Urological Surgery Preoperative Care Quiz
42 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a primary goal in the preoperative phase for patients undergoing invasive procedures related to urinary issues?

  • Minimizing fluid intake
  • Restoration of urinary drainage (correct)
  • Maximizing sexual dysfunction
  • Complete bladder emptying

    • Which intervention is crucial for managing urinary retention preoperatively?

  • Administering oral antibiotics
  • Insertion of a coude catheter (correct)
  • Decreasing fluid intake to 1 L/day
  • Injection of saline solution

    • What should be encouraged to prevent urinary tract infections prior to invasive procedures?

  • High fluid intake (correct)
  • High protein intake
  • Avoiding all fluids
  • Low carbohydrate diet

    • What is a potential impact of surgery on sexual functioning that clients should be aware of?

    <p>Retrograde ejaculation may occur (B)</p> Signup and view all the answers

    Which postoperative goal is essential for optimal recovery after urinary surgery?

    <p>Complete bladder emptying (C)</p> Signup and view all the answers

    What is the typical duration for which a large indwelling catheter is left in place after a radical prostatectomy?

    <p>1 to 2 weeks (B)</p> Signup and view all the answers

    What is the primary goal of a nerve-sparing procedure during radical prostatectomy?

    <p>To preserve neuro-vascular bundles (A)</p> Signup and view all the answers

    What is the rationale for careful dressing changes and perineal care after a bowel movement following prostate surgery?

    <p>To aid in wound healing and prevent infection (D)</p> Signup and view all the answers

    Which statement is true regarding the use of cryosurgery in prostate cancer treatment?

    <p>It involves freezing tissue to destroy cancer cells (B)</p> Signup and view all the answers

    What is a possible risk associated with a nerve-sparing prostatectomy?

    <p>Increased risk of urinary incontinence (A)</p> Signup and view all the answers

    Why is monitoring for an obstructed catheter important post-surgery?

    <p>To maintain proper fluid balance (A)</p> Signup and view all the answers

    In what circumstance is surgery considered a viable option for advanced stage disease?

    <p>To relieve obstructive symptoms (C)</p> Signup and view all the answers

    What is the primary purpose of bladder irrigation after prostate surgery?

    <p>To remove clotted blood and ensure urine drainage (C)</p> Signup and view all the answers

    What indicates that there may be a complication during continuous bladder irrigation (CBI)?

    <p>Outflow is less than inflow (D)</p> Signup and view all the answers

    How long are large amounts of blood clots considered normal after prostate surgery?

    <p>24 to 36 hours (D)</p> Signup and view all the answers

    What condition can lead to bladder spasms after transurethral procedures?

    <p>Irritation of the bladder mucosa (D)</p> Signup and view all the answers

    What should be done if a patient cannot void within 6 hours after catheter removal?

    <p>Reinsert the catheter for a day or two (B)</p> Signup and view all the answers

    What could indicate a hemorrhage in a postoperative patient?

    <p>Bright-red blood in urine (B)</p> Signup and view all the answers

    Which treatment is often used to relieve bladder spasms postoperatively?

    <p>Antispasmodics (D)</p> Signup and view all the answers

    What is monitored to determine the effectiveness of bladder irrigation?

    <p>Color of urine output (B)</p> Signup and view all the answers

    What might a patient experience immediately after catheter removal?

    <p>Poor sphincter tone (D)</p> Signup and view all the answers

    What should be the appearance of urine drainage during CBI?

    <p>Light pink without clots (C)</p> Signup and view all the answers

    What is the primary difference between hypertrophy and hyperplasia in the context of prostate enlargement?

    <p>Hypertrophy refers to an increase in cell size, while hyperplasia refers to an increase in the number of cells. (A)</p> Signup and view all the answers

    Which of the following factors is the most significant risk for developing benign prostatic hyperplasia (BPH)?

    <p>Aging (D)</p> Signup and view all the answers

    At what age does the risk of developing BPH typically begin to increase?

    <p>40 (A)</p> Signup and view all the answers

    Which statement accurately reflects the potential progression of benign prostatic hyperplasia?

    <p>BPH can lead to partial or complete obstruction of the urethra. (D)</p> Signup and view all the answers

    Which lifestyle factor has been shown to contribute to the increased risk of BPH?

    <p>Increasing abdominal obesity (A)</p> Signup and view all the answers

    What is the primary indicator that bladder irrigation is effective postoperatively?

