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Med Surg > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Erectile dysfuntion (organic)

A

due to gradual reduction in function from other sources

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2
Q

Erectile dysfunction (functional)

A

due to psychologicla cuase such as high stress

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3
Q

risk factors for BPH

A

increased age
smoking/chronic alcohol use
sedentary lifestyle
western diet
DM/ heart disease

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4
Q

BPH s/s

A

I-PSS
{determine severity of manifestations and effect on QOL
0-5}
urinary frequency, urgency, hesitancy, or incontinence
urinary stasis and persistent urinary retention
back flow of urine into ureters and kidney

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5
Q

BPH labs

A

WBC elevated, RBCs decreased
Elevated BUN/creatinine
need prostate-specific antigen to rule out prostate cancer
hematuria

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6
Q

BPH diagnostics

A

digital rectal exam
Transrectal ultrasound with needle aspiration biopsy
Early prostate cancer antigen

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7
Q

BPH meds

A

alpha-blocking agents
DHT lowering meds

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8
Q

alpha-blocking agents

A

tamsulosin
cause relaxation of bladder outlet and prostate gland
decrease pressure on urethra
CLIENT ED
{tachycardia, syncope, posteural hypotension can occur with cimetidine}

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9
Q

DHT lowering meds

A
  • finasteride
  • decrease production of testosterone and size of prostate
  • can take 6 months to work
  • impotence and decrease in libido
  • report breast enlargement
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10
Q

Breast Cancer risk factors

A
  • Hx of previous breast cancer
  • BRCA1 BRCA2 genes
  • Dense breast tissue
  • over 65
  • first degree relatives
  • early menarche
  • late menopause
  • no pregnancy or first pregnancy after 30
  • oral contraceptives
  • high-fat, low-fiber diet
  • obesity
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11
Q

Breast cancer s/s

A
  • breast pain or sore ness
  • painless hard palpable masses on outside region of breast
  • skin changes (peau d’orange), dimpling, increase vascularity
  • nipple discharge, retraction, or ulceration
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12
Q

when to consider getting BRCA 1 and 2 testing for breast cancer

A

if two first-degree relatives were diagnosed prior to age of 50 or fhx of breast/ovarian cancer

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13
Q

ovarian ablation

A
  • used for breast cancer
  • LH-RH
  • leuprolide or goserelin
  • inhibits estrogen synthesis
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14
Q

SERMS

A
  • toremifene
  • women who are at high risk for breast cancer
  • suppress growth of remaining cancer cells postmastectomy or lumpectomy
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15
Q

tamoxifen dangers

A
  • increase the risk of endometrial cancer, DVT, PE
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16
Q

surgical interventions for breast cancer

A
  • lumpectomy (breast-conserving)
  • wide excision or partial mastectomy
  • total mastectomy
  • modified mastectomy
  • radial mastectomy
  • CLIENT ED:
    a) sit with HOB 30 degrees, lie on unaffected side
    b) wear sling
    c) avoid all usage of affected arm
    d) monitor surgical drains
    e) drains removed after 1 to 3 weeks
    f) watch for lymphedema
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17
Q

Health promotion for Ovarian Cancer

A
  • use of birth control pills and pregnancy
  • risk reducing or prophylactic bilateral salpingo–ooporectomy
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18
Q

Ovarian Cancer risk factors

A
  • > 40
  • nulliparity or first pregnancy after 30
  • DM
  • FHX
    = endometriosis
    = high-fat diet
  • infertility
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19
Q

S/S Ovarian cancer

A
  • abdominal pain/swelling
    adominal discomfort
    abdominal mass
    vaginal bleeding urianry frequency or incontinence
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20
Q

tumor markers for ovarian cancer

A

germ cell: hCG, AFP, LDH elevated
epithelial CA-125 elevated

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21
Q

surgical interventions for ovarian cancer info

A
  • Exploratory laprotomy
  • TAH with BSO
  • nursing actions:
    a) observe for urinary retention and difficulty voiding
    b) assess bowel sounds
  • client ed:
    a) avoid straining, driving, lifting > 5 lb, sex or vaginal cleaning until provider gives release
    b) immediately report evidence of infection, vaginal discharge that is excessive or has a foul odor
  • complications:
    a) abdominal ascites and intestinal obstruction
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22
Q

