Week 7; Acute Care Kidney Injury & Sexual Dysfunction

Question 1

AKI

Answer 1

Rapid reduction in kidney function; failure to maintain fluid and electrolyte balance and acid–base balance with accumulation of nitrogenous waste products in the blood. Evidenced by increased creatinine and BUN. Occurs over a few hours or days, causes systemic effects and complications, can result in death.

Question 2

Glomerular filtration

Answer 2

First step in urine formation. Normal GFR averages 125 mL/min totaling 180 L day – this is included in reabsorption. Otherwise severe dehydration and death. Only about 1-3 L is excreted each day as urine.
GFR is controlled by BP and blood flow.
Kidneys self-regulate their own blood pressure and blood flow which keeps GFR constant
GFR decreases with age.
By age 65 the GFR is about 65mL/min (half of rate of a young adult) which increases risk of fluid overload.
Diabetes, HTN, or heart failure causes an even faster decline
The combination of reduced kidney mass, reduced blood flow, and a greater risk for drug reactions and kidney damage from drugs and contrast media in older adults.

Question 3

AKI etiology

Answer 3

More likely in hospitalized adults with advanced age or pre-existing conditions, burns, third spacing depletes kidney of fluid, reduced cardiac output and fluid loss

Question 4

3 Categories of Causes of AKI:

Answer 4

1. Prerenal Causes – perfusion reduction, hypovolemia, low cardiac output
2. Intrarenal Causes - Kidney damage, acute tubular necrosis, injury
3. Postrenal Causes – Urine Flow Obstruction (Ureteral or Urethral)

Question 5

Postrenal AKI causes

Answer 5

Ureteral obstruction from cancer, calculi, external obstruction, prostate enlargement, calculi, cancer, stricture, blood clot

Question 6

Nursing priority with AKI

Answer 6

Preventing volume depletion and providing early intervention when volume depletion occurs are nursing PRIORITIES
Reduced perfusion is common cause of AKI

Question 7

Reduced perfusion is a common cause of AKI; assess for:

Answer 7

Low urine output – oliguria begins within 1 day after a hypotensive event and can last 1-3 weeks
Decreasing BP
Decreasing pulse pressure
Orthostatic hypotension

Question 8

Hypovolemic shock review

Answer 8

Abnormally decreased volume of circulating fluid causing peripheral circulatory failure
Endangers vital organs
Brain, heart, kidneys are particularly vulnerable
Tachycardia is an early sign of compensation for excessive blood loss
Tachycardia, tachypnea, BP normal initially, decrease or narrowing in pulse pressure (difference between systolic and diastolic)
elevated BP can occur initially until compensatory mechanisms fail
Acidosis with vasodilation and decreased BP, increased bleeding, decreased circulating volume, and subsequent organ death

Question 9

Health promotion in the patient with AKI

Answer 9

Avoid dehydration by drinking 2 to 3 L of water daily, be aware of urine characteristic changes, such as sediment, hematuria (smoky or red color), foul odor, or any other worrisome changes, avoid nephrotoxic substances such as NSAIDS, antibiotics, organic solvents, chemicals like pesticides, heavy metals

Question 10

Assessment of the patient with AKI

Answer 10

Urine characteristic changes or obstructive problems
Recent surgery or trauma
Drug history
Coexisting conditions
Acute illnesses (immunity-mediated AKI)
Anticipate AKI after hypotension or shock

Question 11

Oliguria output-

Answer 11

<400 ml/24 hours

Question 12

Anuria output-

Answer 12

<50 ml/day

Question 13

Labs in pts with AKI

Answer 13

Creatinine, BUN
GFR (normal 90ml/min or higher)
Electrolyte values (K+, phosphorus, sodium)
Renal phosphate increases and calcium binds – so hyperphosphatemia with hypocalcemia
24 hour creatinine clearance

Question 14

Treatment of AKI

Answer 14

Avoid hypotension, maintain fluid balance
Reduce exposure to nephrotoxic agents
Frequently monitor laboratory values
Closely watch I/O
Drug therapy – including diuretics to rid body of retained fluid, waste products (Lasix (furosemide), Mannitol)
Nutrition therapy
Kidney replacement therapy (intermittent versus continuous)

Question 15

Why is nutrition therapy needed in AKI?

Answer 15

Patients with AKI often have high rate of catabolism (protein breakdown). Rate of protein breakdown correlates with the severity of uremia and azotemia (increase presence of nitrogenous wastes in blood). Parenteral nutrition may be indicated because patient is too ill.

