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EPS is what, how is it done? |
manually stimulates the prostate to produce sections (painful) |
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management includes what? |
-antibiotics |
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Testicular cancer manifestations are what? |
-slow OR rapid onset |
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when are self exams done? |
during a shower, or bad |
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what is specifically done during exam? |
-testis is rolled inbetween thumb and first 3 fingers (one at a time) |
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Diagnosis of testicular cancer is done how? |
-Alpha-feoprotein (blood test) |
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there is a coincidence between testicular cancer and what? |
sports injury |
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hCG stands for what? |
Human chorionic gonadotropin |
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there is a higher level of hCG in what other condition? |
gynecomastia |
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tx for testicular cancer risk for sexual dysfunction include |
-oligosermia (decrease sperm count) |
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interventions to prevent mets is what? |
-surgerical management |
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Post op care and expected problems include |
-pain from surgical incisions |
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what 3 nonsurgical things can be done? |
-chemo |
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what is done after surgery and discharge? |
METICULOUS FOLLOW UP to see if it's spread to other testical |
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Erectile dysfunction (ED) is what? |
-inability to achieve or maintain erection for sex |
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Erectile dysfunction (ED) can occur how? |
-organic Phsyiologic |
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what should our assessment include? |
-medical, social, sex hx |
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Functional dysfunction can result how? |
(psychological) |
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Physiologic dysfunction can result how? |
-cardiovascular |
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tx options include |
-erectogenic meds |
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erectogenic meds are what? |
-Viagra |
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injection meds are what? |
-Caverject |
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What to avoid when taking erectogenic meds |
-Nitrates |
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Vaccum works how? |
-vaccum is created and blood flows into the penis to maintain an erection |
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Intraurethral suppository is done how? |
-placed in urethra |
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a prosthesis is used how? |
-a bag is filled and implanted in the stomach lining or superpubic area |
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how does it work? |
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... |
failure and infection |
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Why would we need to know about a Pt who has a prosthesis? |
the use of SQ injections |
