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104 Cards in this Set
- Front
- Back
what disorders involves prostate gland?
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Beinign prostatic hypertrophy or BPH, prostate cancer, and prostatitis.
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what is the most affected male reproductive organ?
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The prostate gland
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What is the enlargement of the prostate gland also called?
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Benign prostatic hyertrophy or hyperplasia which becomes a problem when enlargement puts pressure on the urethra making it narrow for the urine to pass through
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what are the clinical manifestations of BPH?
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Hesistancy-decreased force of stream, post-void dribbling-nocturia, sensation of incomplete emptying or retention
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what test diagnose BPH?
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DRE, PSA, U/A,urine culture
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What is the management of BPH?
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Catherization( indwelling or intermittent catherization temporarily.
Watch and see and drug therapy |
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What drugs are used to treat
Drug therapy BPH |
Androgen deprivation
Proscar |
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How is the mamagement of BPH dtermined?
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Depends on the severity of obstruction and patient condition.
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For releif from acute urinary retention will be catherized if he goes to emergency room with?
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A coude urethral cathether which has a curved tip help it pass through the prostatic or bladder neck blockage.
He may be prescribed an indwelling cathether or intermittent catherization temporarily intil a definitive treatment is initiated. |
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Watcful waiting is used for what client?
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Clients who have few or mild signs and symptoms ad who is periodically assessed for progression of symptoms
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what is BPH treatment aimed at?
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Decreasing the size of the prostate if hyperplastic tissues is androgen- dependent or relaxing the prostate muscle
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Proscar A 5 alpha reductase inhibitor, what does it do?
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Androgen deprivation-Blocks the conversion of testosterone to dihydrosterone which mediates prostate growth in androgen- sensitive tissues.
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What is the expected outcome of Proscar TX?
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The reduction ofthe size of prostate with concomittant decrease in PSA count.
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Prostate muscle relaxation
name the Alpha adrenergic blockers? |
Hytrin(Terazosin)
Cardura(doxasin) Flomax(tamsulin) |
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Hytrin, cardura, flomax are used to relief what type of BPH?
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Symptomatic
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What relieves signs of urinary obstruction?
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Smooth muscle relaxation within and around the prostate
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Why is the pt started on a lower dose and advised to take at hour of sleep?
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Because these drugs cause orthstatic hypotension
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In addition to traditional medicine what herbal therapy is used to treat urinary symptoms?
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Saw Palmetto
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BPH SURGERY
What does TURP mean? |
Transurethral resection of prostate
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What are some post op concerns that the nurse is responsible for?
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control Pain/Spasms
excessive Bleeding maintain hydration to control infection maintain bladder Irrigation |
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BPH
What are the Closed Surgeries? |
Retropubic approach
monitor dressing( there should be no urine on the dressing. Suprapubic approach Monitor output from suprapubic catheter and urethral cathether seperately Perineal approach Avoid rectal tubes, therometers& enemas |
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What is the most approach often performed after TURP?
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The retropubic approach whed which is indicated when the prostate gland is large and there is no coexisting bladder abnormality.
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what is the retropubic approach?
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Allows the surgeon to remove the hyperplastic tissue directly through an abdominal incision
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what is the nurse rsponsible for after the retropubic approach?
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Monitor the urine output via a foley cathether and abdominal dressing
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If there is trace of urine on the dressing this is an indication of what?
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This means leakage of urine from the bladder
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when there is a coexisting bladder abnormality what approach is used?
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Suprapubic approach is indicated.The incision is made through the bladder permitting its expoloration then, the hypertrophic tissue is removed using a finger.
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What is the nurse responsible for postoperatively,(The suprapubic approach)?
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Abdominal incision and urine output from both aa suprapubic cathether and a urethral cathether
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what preparation is needed for perineal approach?
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A good bowel prepartion with neomycin enema is done before sugery to prevent infection
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What is the the perineal approach?