    <p>Urine drainage should be light pink without clots (A)</p> Signup and view all the answers

    Which intervention should be taken if outflow from the catheter is less than inflow?

    <p>Assess the bladder and check catheter patency (C)</p> Signup and view all the answers

    What complication may arise as a result of a catheter being obstructed?

    <p>Development of bladder spasms (C)</p> Signup and view all the answers

    When should a nurse expect to see blood clots after prostate surgery?

    <p>For 24 to 36 hours post-surgery (A)</p> Signup and view all the answers

    What is a likely outcome if a client cannot void within 6 hours after catheter removal?

    <p>A catheter may need to be reinserted for a day or two (A)</p> Signup and view all the answers

    What is the mechanism by which finasteride alleviates symptoms of benign prostatic hyperplasia (BPH)?

    <p>Blocks 5α-reductase enzyme (A)</p> Signup and view all the answers

    Which minimally invasive therapy uses microwave heat to treat BPH?

    <p>Transurethral Microwave Thermotherapy (TUMT) (D)</p> Signup and view all the answers

    What is the primary characteristic of α-adrenergic receptor blockers in treating BPH?

    <p>They promote smooth muscle relaxation to facilitate urinary flow. (D)</p> Signup and view all the answers

    Transurethral Needle Ablation (TUNA) uses which type of energy to treat enlarged prostate tissue?

    <p>Low-wave radiofrequency (C)</p> Signup and view all the answers

    Which therapeutic approach is considered the standard for treating moderate to severe BPH?

    <p>Transurethral Resection of the Prostate (TURP) (B)</p> Signup and view all the answers

    What does a negative balance of -200 ml between 1100 and 1500 hours indicate?

    <p>The patient is experiencing bladder spasms causing urine retention. (C)</p> Signup and view all the answers

    During Continuous Bladder Irrigation (CBI), if 3400 ml is emptied from Bag #1 and the bag started with 3000 ml, what is the true urine output?

    <p>400 ml (C)</p> Signup and view all the answers

    What should be assessed if a patient shows a negative urine output balance post-surgery?

    <p>Presence of clots that may block the catheter. (B)</p> Signup and view all the answers

    What is indicated if a patient’s urine appears light pink 24 hours post-operatively?

    <p>It is a normal response following surgery. (B)</p> Signup and view all the answers

    In the context of CBI, how is the total urine output computed for the day shift?

    <p>By summing the true urine output from each bag. (D)</p> Signup and view all the answers

    Flashcards

    Risk for infection

    A potential danger of illness from pathogens due to insufficient knowledge to prevent them, or by urinary stasis (fluid buildup).

    Radical Prostatectomy Post-Operative Care

    Care after a prostate cancer removal surgery, focused on urinary elimination, wound care, and discharge.

    Urinary Elimination (post-prostatectomy)

    Involves a catheter, monitoring for blockage, and fluid balance maintenance after a prostatectomy.

    Urinary retention cause

    Urinary retention is often caused by blockage in the urethra, sometimes related to prostate enlargement or tumors.

    Signup and view all the flashcards

    Pre-operative goals

    Invasive procedure preparation focuses on restoring urine drainage, treating UTIs, and educating the patient about the procedure, sexual implications, and urinary control.

    Signup and view all the flashcards

    Wound Care (post-prostatectomy)

    Includes pain management, drain placement and removal, and perineal care to prevent infection after prostrate surgery.

    Signup and view all the flashcards

    Post-operative goals

    Post-operative goals aim for no complications, restored urinary control, complete bladder emptying, and satisfying sexual expression.

    Signup and view all the flashcards

    Nerve-Sparing Procedure (Prostatectomy)

    A surgical prostate removal technique that attempts to preserve nerves for erectile function.

    Signup and view all the flashcards

    Restoring urine drainage

    Using a coudé catheter (curved tip) to restore the flow of urine, often assisted by lidocaine gel for easier insertion.

    Signup and view all the flashcards

    Cryosurgery for Prostate Cancer

    A surgical treatment that freezes cancer cells in the prostate.

    Signup and view all the flashcards

    Advanced Stage Disease (Surgery)

    Often not treated with surgery unless symptoms, like obstruction, are severe.

    Signup and view all the flashcards

    Post-operative Erectile dysfunction risk

    The risk of losing erectile function is reduced with the nerve sparing technique during the prostatectomy. However, this does not guarantee potency will be maintained

    Signup and view all the flashcards

    Postoperative Bladder Irrigation

    Using a catheter with multiple ports to irrigate the bladder with sterile saline to remove clots and ensure urine drainage.