Endometrial Cancer health promotion

A
  • avoid the use of unopposed estrogen
  • avoid smoking
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23
Q

Endomerial cancer risk factors

A
  • family history of endometrial or colorectal cancer
  • DM
  • HNPCC
  • nulliparity
  • use of tamoxifen
  • late menopause
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24
Q

Radiation therapy and endometrial cancer

A
  • brachytherapy: seed in vagina, occur 2 - 10x/week; client must stay in bed during treatment.
    client ed:
    a) report vaginal bleeding, urethral burning, hematuria, fatigue, diarrhea, fever or abdominal pain
    b) no radioactivity between treatments and no visitation restrictions
  • EBRT: delivered outside, used in combo with surgery, given for 4 to 6 weeks outpatient basis
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25
Q

Cervical cancer health promotion

A
  • get HPV vaccine
  • Pap and pelvic exams
  • HPV screening every 5 years for women 30 - 65
  • limit sex partner
  • avoid smoking
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26
Q

risk factors cervical cancer

A
  • infeciton iwht HPV
  • chronic cervical infection or inflammation
  • infection with immunosuppressive dsorder
  • early sexual activity (before 18)
  • fhx of cervical cancer
  • cigarette smoking
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27
Q

s/s cervical cancer

A
  • painless vaginal bleeding between menses
  • dysuria, hematuria
  • watery, blood-tinged vaginal discharge (early findings)
  • dark, foul-smelling discharge (late finding)
  • leg pain or edema (late)
  • rectal bleeding
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28
Q

therapeutic procedure for cervical cancer

A

1) removal of lesion via conization, cryotherapy, laser ablation, hysterectomy; teach client to report heavy vaginal bleeding, foul-smeelling discharge or fever, vaginal discharge is normal, don’t lift, avoid vaginal penetration, douches, and tampons for about 3 weeks, and take showers instead of baths
2) radiation
3) hysterectomy
4) exenteration

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29
Q

exteneration

A

removal of all pelvic organ and lymph nodes; manage drains as well as urinary and bowel diversions; monitor vaginal bleeding (normal = 1 saturated perineal pad every 4 hrs)

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30
Q

TURP

A
  • for BPH
  • use epidural and spinal anesthesia
  • must assess CV, respiratory and renal systems preop
  • postop care:
    a) ambulate ASAP
    b) administer: antisposmatics, stool softeners, antibiotics, and analgesics
    c) after catheter removal: monitor Urine output, the inital voiding may be uncomfortable, red in color, urine will progress toward amber in 2 to 3 days, expected output of 150 to 200 mL every 3 to 4 hrs
  • client education:
    a) avoid heavy lifting for 2 to 6 weeks
    b) increase water intake
    c) avoid NSAIDs, bladder stimulants
31
Q

medications for ED

A
  • PDE-5 inhibitors and vasodilators
  • NEED CV WORKUP*
32
Q

vasodilators and ED

A

injected into penis to cause engorgement leading to erection

33
Q

PDE-5 Inhibitors and ED

A
  • relaxes smooth muscles to increase blood flow; take meds 1 hour before sex, may cause dyspepsia headaches facila flushing and stuffy nose
  • can only take 1 dose per day more than one may lead to leg and back cramps and n/v
  • DONT TAKE NITRATES
34
Q

VCD

A

cylinder placed around penis while vacuum is created to draw blood into penis; place rubber ring at base to maintain erection

35
Q

alprostadil

A
  • penile supository (vasodilator)
  • take 10 minutes before intercourse
  • erections can last up to 1 hour and be used bid
  • dont recommend with pregnant partners
36
Q

prostatitis s/s

A

acute: boddy, tender prostate, palpitation in prostate results in urethral discharge containing WBC, dysuria
chronic: urinary hesitancy, frequency, difficulty initiating and stopping urine flow, decreased strength and volume of urine, pain in back and perineal area