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The surgeon makes an incision
between the scrotum and the rectum and then removes the hypertrophied prostate tissue from below. |
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Although PA is associated with less operative time and bleeding but what higher incidence?
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Impotence, urinary incontinence, and infection than the other approaches
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what does the nurse monitor?
Perineal approach |
Monitor the dressing over the perineal incision as well as the attached drains for excessively bleeding.
Monitor urinary ouput is monitor carefully |
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PA
Trauma to the incision is avoided by? |
Avoiding rectal tubes, Thermoeters, and enemas
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What are the newer methods?
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Laser incision of the prostate and balloon dilation of the prostate that may entail less risks and shorter hospitalization
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Post-Prostate surgery
what are some potential diagnosis? |
Hemorrhage, pain, fluid volume excess
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what does the nurse check immediately after surgery?
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The V/S, his urine output via cathethers
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why are Irrigation systems often ordered?
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To prevent formation of blood clots which cause obstruction, distention, and hemorrrhage
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In continuous bladder irrigation,what gauge needle is used?
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3-way gauge 18-22 with a 30-45 cc ballon Foley cathether is inserted &Isotonic saline is used as the irrigant.
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In the first 24 what is assess frequently?
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The character of the urine
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What is considered normal output on first day of surgery?
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A light red to red output with occasional clots and first day post op.
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Day of surgery or first if brigt red output indicates what?
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Surgeon is notified because that indicates arterial bleeding so nurse must check V/S. increase the CBI rate and notify the SURGEON STAT
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During the rest of hospital stay what color is output?
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Clear to pink.Hemmorrhage is normal.
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How to prevent hemmorrhage?
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Traction on the cathether is secured to the thighs or abdomen tightly ti apply pressure on the bleeders surrounding the bladder of the prostate
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In this case what should the nurse ?
TURP |
Nurse should not manipulate the cathether ot retape it
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How is pain controlled
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By presribed analgesics
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Altered comfort due to bladder spasms maybe minimize by the use of?
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Antispasmodics
Baolidone or Opiod suppository or Ditropan |
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When does turp syndrome occur?
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During or after TURP when pt absorbs a large amount of fluid since venous sinuses are opened during surgery
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After a turp pt show what signs?
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s/s of FVE which include decreased HCT and HGB, bradycardia, nausea, and confusion. In this case, diuretics and fluid restriction may be instituted.
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what are Discharge instructions fter a prostatectomy?
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Drink adequate amount of fluids
Do not have sexual intercourse for 6 wks Avoid strenous activities Empty bag Q 3-4 hours |
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Watch for signs and symptoms of complictions depending on surgical approach?
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Bleeding
Stress incontinence Retrograde ejaculation UTI/Epidiymitis Deep Vein Thrombosis is a possibility pt still need to be taught about it |
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Discharge instuctions after a prostatectomy include what?
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Increased fluid intake to prevent infections
Refraining from sexual intercourse for 6 wks avoiding strenuous activities & long driving emptying urinary drainage bags q 3-4 hrs switch from a leg bag to a drainage bag at night to prevent reflux may also experience Symptoms of UTI or Epididymitis How to perform kegel exercises to minimize stress incontenence and decrease semen durin ejaculation or backward ejaculation |
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If pt has increased bleeding, what is he to do?
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Rest, increase his fluids and then notify the MD
If frank bleeding, large clots and decrease in urine output, must call Doc stat |
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Prostate cancer
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The most common form of cancer in men and second leading cause of cancer death in men after lung cancer. Higher incidence in men 65 and older, African american men.
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what is prostate cancer associated with?
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The presence of androgen since it is never found in those who have no testicles or those who had testes removed
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is the tumor slow growing in prostate cancer?
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Yes. Slow growing and is spread by direct extension via lymphatics and via blood stream
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in the early stage of prostate cancer it is what?
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ASymptomatic, eventually the pt may have S/S similar to BPH and S/S of metastasis.
