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1

PAD (peripheral arterial disease) classified as

inflow (distal aorta and iliac arteries) or outflow (femoral, popliteal, and tibial arteries) and can range from mild to severe. Tissue damage occurs below the arterial obstruction

2

Erectile Dysfunction risk factors:

morbid obesity, diabetes, use of HTN's

3

Erectile Dysfunction Health Promo:

-maintain a healthy diet
-avoid heart disease, diabetes, penile trauma
-NO use of drugs inappropriately
-NO excessive alcohol
-NO smoking
-exercise regularly
-healthy coping/stress management
Assess: medications: antihypertensives, antihistamines, antidepressants, tranquilizer, appetite suppressant, cimetidine

4

Erectile Dysfunction Management of Care:

no Sildenifil and Nitrates

5

Erectile Dysfunction Pharm Interventions:

nitrate drugs, hydrochloride, isosorbide

6

Erectile Dysfunction Patient Education:

severe HYPOtensive crisis. If a PT takes viagra and then takes an antihypertensive medication, can cause HYPOtensive crisis b/c viagra and HTN medications are both vasodilators.

7

Erectile Dysfunction Complications S/S:

-diagnosis dependent on problem occurring at least 3 months
-priapism w/med therapy
-disturbed self image and depression
-sexual complications
-loss of satisfaction and libido

8

Erectile Dysfunction Nursing Interventions:

Discuss Sexual Dysfunction:
-provide up-to-date education
-discuss previous methods of coping
-treatment options
-promote self-esteem: may feel "less than a man" and implants may disturb body image

If the man has had a penile implant, teach him and partner how to use the pump, including how to inflate and deflate the device:
-wear snug underwear w/penis placed in an upright position on the abdomen and loose trousers
-sex activity may resume within 6-8 weeks following surgery

9

Genital Herpes agent

sexual contact

10

Genital Herpes Patho

still transmit even if no symptoms

11

Genital Herpes Manifestation

pain, itching, small red bumps, blisters, ulcers, scabs, flu like symptoms

12

Genital herpes teaching

dont rub

13

Genital herpes Pharm/Treatment

NO CURE, antivirals (acyclovir)

14

HPV agent

vaginal, anal, oral, genital contact. breaks in skin/mucosal lining

15

HPV manifestations

genital warts, asymptomatic normally, common warts, plantar warts, not painful warts

16

HPV teaching

can get cervical cancer

17

HPV Pharm/treatment

NO CURE, remove wart by freezing, vaccines given to males up to 21 and females 26
-Gardasil and cervarix vaccine
-pap smear check for cancer
-warts can be removed by cryo probes

18

Chlamydia agent

sexual contact, enters cell and reproduces only within the host cell, bacteria that causes this is C. trachomatis. most commonly reported bacterial STI in US

19

Chlamydia Patho

assess sexual history

20

Chlamydia Manifestation

-females often ASYMPTOMATIC but carry
-painful urination, lower abdomen pain, vaginal/penile d/c pain, sexual intercourse,dysuria, urinary frequency discharge

21

Chlamydia Management of Care and Complications

no sex 7 days when treated

-complications: chronic pelvic pain, scaring of fallopian tubes, infertility

22

Chlamydia Teaching

no sex 7 days when treated, no treatment= infertile!

23

Chlamydia Pharm/Treatment

-antibiotics (azithromycin) (doxycycline)
-partner treated at same time
-7 days oral antibiotics or single dose oral

24

Gonorrhea Agent/Prevention

-sexual contact
-targets cervix in females/urethra in males

25

Gonorrhea Patho

-kramer had s/s of seinfeld

26

Gonorrhea manifestation

-dysuria, d/c of milky
-men: pain, swelling
-women: pain intercourse, abnormal menses, 80% of women are ASYMPTOMATIC

