Meds And Labs For 2Nd Med/surg Exam

Front 1

PSA

Back 1

*Prostate specific antigen
*Check for prostate CA

Front 2

Elevated PSA

Back 2

*Above 4
*Benign prstatic hypertrophy
*Prostate CA

Front 3

Urine C&S

Back 3

*Check for UTI
*<10,000 bacteria/ml is negative
*>100,000 bacteria/ml is positive

Front 4

IVP

Back 4

*Intravenous pyelgraphy
*Visualizes kidneys, renal pelvis, ureters amd bladder via x-ray and dye

Front 5

Abnormal IVP

Back 5

*Pyelonephritis
*Glomerulonephritis
*kidney tumor
*Bladder tumor
*prostate enlargement (male)

Front 6

Why would an IVP be ordered?

Back 6

*Pain compatible with urniary stones
*Blood in urine
*Preposed pelvic surgery to locate ureters
*Trauma to the urinary system
*Urinary outlet obstruction
*Suspected kidney tumor

Front 7

Diagnostic reasoning for cystoscopy

Back 7

*Inspect bladder, prostate, urethra
*ID kidney stones
*measure bladder capacity

Front 8

Theraputic reasoning for cystoscopy

Back 8

*Resection of small bladder tumors and foriegn bodies
*Dilation
*Placement of catheters
*Coagulation
*place radium seeds into tumor

Front 9

Urodynamic Studies

Back 9

*Measures the rate of urine flow from the bladder per second

Front 10

Abnormailites found with urodynamic studies

Back 10

*Dysfunctional voiding
*Urethral stricture
*Prostate cancer
*Prostatic hypertrophy

Front 11

Classification of Cipro

Back 11

*Quinolone antibiotic

Front 12

Indication of Cipro

Back 12

*UTI

Front 13

Side effects of Cipro

Back 13

*Local burning and discomfort
*Crystalline precititate on superficial portion of cornea

Front 14

Nursing considerations and implications

Back 14

*Watch for tendon inflammation
*C&S before giving
*I and O's
*PT with INR in pts with coumadin

Front 15

Classification of Proscar

Back 15

*Hormone
*Antiandrogen
*5-alpha reductase inhibitor

Front 16

Indication for Proscar

Back 16

*Benign Prostatic Hypertrophy
*Male pattern hair loss

Front 17

Side effects of Proscar

Back 17

*Impotence
*Decreased libido
*Decreased volume of ejaculate

Front 18

Nursing considerations

Back 18

*Monitor PSA levels
*watch pts with large residual urinary volume or decreased urinary flow

Front 19

Classifications of Ditropan

Back 19

*Anticholinergic
*Antimuscarinic
*Antispasmodic

Front 20

Indication for Ditropan

Back 20

*Relieve symptoms associated with voiding in pts with neurogenic bladder
*Relieve pain of bladder spasm following transurethral surgical procedures

Front 21

Side effects of Ditropan

Back 21

*Drowsiness
*Blurred vision
*Dry Mouth
*Constipation
*Pruritus at site

Front 22

Nursing conciderations with ditropan

Back 22

*Periodic interruptions of therapy are recommended to determine pts need for continued treatment r/t tolerance
*Watch pts with colostomy or ileostomy closely for s/s of GI probs due to obstruction or toxic megacolon
*Be careful in heat
*Caution driving until you know how you will respond to the medicine

Front 23

Classification of Pyridium

Back 23

*Urinary tract analgesic

Front 24

Indication of Pyridium

Back 24

*relief from pain, burning, frequency, and urgencey coming from irritation of urinary tract mucosa from infection, trauma, surgery, or intrsumentation

Front 25

Side effects of Pyridium

Back 25

*Orange urine

Front 26

Nursing considerations and implications for Pyridium

Back 26

*Kidney fx tests with prolonged therapy or impaired kidney fx
*Watch for yellowish discoloration in skin or eyes--it means there is accumulation r/t renal impairment.

Front 27

Classification of Bactrim

Back 27

*Urinary tract agent
*Sulfonamide

Front 28

Indication of Bactrim

Back 28

*Severe complicated UTI's

Front 29

Side effects of Bactrim

Back 29

*toxic epidermal necrolysis
*aplastic anemia
*Allergic myocarditis
*Rash

Front 30

Nursing considerations and implications for Bactrim

Back 30

*Watch CBC
*Platelets
*BUN and Creatinine with prolonged therapy
*Coags
*I and O for significant changes in case of renal calculi
*Watch for UTI improvement
*Plenty of fluids

Front 31

Classification of Macrobid

Back 31

*Urinary tract antibiotic

Front 32

Indication for Macrobid

Back 32

*Pyelonephritis

Front 33

Side effects of Macrobid

Back 33

*Hepatic necrosis
*Anaphylaxsis
*Interstitial pneumonitis or fibrosis
*Exfoliative dermatits

Front 34

Nursing considerations and implications for Macrobid

Back 34

*C & S before begin
*I and O (report oliguria or anuria)
*Watch for pulmonary sensitivity
*Watch for super infection

Front 35

Classification of Cardura

Back 35

*Alpha-Adrenergic antagonist

Front 36

Indication of Cardura

Back 36

*BPH

Front 37

Side effects of Cardura

Back 37

*Orthostatic hypotension
*Headache

Front 38

Nursing considerations for Cardura

Back 38

*Orthostatic hypotension--maybe give at night
*Do no drive until you know how you will react to the medicine

Front 39

Classification of Flomax

Back 39

*Alpha-Adrenergic antagonist

Front 40

Indication for Flomax

Back 40

*BHP

Front 41

Side effects of Flomax

Back 41

*H/A
*Dizziness
*Orthostatic hypotension (especially in first dose)
*Rhinitis
*Abnormal ejaculation

Front 42

Nursing considerations and implications

Back 42

*Monitor for orthostatic hypotension

Front 43

Classification of Calcium Gluconate

Back 43

*Fluid and Electrolytic replacement therapy

Front 44

Indication for Calcium Gluconate

Back 44

*Negative Calcium balance
*Antidote for mag sulfate
*cardiac toxicity of hyperkalemia

Front 45

Side effects of calcium gluconate

Back 45

*Cardiac Arrest

Front 46

Nursing considerations and implications of Calcium Gluconate

Back 46

*Watch for s/s vasodilation
*Monitor EKG for decreased QT interval with inverted T wave
*watch for hypocalcemia as well as hyper
*Watch electrolyte balance

Front 47

Location of the prostate

Back 47

*Surrounding the male bladder and urethra

Front 48

Function of the prostate

Back 48

*Produce/secrete seminal fluid
*Provide nutrients for sperm

Front 49

Normal size of prostate

Back 49

*walnut

Front 50

Risk factors of BPH

Back 50

*Not well defined
*Obesity
*Diet with less fruit and vegi's in them

Front 51

Culture with lower risk for BHP

Back 51

*Asian Americans because they eat more fruits and vegetables

Front 52

Effect of smoking, ETOH, & cirrhosis on the prostate

Back 52

*Decreases the size

Front 53

Incidence of BHP in elderly

Back 53

*80% by age 80
*Will just increase with age

Front 54

Clinical manifestations of BHP

Back 54

*Lower urinary tract symptoms (LUTS)
*Nocturia
*Day time frequency
*Decreased force and caliber of urine stream
*Urine dribble
*UTI
*Hematuria
*Bladder diverticulli

Front 55

Nocturia

Back 55

*Frequent urination at night
*Normally when men seek help for BHP

Front 56

Cause of Bladder diverticuli in pt with BHP

Back 56

*Pressure weakens the bladder wall.
*Wall could rupture

Front 57

Diagnosis of BPH

Back 57

*S/S
*DRE
*Increased PSA
*Post-void residual
*Urodynamic studies
*BPH Symptom score

Front 58

What is a DRE looking for?

Back 58

*Nodules and checking borders

Front 59

DRE with BPH

Back 59

*Nodules present
*Symetrical
*Regular
*Smooth borders

Front 60

DRE with prostate CA

Back 60

*Nodules present
*Fixed
*Hard
*Asymetrical
*Irregular borders

Front 61

Normal PSA

Back 61

*<2.6
*Will increase with age (4is at 70)

Front 62

When do we worry about an icrease of PSA?

Back 62

*Rapid increase within a year
*3-10 in one year could mean CA

Front 63

Managment of BPH

Back 63

*Watchful waiting
*Medications

Front 64

Medications for BPH

Back 64

*Alpha blockers
*5 alpha reductase enzyme
*combinate both categories
*herbal therapies

Front 65

Alpha blockers for BPH

Back 65

*Doxazosin (Cardura)
*Tamsulosin (Flomax

Front 66

Function of alpha blockers for BPH

Back 66

*Relax prostate muscles

Front 67

Reason for taking Alpha blockers at night

Back 67

*lowers blood pressure so pt could experience orthostatic hypotension

Front 68

5 alpha reductase enzymes

Back 68

*Finasteride (Proscar)
*Dutasteride (Avodart)

Front 69

Function of 5 alpha reductase enzymes with BPH

Back 69

*Slows prostate growth

Front 70

Considerations with 5 alpha reductase enzymes

Back 70

*take 6-12 months

Front 71

Saw Palmedo

Back 71

*Herbal therapy
*Decreases prostate size

Front 72

Surgical intervention with BPH

Back 72

*TURP
*Suprapubic, retropubic, pereneal prostatectomy
*Microwave heat
*Laser ablation
*TUNA

Front 73

TURP

Back 73

*Remove pieces of prostate to decrease the size
*Shows immidiate results
*Risk for bleeding
*Often must be done within 5 years

Front 74

Post-op TURP care

Back 74

*Continuous irrigation (TUR drip)

Front 75

Continuous irrigation after a TURP

Back 75

*3000 mL bag of NS X2
*1 bag connected to pt, the other waiting to be infused because you don't want the flow to ever stop
*another bag at bottom to catch the fluid that goes through the bladder as well as any urine that comes out
*Rate is pretty much all the way open, don't use a pump
*CNA can empty the bottom bag.
*Bags are labeled like in room 9 (1, 2, 3, 4...)
*If output is NOT greater then input then there is no way to measure urine
*May be the case in the beginning

Front 76

Red fluid coming out of bladder during continuous irrigation

Back 76

*Normal for first few hours
*Should be pink by 12 hours post op
*Almost clear in 24 hours post op

Front 77

Possible clot in bladder after TURP

Back 77

*Irrigate with syringe, per MD order
*Could cause bladder spasms

Front 78

Pt position after TURP

Back 78

*Pt may have sitting restrictions r/t putting pressure on site
*Have pt semi folwers for 24 hours post op

Front 79

Risk for bleeding after TURP

Back 79

*Monitor for hypotension and tachycardia
*H&H

Front 80

Pain after TURP

Back 80

*Bladder spasms (could be from bleeding)
*Give antispasmodics
*Narcotic analgesics
*Stool softeners

Front 81

Antispasmodics after TURP

Back 81

*Levsin
*mostly Ditropan
*Can cause dry mouth and confusion!!!! (Be careful with elderly)

Front 82

Narcotic analgesics after TURP

Back 82

*B & O suppositories (Beladona and opium--almost like a local anasthetic)

Front 83

Stool softeners after TURP

Back 83

*So that pt doesn't strain when going to restroom!!
*Also need to increase fluid to assist with BM