Question 16

Signs of uremia-

Answer 16

n/v, anorexia, headache, dizziness, coma, death

Question 17

Nutrition needs in pts with AKI

Answer 17

Several kidney specific supplements that are lower in sodium, potassium and phosphorus but high in calories. Lower protein, carbs increased. Goal is to provide sufficient nutrients to maintain or improve nutrition status, preserve lean body mass, restore or maintain fluid balance and preserve kidney function

Question 18

Azotemia –

Answer 18

build up of nitrogen based wastes

Question 19

Uremia –

Answer 19

azotemia with symptoms

Question 20

Key features of uremia

Answer 20

Metallic taste in mouth
Anorexia
N/V
Muscle cramps
Uremic “frost” on skin
Itching – caused by uremic frost, and excess phosphorus
Fatigue and lethargy
Hiccups
Edema
Dyspnea
Paresthesias

Question 21

Albumin in the urine is a marker of __ __, whereas GFR reflects __ __.

Answer 21

kidney damage, kidney function

Question 22

Teach patients with mild CKD:

Answer 22

carefully managing fluid volume, blood pressure, electrolytes, and other kidney damaging diseases by following prescribed drug and nutrition therapies can slow progression to end-stage kidney disease.

Question 23

Stage 1 CKD

Answer 23

Patient may have normal GFR >90 but have abnormal urine findings, structural abnormalities or genetic traits that point to kidney disease

Patient is at increase risk for kidney damage from infection, pregnancy, dehydration, and hypotension

Careful management of conditions such as diabetes, hypertension, and hear failure can slow onset and progression

Question 24

Stage 2 CKD

Answer 24

GFR reduced ranging between 60-89
Albuminuria may be present
Kidney nephron damage has occurred.
There may be slight elevations in BUN, serum creatinine, uric acid, and phosphorus

Question 25

Stage 3 CKD

Answer 25

GFR reduction continue and ranges between 30-59 Albuminuria usually present Nephron damage greater and azotemia reflecting poor waste elimination is present

Question 26

Stage 4 CKD

Answer 26

Waste elimination poor GFR 15-29 Manage complication Educate about options for renal replacement therapy

Question 27

Stage 5 CKD

Answer 27

End stage kidney disease (ESKD) GFR <15 Kidneys cannot maintain homeostasis Waste elimination poor and without kidney replacement therapy death will result

Question 28

Systemic changes associated with CKD: Metabolic changes

Answer 28

Electrolyte changes Early stages hyponatremia, later stages hypernatremia Hyperkalemia – late stage during diuresis - hypokalemia As more nephrons are lost – METABOLIC ACIDOSIS KUSSMAUL respirations – increases with worsening kidney disease Respiratory system tries to adjust or compensate for increased blood hydrogen, acidosis or decreased pH by increasing rate and depth of breathing causing further acidosis, particularly severe in DKA

Question 29

Systemic changes associated with CKD: cardiac changes

Answer 29

Hypertension Hyperlipidemia (increased triglyceride, total cholesterol, and LDL) Heart failure Pericarditis Hematologic/immunity changes GI changes Cognitive and functional changes

Question 30

CKD incidence

Answer 30

African-Americans are nearly 3X as likely to develop kidney diseases than white populations. Kidney disease linked to HTN.

Question 31

Health promotion and maintenance in pts with CKD

Answer 31

Control diseases that lead to CKD, dietary adjustments, weight maintenance, smoking cessation, exercise, limitation of alcohol

Question 32

CKD teaching

Answer 32

Teach adults treated for an infection anywhere in the kidney/urinary system to take all antibiotics as prescribed. Urge adults to drink at least 2 L of water daily unless a health problem requires fluid restriction. Caution adults who use NSAIDs to use the lowest dose for the briefest time period because these drugs interfere with blood flow to the kidney. High-dose and long-term NSAID use reduces kidney function.

