WEEK 6 Prostate Disorders Flashcards
(114 cards)
1
Q
What is Benign Prostatic Hyperplasia (BPH)?
A
Glandular units in the prostate that undergo an increase in number of cells (HYPERPLASIA), resulting in enlargement of prostate gland - inflammation occurs!
2
Q
What are the risk factors for BPH? (7)
A
- Aging
- Obesity (“apple”)
- Lack of physical activity
- Alcohol consumption
- Erectile dysfunction
- Smoking
- Diabetes
3
Q
BPH is influenced by __
A
androgens !
4
Q
What are symptoms of BPH? (11)
A
- Hyperirritable bladder
- Urgency and frequency
- Hypertrophied bladder wall muscles
- Cellules and diverticula
- Hydroureter
- Hydronephrosis
- Overflow urinary incontinence
- Urinary retention
- Nocturia
- they might have to strain
- stream itself might be very weak
5
Q
In BPH, prostate grows __ causing narrowing of the __.
A
inward
urethra
6
Q
The prostate should be __, __ __, and should not be __.
A
soft, freely movable
hard
7
Q
In __, the patient has similar symptoms as an individual with BPH
A
prostatitis
8
Q
For a patient with BPH, the ureter can become __, when urine is __ __ if outflow is completely obstructed from prostate enlargement. Stones can form from __ __ and __ __. When the urine backs up all the way to the __, hydronephrosis can occur.
A
irritable
backed up
urinary retention; urinary stasis
kidney
9
Q
What are diagnostic studies for BPH? (6)
A
- Digital rectal exam
- Urine analysis and culture
- Serum creatinine and BUN
- PSA (Prostate Specific Antigen)
- Urodynamic flow studies
- Cystourethroscopy
10
Q
What are treatment goals for BPH? (3)
A
- Restore bladder drainage
- Relieve symptoms
- Prevent/Treat complications
11
Q
What drug therapies are used for individual with BPH? (4)
A
- Hormonal manipulation (androgen)
- Alpha-adrenergic blockers
- Conservative therapy
- Invasive therapy
12
Q
What androgen is used in hormonal manipulation as a drug therapy method for BPH pts?
A
Proscar (finasteride)
13
Q
What is Proscar (finasteride)? What is its mechanism of action?
A
A 5-alpha-reductase inhibitor. Mechanism of Action: inhibits enzymes that converts testosterone to a potent androgen dihydrotestosterone (DHT), which the prostate glad need for its development. “Shrinks” the prostate.
14
Q
When administering Proscar (finasteride), what should you remember to do?
A
wear gloves! there’s some degree of androgens within it
15
Q
One should check __ before conducting a __ __ __ b/c the __ can be ELEVATED if __ is done first
A
PSA
digital rectal exam
PSA
DRE
16
Q
When can PSA levels be falsely elevated?
A
- when doing a digital rectal exam before getting PSA levels
- when foley catheter is inserted before getting PSA levels
17
Q
If the PSA is greater than __, a __ is done because they may potentially have prostate cancer
A
4
biopsy
18
Q
If PSA is less than __, a patient may still have __ __
A
4
prostate cancer
19
Q
What are 3 examples of alpha-adrenergic blockers used in drug therapy for BPH pts?
A
- Minipress
- Cardura
- Hytrin
20
Q
What do alpha-adrenergic blockers to help BPH pts?
A
they relax smooth muscle and increase urinary flow
21
Q
What are side effects of alpha-adrenergic blockers?
A
- orthostatic hypotension
2. dizziness
22
Q
When are alpha-adrenergic blockers normally given?
A
They are typically given at night
23
Q
What two things are used in conservative therapy for the BPH pt?
A
- stents, prostatic balloon
2. foley catheters
24
Q
What does the invasive therapy for the BPH pt consist of?
A
TURP
25
What are 4 indications for BPH surgery?
1. Decrease in urine flow sufficient to cause discomfort
2. Persistent residual in urine
3. Acute urinary retention
4. Hydronephrosis
26
What does TURP stand for?
Transurethral Resection of Prostate
27
TURP is the __ __ for BPH!
GOLD STANDARD
28
When would it be appropriate for a patient to receive a TURP?
for debilitating patient with moderate prostatic enlargement
29
Does TURP involve an incision?
NO, therefore it is less likely to cause ERECTILE DYSFUNCTION
30
Does TURP completely remove the prostate tissue?