    Signup and view all the flashcards

    Bladder irrigation solution

    Sterile normal saline or prescribed solution used to irrigate the bladder.

    Signup and view all the flashcards

    Infusion-output balance

    Irrigation fluid inflow and outflow balance must be monitored. If outflow is slower than inflow, the bladder and catheter must be assessed for blockage.

    Signup and view all the flashcards

    Post-prostate surgery blood clots

    Blood clots are common for the first 24-36 hours.

    Signup and view all the flashcards

    Bladder spasms after surgery

    Irritation of the bladder from procedures or clots can cause bladder spasms, requiring pain relief.

    Signup and view all the flashcards

    Catheter removal

    Typically occurs 2-4 days after surgery, with client expected to void within 6 hours.

    Signup and view all the flashcards

    Self-catheterization

    Instruct on self-catheterization when client cannot void after catheter removal, or if the problem continues.

    Signup and view all the flashcards

    Urinary incontinence

    Weak sphincter tone post-catheter removal can lead to incontinence or dribbling.

    Signup and view all the flashcards

    Catheter Patency

    Ensuring the catheter is open and clear from obstructions that may prevent proper urine flow

    Signup and view all the flashcards

    Color of urine drainage

    Urine should be light pink without clots as a sign of proper irrigation and drainage.

    Signup and view all the flashcards

    What is Benign Prostatic Hyperplasia?

    Benign Prostatic Hyperplasia (BPH) is a common condition in older men where the prostate gland enlarges, but it's not cancerous. This enlargement can press on the urethra, making urination difficult.

    Signup and view all the flashcards

    What's the key risk factor for BPH?

    Aging is a primary risk factor for BPH. The chance of developing BPH rises significantly with age, affecting about 50% of men by age 50 and 80% by age 80.

    Signup and view all the flashcards

    How does obesity affect BPH?

    Obesity, especially abdominal fat and high leptin levels, can make BPH worse. Leptin is a hormone in fat tissue that can increase prostate size.

    Signup and view all the flashcards

    How does lack of exercise link to BPH?

    Lack of physical activity increases the risk of BPH. This might be because exercise helps fight obesity, inflammation, and other factors related to BPH.

    Signup and view all the flashcards

    How does smoking impact BPH?

    Smoking increases inflammation, and nicotine, a key component in cigarettes, is a major contributor to this inflammation. This can worsen the progression of BPH.

    Signup and view all the flashcards

    Finasteride (Proscar)

    A medication used to treat benign prostatic hyperplasia (BPH) that works by blocking an enzyme called 5α-reductase, which is necessary for the conversion of testosterone. This action causes regression of hyperplastic tissue, effectively shrinking the prostate.

    Signup and view all the flashcards

    α-adrenergic Receptor Blockers (for BPH)

    These medications promote smooth muscle relaxation in the prostate, making it easier for urine to flow through the urethra. Examples include prazosin and doxazosin.

    Signup and view all the flashcards

    Transurethral Microwave Thermotherapy (TUMT)

    A minimally invasive treatment for BPH that uses microwave radiation to heat and destroy prostate tissue.

    Signup and view all the flashcards

    Transurethral Needle Ablation (TUNA)

    A minimally invasive procedure that uses radiofrequency waves to heat and destroy prostate tissue, shrinking the prostate and improving urine flow.

    Signup and view all the flashcards

    Transurethral Resection of the Prostate (TURP)

    The gold standard surgical treatment for BPH, involving the removal of prostate tissue using an instrument called a resectoscope. It is a more invasive procedure than TUMT or TUNA.

    Signup and view all the flashcards

    Triple-lumen catheter

    A catheter with three tubes: one to deliver irrigation solution into the bladder, one to drain urine from the bladder into a bag, and one to inflate a balloon that secures the catheter in place.

    Signup and view all the flashcards

    Bladder Irrigation (CBI)

    A procedure used to remove blood clots from the bladder after prostate surgery, ensuring proper urine drainage.

    Signup and view all the flashcards

    CBI Flow Rates

    The speed of irrigation solution flow is adjusted based on the color of the urine drainage. Light pink without clots indicates proper irrigation and drainage.

    Signup and view all the flashcards

    CBI Outflow Blocked

    If the outflow of urine is blocked during CBI, immediately stop the procedure and notify the healthcare provider.

    Signup and view all the flashcards

    Bladder Spasms

    Painful contractions of the bladder muscle, often caused by catheter irritation or blood clots.