Question 33

CKD assessment

Answer 33

Weight and height Daily weights, use same scale, same time of day Medical history, especially of kidney or urologic origin Drug use Dietary habits GI and GU problems Energy level

Question 34

Physical assessment/signs and symptoms in CKD

Answer 34

Neurological and sensory changes Fluid overload Tachypnea and hyperpnea Anemia, abnormal bleeding Foul breath, mouth inflammation or ulceration Osteodystrophy Protein, sediment, or blood in urine Skin discoloration or uremic frost

Question 35

CKD assessment

Answer 35

Laboratory assessment Various blood and urine tests GFR estimated from serum creatinine, age, gender, race, and body size Imaging assessment x-ray findings Kidney or CT scan

Question 36

Patients with CKD are at risk for;

Answer 36

fluid overload, decreased cardiac function, and weight loss due to inability to ingest, digest, or absorb food and nutrients as a result of physiologic factors, potential for infection, injury, fatigue, anxiety, depression

Question 37

Erthropoietin

Answer 37

EPO and reduced RBC production decreased. Risk for anemia Patient may be prescribed Erythropoietin-Stimulating Agents such as: Epoetin Alfa (Epogen or Procrit) injection Signals bone marrow to make more RBCs Monitor Hgb levels – do not give if over 13g/dL

Question 38

Common drugs used in CKD

Answer 38

Loop Diuretics – Lasix Vitamins and minerals Combo bicarb, insulin, glucose if K+ rises too high Folic acid, iron supplements Erythropoietin Stimulating Agents – Epogen (anemia), decreases need for blood transfusion

Question 39

Managing acidosis

Answer 39

Sodium bicarb or calcium carbonate to correct mild acidosis Oral phosphorus binding agents to lower serum phosphate levels such as calcium carbonate or calcium acetate) Aluminum hydroxide for acute hyperphosphatemia Vit D supplements to improve calcium absorption

Question 40

Kidney replacement therapy

Answer 40

Used for patients with loss of kidney function and inadequate waste elimination. Indications: uremia, persistent or rapidly rising high potassium levels (greater than 6.5), severe metabolic acidosis (ph less than 7.1), or fluid overload that inhibits tissue perfusion. If AKI occurs with drug or alcohol intoxication, KRT can also remove toxins

Question 41

Hemodialysis

Answer 41

Most commonly done on intermittent basis. Can be done on inpatient, mostly done on outpatient in a dialysis center. Often done 2-3 times per week – takes approx. 4 hours. Most commonly, patient has a fistula for access. A dialysate and blood flow in opposite directions. The dialysate contains a balanced mix of electrolytes and water resembling human serum. Circulating process continues removing wastes. Blood clotting can occur during the procedure and anticoagulation, usually heparin is delivered into the blood circuit via a pump

Question 42

Vascular access for dialysis

Answer 42

Temporary catheter is placed in a central vein, most often internal jugular. Long term dialysis catheter may be placed by interventional radiology Intermittent done at bedside. Most units are portable and a dialysis machine is brought to the unit

Question 43

Continuous Kidney Replacement (hemofiltration)

Answer 43

is an alternative method for removing wastes ad restoring acid-base balance and fluid and electrolyte balance. Continuous Kidney Replacement is done over 12-24 hours. Hospitalized patients are too unstable to tolerate changes and may be in ICU

Question 44

Dialysis disequilibrium syndrome –

Answer 44

headache, N/V. changes in LOC – thought to be caused by rapid reduction in electrolytes

Question 45

Assessment of the pt receiving hemodialysis

Answer 45

Weight, VS, orthostatic hypotension, vascular access device, LOC, headache, N/V, labs, dialysis disequilibrium syndrome, cardiac symptoms, signs of infection

Question 46

Peritoneal Dialysis (PD) route

Answer 46

Siliconized rubber catheter placed into abdominal cavity for infusion of dialysate. Types of PD (selection depends on patient’s ability and lifestyle) Continuous ambulatory Multiple-bag continuous ambulatory Automated Intermittent Continuous-cycle

Question 47

Peritoneal Dialysis (PD)

Answer 47

Usually infused by gravity into peritoneal space over a 10-20 minute period according to patient’s tolerance. Fluid stays in the cavity for a specified time prescribed individually for each patient by the nephrologist. Then fluid flows out of the body (drains) by gravity into a drainage bag. Peritoneal dialysis occurs through diffusion and osmosis across the semipermeable peritoneal membrane and capillaries. There are also machines that can perform peritoneal dialysis including at home machines.

Question 48

Automated Peritoneal Dialysis

Answer 48

Permits in-home dialysis during sleep, allowing the patient to be dialysis free during waking hours. The incidence of peritonitis is reduced with APD because fewer connections and disconnections are needed. Also, APD can be used to deliver larger volumes of dialysis solution for patients who need higher clearances.

Question 49

Intermittent peritoneal dialysis (IPD) 

Answer 49

combines osmotic pressure gradients with true dialysis. The patient usually requires exchanges of 2 L of dialysate at 30- to 60-minute intervals, allowing 15 to 20 minutes of drain time. For most patients, 30 to 40 exchanges of 2 L three times weekly are needed. IPD treatments can be automated or manual.

Question 50

PD complications

Answer 50

Peritonitis Pain Tunnel infections Poor dialysate flow Fibrin clot formation Dialysate leakage Other complications

Question 51

Caring for the patient receiving PD

Answer 51

Before treatment: Evaluate baseline vital signs, weight, laboratory tests Continually monitor patient for respiratory distress, pain, discomfort Monitor prescribed dwell time, initiate outflow Observe outflow amount and pattern of fluid

Question 52

Kidney transplant

Answer 52

Candidate selection criteria Free of problems that might raise procedural risk Certain conditions preclude kidney transplant Donors Available kidneys matched based on tissue similarity between donor and recipient Organs from LRDs have highest rates of kidney graft survival Physical criteria must be met

Question 53

Kidney transplant pre-op care

Answer 53

Immunologic studies Dialysis 24 hours before surgery

Question 54

Kidney transplant complications

Answer 54

Many complications possible after kidney transplantation. Early detection and intervention improve the chances for graft survival. Rejection is the most serious complication of transplantation and is the leading cause of graft loss. A reaction occurs between the tissues of the transplanted kidney and the antibodies and cytotoxic T-cells in the recipient's blood. These substances treat the new kidney as a foreign invader and cause tissue destruction, thrombosis, and eventual kidney necrosis. Lifetime anti-rejection medication.

Question 55

Post op care of kidney transplant

Answer 55

Urologic management Assessment of hourly urine output × 48 hours Complications Rejection Thrombosis Renal artery stenosis Other complications Immunosuppressive drug therapy

Question 56

Goals for pt with CKD

Answer 56

Achieve and maintain appropriate fluid and electrolyte balance Maintain an adequate nutrition status Avoid infection at the vascular access site Use effective coping strategies Prevent or slow systemic complications of CKD, including osteodystrophy Report an absence of physical signs of anxiety or depression

Question 57

Urolithiasis

Answer 57

Is the presence of calculi or stones in the urinary tract. Stones often do not cause symptoms until they pass into the lower urinary tract causing severe pain. Stones are particles in the urine that occur in amounts too high to stay dissolved in the urine. Particles precipitate and form calculi

Question 58

Nephrolithiasis

Answer 58

is formation of stones in the kidney

Question 59

Ureterolithiasis

Answer 59

Is formation of stones in the ureter.

Question 60

Stones can cause:

Answer 60

Pain associated with ureteral spasm is excruciating and may cause the patient to go into shock form stimulating nearby nerves Hematuria may result from damage to the urothelial lining If obstruction in not removed, urinary stasis can lead to infection and impair kidney function to side of the blockage As blockage persist, hydronephrosis can result

Question 61

hydronephrosis

Answer 61

Enlargement of kidney and possibly permanent damage

Question 62

Stone formation r/t

Answer 62

Dehydration Obesity Diabetes Gout Calcium, vitamin D and high dose Vitamin C

Question 63

Prevention of stone formation:

Answer 63

high intake of fluids, fruit vegetables, low consumption of protein and a balanced intake of fats and carbs

Question 64

Renal Colic –

Answer 64

Severe pain related to stones. Sometimes sudden, unbearable pain, causes N/V, pallor, diaphoresis. A large stationary stone may not cause pain because it is not moving, when stone reaches bladder, frequency and dysuria can occur

Question 65

Urinary tract obstruction

Answer 65

is an emergency and must be treated immediately to preserve kidney function

Question 66

Assessment of pt with calculi

Answer 66

Check for bladder distention Assess pain – onset, location, description, intensity, Pale, ashen, diaphoretic UA – low pH is associated with uric acid and cysteine stones, high pH is associated with calcium phosphate and struvite stones 24 hour urine collection – determine whether supersaturation of common stone particles is present Hematuria WBC and bacteria may be present as a result of urine stasis Serum WBC elevated Current standard for confirmation – CT can

Question 67

Assessment of pt with calculi

Answer 67

Check for bladder distention Assess pain – onset, location, description, intensity, Pale, ashen, diaphoretic UA – low pH is associated with uric acid and cysteine stones, high pH is associated with calcium phosphate and struvite stones 24 hour urine collection – determine whether supersaturation of common stone particles is present Hematuria WBC and bacteria may be present as a result of urine stasis Serum WBC elevated Current standard for confirmation – CT can

