Nurs222 Exam 3 Study Guide PDF

Ch 64: Male Reproductive Problems Quizlet BPH: overgrowth of the prostate Extends into bladder causing obstruction Experience lower UTI sx, hydroureter (ureter enlargement), hydronephrosis (kidney enlargement) Can cause acute urinary retent...

Ch 64: Male Reproductive Problems Quizlet BPH: overgrowth of the prostate Extends into bladder causing obstruction Experience lower UTI sx, hydroureter (ureter enlargement), hydronephrosis (kidney enlargement) Can cause acute urinary retention & need emergent care Etiology & Genetic Risk Modifable ○ Obesity, metabolic syndrome, HTN, dyslipidemia ○ caffeine/coffee intake ○ Low activity levels Unmodifable ○ Aging ○ Race - black men need more treatment ○ Genetics - GATA3 gene variants ○ Family hx of bladder cancer Recognize Cues: Assessment Hx Severity of lower UTI sxs International prostate sx score Physcial assessment Elimination pattern, urinary frequency/urgency, nocturia, hesitancy, weak stream, straining to start, postvoid dribble, blood in urine Palpate & inspect abdomen (bladder scanner for overweight pt) ○ Should void prior to this DRE Psychosocial assessment Assess sleep interruption effect (mood/mental status) Assess for any embarrassment Labs UA & urine culture for UTI CBC for infecton BUN & creatinine for kidney function PSA for screening Serum acid phosphatase level for cancer Biopsy Diagnostic  Transrectal ultrasound MRI, PET Cystoscopy Bladder ultrasound for residual Generate Solutions & Take Action Improving urinary elimination Nonsurgical ○ Avoid large amounts of fls in short time ○ Caffeine & alcohol consumption should be limited ○ Tell HCP about BPH diagnosis so certain drugs are not prescribed Anticholinergics, antihistamines, antipsychotics, muscle relaxants ○ Drugs Alpha 1 selective adrenergic blockers & 5 alpha reductase inhibitors (same as pharm) Assess for orthostatic hypotension, tachycardia, & syncope for alpha 1 5 ARI may take 6 months before improvement noticed ○ Frequent sex Surgical management ○ Prostate artery embolization to shrink prostate ○ TURP Continuous bladder irrigation after procedure Nursing care Monitor for infection, help pt get out of bed, assess pain, safe environment, maintain irrigation rate, check tubing for kinks, asess for bladder spasm w/ low output Inform pt he will feel the constant need to void but to not try to void Care Coordination Home care management ○ May be d/c w/ catheter ○ Older men may benefit from 1-2 visits from home health Self education ○ Tell pt to not take a bath or swim w/ catheter ○ When catheter removed it is normal to feel burning, frequency, dribbling ○ Keep area clean ○ Increase fl intake if not contraindicated by other conditions such as kidney failure or HF ○ Kegal exercises  Health care resources ○ Typically don’t require much Prostate Cancer: testosterone & dihydrotestosterone are the two main androgens (hormones) In some pt the prostate grows rapidly causing noncancerous high grade prostatic intrwpithelial neoplasia (PIN) ○ This impairment on cellular regulation increases risk for cancer Metastasizes in a predictable pattern ○ Bone, nearby lymph nodes, pelvis, sacrum, lumbar spine Etiology and Genetic Risk Advanced age Fam hx (father, brother, son) Fam w/ breast, ovarian, or pancreatic cancer African americans Gene mutations ○ GSTP1 & BRCA2 Recognize Cues: Assessment Hx Age, ethnicity, fam hx Nutrition - red meat & dairy products Elimination problems, frequency, nocturia, hematuria, wt loss, pain in the hips/legs Sexual hx Physical assessment Typically no sx early on Gross blood Pain in the pelvis, spine, hips, ribs, or swollen nodes Wt loss Psychosocial Labs PSA levels for screening Prostate specific proteins, PSA isoforms, & prostate cancer specific biomarkers Diagnostics Transrectal ultrasound Biopsy Lymph node biopsy, CT, MRI Generate Solutions & Take Action Preventing metastasis  ○ Active surveillance - observation w/out immediate treatment in early stage regular visits where treatment can be started if cancer is progressing ○ Nonsurgical - as adjunct to surgery or alternative Radiation, hormone therapy, chemotherapy ○ Surgical - prostate removal or testicle removal Postop care Hydration, wound drains, manage pain, preventing pulmonary complications Care Coordiation