Front 84

Incontinence/self-image after TURP

Back 84

*Pelvic muscle rehab after surgical healing

Front 85

Potential sexual dysfunction after TURP

Back 85

*Mostly with large surgeries, not really with TURP

Front 86

Nursing care for the TURP pt

Back 86

*Risk for bleeding
*pain
*Incontinence/self-image

Front 87

Prostatectomy

Back 87

*If prostate is too big to remove with TURP
*Removes many other things besides prostate longer recovery time

Front 88

Suprapubic Prostatectomy

Back 88

*Through the front, through the bladder
*Greater risk of bladder spasm and incontinence
*foley and suprapubic catheters

Front 89

Retropubic prostatectomy

Back 89

*Through to back of bladder
*If prostate is very large with severe stricture
*Not as many issues with nerves--decreased risk for erectile dysfunction

Front 90

Perineal prostatectomy

Back 90

*Issues with impotence
*Reduced risk of urinary incontinence
*Shorter procedure

Front 91

Minimally Invasive options for BPH

Back 91

*Will try before surgeries are preformed
*Normally done outpatient
*Microwave heat
*Laser ablation
*TUNA

Front 92

Microwave heat

Back 92

*Transurethral
*Microwave antenna attached to tube and inserted into bladder through urethra and prostate
*Treatment last 30-60 minutes
*will need foley r/t prostate edema

Front 93

TUNA

Back 93

*Transurethral blation
*More pain than microwave

Front 94

Difference between prostate CA and BPH

Back 94

*In CA the cells are now changing

Front 95

Incidence of prostate CA in men

Back 95

*1 in 6 men
*2nd most common CA in men (first is skin)
*Leading cause of CA death in men

Front 96

Etiology and risk factors for prostate CA

Back 96

*2/3 are found after age 65
*More common in AA men
*10 % is inherited
*Diet high in red meat, high fat dairy products
*Pts who take Proscar for BPH

Front 97

Clinical manifestations/Diagnosis of prostate CA

Back 97

*similar to BPH
*on palpation, feels hard, fixed and enlarged, asymetrical
*DRE anually after 50
*PSA
*Biopsy

Front 98

How often for PSA?

Back 98

*Begin 50-70 years old
*Begin at 40 for high risk men and AA
*Initial PSA of < 1 retest every 5 years, 1-2 test annually

Front 99

Secondary prevention of prostate CA

Back 99

*Screening

Front 100

Managment of prostate CA

Back 100

*Instead of watching and waiting if it is CA we will interviene much faster
*Radical prostatectomy
*Retropubic approach
*Perineal approach
*Laproscopic prostatectomy is becoming more common r/t nerve sparing and shorter hospital stays

Front 101

Complications/side effects of treatment of prostate CA

Back 101

*Imcontinence
*Impotence
*Lymphedema

Front 102

Incontinence after tx of prostate CA

Back 102

*May improve over time
*Kegal exercises

Front 103

Impotence after prostate CA

Back 103

*No erection possible for up to a year after surgery
*May use ED meds

Front 104

Lymphedema after tx of prostate CA

Back 104

*Rare side effect of lymph node removal

Front 105

Radiation with prostate CA

Back 105

*External beam therapy 6-9 weeks
*Brachytherapy

Front 106

Side effects of external beam therapy with prostate CA

Back 106

*everything around where the beam hits will have issues as well such as the intestines and what not
*Stricture, and decreased funcitoning

Front 107

Brachytherapy

Back 107

*small seeds placed in prostate and left there.
*Radiation decreases over time
*No sex or kids sitting in lap for up to 2 months
*Clear liquid diet pre-op
*Bowel cleansing pre-op

Front 108

Orchiectomy

Back 108

*Rare
*Remove everything around prostate.... EVEN TESTES!!

Front 109

Hormone therapy with prostate CA

Back 109

*Leuprolide (Lupron)--lowers testosterone
*Blocks androgen production
*Used for men who aren't good candidates for surger
*Does not cure CA
*Cause men to have a menapause like situation

Front 110

Chemotherapy with prostate CA

Back 110

*Palliative care