Question 68

Managing pt with calculi

Answer 68

Acute nursing interventions focus on promoting comfort and prevent infection and urinary obstruction Most patient expel the stone without invasive procedures The larger the stone and higher up in the urinary tract, the less likely to pass When passed, should be capture if possible for lab analysis

Question 69

Pain management for the pt with renal calculi

Answer 69

Opioids to control severe pain NSAIDS such as ketorolac (Toradol) in acute phase may be effective NSAIDS interfere with renal autoregulation and the risk for impairment is greater in patients with pre-existing kidney disease Also NSAIDS increase risk for bleeding

Question 70

Drug combo for stones

Answer 70

thiazide diuretic and allopurinol combined with high fluid intake. These increase urine volume and decree pH and help increase the excretion of the stones

Question 71

Other interventions for stones

Answer 71

Lithotripsy – extracorporeal shock wave lithotripsy; use of sound, laser, or dry shock waves to break up the stone Surgical management – using a stent to keep ureter open enlarging passage Surgical removal

Question 72

Preventing obstruction –

Answer 72

high intake of fluids and accurate I&O

Question 73

Treat underlying cause –

Answer 73

lower calcium levels with thiazide diuretics or treat gout

Question 74

Education for the pt being treated with calculi

Answer 74

Finish entire prescription of antibiotics Resume usual activities Balance regular exercise with work and rest Return to work 2 days to 6 weeks after surgery depending on type of intervention, personal tolerance, and primary provider’s directives Depending on type of stone – take medications Drink at leas 3L of fluids per day to dilute potential stone-forming crystals, prevent dehydration and promote urine flow

Question 75

Additional education for the pt with renal calculi

Answer 75

Monitor urine pH as directed, expect bruising after lithotripsy, urine may be bloody after surgery for several days, pain in the kidney or bladder region may signal beginning of an infection or formation of another stone. Report pain, fever, chills or difficulty with urination to pcp, keep follow up appointments as directed by primary care provider

Question 76

Normal menses involves minor discomfort, such as:

Answer 76

Breast tenderness, cramping, low back pain, mood swings

Question 77

Dysmenorrhea

Answer 77

Pain associated with menses, one of most common menstrual dysfunctions

Question 78

Dysfunctional uterine bleeding (DUB)

Answer 78

Heavy uterine bleeding that is irregular, painless

Question 79

Primary Dysmenorrhea

Answer 79

Hormonal, common in young women with normal menstrual function

Question 80

Primary dysmenorrhea s/s

Answer 80

Pelvic pain that radiates to the groin Low backache lasting 12–48 hours Pain radiating to lower back, thighs Diarrhea Headache Nausea, vomiting Anorexia Breast tenderness Pain begins on first day of menses or 3–5 days before Typically peaks 24 hours after menses begins, decreases in 2–3 days

Question 81

Secondary dysmenorrhea

Answer 81

Related to pathology or diseases of uterus, pelvic area. More likely in women ages 30–50. Pain may occur at any time in menstrual cycle, can be severe. Dull lower abdominal pain radiating to back, down thighs. May begin early in menstrual cycle, last longer than primary dysmenorrhea pain

Question 82

Endometriosis

Answer 82

Most common cause of secondary dysmenorrhea Cells from endometrial tissue implant and grow outside uterus, responding to estrogen and progesterone. Mature, open, bleed each month, causing pain, fibrosis, adhesions. May occur anywhere in body, usually on organs in lower pelvis

Question 83

Dysfunctional uterine bleeding (DUB)

Answer 83

Involves little or no pain. Profuse painless bleeding preceded by long stretches of amenorrhea. Most often associated with anovulatory cycles. Cycles produce thickened endometrial lining that begins irregular sloughing, prolonged heavy bleeding.

Question 84

Primary dysmenorrhea etiology

Answer 84

Caused by release of prostaglandins → uterine contractions to expel menstrual fluid, tissue Other inflammatory mediators may prolong contractions, decrease blood flow. Pain from passage of menstrual tissue, lack of exercise, anxiety about menses Pain may be associated with shape, position of reproductive organs

Question 85

Secondary dysmenorrhea etiology

Answer 85

Caused by abnormalities or disease in the pelvic area, congenital malformations such as tumors, cysts, pelvic adhesions, pelvic inflammatory disease (PID), infections, cervical stenosis, uterine leiomyomas, adenomyosis, endometriosis.