37
Q

client ed for prostatitis

A
  • take meds as directed
  • avoid OTC
  • avoid diuretics
  • sex and masturbate to help with chronic problem
38
Q

whipple procedure info

A
  • removal of head of pancreas, duodenum, and parts of jejunum and stomach, gallbladder, and maybe spleen
  • monitor NG, for bloody or bile tinged drainage, place in semi-fowlers, montior BG and administer insulin
  • complications include extensive blood loss, hypervolemia, fluid/electrolyte imbalance, uncontrolled BG, kidney failure, third spacing, respiratoyr disters, and ileus obstruction; fistulas, peritonitis, and throboembolism
  • treatment is usually palliative (stent and bypass surgery)
39
Q

pancreatic cancer risk factors

A
  • chronic pancreatitis
  • cirrhosis
  • > 45 male
  • DM
  • high intake of red meat or high fat diet
40
Q

s/s of pancreatic cancer

A

same as pancreatitis with gallbladder or liver symptoms

41
Q

Trousseau’s sign

A

hand spasm when BP cuff is inflated

42
Q

cullen’s sign

A

periumbilical bluish-gray discoloration

43
Q

grey-turner sign

A

ecchymoses on flanks

44
Q

fibrocystic breast information

A
  • rf: premenopausal or postmenopausal hormone therapy
  • s/s: breast pain, tender rubberlike lumps upper outer quadrant, rope like consistency
  • dx: breast ultrasound to confirm, fine-needle aspiration to confirm dx or reduce pain
  • recommend reducing intake of salt before menses, discuss risks of hormonal medication therapy
  • give: ibuprofen or acetaminophen, diuretics (decrease engorgements), oral contraceptives or hormonal meds to decrease/ suppress estrogen/progesterone secretions
45
Q

hysterectomy client education

A
  • dont lift anything > 5 lb or sex for 6 weeks
  • sutures are absorbable
  • avoid straining
  • monitor for infections
46
Q

complications of hysterectomy

A
  • dyspareunia, vaginal erosion and serious infection
47
Q

kegel exercise information

A
  • contract circumvaginal and perirectal muscles gradually increasing contraction period to 10 seconds, with a relaxing period of 10 seconds after, do 30 to 80 times per day, perform when lying down, sitting, or standing, keep abdominal muscles relaxed during contractions; helps strengthen pelvic floor muscles
48
Q

therapeutic procedures for cystocele and rectocele

A

intravaginal estrogen, bladder training, kegel exercise, vaginal pessary, anterior-posterior repair, hysterectomy, transvaginal repair

49
Q

posterior colporrhaphy

A
  • using vaginal or perineal approach pelvic muscles are shortened and tightened
  • postop care: warm compresses, sitz baths, low residue diet, administer analgesics, antimicrobials, and stool softeners
  • for rectocele
50
Q

anterior colporrhaphy

A
  • for cystocele
  • using vaginal or laproscopic approahc pelvic muscles are shortened and tightened leading to icnreased bladder support
51
Q

s/s of cystocele

A
  • urianry frequency and or urgency
  • stress incontinence
  • hx of UTI
  • feeling of fullness
52
Q

cystocele risk factors

A
  • obses
  • advanced age
  • fhx
  • multiparity
  • increased abdominal pressure during pregnancy
  • strain and injury during vaginal childbirth
53
Q

rf rectocele

A
  • pelvic structure defects
  • family history
  • difficult vaginal childbirth necessitating repair of a tear
54
Q

s/s rectocele

A
  • constipation and/or the need to place fingers to elevate vagina to elevate rectocele to complete evacuation of feces
  • sensation of mass in vagina
  • pelvic or rectal pressure/pain
  • dysparenunia
  • fecal incontinence
  • hemorrhoids
  • uncontrollable flatus
55
Q

disease prevention for cholecystitis/cholelithiasis

A
  • low fat diet rich in HDL
  • regularly exercise
  • dont smoke
56
Q

rf for gallbladder diseases

A
  • female
  • obese
  • genetic
  • DM, chron’s
  • low calorie, liquid protein diet
  • rapid weight loss
  • estrogen therapy and use of some contraceptives (oral)
57
Q

s/s for gall diseases

A
  • sharp pain in RUQ that radiates to right shoulder
  • murphy’s sign
  • blumberg’s sign (rebound tenderness)
  • jaundice, icterus, clay colored stool, pruritus
58
Q

labs for gall diseases

A
  • increased WBC
  • increased lipase and amylase
  • increased liver enzymes and increased bilirubin (if bile duct is obstructed)
59
Q

gallbladder disease diagnostics

A
  • HIDA
  • endoscopic retrograde cholangiopancreatography
  • MRI
  • CT/abdominal xray
  • ultrasound
60
Q

