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28 Cards in this Set

  • Front
  • Back
Anatomy Review
*Prostate gland: located in front of rectum and below the bladder
*Purpose: to secrete fluid for semen
*Normally walnut size and shape
*Wraps around the urethra
Epidemiology and Statistics
*Second leading cancer cause of death in men second only to lung cancer
*234,460 est. new cases 2006 with 27,350 deaths
*More than 70% new diagnoses are in men over age 65
**Older man's disease vs testicular cancer**
Risk Factors: Non-modifiable
*Race: Black males have twice the risk as White males
*Age: over 50, most common over 65
*Family History: first degree relative with prostate cancer DOUBLES risk
*Nationality: most common in North America, less in Asia, Africa
Risk Factors: Modifiable
*Diet: high in red meat, fat, dairy
*Physical inactivity
*Exposure to hormones
*Multiple sex partners
*Low socioeconomic status
*Occupational exposure to chemicals
Health Promotion
*Annual Exams with DRE at 50 or earlier if at risk
*Prostate Specific Antigen (PSA) at 50 or earlier if at risk (Best Marker)
*Know risk factors
*Know symptoms of prostate cancer mimic BPH
*See MD for any of the following:
-Frequent urination
-Blood in urine
-Painful ejaculation
-Back/leg pain
Clinical Manifestations
*Early stages: asymptomatic
*Dysuria, hesitancy, dribbling, frequency, hematuria, nocturia and retention
**Enlarged, hard fixed prostate on DRE**
**Pain in lumbosacral area radiating to hips or legs (metastasis)
Diagnostic Studies/Procedures
*Complete history and physical exam
*Prostate Specific Antigen (PSA)
*DRE (Digital Rectal Exam)
*CBC, Lytes, BUN, Cr (looking for infection or metastasis)
*TRUS (Transrectal ultrasound) with bx (TRUS done rectally, guided by ultrasound)
*CT, MRI, CXR, Bone scan
Nursing Assessment
*Explore chief complaint, ask re:
Staging (3 ways)
*Whitmore-Jewett staging classification
-Based on A,B,C,D (A is confined to prostate, D refers to cancer that has spread to lymph nodes or to other places in the body.)
*Tumor-node-metastasis (TNM)
*Gleason scale
-Based on tumor histology, differentiation, 1-5 (1-well differentiated, 5-poorly)
Collaborative Care
*Stage A: watchful waiting
-Annual PSA and DRE
-Radical prostatectomy(rare) client may insist
-Radiation therapy:
External beam and brachytherapy
*Stage B: usually surgery and radiation
-Radical prostatectomy
-Radiation therapy
Collaborative Care, cont.
*Stage C:
-Radical prostatectomy
-Radiation therapy
-Hormone therapy
*Stage D:
-Radical Prostatectomy
Treatment: Radical Prostatectomy (Major Surgery - Under age 70 treatment of choice for Stage A & B)
*Removal of:
-Prostate gland
-Seminal vesicles
-Part of bladder neck
-Retroperitoneal lymph node dissection
Types of Prostatectomies
*Transurethral Resection
Nursing Interventions
*Address major complications post-op:
-Bladder spasms/acute surgical pain
-Urinary incontinence/Erectile problems
-Catheter obstruction
Acute pain and Bladder Spasms
*Assist if necessary with catheter insertion
*Percuss bladder for distention
*Maintain catheter patency
*Assess pain, medication as needed
*Narcotics, Ditropan, Detrol
*Notify MD if medication ineffective
Incontinence (Major Nursing Diagnosis)
*Teach kegal exercises - do only when catheter is removed
*Teach client catheter care (wash insertion site soap & water, dry well. wash catheter bag with vinegar)
*Nearly all men experience incontinence
*After 18 months, only 6.4% were incontinent of urine
*No alcohol, caffeine, fluid late in evening (causes irritation to bladder)
Risk for Infection
*Assess VS every 4 hours and prn
*Obtain urine culture if cloudy/sediment
*Administer fluids - PO or IV as ordered
*Maintain strict aseptic technique when accessing/irrigating catheter
*Maintain 3-way irrigation as ordered
*Monitor surgical site and drains
Risk for Hemorrhage
*Monitor output, report bright red drainage in larger than expected amounts
*Monitor VS and report abnormalities
*Maintain catheter patency
*NO rectal treatments: temps, enemas, suppositories - can cause bleeding
Catheter Obstruction
*Maintain 3-way irrigation at speed to keep clots from forming
*Irrigate catheter if it becomes occluded
*Advise client not to void around catheter
*Monitor I and O, take action if output less than intake at any time
*Perform pre-op teaching to provide information about what to expect
*Assess client's concerns re: sexual function, provide correct information
*Provide opportunity for private conversation so client may ask personal questions
Erectile Dysfunction
*Incidence of impotency depends on:
-Preoperative sexual function
-If surgeon performed nerve sparing surgery
-Expertise of surgeon (pick surgeon that has lots of experience=better outcomes
Treatment: Radiation Therapy
*Common option for men >70 years old or in poor health
*External beam: treats stages A, B and C
*Usually 6-8 weeks, 5 days/week
*Side effects: skin, GI, urinary tract, sexual function, fatigue, immunosuppression
Radiation cont.
*Brachytherapy: implantation of radioactive seed implants into prostate gland
*Used in Stage A and B
*More convenient than external beam
*Side Effect: irritation or blockage of urinary tract
Treatment Continued: Drug Therapy: Hormone Therapy
*Prostate cancer is largely androgen dependent
*Androgen deprivation is primary goal
*Can be adjunct before surgery or radiation
*Problem is development of hormone refractory disease within 18-24 months
Hormone Therapy
1. Luteinizing Hormone - Releasing Hormone (LH-RH) Agonists or Gonadotropin-Releasing Hormone Agonist
2. Androgen Receptor Blockers
3. Estrogen blocks testosterone
4. Orchiectomy - surgical removal of testicles, removes 95% of testosterone source
*Bilateral orchiectomy - removal of both testicles
*Reduces circulating testosterone by 90%
*Results in hot flashes, erectile dysfunction, loss of sex drive, weight gain and loss of muscle mass
*Used only in hormone resistant tumors
*Poorly responsive to chemotherapy
*Goal of chemotherapy is usually palliation
Health Promotion
*Ideally no man should be unaware fo his risk for prostate cancer and PSA
*Encourage all men to have annual PSA and DRE at age 50 for average risk
*High risk men should start at 45 years old