Untitled

• Dietary Approaches to Stop Hypertension (DASH) is a diet to lower BP and Cholesterol
• DASH has low sodium, and is high in potassium and calcium

DASH Diet specifics

• Avoid canned soups, chips, smoked meats, and processed foods to keep sodium levels low
• Eat apricots, bananas, potatoes, and tomatoes as they are rich in Potassium
• Recommended to consume less than 2,300 milligrams of sodium daily

Erectile Dysfunction (ED)

• ED is the inability to achieve or maintain an erection, organically or functionally, present for 3+ months for medical diagnosis
• Organic ED has a gradual reduction in function resulting from diabetes, medications, vascular disease, hyperlipidemia, atherosclerosis, direct injury to the penis, and hypertension
• Functional ED results from physiological causes like high stress, guilt, and low self-esteem

ED Risk Factors

• Inflammation of seminal vesicles, urethra, and prostate
• Surgical procedures, such as prostatectomy, spinal surgery, and bladder surgery
• Damage to smooth muscles and nerves
• Pelvic fracture
• Vascular disease/hypertension (HTN)
• Chronic neurologic conditions
• Endocrine disorders, including diabetes, thyroid disorders, and low testosterone
• Smoking/alcohol consumption
• Use of antihypertensives
• Poor overall health that prevents sexual intercourse

Pharmacological Interventions for ED

• PDE-5 Inhibitors such as Sildenafil and Vardenafil relax smooth muscle to increase penile blood flow while compressing veins to prevent blood loss
• Take one hour before sex
• 1+ per day can cause leg/back cramps and N/V
• Avoid alcohol during use
• Adverse effects: dyspepsia, headache, facial flushing, and stuffy nose
• Leg/back cramps can occur from more than one dose per day
• Side effects can include Priapism and hypotension
• Do not take with Nitrates
• Seek medical attention if erection lasts over 4 hours

ED Vasodilators and Hormone Replacement

• Vasodilators like Alprostadil, papaverine, and Phentaphentolamine are injected into the penis to cause an erection
• Hormone replacement via testosterone injections or creams

Management of Care for ED

• Prior to giving medication, a cardiovascular workup is recommended
• The Vacuum Constriction Device (VCD) draws blood into the penis, a rubber ring is placed at the base to maintain erection

Penile Implants

• A three-piece inflatable device is implanted into the penis to achieve an erection
• Squeeze a pump in the scrotum to fill the penis with fluid, release a button to deflate
• Watch surgical site for bleeding and infection following insertion
• A penile suppository relaxes smooth muscle to increase blood flow

Penile Suppository & Health Promotion

• Insert 10 minutes before intercourse
• Erections last up to 1 hour and can be used twice a day
• Educate patients that erections achieved post treatment may not be the same as before

Complications from ED treatment

• Priapism or severe hypotension resulted from medication therapy

Benign Prostatic Hyperplasia (BPH)

• Occurs when the prostate gland enlarges, resulting urinary dysfunction
• Very common in older adult males and is non-cancerous

BPH Health Promotion

• Watch with age
• Smoking cessation
• Obesity control, exercise
• Avoid decongestants, antihistamines, and anticholinergics because these decrease bladder contractility, restriction, and impairment of the urethra
• Avoid a Western diet of high fat, protein, carbs, and low fiber
• Manage risk factors, such as from diabetes and heart disease
• Avoid holding pee in, pee when you have the urge
• Decrease stress

BPH Medications: DHT Lowering

• Finasteride decreases the production of testosterone in the prostate gland
• Takes six months for effects
• Decreases libido and can cause impotence
• Report breast enlargement to provider
• Pregnancy Category X: avoid touching as it can absorb through the skin

BPH Medications: Alpha-Blocking Agents

• Tamsulosin causes relaxation of the prostate gland and bladder to relieve obstructions and establish strong urine flow
• Education includes potential for high HR, syncope, and orthostatic hypotension

Management of Care

• Transurethral ablation (TUNA) uses low-level radiation to shrink the prostate
• Transurethral microwave therapy (TMT) uses heat to shrink the prostate
• TUNA and TMT are used before transurethral resection of the prostate (TURP)

TURP

• A resectoscope is inserted through the urethra to trim away excess prostatic tissue with a three-way indwelling catheter
• Continuous or intermittent bladder irrigation (CBI) is typical
• If the bladder becomes obstructed, turn off CBI and irrigate with 50 mL irrigation solution using a large piston syringe

Post TURP Education & Management

• With CBI, output should be pink or light colored
• If output is bright red, clots are present, and flow rate increases
• High flow rate flushes out clots
• The catheter has a large balloon (30-45 mL) taped to the leg, avoid kinks
• Instruct client NOT to void around the catheter to avoid bladder spasms/bladder obstruction
• Control pain with analgesics, decrease activity in first 24 hours