meds for gallbladder disease

A
  • morphine sulfate, hydromorphone (acute pain)
  • ketorolac for mild to moderate pain (NSAIDs)
  • bile acids (-odiol); gradually dissolves cholesterol based gall stones; dont take with liver condition, report abdominal pain, diarrhea, or vomiting, limit to 2 years, and gallbladder ultrasound every 6 months for first year
61
Q

complications of gallbladder diseases

A
  • obstruction of bile duct that can cause ischemia, gangrene, and rupture of gallbladder wall
  • bile peritonitis (monitor for pain, fever, jaundice, report immediately) occurs if bile is not adequately drained form surgical site
  • postchlecystecomy syndrome (gallblader disease post surger can recur immediately or months after)
62
Q

therapeutic procedures for gallbladder diseases

A
  • extracorporeal shock wave lithoscopy (breaks up stones who are normal weight and have small cholesterol based stones). Lay them on fluid filled pad and administer aanalgesia, it can be painful
  • cholecystectomy: removal of gallbladder, discharged within 24 hrs in laproscopic, if open approach - hospitalization for 1 to 2 days
63
Q

open approach to gallbladder disease treatment

A
  • need either: JP drain in gallbladder bed or T-tube in common bile duct
64
Q

care of JP tube

A
  • monitor and record drainage (starts serosanguinous with green-brown bile tinge), give antibiotics
65
Q

care of T-tube

A
  • report an absence of drainage with Nausea and pain
  • inspect around skin for infection or bile leakage
  • keep above level of abdomen
  • clamp tube 1 hour before and after meals
  • monitor for bile peritonitis
  • remove after 1 to 3 weeks
  • monitor and document response to food
66
Q

education for laprascopic or NOTES approach for gallbladder

A
  • ambulate frequently to decrease free air pain (pain that radiates to shoulder)
  • report bile leak
  • monitor incision
67
Q

open approach gallbladder education

A
  • avoid heavy lifting for 4 to 6 weeks
  • clear liquids and advance to solid food as peristalsis returns
  • take showers until tube removed
  • color of stool will return to brown in about a week; common diarrhea
68
Q

post surgery gallbladder diet

A
  • low fat diet
  • small, frequent meals
  • avoid gas forming foods
  • ocnsider weight reduction
  • take fat-soluble vitamins (ADEK), or bile salts
69
Q

s/s of pancreatitis

A
  • Grey-Turner sign
  • Cullen’s sign
  • Tetany (b/c hyocalemia)
  • Trousseau’s sign
  • Chvostek’s sign
  • generalized jaundice
  • absent or decreased bowel sounds
  • left sided abdominal pain that gets worse when lying down and is relieved by sitting, fetal positon, or bending forward
70
Q

rf of pancreatitis

A
  • alcohol use
  • gi surgery
  • cigarette smoking
  • GI surery
  • biliary tract disease
  • ERCP
71
Q

treatment for pancreatitis

A
  • ERCP (creating opening if caused by gallstones)
  • Cholecystectomy (if due to gallstones or cholecystitis)
  • sphincterotomy (enlarge panc duct)
  • pancreaticojejunostomy (reroutes drainage to jejunum)
  • Endoscopic pancreatic necrosectomy: remove necrotic tissue
72
Q

medications for pancreatitis

A
  • opioid (morphine/hydromorpone - acute pain), ketorolac (moderate)
  • imipenem (for acute necrotizing pancreatitis, watch for seizures)
  • rantidine (decrease gastric acid secretion; take 1 hour before or after antacid)
  • omeprazole (decrease gastric acid secretion, monitor for hypomagnesemia)
  • pancrelipase (aids digestion of fats and proteins; sprinkle on all food except proteins and drink full glass of water, take after antacid or histamine receptor antagonist, wipe mouth after)
73
Q

complications of pancreatitis

A
  • hypovolemia
  • pancreatic infection
  • type 1 diabetes
  • left lung effusion and atelectasis
  • coagulation defects
  • multisystem organ failure
74
Q

nursing care for pancreatitis

A
  • rest pancreas (NPO, bland, high protein low fat diet, small frequent meals, antiemetic, NG, pain management), position client for comfort, monitor blood glucose, monitor hydration, admin IV and electrolyte replacement, administer analgesics

Med Surg (2 decks)

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