Question 86

Endometriosis etiology

Answer 86

Thought to have genetic component or related to immune dysfunction

Question 87

DUB etiology

Answer 87

Hormonal, similar to abnormal uterine bleeding caused by uterine tumors, endometrial or cervical cancer, polyps, ovarian cysts, bleeding disorders, complications of pregnancy. Causes of abnormal uterine bleeding must be ruled out before diagnosis of DUB can be made

Question 88

Dysmenorrhea risk factors

Answer 88

Early age at menarche Long or heavy menstrual periods Smoking Family history of dysmenorrhea

Question 89

Endometriosis risk factors

Answer 89

Menarche before age 11 Cycle length <27 days Heavy or prolonged menses Sedentary lifestyle Increased dietary fat First-degree relative with endometriosis

Question 90

DUB risk factors

Answer 90

Age Teens, early 20s Approaching menopause Stress Extreme weight changes Obesity Thyroid disease Metabolic disorders Use of hormone replacement therapy (HRT) or some types of hormonal contraceptives Use of intrauterine contraception (IUC) device

Question 91

Prevention

Answer 91

Lifestyle changes may benefit patients at risk for them: Balanced diet, avoiding sugary and salty foods Avoiding caffeine, alcohol, cigarettes Regular exercise and stress-relieving activities Healthy, gradual weight loss for overweight patients Once diagnosis has been made, prevention of future episodes depends on Long-term maintenance of prescribed treatment regimen Even in absence of symptoms

Question 92

Focuses of care

Answer 92

Identify underlying cause Reestablish functional capacity Manage pain

Question 93

Focus of care of woman with DUB

Answer 93

Identify, treat underlying disease, hormonal disorder Patient to keep diary of menstrual patterns to help diagnose cause

Question 94

Pharmacologic therapy for dysmenorrhea

Answer 94

Combined oral contraceptives (COCs), Depo-Provera, danazol, or gonadotropin-releasing hormone (GnRH) agonists to suppress ovulation COCs and progesterone injections to relieve cramping Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve cramping Selective serotonin reuptake inhibitors (SSRIs) to manage mood, help patient cope with chronic pain Diuretics to relieve bloating

Question 95

To correct menstrual irregularities

Answer 95

COCs for anovulatory DUB Depo-Provera to regulate uterine bleeding Hormonal IUCs to control irregular bleeding Conjugated estrogens and medroxyprogesterone for heavy bleeding Oral iron supplements to replace iron lost through bleeding

Question 96

ED s/s

Answer 96

– Inability of male to attain or maintain erection sufficient for sexual intercourse – May involve total or inconsistent inability to achieve erection or ability to sustain erection only briefly – Penis may become semi-erect but lack sufficient rigidity for intercourse

Question 97

ED characteristics

Answer 97

– Characterized as disorder of arousal – May or may not be associated with loss of libido – Occurs in men of all ages – Can be chronic, intermittent, or episodic

Question 98

ED dx:

Answer 98

Medical diagnosis: dysfunction present ≥3 months Psychiatric diagnosis: dysfunction present ≥6 months

Question 99

ED risks

Answer 99

Older men affected at higher rates – Rates for chronic or complete ED lower than those for occasional ED

Question 100

ED causes:

Answer 100

Vascular, neurologic, urologic, endocrine, respiratory, iatrogenic, lifestyle related, psychologic, aging process

Question 101

Aging process r/t ED

Answer 101

Less elastic collagen in penis interferes with veno-occlusive mechanism Declining ability of skin to sense vibrotactile stimulation Hypogonadism → decreased testosterone Likelihood of chronic conditions that are linked to ED

Question 102

Prevention of ED

Answer 102

▪ Regular exercise ▪ Balanced diet ▪ Healthy body weight ▪ Abstaining from tobacco, alcohol – Mitigation of risk factors specific to particular patients ▪ Men with diabetes: maintain appropriate blood glucose levels ▪ Men with depression: seek counseling – Many medications used to treat problems related to ED can themselves produce erectile problems as side effect

Question 103

Medications for ED

Answer 103

–Oral, injection into penis, or insertion into urethra –Oral medications: sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), avanafil (Stendra) ▪ Injectable medications for ED –Alprostodil –Difficult to administer, used for patients who cannot take oral drugs