27

Gonorrhea Management of Care

dont culture if on period, eye cream on baby, not blood culture

28

Gonorrhea Teaching and Complications

safe sex, check (test) before sex

-complications: inflammatory pelvic disease in women, infection in blood

29

Gonorrhea Pharm/Treatment

general antibiotics, ceftriaxone IM

30

Syphilis Agent

lymph system/blood, bacteria that causes this is spirochete Treponema pallidum

31

Syphilis Manifestations: Primary

enlarged lymph nodes, cankers, achy (4-6 weeks), if UNTREATED leads to secondary

32

Syphilis Manifestations: secondary

rash on palms, sore throat, swelling lymph nodes, flu symptoms (2-6weeks), if UNTREATED leads to Latent stage

33

Syphilis Manifestations: Latent

no S/S but spread (1 year to life)

34

Syphilis Manifestations: Tertiary

late S/S, tumors bone/liver; near syphilis (worst stage)

35

Syphilis Management of Care

Test: RPR, VDRL
-citz baths

36

Syphilis Teaching

sex from S/S begin until 10 days after all lesions healed

37

Syphilis Pharm/Teaching

Penicillin G IM, can give tetracycline if allergic to Penicillin

-Jarish herxheimer can occur with Penicillin, S/S fever, tacky, HTN

38

What is BPH (benign prostatic hyperplasia)?

As an adult male ages, the prostate gland enlarges. When the enlargement of the gland begins to cause urinary dysfunction, it is called benign prostatic hyperplasia (BPH). BPH is a very common condition of the older adult male

39

BPH Risk Factors

-increased age
-smoking, chronic alcohol use
-sedentary lifestyle, obesity
-western diet (high fat, protein, carbs; low fiber)
-diabetes mellitus, heart disease

40

BPH expected findings

-urinary frequency, urgency, hesitancy or incontinence
-incomplete emptying of the bladder
-dribbling post-voiding
-nocturia
-diminished force of urinary stream
-straining with urination
-hematuria
-urinary stasis and persistent urinary retention leads to frequent UTI's
-If BPH persists, back flow of urine into the ureters and kidney can lead to kidney damage

41

BPH Patient Centered Care

-frequent ejaculation releases retained prostatic fluids, thereby decreasing the size of the prostate
-tell the client to avoid drinking large amounts of fluids one time, and to urinate when the urge is initially felt
-avoid bladder stimulates, such as caffeine and alcohol
-avoid medications that cause decreased bladder tone, such as anticholinergics, decongestants, and antihistamines
-medication is used for conservative treatment of BPH

42

BPH Medications

Dihydrotestosterone (DHT)-lowering medications (like finasteride)
-finasteride is TERATOGENIC TO A MALE FETUS
-women who are pregnant or who could become pregnant should avoid contact with tablets that are crushed or broken and with the semen of a client currently taking this medication

Alpha-blocking agents: tamulosin
-orthostatic hypotension can occur
-concurrent use w/cimetidine canpotentiate the hypotensive effect

43

BPH Surgical procedure: Postoperative nursing actions:

Transurethral resection of the prostate (TURP):
-postop treatment for a TURP usually includes placement of an indwelling three-way catheter
-if the catheter becomes obstructed (bladder spasms, reduced irrigation outflow), turn off the CBI and irrigate with 50 mL irrigation solution using a large piston syringe or per facility or surgeon protocol
-monitor for bleeding (persistent bright-red bleeding unresponsive to increase in CBI and traction on the catheter or reduced HGB levels) and report to the provider

44

BPH Surgical Procedure: Administer Medications PostOp

-analgesics (surgical manipulation or incisional discomfort)
-antispasmodics (bladder spasms)
-antibiotics (prophylaxis)
-stool softeners (avoid straining)

45

BPH Surgical Procedure client education

tell the client to avoid nonsteroidal anti-inflammatory medications due to increased risk for bleeding, also avoid anticholinergic meds like antihistamines b/c of urinary retention

46

Menopause Assessment/Expected Findings

hot flashes and irregular menses, decreased vaginal secretions, decreased HDL and increased LDL, decreased skin elasticity, loss of hair on the head and pubic area

47

Menopause Medication

Menopausal hormone therapy (HT)
-HT places women at risk for a number of adverse conditions, Coronary heart disease, MI, DVT, Stroke, breast cancer