NOPE
31
What is common for a patient undergoing a TURP?
| After the procedure what medications should you take the patient off of?
BLEEDING
Anticoagulants like Plavix, Coumadin
32
What type of anesthesia is given to the patient during a TURP? What should you check for?
semi-conscious anesthesia
check for HYPOnatremia
33
After a TURP is done, the prostate can or cannot grow back?
CAN
34
Prior to a TURP, the bladder is irrigated for the first __ hours to prevent what?
24
mucous and blood clots
35
Complications of TURP include? (4)
1. bleeding
2. clot retention
3. dilutional hyponatremia
4. retrograde ejaculation (backwards ejaculation)
36
Patients must stop __ before surgery (TURP)
ANTICOAGULANTS
37
During the TURP procedure, the bladder is ...
This person is going to have __ after procedure. Important to wash out bladder so __ aren't retained.
irrigated with lots of fluid
hematuria
clots
38
What should be included in nursing care for continuous bladder irrigation (CBI)?
1. Monitor I/O and drainage color
2. Anchor catheter
3. CAUTI Prevention
4. Pain and spasm – nl to have bladder spasms but if severe, may have clots/obstruction
39
What type of catheter is used for continuous bladder irrigation (CBI)?
a 3 way catheter - one port connected to fluids, one port connected to drainage back, one port to inflate balloon
40
What is the goal of continuous bladder irrigation (CBI)?
To keep the urine as clear as possible!
41
Remember for continuous bladder irrigation: WHAT YOU'RE PUTTING IN IS...
WHAT YOU'RE PUTTING OUT AND THEN SOME
42
If you give a patient 3 L how much should come out?
3L should come PLUS urine that is made
43
What are pre-operative assessment/nursing diagnoses for pts undergoing TURP?
1. Pain (? Anxiety)
2. Fear related to sexual dysfunction
3. Possible diagnosis of cancer
4. Knowledge deficit (surgery)
5. Risk of infection
44
What are post-operative assessment/nursing diagnoses for pts undergoing TURP?
1. Pain related to bladder spasms
2. Urge incontinence related to poor sphincter control
3. Potential for hemorrhage
4. Hyponatremia
45
What are preoperative nursing INTERVENTIONS for pts undergoing TURP?
1. use catheters (3 types)
2. treat urinary infection
3. high fluid intake (2-3 L/day)
46
What are the 3 types of catheters than can be used for pt undergoing TURP?
1. Urethral catheter – to restore urinary drainage
2. Coude catheter (curved tip catheter)
Much more rigid, harder, allows to push past prostate vs inserting TURP
3. Filiform (rigid)
47
What are postoperative nursing INTERVENTIONS for pt who has undergone TURP?
1. CBI: Use of 3 way foley catheter; removes clots, urinary drainage
2. Observe for hemorrhage
24-36 hours, normal blood clots
3. Avoid activities that increase intra-abdominal pressure – coughing, sneezing, straining (pt needs to be on stool softeners)
48
For postoperative care of the pt who has undergone TURP, urinary catheter with __ __ is placed into bladder. Apply traction via taping to patient's __ or __. Patient will feel uncomfortable urge to __ __. Tell patient not to force __. Once catheter is removed, might feel __ __ __ which is normal. Pt should increase __ __ as long as they don't have __/__ conditions.
retention ballon
abdomen; thigh
void continuously
urination
urge to void
fluid intake
cardiac/kidney
49
In caring for the client who has had a TURP, the nurse assess the client frequently for which of the following complications?
1. HTN and bradycardia
2. bright red blood and large clots in urine
3. Large amounts of dilute, light pink urine
4. Increased hgb and hct
2
50
For postoperative nursing interventions for the pt with TURP done, make sure to relieve __ __. What can you use to relieve this?
bladder spasms
1. Belladonna
2. Opium
3. Suppositories
4. Antispasmodics
51
For postoperative nursing interventions for the pt with TURP done, you should promote __ __. What can you teach the patient to achieve this?
sphincter tone
Kegel's exercise
52
The nurse should monitor for signs and symptoms of __ for the post op TURP patient.
infection
53
How do you teach Kegel's exercise?
Start urinating, hold for a couple of seconds, urinate again, and hold
54
What should you include in your patient teaching for the post op TURP pt?