    Signup and view all the flashcards

    CBI Bag Calculation

    Calculating the true urine output by subtracting the initial bag volume from the amount emptied into the cannister for each CBI bag.

    Signup and view all the flashcards

    Negative Urine Output

    A negative urine output in the CBI calculation indicates there's an issue with drainage. Potential causes include bladder spasms, leaking around the catheter, or a blocked catheter.

    Signup and view all the flashcards

    Purpose of CBI

    Continuous Bladder Irrigation (CBI) uses sterile saline to flush the bladder, removing blood clots and ensuring proper urine drainage after surgery.

    Signup and view all the flashcards

    CBI Bag Numbering

    The same CBI bag number is reused when a new bag replaces the old one.

    Signup and view all the flashcards

    Post-Prostatectomy Urine Color

    Healthy urine drainage should be light pink without clots after a prostatectomy.

    Signup and view all the flashcards

    Study Notes

    Benign Prostate Hypertrophy (BPH) and Prostate and Testicular Cancer

    • Content focuses on individuals assigned male at birth (AMAB)
    • BPH is a benign enlargement of the prostate gland.
    • Non-inflammatory enlargement.
    • Resulting from hormonal changes & increase in cells.
    • Hypertrophy is an increase in cell size.
    • Hyperplasia is an increase in the number of cells.
    • BPH develops in the inner part of the prostate.
    • The most common urological problem in adult males/AMAB.
    • Occurs in 50% of males/AMAB over 50, and 80% of males/AMAB over 80.
    • Approximately 25% will require treatment by age 80.
    • Risk of developing prostate cancer is not clear, but having BPH may not lead to increased risk.
    • Important risk factors related to BPH include obesity, lack of physical activity, smoking and diabetes.
    • Symptoms worsen as obstruction increases.
    • Early symptoms are usually minimal.
    • Classified into 2 groups: obstructive (urinary retention) and irritative (inflammation/infection).
    • Obstructive symptoms: decrease in the caliber and force of urinary stream, difficulty initiating voiding, intermittency, and dribbling.
    • Irritative symptoms: Urinary frequency, urgency, dysuria, bladder pain, nocturia, and incontinence.
    • Complications related to urinary obstruction include acute urinary retention, urinary tract infection (UTI), incomplete bladder emptying, formation of calculi in the bladder, renal failure, pyelonephritis, and bladder damage.
    • Primary diagnostic methods include history and physical examination.
    • Digital rectal examination (DRE): Palpates prostate (firm and smooth, enlarged/symmetrically)
    • Prostate-Specific Antigen (PSA) levels were not recommended due to greater risks than benefits.
    • Normal reference PSA level: 0-4.0 ug/L
    • Serum creatinine to rule out renal insufficiency.
    • Additional diagnostic studies include transrectal ultrasound (TRUS), uroflowmetry, and cystourethroscopy.

    Trans Women and Prostate Cancer

    • Individuals assigned male at birth (AMAB) who transitioned, but did not undergo bottom surgery, still have a prostate.
    • Links to stories of transwomen impacted by prostate cancer.

    Risk Factors for Prostate Cancer

    • Aging: Risk increases with age, becoming noticeable around age 40, with higher incidence at age 50 and 80 (80%).
    • Obesity: Larger waist circumference, higher abdominal fat and leptin (hormone) levels, related to chronic high insulin levels and increased prostate volume.
    • Lack of physical activity: Exercise helps in fighting obesity, reducing inflammation, and managing Type 2 Diabetes and Insulin resistance.
    • Smoking: Causes inflammation.
    • Diabetes: High glucose levels and insulin resistance are linked to BPH development. Obesity worsens the progression.
    • Family history: First-degree relatives with prostate cancer increase risk.

    Clinical Manifestations of BPH

    • Early symptoms are usually minimal.
    • Symptoms worsen with increased obstruction.
    • Classified into obstructive and irritative symptoms.