Home care Self education ○ Teach about how to care for a catheter at home ○ Inspect incision sites ○ Don’t strain to defecate ○ Follow up appts for PSA levels Health care resources ○ Cancer support groups Testicular Cancer: rare, usually seen in younger males Groups ○ Germ cell tumors - sperm producing cells ○ Non germ cell tumors - stromal, interstitial or leydig cells that produce testosterone Recognize Cues: Assessment Hx Undescended testis Fam hx Painless, hard swelling or enlargement of the testicle Asking about plans for kids S/S Swelling or lumps in the testicles that are painless Psychosocial Diganotics Alpha fetoprotein (AFP) Beta human chorionic gonadotropin (hCG) Lactate dehydrogenase (LDH) Scrotal ultrasound Bone scan  Chest xray & CT CT of abdomen MRI of brain Generate Solutions & Take Action Sperm bank storage if wanted Nonsurgical ○ Chemo or radiation Surgical ○ Unilateral orchiectomy to remove testicle Care Coordination Scrotal support Sutures to be removed in 7-10 days by HCP Avoid lifiting/ driving for several weeks Monthly testicular self exams Refer as needed Erectile Dysfucntionxu: impotence Organic - gradual deterioration of function Psychogenic - related to anxiety, depression, trauma, stress, etc Diagnostic testing Glycated hemoglobin, lipid panel, TSH to rule out, serum total testosterone Doppler To determine bloodflow to the penis Trx - depends on underlying cause Lifestyle modifications, manage meds, penile self injection w/ prostaglandin E1, PDE5 drug therapy, testosterone therapy, surgery, vacuum assisted erection devices Vasectomy: male contraception / sterilation Postop teaching Leave dressing & scrotal support for 48 hrs Apply ice pack intermittently for 24-48 hrs Mild pain, bruising, swelling are normal for first few days Rest for 24 hrs after Heavy lifting, sports, or sex should be avoided for at least 1 week Barrier method of contraception used until confirmation  Questions 1. A client with testicular cancer is worried about sterility and the ability to conceive children later. Which resource will the nurse share with the client? A. American Cancer Society B. A psychologist C. RESOLVE: The National Infertility Association D. A sperm bank facility 2. The nurse is caring for four clients. With which client does the nurse discuss prostate cancer screening? A. A 21-year-old with a history of urinary tract infections B. A 37-year-old with an injury to the external genitalia C. A 49-year-old with uncontrolled hypertension D. A 57-year-old with a brother with prostate cancer 3. The nurse is educating a group about testicular self-examination (TSE). Which statement by a member of the group indicates teaching has been effective? A. “I will examine my testicles right before taking a shower.” B. “I will squeeze each testicle firmly in my hand to feel abnormalities.” C. “I only need to report large masses to my primary health care provider.” D. “I will look and feel for any lumps or changes to my testes.” 4. Which assessment finding is the priority for the nurse to report to the health care provider? A. Hematuria B. Penile discharge C. Painless testicular lump D. Decrease increase in libido 5. A client reports taking a supplement that a friend recommended for benign prostatic hyperplasia (BPH). Which supplement does the nurse anticipate the client is taking? A. Magnesium B. Calcium C. Saw palmetto D. Feverfew 6. The nurse is teaching a client with BPH about how to manage incontinence. Which teaching will the nurse provide? A. Request a prescription for sildenafil. B. Use analgesic medications as needed for comfort.  C. Practice Kegel exercises to improve muscle control. D. Perform routine self-catheterization and bladder retraining. 7. Which client will the nurse prioritize when teaching about prostate cancer screening? A. A 24-year-old Indian American B. A 36-year-old Hispanic American C. A 47-year-old Native American D. A 51-year-old African American 8. A young adult with testicular cancer is admitted for unilateral orchiectomy and retroperitoneal lymph node dissection. Which task will the nurse delegate to assistive personnel (AP)? A. Encourage the client to cough and deep-breathe after surgery. B. Discuss reproductive options with the client and significant other. C. Teach about the availability of a gel-filled silicone testicular prosthesis. D. Evaluate the client’s understanding of chemotherapy and radiation treatment. 9. The emergency nurse is assigned to care for four clients. Which client does the nurse see first? A. Adolescent with an erection for “10 or 11 hours” who is reporting severe pain B. Young adult with a swollen, painful scrotum who has a recent history of mumps C. Middle-age adult discharged 2 days ago after a TURP with ongoing hematuria D. Older adult with a history of benign prostatic hyperplasia and bladder distention 10. A client with erectile dysfunction has been prescribed a PDE-5 inhibitor. Which client statement demonstrates that nursing teaching has been effective? A. “I can drink a little alcohol before intercourse to relax.” B. “I have to be sure to be careful when I sit up or stand up.” C. “I will have my partner take this drug 30 minutes before intercourse.” D. “I need to increase fiber in my diet to avoid constipation.” 11. A client with benign prostatic hyperplasia (BPH) is being discharged with a prescription for prazosin. Which teaching will the nurse include? (Select all that apply.) A. Avoid drugs used to treat erection problems. B. Be careful when changing positions. C. Keep all appointments for laboratory testing. D. Hearing tests will need to be conducted periodically. E. Take the medication in the afternoon 12. A client has undergone transurethral resection of the prostate (TURP). Which intervention does the nurse incorporate in the postoperative plan of care? (Select all that apply.) A. Administer antispasmodic medications. B. Encourage urination around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place in a supine position with knees flexed. E. Assist with moving to a chair as soon as permitted. 13. After returning from transurethral resection of the prostate, the client’s urine in the continuous bladder irrigation system is a burgundy color. Which order does the nurse anticipate after the surgeon sees the client? (Select all that apply.) A. Antispasmodic drugs B. Emergency surgery C. Encouragement of oral fluids D. Increased intermittent irrigation E. Monitoring for anemia A client has continuous bladder irrigation after surgery yesterday. The amount of bladder irrigating solution that has infused over the past 12 hours is 1200 mL. The amount of fluid in the urinary drainage bag is 2050 mL. The nurse records that the client had 850 mL of urine output in the past 12 hours. Fill in the blank The nurse is caring for a client on continuous bladder irrigation who had a transurethral resection of the prostate (TURP) yesterday. When bright red urinary drainage is noted, which primary action would the nurse take? A. Calculate intake and output. B. Monitor hemoglobin and hematocrit. C. Increase the rate of the bladder irrigation. D. Document findings in the electronic health record. The nurse is caring for a client who had an orchiectomy and laparoscopic radical retroperitoneal lymph node dissection yesterday. Which assessment finding would the nurse report to the health care provider? A. Total urine output in 24 hours of 1314 mL B. BP 130/90 mm Hg, T 99.0°F (37.2°C), RR 18, P 90 C. Reports pain of 7 on a 0-to-10 scale after receiving opioid medication D. Expresses uncertainty about ability to obtain an erection in the future 1. The nurse has provided teaching to a client with erectile dysfunction who was prescribed sildenafil. Which client statement demonstrates an understanding of this drug? A. “I might get a headache or stuffy nose when this drug is used.”  B. “After I take this drug, I can have intercourse up to 4 hours later.” C. “Taking this drug with a drink of alcohol will enhance my performance.” D. “If one pill doesn’t work, I can take another pill to achieve an erection.” 2. A client with a history of BPH contacts the telehealth nurse, reporting the sudden onset of testicular pain after moving heavy furniture. Which nursing response is appropriate? A. “Taking acetaminophen will help alleviate the pain intensity.” B. “The BPH is probably increasing because you were moving furniture.” C. “Please call 911 to take you to the closest emergency department right away.” D. “The pain will go away soon, as this is a common reaction when performing labor.”