1. Catheter care
2. Managing incontinence
3. Maintain adequate oral intake (2-3 L/day)
4. Sexual counseling
like Erectile dysfunction and Retrograde ejaculation
55
An older male is being evaluated for hydronephrosis . What priority health history question may provide info about cause of disorder?
1. Do have have HTN?
2. Do you have difficulty starting and continuing urinating?
3. Do you have family h/o kidney disease ?
4. Do you have UTI?
2
56
Prostate cancer consists of a __ __ of the prostate gland
malignant tumor
57
What is the most common form of cancer in MEN?
What is the ratio? What is the lifetime risk percentage?
prostate cancer
1 in 5 men
15.9%
58
Prostate cancer is the __ leading cause of cancer DEATH in men after __ cancer.
2nd
lung
59
Prostate cancer has a higher incidence in men greater than __ years and majority of deaths occur after age __.
65
75
60
Which racial group has a higher risk for prostate cancer?
African American men
61
Prostate cancer can spread locally to nearby __ __ and can eventually affect: (5)
lymph nodes
```
bone
hips
lumbar spine
liver
lungs
```
62
According to research, risk factors and causes for prostate cancer may be linked to __-__ __ and __ factors
high-fat diet; environmental
63
What are genetic risk factors for prostate cancer?
1. 3 or more 1st-degree relatives with prostate cancer
2. Prostate cancer in 3 generations on the same side of the family
3. 2 or more close relatives on the same side of the family diagnosed with prostate cancer before age 55 (Father, brother, son, grandfather, uncle, nephew)
64
What type of adenocarcinoma is a risk factor for prostate cancer?
Androgen-dependent adenocarcinoma
65
Androgen-dependent adenocarcinoma is __ growing and usually begins in the __ or __ portions of the __. Can be spread to: (6)
slow
posterior; lateral ; prostate
1. pelvic bones
2. femur (bones)
3. lymph
4. lower spine
5. liver
6. lungs
66
In the early stage of prostate cancer, patient is __.
asymptomatic
67
Prostate cancer clinical manifestations are similar to that of __.
BPH
68
What are some symptoms of prostate cancer? (6)
1. Dysuria
2. dribbling
3. frequency
4. hematuria
5. nocturia
6. retention
69
For a pt with prostate cancer, prostate feels...
hard, enlarged, and fixed on rectal exam
70
Where is pain felt for a pt with prostate cancer? And what is this indicative of?
pain in the lumbosacral area with radiation down the hips and legs are indicative of metastasis (renal calculi symptoms?)
patient may also feel pain of lymph nodes and groin area
71
Is hematuria an early or late sign of prostate cancer?
LATE sign
72
Prostate cancer pt may have pain during __ especially when __.
intercourse
ejaculating
73
Another sign of prostate cancer is sudden, unexplained __ __
weight loss
74
What are NON-DEFINITIVE diagnostic studies for prostate cancer? (2)
1. digital rectal exam (DRE)
| 2. (+) elevated PSA
75
What are abnormal findings of DRE for a prostate cancer patient?
1. areas of firmness
2. localized (nodules) or generalized
3. bogginess and asymmetry
76
What is the normal range for PSA (prostate-specific antigen) ?
0.2-4 ng/ml
77
When can there be mild elevation of PSA?
BPH
| UTI
78
the higher the PSA the larger the __ __
tumor mass
79
Since PSA and DRE are __ __ diagnoses, we need a __.
NOT definitive
BIOPSY
80
Does the U.S. Preventive Services Task Force (USPSTF) recommend prostate-specific antigen (PSA)-based screening for prostate cancer?
NO
81
Management strategies for localized prostate cancer include: (4)
1. watchful waiting
2. active surveillance
3. surgery
4. radiation therapy
82
Is there a consensus regarding optimal treatment for PSA testing?
NOPE
83
What are the harms of screening for PSA testing?
1. pain
2. fever
3. bleeding
4. infection
5. transient urinary difficulties associated with prostate biopsy
84
There can be __ harm of false-positive test results for prostate cancer screening and __.
psychological
overdiagnosis
85
The time between actual diagnosis of prostate cancer and treatment can be __ years because it is __ growing cancer. Initially, may just keep watchful observation by doing __ and __.
10
slow
DREs, PSAs
86
What are the definitive diagnostic studies for prostate cancer and metastasis?
1. Trans-rectal ultrasound
2. Prostate biopsy – confirms diagnosis
3. CT or MRI to assess metastasis
4. Elevated alkaline phosphatase indicates bone metastasis
5. Grading & Staging (TNM classification)
87
In suprapubic prostatectomy, patient has __-__ problems
co-existing
88
In suprapubic prostatectomy, what two catheters are inserted?
Suprapubic catheter & Foley catheter
89
In suprapubic prostatectomy, the foley catheter is removed __-__ __ day
2-4th
postoperative day
90
In suprapubic prostatectomy, the __ tube has a greater risk for bladder spasms
suprapubic
91
For a patient who had a suprapubic prostatectomy, monitor frequently for __ on __
urine; dressing
92
For post-op CBI, watch for __ and __ in the patient who had a suprapubic prostatectomy.
hyponatremia
| seizures
93
In the suprapubic catheter, catheter goes through the __
bladder
94
For a suprapubic prostatectomy, it can be done __ therefore the patient can go home more __
microscopically
quickly
95
There is less risk for __ __ for a suprapubic prostatectomy because this procedure does not cut __ __
erectile dysfunction
perineal nerves
96
In retropubic prostatectomy, is there a bladder incision?
No
97
How do you perform catheter care for retropubic prostatectomy?
clean urethral meatus with soap and water
secure catheter
98
In retropubic prostatectomy, wound is serosanguinous for __-__ days
4-5
99
In retropubic prostatectomy, discharge with catheter for __-__ days
3-5
100
In retropubic prostatectomy, how do you help with urinary incontinence?
Kegel's exercises
101
What are discharge teaching instructions for retropubic prostatectomy?
1. No lifting heavy objects
2. no driving
3. no sex
4. drink 2-3 liters/day
5. stool softeners
6. high fiber in diet
7. walk
8. question about impotence
102
Can retropubic prostatectomy cause erectile dysfunction?
yes
103
Can retropubic prostatectomy including the removal of lymph nodes?
yes
104
Can patients go home with a catheter after a retropubic prostatectomy?
yes
105
What is Erectile Dysfunction?
it is an inability to achieve or maintain erection for sexual intercourse
106
what is organic vs. functional ED?
physiologic vs. psychosocial
107
how does a nurse assess for ED?(3)
1. medical, social, sexual history
2. complete physical examination
3. duplex doppler ultrasonography test
108
What are some Organic (Physiologic)
| Causes of ED? (10)
1. Inflammation of prostate, urethra or seminal vesicle
2. Surgery, e.g., prostatectomy
3. Pelvic fractures
4. Lumbosacral injuries
5. Vascular disease, e.g., HTN – may have impairment of blood flow
6. Chronic neuro conditions, e.g., Parkinson’s or MS
7. Endocrine disorders, e.g., DM or thyroid
8. Smoking & alcohol
9. Drugs, e.g., antihypertensives
10. Poor overall health
109
how can DM affect ED?
DM can interfere with blood flow, microscopic changes in vessels
110
What are some Collaborative Care for ED?
- Phosphodiesterase-5 (PDE-5) inhibitors, e.g., sildenafil (Viagra), Levitra, Cialis
- --1st line oral drugs
- --Relax corpora cavernosa to ↑ penile blood flow
- --Compress exit veins, limiting outward blood flow → penile tumescence (swelling)
- --Teach to take 30 minutes to an hr before intercourse
- --> natural → preferred by most men & partners
* * basically to relax smooth muscle to let blood flow in.
111
What are other Collaborative Care of ED?
1. Instruct pts to abstain from alcohol before intercourse
2. Educate re: common side effects of PDE-5 inhibitors
- --Dyspepsia, H/A, facial flushing, stuffy nose
- --If > 1 pill: leg & back cramps, n/v may also occur
- --If taking nitrates, do NOT take PDE-5 inhibitors!
- ----Profound ↓ BP & ↓ blood flow to vital organs
3. If can’t take PDE-5 inhibitors or ineffective, use other methods
112
What is one caution about a pt taking PDE-5 inhibitors?
Don’t want patient on NTG – avoid 24-48 hours between NTG and PDE-5 inhibitors – if taken together, will have severe hypotension
113
What is Priapism?
erection that won’t go away for 4 hours that can be life threatening = medical emergency
114
What is one way to remove erection?
Aspirate blood, use injection of medications like phenoephrine (but you worry about hypotension?) to remove erection, other vasodilators