BPH Nutrition & Monitoring

• Monitor V/S and I&O for decreased output, infections, and overhydration
• Consume a high-fiber diet and laxatives to avoid straining
• Drink 12+ 8 oz glasses of water daily
• Avoid caffeine and alcohol
• Avoid drinking large amounts of fluid at one time

Menopause

• Permanent and is a normal physiologic process, cessation of menses for 12 months
• Perimenopause lasts for years due to decreased estrogen production
• Postmenopause is 1 year after the final menstrual period

Promoting Health During Menopause

• Weight bearing exercise
• Proper nutrition
• Discuss feelings about sex life
• Improve self-esteem and body image
• Take supplements
• Stop smoking

Clinical Manifestations of Menopause

• Hot flashes
• Atrophy of the vagina
• Vaginal dryness
• Osteoporosis risk
• Coronary artery disease risk
• Decreased HDL and LDL
• Decreased skin elasticity and hair loss
• Mood swings

Diagnostic Tests for Menopause

• Follicle Stimulating Hormone (FSH) measures one year after cessation of menses, expect increased levels (>30) during menopause
• Pelvic exam or pap smear to rule out cancer in cases of abnormal bleeding
• Breast mammogram to rule out cancer in cases of fatty tissue change
• Uterine lining biopsy to diagnose abnormal uterine bleeding in clients over 40 years
• DXA (bone mineral density measurement) to determine risk for osteoporosis, baseline is needed

Optimizing Nutrition During Menopause

• Increase intake of high protein and high calcium food
• Decrease intake of fats
• Avoid alcohol, caffeine, and tobacco
• Take Ca, Vitamin D, and Phosphorus supplements
• Vitamin D from fish, fortified dairy products, egg yolks, and sunlight
• Vitamin E and B6 decrease hot flashes
• Vitamin E from vegetable oils, grains, nuts, and dark green veggies
• Vitamin B6 from meats, grains, and legumes (beans)

Fibrocystic Breast Disease

• Manifests as painful, tender lumps in breast tissue common in the upper outer quadrant
• Does not increase risk for breast cancer, and are common in younger women, and is not cancerous

Fibrocystic Breast Disease Risk Factors & Diagnostics

• Risk factors premenses and postmenopausal hormone replacement therapy
• Diagnostic Procedures include breast ultrasound to confirm and rule out cancer
• Fine needle aspiration to confirm and reduce pain from fluid build up

Fibrocystic Breast Disease Treatment & Management

• Medicate with OTC analgesics like acetaminophen or ibuprofen
• Use oral contraceptives to suppress estrogen or progesterone secretion
• Use diuretics to decrease breast engorgement
• Suggest to client to reduce salt intake before menses to reduce breast enlargement
• Wear a supportive bra, apply local heat/cold for temporary pain relief
• Discuss risks of hormone medications: liver disease and stroke
• Encourage client to journal effectiveness

Cystocele

• Protrusion of the bladder into anterior vaginal wall due to weak pelvic muscles and/or structures
• Health promotion; weight loss if obese and at risk, eat a high-fiber diet, and drink adequate fluids to prevent constipation, watch increased risk from aging and post menopause
• Management of care; anterior colporrhaphy where pelvic muscles are shortened and tightened to increase bladder support, intravaginal estrogen Prevents atrophy of the vagina

Cystocele Interventions

• Bladder training
• Kegel exercises help with urinary incontinence
• Vaginal pessary is a silicone device inserted to provide support and block profusion of other organs into the vagina, check that client does not have latex ALLERGY
• Transvaginal repair uses vaginal mesh or tape to create a sling that supports the pelvic floor

Post Operative Care

• Notify provider if signs of infection; elevated temp, HR, and RR, foul smelling or purulent discharge and pain
• Avoid straining at defecation, sneezing, coughing, lifting, sitting, walking or standing for long periods of time
• Tighten and support pelvic muscles when coughing or sneezing
• Adhere to post-op restrictions; avoid strenuous activity, take analgesics, antibiotics, and stool softeners, refrain from sex for 6 week, sutures absorb and do not require removal

Sexually Transmitted Infections (STI’s)

• Syphilis is a bacterial infection typically transmitted via sexual contact that starts as a painless sore
• Clinical manifestations; Primary: Canker sore with little or no pain (6 weeks)

Secondary stages

• Skin rash, mucous patches, sore throat, flat broad papule on labia, flu-like symptoms (2-6 weeks)
• Latent: No signs or symptoms but can spread with time (1 year)
• Tertiary: infiltrating tumors and inflammatory response

Syphilis Diagnostics and Treatment

• Venereal Disease Research Laboratory (VDRL) is the oldest blood series used for screening Rapid Plasma Reagin (RPR) is a blood test (+) 4-6 weeks after infection
• If either are (false) positive, a FTA-ABS test (antibody test) should be administered
• Primary Treatment is Penicillin G

Genital Herpes

• Caused by the herpes simplex virus and can be transmitted when ptnt does not have S&S
• Clinical Manifestations are pain, itching, and small red bumps
• White blisters, ulcers and scabs
• Viral tests are used for diagnostics

Genital Herpes Diagnostics

• Swab fluid from lesion
• PCR to identify genetic material from the virus: lesion, blood or body fluids. Recognize HSV 1 & 2
• Immunoblot and enzyme-linked immunosorbent assay (ELISA) test to differentiate between HSV 1 & 2
• Complications; Other STI's, Meningitis, Bronchitis

HPV

• Transmitted via antivirals -vir to decrease risk of transmission
• The virus that can cause genital warts and asymptomatic infection. Vaccines are available
• clinical manifestations Genital warts/plantar warts

HPV Complications and Diagnostics

• can cause cervical cancer or Oral and upper respiratory lesions or cancer
• Diagnostic steps: a pap test needs Abstain from sex until discharge has stopped Notify if heavy vaginal bleeding, fever or foul discharge, a DNA test, or laser treatment

Chlamydia

• A bacterial infection that affects the reproductive organs of both males and females
• Clinical Manifestations; Females are often asymptomatic

Chlamydia Manifestations and Complications

• Can have pain urinating, lower abdomen pain, vaginal discharge, and painful intercourse
• Diagnosed via Urine test or Culture swab
• Treatment Azithromycin - Single dose, Doxycycline - 2x daily for 7 days Other STI's, Pelvic inflammatory disease or infection. Education: No sex for 7 days, retest in 3 months Testicle and prostate gland infections. Infertility

Gonorrhea

• A bacterial STD that usually affects mucous membranes of male urethra or female cervix
• Manifestations include Dysuria Pus-like discharge foul smelling discharge, (From M/F), Swelling in testicles dyspareunia (painful sex)
• Abnormal menses, Vaginal bleeding b/w periods

Gonorrhea Diagnostics and Complications

• diagnosed via Urine test or culture of infected area
• can lead to infertility or spread to other parts of body
• diagnostics can measure increased risk for: HIV/AIDS, Atopic pregnancy, Bindness in infants
• treated with antibiotics “-cillin,-ceph,-mycin

Perfusion and Coronary Artery Disease (CAD) & Angina

• Angina: chest pain from decreased coronary blood flow
• Stable Angina: (most common & predictable) increased by physical exertion, relieved by rest and nitrates
• Variant Angina: usually at night, from coronary spasm, with or without plaque (unpredictable and mechanism unknown)

Risk factors

• CAD: Modifiable
• Lifestyle and high cholesterol Smoking ,Obesity, Inactivity, Birth control and hormone replacement therapy and Stress
• Non-modifiable
• Age, gender, genetics and race (diagnosis HTN/DM) Clinical Manifestations CAD

Diagnostics & Medications: CAD & Angina

• History/Physical
• Screen for risk factors and related diseases
• Serum Cholesterol Levels: Check for hyperlipidemia
• C-reactive Protein (CRP): Increased indicates inflammation
• Ankle-Brachial Index (ABI). BP in arms and legs and <0.9 = PAD/CAD
• Stress Test (Exercise EKG Testing): Must have consent, invasive injection of IV iodine contrast with treadmill to stress the heart
• Cardiac Catheterization: Injection of iodine dye to highlight coronary arteries Check allergy to iodine/shellfish prior and have consent
• NPO after midnight, check pedal pulses, kidneys must be functioning and Echocardiography

Angina Medication

• antiplatelets Aspirin Muscle and Liver!! Medications Angina and Nitrates Nitroglycerin SLTD patches CCB beta blockers
• Monitor BP and HR (withhold <50 bpm) Contraindicated Educate diabetics how they masks high HR

CAD & Angina Nutrition & Teachings

• Lifestyle exercise/stress management Proper nutrition Peripheral Arterial Disease (PAD) Results from atherosclerosis characterized by trouble getting blood to lower extremities

CAD

• Diet and exercise and maintain physical activity

Clinical Manifestations

Cramping and pain in legs during exercise Burning in feet when in bed Pain relieved capillary refill >3 decreased pulses and loss of hair dry scaly mottled skin

• with elevation, redness when dangling

Diagnostics & Testing: PAD

• Dry, necrotic ulcers and gangrene to toes
• Begin with client history and physical examination
• Used for patients that can’t feel a pulse
• Doppler test: used if cant feel pulse and Pressures in thigh, calf and ankle are lower than in upper extremities = arterial disease
• Ankle Brachial BP Index compared to BP -Education Exercise gradually or hold and assess

Medical advice

• Stress test Requires consent, With or without -Pulse volume and BP taken before and after 5 minutes of exercise
• arterial disease B4/
• Hold 24-48 hours and stress education