    Complications of BPH

    • Acute urinary retention
    • Urinary tract infections (UTIs)
    • Incomplete bladder emptying.
    • Development of kidney stones.
    • Renal failure
    • Pyelonephritis.
    • Damage to the bladder

    Diagnostic Studies for BPH

    • History and physical examination
    • Digital rectal examination (DRE)
    • Prostate-Specific Antigen (PSA) levels
    • Serum creatinine

    Collaborative Therapies for Prostate Cancer

    • Active surveillance
    • Conservative therapy: Watchful waiting with annual physical exams, DRE, and considering aspects like life expectancy and co-morbid diseases. Low-grade, low-stage tumor and noticeable changes in DRE need reassessment.
    • Surgical options: Radical prostatectomy (nerve-sparing procedure), Cryosurgery, brachytherapy.
    • Radiation therapy (external beam) for primary, adjuvant and recurrent diseases
    • Hormone therapy of various kinds
    • Chemotherapy for metastatic disease

    Nursing Interventions for pre-operative phase of BPH:

    • Restoration of urinary drainage.
    • Treatment of any UTI.
    • Understanding of procedure implications pertaining to sexual function and urinary control.

    Nursing Interventions for post-operative BPH:

    • No complications (no further risks)
    • Restoration of urine control.
    • Complete bladder emptying.
    • Satisfying sexual expression.

    Nursing Interventions for post-operative BPH and other cancer surgeries:

    • Maintaining urinary drainage (urinary catherization).
    • Administration of proper antibiotics for any infection.
    • Adequate fluid intake for flushing out the urinary tract to avoid infections and obstructions.
    • Pain management.
    • Monitoring for any infection or complications.

    Diagnostic Studies for Prostate Cancer:

    • DRE (Digital Rectal Examination): Abnormalities are assessed (hard, nodular asymmetric).
    • PSA (Prostate-Specific Antigen) blood test: is no longer recommended as the risks outweigh the benefits. Used to monitor successful treatment. Low levels of PSA indicate successful treatment and undetectable levels means that treatment is successful.
    • Transurethral Resection of the Prostate (TURP): This is a procedure in which tissue is excised or removed cystoscopically.
    • Transurethral Incision of the Prostate (TUIP): Transurethral incisions are made for obstruction. This is effective for smaller sized prostate.
    • Prostatectomy: Surgical removal of the prostate- used as a last resort.
    • PCA3: A test more accurate than PSA. Benign prostate enlargement will NOT increase PCA, but will cause a rise in PSA. Useful for identifying early prostate cancer.
    • Biopsy of Prostate Tissue: Using transrectal ultrasound to visualize prostate gland.
    • Imaging: Bone scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI) to evaluate for metastatic disease in advanced stages.

    Risk Factors for Testicular Cancer

    • Age: Most commonly diagnosed between age 15 and 40.
    • Cryptorchidism: Undescended testicles increase risk.
    • Klinefelter's syndrome: Extra X chromosome may lead to increased risk
    • Family history: A relative with testicular cancer increases the risk.
    • Ethnicity: White Canadian men have a higher risk, followed by black and Asian Canadian men.
    • Chemicals: Exposure to zinc, cadmium, and benzene (Group 1 carcinogens) in mining, oil and gas production.

    Clinical manifestations of testicular cancer

    • Painless lump in scrotum.
    • Swelling in the scrotal area, feeling of heaviness.
    • Firm, nontender scrotal mass.
    • Dull ache in the scrotum, lower abdomen, or perineal area.
    • Acute pain in 10% of patients
    • Metastatic disease (metastatic manifestations) - lower back, chest, dyspnea.

    Diagnostic Studies for Testicular Cancer

    • Palpation: First step to diagnosing testicular cancer - palpate scrotal contents for swelling, hardness, or lumps.
    • Testicular ultrasound: Diagnoses cancers that are not palpable or are suspected.
    • Lab tests: High levels of proteins and enzymes such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) help in finding tumors too small to be felt.
    • Testicular biopsy: Used for small, not palpable cancers - A small portion of the tissue sample is examined.
    • Imaging: Chest radiograph, CT, or MRI scan for metastatic cancers, and other tests such as anemia assessment, kidney function etc

    Collaborative Management for Testicular Cancer

    • Radical Orchiectomy: Removal of the affected testis, spermatic cord and regional lymph nodes in pre-operative phase.
    • Post-surgery: Constant monitoring, radiation therapy, chemotherapy based on stage of the cancer
    • Stage 1: Removal of the single testis. If both testicles are removed, male fertility is compromised
    • Stages 2 and 3: Chemotherapy in combination with radiation therapy.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Week 12 Neoplasm Male-AMAB Cancers Past Paper 2024-2025 PDF

    Description

    This quiz assesses your knowledge of crucial preoperative goals and interventions for patients undergoing invasive urinary procedures. Topics include urinary retention management, infection prevention, and understanding the impact of surgery on sexual functioning.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser