Cyndi - Week 8 - Exam 4 Flashcards
(49 cards)
1
Q
what is benign prostatic hypertrophy?
A
enlargement of prostate gland d/t overgrowth of tissue; hormonal changes during aging process
2
Q
what are the 6 characteristics of BPH?
A
- ↑ % estrogen/↓ testosterone
- ↑ accumulation of DHT? (prostatic androgen made from testes)
- result = hyperplasia - more cells
- enlargement compresses urethra
- compression not r/t size but location
- lack of cellular apoptosis
3
Q
what are the 4 complications of BPH?
A
- urinary retention
- UTI
- bladder or kidney damage
- hydronephrosis (fluid backup in kidney)
4
Q
what are the 8 risk factors for BPH?
A
- obesity
- sedentary lifestyle
- alcohol use
- age (> 50 years = 50%; >80years = 90%)
- erectile dysfunction
- smoking
- diabetes
- family hx
5
Q
T/F: BPH does predispose to prostate cancer
A
FALSE; it does NOT predispose to cancer
6
Q
how is BPH diagnosed? (8)
A
History + Physical DRE – digital rectal exam done by 50 y/o to r/o cancer Urinalysis (UA) with culture PSA – Prostate‐specific antigen Serum creatinine TRUS: Trans Rectal UltraSound Uroflowmetry/Post Void Residual Cystoscopy (risk for infection; 5-10 min; anesth; bleeding normal for 24hrs; clot; irrigation)
7
Q
what are the two main clinical manifestations of BPH?
A
- obstruction (d/t obstruction or retention)
- irritation (d/t inflammation or infection)
8
Q
what are the sxs of obstruction for BPH?
A
- Decreased force (weaker stream)
- Difficulty initiating
- Intermittency (stopping and starting)
- Dribbling - bladder full → still have some → go a little
9
Q
what are the sxs of irritation for BPH?
A
- Frequency, urgency
- Pain
- Nocturia
- Incontinence
10
Q
what are the 3 different tx for BPH?
A
- watchful waiting
- medications
- invasive
11
Q
what does watchful waiting consist of for BPH tx?
A
- Dietary (no artificial sweetners, no coffee)
- Timed voiding schedule (q2hr to try to urinate)
- Pt education
12
Q
what meds are used for BPH tx?
A
- 5 alpha reductase inhibitors - Proscar
- Alpha adrenergic receptor blocker - Hytrin
- Erectogenic drugs - Cialis,Viagra
- Herbal therapy - Saw Palmetto
13
Q
what invasive tx is used for BPH?
A
- Coude catheter – special catheter
- Prostate stent
- Surgery – TURP
14
Q
what is the post op care for transurethral resection of the prostate (TURP)?
A
- Ambulate
- Monitor for hemorrhage
- Bladder spasms
•Treat with Belladonna (B&O suppository) - Urinary incontinence
- Monitor for S/S infection:
•Assess urine character and amounts; enc hydration - Continuous bladder irrigation (CBI)
•To manage blood clots and prevent obstruction
15
Q
what is continuous bladder irrigation used for in BPH?
A
NS irrigation used to remove blood clots
16
Q
what are the NI for bladder irrigation?
A
- Clots may occur for 24‐36 h
- Removed 24‐48 H post‐op
- Irrigation may be used intermittently
- Pt may experience bladder spasms
- Strict I&O
17
Q
what is important to remember about the catheter used for continuous bladder irrigation?
A
has a large balloon (30 mL)
18
Q
what is prostate cancer? and three characteristics of prostate cancer?
A
Malignant tumor of the prostate gland
• One in 6 men
• Generally good long‐term survival – but depends
• Androgen‐dependent tumor
19
Q
what are the risk factors for prostate cancer?
A
- Ethnicity (African American) *test
- Age
- Familial history
- Other
20
Q
what are the diagnostics used for prostate cancer?
A
- Labs
- Digital Rectal Exam ‐ hard, nodular, asymmetrical area felt for
- Ultrasound used to locate tumor sites
- TRUS
- Biopsy
- CT, MRI, bone scan to look for metastases
21
Q
what labs are used to help diagnose prostate cancer?
A
- PSA – initial and monitoring
- PAP‐prostatic iso‐enzyme of acid phosphates
- Alkaline phosphatase - met. into bone - elevated
22
Q
what grading system is used for biopsies for prostate cancer?
A
TNM system for grading tissue pathology (1‐4)
23
Q
what are the initial symptoms of prostate cancer?
A
same as BPH • Frequency, urgency • Pain • Nocturia • Incontinence • Decreased force (weaker stream) • Difficulty initiating • Intermittency (stopping and starting) • Dribbling - bladder full → still have some → go a little
24
Q
what are the later symptoms of prostate cancer?
A
- Pain, back pain
- Urinary retention
- Bilateral lower extremities weakness, bowel or bladder dysfunction
- Weight loss and fatigue
25
T/F: prostate cancer may be asymptomatic
TRUE
26
what is the tx of prostate cancer?
- Watchful waiting/active surveillance
- Surgical approach
- Radiation ‐ implanted seeds, external beam
- Medications ‐ hormone therapies
- Orchiectomy- removal of testes
27
what are the surgical tx for prostate cancer?
1. Radical prostatectomy
- Retropubic
- Perineal
- Nerve sparing to maintain sexual function
2. Cryotherapy-
28
TEST: what are the considerations for perineal radical prostatectomy?
concerned about infection, clean frequently, constipation, care with wound
29
what is post op care for prostatectomy for prostate cancer?
* Retropubic versus perineal
* Treat pain
* Accurate I&O
* Encourage po as tolerated
* Ambulate
* Encourage to verbalize feelings
* Assess the urinary catheter for patency ‐ blood clots may impede drainage – monitor urine output!!
* Minimize catheter manipulation - sticker the way they go1
* Care of drain, dressing changes
30
what are the complications of prostate cancer?
```
Metastases
Surgery complications:
- Infection
- Incontinence
- Erectile dysfunction
- Hemorrhage
- Urinary retention
- DVT
- PE
```
31
what is testicular cancer and what are the characteristics?
Rare cancer of young men developed from embryonic germ cells
• Seminoma (not as aggressive/common)
• Nonseminoma (rare/aggressive)
• Others 10%
32
whata are the risk factors for testicular cancer?
* History of cryptorchidism
* A family history of testicular cancer
* Others: orchitis, HIV, maternal exposure to exogenous estrogen, testicular cancer in other testes
33
what are the diagnostic tests for testicular cancer?
```
• Self exam *test**
- Perform in warm area
• Physical exam
- Firm non‐tender lump
- Testicular swelling
- Although testicles may not be same size normally
• Flashlight exam
• Ultrasound of testes
• Labs – tumor markers
• CT‐Abdominal and pelvis
```
34
T/F testicular cancer may be asymptomatic
TRUE
35
what are the possible early sxs of testicular cancer?
- Painless lump
- Scrotal swelling
- Feeling of scrotal heaviness
- Non‐tender, firm mass
- Pain or ache
36
what are the possible late sxs of testicular cancer?
back or chest pain
cough
dyspnea
37
what are the different tx for testicular cancer?
Surgery – radical orchiectomy
Radiation
Chemotherapy
38
T/F: 95% have complete remission if detected and treated in early stages
TRUE
39
why aren't meds routinely used for testicular cancer and what might a man want to consider?
- Medications used can cause infertility, as well as other serious complications.
- Patients may save sperm before treatment
40
what is erectile dysfunction?
Inability to obtain or maintain an erection
41
how is ED diagnosed?
- self‐report of problem – age can affect causes
- Sexual and psychosocial history questionnaire
- Physical exam
- Labs
42
what are the possible reasons for ED for a younger man?
Stress, depression, substance abuse
43
what are the possible reasons for ED for an older man?
Atherosclerosis, medications, diabetes
44
what are the clinical manifestations of ED?
- Gradual vs sudden
- Intermittent vs continuous
- Psychological or life changes
- Distress
45
what types of drugs are known to cause ED?
- ARBs, ACE, CCB
46
what is the treatment for ED?
- Diet and lifestyle changes
- Erectogenic drugs
- Penile implants
- Sexual counseling
- Emotional support
47
what is the primary goal for someone with ED?
restore satisfactory sexual function
48
what is incontinence?
The involuntary leaking of urine
| • 80% of incontinence can be improved
49
how can incontinence be managed?
```
Causative factors
Kegel exercises to strengthen pelvic muscles
Timed voiding schedule
Medications
Surgery
```