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Where does the pain radiate in prostate cancer?
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Pain in lumbosacral area radiating to the hips or legs within malaisw may indicate metastasis to the bone,
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Where can prostate cancer met to?
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It can also met to liver, the brain and lungs
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how is screened for prostate cancer done?
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DRE And PSA
DRE of PG where gland may feel hard and unilaterally enlarged. Increased PSA levels are indicative of prostate pathology but not necessarily cancer |
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How is definitive diagnosis made after a DRE and PSA are abnormal?
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Biopsy of tissue.
The nurse needs to encourage alll to have a annual DRE and PSA level check starting at 50 to detect cancer early |
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The management of Prostate cancer depends on what?
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The staging of the disease.
Staging is based on tumor growth and spread |
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In stage 1 and 11 what happens?
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The cancer is confined to the prostate and the chance of a 5 yr survival is 100% after a radical prostatectomy and radiation
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How is Radiation treatment given?
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given in a form of external beam or interstitial implant of radioactive seeds
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In stage 3 the cancer is spread where?
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spread to semivesicles and is further managed with hormone therapy
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in stage 4 where has it spread to?
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spread to surrounding tissues and distant organs,
is further managed with chemotherapy and Orchietomy |
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How is the decision made for treatment?
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Joint decision between pt and physican,
Surgery made be delayed if pt asymptomatic, if the tumor is slow growing, if pt is elderley, monitoring is then done with annual DRE and PSA |
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what is a radical prostatectomy?
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A surgical procedure which involves the removal of the bladder neck, entire prostate gland, part of seminal vesicles and regional lymph nodes
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what is the nursing care for Prostatectomy?
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Control pain
Incision care Care of drains including CBI |
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How does the nurse Prevent DVT?
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Administer heparin SQ and the application of anti-embolism stockings.
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What does the nurse teach the patient after prostatectomy?
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Regarding incontinence, infection, and impotence as possible complications
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What is Radiation?
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An external beam or interstitual radioactive implants (bradytherapy)
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Radiation is used on which age group?
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Primary treatment especially in men over 70 yrs old who are considered poor surgical risk. It may be curatively for portate cancer that is confined to the prostate or as pallitive TX for late prostate cancer
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When is external beam done? Radiation
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Week period is the most widely used approach
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what is bradytherapy/
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using a radioactive seed implants placed in the PG is suitable in early prostate cancer
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what complication happens for either Radiation therapy?
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cystitus, incontinence, impotence, diarrhea, may result- most side-effects are temporary
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what does prostate cancer growth largely depend on?
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availability of androgen and therfore hormonal therapy focuses on decreasing the level of androgen production
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what is an example of hormonal therapy?
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Use lupron which is a gonadotropin releasing hormone that inhibits the secretion of pituitary gonadotropins leading to decresed testosterone production
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How is the hormonal therapy Lupron given?
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SQ, it is expensive,has a slow onset, and cause hot flashes, loss of libido, impotence and gynecomastia.
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Has chemotherapy show an increase in survival rate in late stage cancer?
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No but may be used for pallitive TX especially when the cancer is resistant to hormone TX
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What is Prostatitis?
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inflammation of the prostate is common problem in men
IT can be acute or chronic is non bacterial |
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What is acute bacterial prostatitis?
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S/S Burning, frequency and urgency of urination, fever, perineal
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what is Bacterial prostatitis usually due to?
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Escherichacoli, Enterobacter, and klebsiella
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what are the manifestions of acute bacterial prostatitis ?
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may include burning frequency, urgency in urination, fever, and perineal pain esp during or after ejaculation
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what are the s/S in chron bacterial prostatitis?
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S/S are usually milder.
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what is the cause of non-bacterial prostatitis?
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The cuase of non bacterial is unknown and prostate secretions are negative for infection or inflammation
Manifestations are similar to non-chronic bacterial prostatitis, with painful prostate being the major complaint |
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what is the TX of Prostatitis?