48

Menopause Medication Client Education

-no smoking
-teach client how to prevent and assess the development of venous thrombosis:
-avoid wearing knee-high stockings and clothing or socks that are restrictive
-take short walks throughout day to promote circulation
-not and report manifestations of unilateral leg pain, edema, warmth, and redness
-oral medications cause nausea, so take with food
-avoid using vaginal creams or suppositories of estrogen compounds prior to intercourse b/c partner can absorb some of the product
-atrophic vaginitis S/S: vaginal bleeding and burning, pruritus, and painful intercourse, can improve with HT

49

Menopause Client Education for Older Adults

-can decrease the risk of osteoporosis by performing regular weight-bearing exercises, increase intake of high protein and high calcium foods, avoid alcohol, caffeine, and tobacco, and take calcium with vitamin D supplements

50

Menopause alternative therapies

-black cohosh, ginseng, and red clover help relieve the effects of menopause.
-Vitamins E and B6 are reported to decrease hot flashes in some women
-Phytoestrogens interact with estrogen receptors in the body, which can result in a decrease in the manifestations of menopause. Vegetables such as, dandelion greens, alfalfa sprouts, black beans, and soy beans contain phytoestrogens.

51

Fibrocystic breast condition risk factors

premenopausal status and postmenopausal hormone replacement therapy

52

Fibrocystic breast condition expected findings

breast pain, tender lumps, commonly in upper, outer quadrant

53

Fibrocystic breast condition Nursing Care

-suggest that the client reduce the intake of salt before menses, wear a supportive bra, and apply either local heat or cold to temporarily reduce pain
-condition DOES NOT increase risk of breast cancer

54

Fibrocystic breast condition Medications

-OTC analgesics like acetaminophen or ibuprofen
-oral contraceptives or hormonal medication therapy if manifestations are severe to suppress estrogen/progesterone secretion
-diuretics to decrease breast engorgement
-decrease caffeine
-vitamin E helps with pain

55

What is Cystocele?

is a protrusion of the POSTERIOR bladder through the anterior vaginal wall. It is caused by weakened pelvic muscles and/or structures

56

Cystocele risk factors

-obesity
-advanced age (loss of estrogen)
-family history
-multiparity
-increased abdominal pressure during pregnancy
-strain and injury during vaginal childbirth

57

Cystocele Expected Findings

-urinary frequency and/or urgency
-stress incontinence
-history of frequent urinary tract infections
-sense of vaginal fullness
-dyspareunia
-fatigue
-back and pelvic pain

58

Cystocele specific therapeutic procedure

Anterior colporrhaphy: using a vaginal or laparoscopic approach, the pelvic muscles are shortened and tightened, resulting in increased bladder support

59

What is Rectocele?

is a protrusion of the ANTERIOR rectal wall through the posterior vaginal wall. It is caused by a defect of the pelvic structures, a difficult delivery, or a forceps delivery.

60

Rectocele risk factors

-pelvic structure defects
-obesity
-aging
-constipation
-family history
-difficult vaginal childbirth necessitating repair of a tear

61

Rectocele expected findings

-constipation and/or the need to place fingers in the vagina to elevate the rectocele to complete evacuation of feces
-Sensation of a mass in the vagina
-pelvic/rectal pressure or pain
-dyspareunia
-fecal incontinence
-uncontrollable flatus
-hemorrhoids

62

Rectocele specific therapeutic procedure

posterior colporrhaphy: using a vaginal/perineal approach, the pelvic muscles are shortened and tightened, resulting in a reduction of rectal protrusion into the vaginal canal

63

Cystocele and Rectocele therapeutic procedures

Kegal exercises, anterior-posterior repair, hysterectomy

64

Cystocele and Rectocele Client Education

-instruct the client to notify the provider about indications of infection (elevated temperature, pulse, or respirations; foul-smelling or purulent vaginal discharge; or consistent pain)
-posto: avoid strenuous activity, lifting anything weighing greater than 5 lb, and sexual intercourse for 6 weeks