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Bacterial Acute
Pt is put on antibiotics Levaquin IV if severe for a month, rest and refrain from sexual activity. After acute stage- pt put on antibiotis AB to eradicate infection and prevent chronic prostatitis |
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what is given in chronic prostatitis?
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The same antibiotics but lower dose and a longer period.
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Although non-bacterial prostatis have negative cultures what antibiotics are given?
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Doxycline with positive results
Pts are advised to take measure to relieve perineal pain, by taking analgesics, warm sitz bath and perform regular sexual activity. Sexual activity is believed to help decreas the congestion of PG Pt cannot transmit the disiese to their partners |
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disorders of TEstes/ Scrotum
what is testicular cancer? |
Most common cancer in males aged 15-35
survival rate>90% Major risk factor is cryptorchidism Manifestations pain less hard nodule on testes |
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what is testicular cancer?
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A rarwe but it is most common in males 15-35, eg scott hamilton, and lance Armstrong.
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what is an undescended testicle?
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Cryptorchidism It increase the risk for this cancer 35 times the normal population. Other predisposing factors are maternal exposure to DES and Family HX of testicular cancer
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What is the classic sign of testicular cancer?
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Painless hard nodule on the testicle, loss of weight and weakness or signs of metastasis.
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Where does the tumor spread to in testicular cancer?
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Bones, chect, lungs, liver, and brain via lymphatics
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Testicular cancer screening
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monthly testicular self -Exam starting at age 13 or 15 for early detection of testicular
It done after a warm bath which makes the skin loose and makes the testes easier to examine |
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what is the DX of testicular cancer?
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on clinical assessment.
Biopsy is NOT done to prevent the spread of malignant cells along the spermatic cord or sac Although tumor markers are not specific TC elevation of TM is a presence of tumor in the body |
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when is Testicular cancer finally diagnosed?
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after Orchiectomy
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Testicular Torsion
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Twisting of the spermatic cord and testes R/T sudden pull on cremasteric muscle and arteries and veins cutting off blood supply
Can occur due to vigorous activity or trauma Manifested by: chief complaint Scrotal pain and accompained by swelling DX Testicular scan and doppler Ultrsound to assess for decreased or absent blood flow to testicle ER TX shound be initiated in 6-12 hrs since it can lead to necrosis and eventually sterility TX Orchipexy- untwisting of spermatic cord and immobilizing the testicle by suturing it to scrotum Orchidectomy- only if testicle is necrotic |
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Benign Scrotal Masses
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Hydrocoele, most common benign scrotal mass and it non-tender collection of clear amber within outer covering of testicle. if large cause pain and I &D may be done, otherwise left alone
SPERMATOCOELE contains cysts in epididymid. contains dead spermatozoa R/T leakage in of sperm which occurs d/T infection and trauma. It is non-tender mass attached to epididymid& contains milky fluid and sperm . usually requires no TX Varicole is a condition where there are dilated vein int he scrotum which forms a mass. This is secondary to incompetent values or obstruction of gonadadal vein and is usually noted on left scrotum B/C pressure of renal vein Manifestations: Complians of pain may be relieved by masturbation or scrotal support, can decrease sperm count and cause atrophy, leading to infertility, if this a problem it is ligated TX Radiation Radical orchiectomy followed by retroperitoneal lymph node dissection (RPLND) Nursing care : Control pain. control swelling and wound care, by monitoring hematoma, drainage, and bleeding. ice pack, and analgesics. TX combination chemotherapy is why most men survive |
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Epididymis and Orchitis
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Epididdymis associated with STDs, prostatitis or UTI in older men trauma, instumentation, most common intrascrotal inflammatory condition in men.usually in tose uner 35 yrs old with chlamydia and gonorrhea.
ORCHITIS inflammation or infection of testes Most common infectious cause: post pubertal mumps Asssociated with STDs, trauma and hydrocoeole Manisfeatations local swelling andpain, sometimes fever. TX both conditions Pin control with NSAIDS, scrotal support, Sitz bath, ice pack, bed rest. avoid sex stimulation and lifting. Antibiotics for control of inflammation. To prevent Orchitis in post -pubrtal boy who is exposed to mumps, gamma globulin must be given or infertility may result |
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Disorders of Penis
Cancer of penis |
Is a psychologically devastating diagnosis. although rare it occur in men between 40-70 never seen in jewish or muslem population
Associated with uncircumcised/tight foreskin(phimosis), >50. multiple sex partners, HPV, poor hygiene, UV radiation Chief manifestation painless lesion on tip of penis, may be nodular, wart like or red velvety in appearance. The lesion may be accompanied by ulceration, bleeding, or foul smelling discharge mistaken for STD which delays diagnosis. No screening for penile cancer and asc has no recommendation for routine circumcision to prevent penile cancer DX by Biopsy Tx with topical chemo, external beam radiation or laser removal of lesion. Sever cases TX is amputation of penis. Penetomy, pt will void sitting down,or urethrosotomy creaate in perineum. Systemic shem given for distan met |
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Priapism
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Painful persistent eretion not associated with sexual arousal more than 6 hrs,
Cause by impaired blood flow to corporacavernosa secondary to impaired clotting mechanisms or filure of mnormal; Autonomic response that facilitate return to non-erect state If prolonged cause penile necrosis and impotence by spinal cord trama/tumors, sickle cell, anemia, leukemia, diabetes mellitusand drugs Vasoactive injectiond, alcohol, psychotropics, marijuana/cocaine Tx Sedatives, aspiration of blood, injection of smooth muscle relaxants, shunting procedure |
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Phimosis and paraphimosis
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Phimosis- Tight foerskin/ prepuce R inaability to retract it
Paraphimosis -tight foeskin inability to pull it forward from retracted position These two conditions only happens in men and boys who are not circumcised |
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Phimosis
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may be congential or may be cause by edema due to infection, inflammation or trauma
S/S may include redness, edema with tenderness and purulent discharge Tx antibiotic therapy and good genital hygiene to control infection |
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Paraphimosis
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Nurse pull forskin back to ot clean it and put in cathether. Report it to Md if forskin cannot be gently pull back B/C can cuse penis to swell and necrosis.
Tx warm soaks, treat swelling by pressing penis with hand or wrapping the penis in a tight bandgae then pull back foreskin, in unscuccessful small incision is made in the trapped foreskin to loosen it. Circumsion may be considered to preven tcancer and recurrance Tx done with general anesthesia sutures covered with petroleum dressing. The nurse responsiblilities monitor incison for excessive bleeding and teaching pt about prper wound care. Refrain from sex for 1-2 wks, taking barbiturates or estrogen which are usually prescribed for several days to prevent nocturnal erection while wound is not yet healed |
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Erectile dysfunction
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Failure to achieve penile tumescence of adequate rigidity or duration for successful intercourse
Physiologic (organic) versess psychogenic causes Major ED results from psychologic causes - DM, vascular diseases,procedures -prostatectomy and various medications- HTN, psychotropics, alcohol and marijuana Psychogenic ED is often associated stress, depression, difficulty in a relationship, low self esteem To differentiate a nocturnal penile test is done DX hormonal levels and vascular studies, penile blood flow, duplex doppler ultrasound Tx Based on underlying cause Erectogenic drugs Tadalafil(cialis) Vacum constriction device applied to flaccid penis to produce erection, device is remove for intercourse but babd is left to maintain erection Vasoactive drugs Alprostadil( urethral supp) Papaverine& phentolamine injection Nitroglycerine paste Surgery Semi rigid or inflatable prosthesis is becoming common tx alternative for those with ED they have cmplications, infections,extrusion of prothesis through skin, pain and swelling or mechanical failur pt teaching use of device,appropriate underwear, healing time and when right time to resume sex |